Debra Soh is really bad at trans science (part 1)

Her alarmist claims of affirming care for trans youth functioning as anti-gay “conversion therapy” present a scenario wildly at odds with current evidence.

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Zinnia JonesDebra Soh, a science writer for Playboy who’s offered uncritical coverage of the “rapid onset gender dysphoria” hoax condition and an equally uncritical profile of right-wing YouTube transphobe Blaire White, recently published an article in Quillette arguing that there is “unspoken homophobia propelling the transgender movement in children”. This article is tagged under “hypothesis”, which is one of the more friendly ways to describe the claims she makes. The main thrust of her argument proceeds as follows:

And as I’ve watched as glowing stories about transgender children have flooded every progressive news outlet over the last few years, every one of them appalls and saddens me. Because the underlying story that the public isn’t privy to is that many of these children would have grown up to be gay, but are instead undergoing a new form of conversion therapy. …

On some level, these parents likely know that there is a chance their feminine son will grow up to be sexually attracted to men. Instead of allowing this to happen, they may be more than happy to go along with facilitating their child’s requests to transition to the opposite sex, so that to the outside world, that child will appear heterosexual—an adolescent boy who is attracted to other boys will appear to be straight if he transitions to female. What’s most disturbing is that these parents will be lauded as open-minded and “on the right side of history,” when in actuality, they are homophobic.

Similar claims have previously been made by Alice Dreger, 4thWaveNow, and Transgender Trend. Soh largely repeats those arguments here, and repeats their mistakes, sprinkled with an additional twist of bad science courtesy of the “rapid onset gender dysphoria” study. From beginning to end, the narrative she presents is one that is alternately unsupported by evidence or contradicted by evidence. This misinformation, which distorts and undermines the public’s understanding of transgender lives, deserves refutation – fortunately, Soh has amply stocked this barrel with fish.

Therapy that seeks to help gender dysphoric children grow comfortable in their birth sex (known in the research literature as the “therapeutic approach”) has been conflated with conversion therapy, but this is inaccurate. All of the available research following gender dysphoric children longitudinally shows that the majority desist; they outgrow their feelings of dysphoria by puberty and grow up to be gay in adulthood, not transgender. …

Yet of children who exhibit signs of gender dysphoria, we aren’t yet able to tell who will fall into the category of those who will desist (which is the majority) as opposed to the minority who persist and who would actually benefit from transitioning.

Gender-dysphoric youth who do go on to begin medical transition in adolescence using puberty blockers are known to experience alleviation of their gender dysphoria, improvements in body image, and levels of psychological functioning and health similar to their cisgender peers – with no evidence of regret for transitioning (de Vries et al., 2014). What a thing to be appalled and saddened by. Soh’s belief that such youth would have otherwise grown up to be cisgender gay people, were it not for gender-affirming interventions, is unfounded. There already is, and has been for some time, a way “to tell who will fall into the category of those who will desist … as opposed to the minority who persist and who would actually benefit from transitioning”.

What she has omitted here is that even under affirming treatment protocols, puberty blockers are withheld in the initial stages of puberty precisely to allow for desistance: whether gender-dysphoric children become comfortable with the development of these secondary sexual characteristics, or are further distressed by this, is considered indicative of desistance or persistence of their dysphoria into adolescence (de Vries & Cohen-Kettenis, 2012). Those whose dysphoria persists are those who are not in that supposed majority and have not outgrown their feelings of dysphoria. And those whose dysphoria does desist obviously are not given continuing treatment to transition – the opposite of what would be expected if clinicians were pursuing a blanket “conversion therapy” strategy of encouraging all dysphoric children to transition regardless of persistence or desistance of that dysphoria.

And even those clinicians who did practice a “therapeutic approach” of attempting to change the gender identity of dysphoric children, such as Ken Zucker, Susan Bradley, and Devita Singh of the former child gender identity clinic at Toronto’s CAMH, have found that this approach is not known to make any difference in whether or not a child’s dysphoria will persist into adolescence. In Singh’s (2012) thesis – the very thesis Soh herself cites in her article – one can find the following admissions:

As a point of agreement, proponents of both the therapeutic and accommodation model agree that, if it is apparent that an adolescent is committed to transitioning, the recommended treatment approach is to provide cross-sex hormonal therapy, to be followed by surgery, if desired, in adulthood. …

As noted previously, most children with GID seem to desist in their gender dysphoria by adolescence. It remains unknown whether the aforementioned treatment approaches are associated with different long term outcomes (e.g., persistence vs. desistence of GID, general psychiatric functioning, psychosocial adjustment). …

Without empirical comparative data on treatment approaches, one can only speculate on the effects of treatment on gender identity outcomes, if there are effects. At the follow-up assessment, participants in the present study were asked if they previously received treatment; however, a qualitative assessment of the interview data would be required to draw any substantial conclusions, which was beyond the scope of the present study. At the same time, it can be commented that some of the persisters in the study received treatment efforts aimed at helping them to resolve their gender dysphoria while in other cases much in the way of intervention was not attempted. The same can be said for the desisters.

Attempted conversion therapy of gender-dysphoric children is not known to produce any effect on their ultimate gender identity and dysphoric symptoms. Moreover, clinicians who treat trans adolescents with puberty blockers have stated that this is not likely to alter the development of their gender identity from its natural course (Vrouenraets et al., 2015):

However, although most informants agreed on the fact that treatment with puberty suppression indeed may change the way adolescents think about themselves, most of them did not think that puberty suppression inhibits the spontaneous formation of a gender identity that is congruent with the assigned gender after many years of having an incongruent gender identity. …

Various endocrinologists made the comparison with precocious puberty; a medical condition in which puberty blockers have been used for many years, and no cases of GD have been described (at least to their knowledge). Besides, most of them emphasize that they deliberately start treatment with puberty suppression only when the youngsters have reached Tanner stage two or three to give them at least a kind of “feeling” with puberty before starting with puberty suppression.

Where any of Soh’s claimed transgender-encouraging “conversion therapy” would be located in all of this is entirely unclear.

Next: What the “rapid onset gender dysphoria” study does and does not show.

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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