Science or Bias? A Critique of “Anti-Trans Myths”
Gender activists claim that people are manipulating scientific evidence to spread “anti-trans myths.” In reality, it is the activists who are manipulating the evidence. We explore how in this detailed piece.
Illustration by Cynthia (@PTElephant).
"Anti-Trans Myths" is the title of a new opinion piece published in Open Mind, an online magazine (D. Sun and Ashley 2023). In the article, the authors Simón(e) D. Sun and Florence Ashley outline how "anti-trans" activists use scientific misinformation and manufactured or flawed data to try to "legitimize hate," specifically through "transphobic" laws.
These are bold claims to make. Unfortunately for the authors, they fail at understanding the basis of the science behind these claims, which is disappointing for Sun, who works as a neuroscientist. But, from the beginning, it is clear to see that both Sun and Ashley have forgotten a crucial aspect of research and science: being impartial. Both Sun and Ashley identify as transgender and their critique is little more than attempting to justify their own belief system and self identity.
Let's break down some of these claims.
The Law
The critique begins with a rather generalized claim that "anti-trans" activists use oversimplified explanations of biology, fabrication and misinterpretation of research, deflection of criticism (an amusing claim as Ashley blocked me on X/Twitter after I announced I would write this article), and false equivalencies. These generalized statements come with sources to various law proposals, some of which have been struck down outright. But this brings me to my first criticism: law does not determine scientific understanding.
There have been numerous times throughout history when scientific research and political bodies (including religiously led political bodies) have collided, often resulting in injustices. However, it is not the job of scientists to create laws. It is the job of scientists to pursue the truth through empirical observation. Certainly, some scientists can act as advisors to lawmakers, and often, scientists of various specialties are called into court for testimony of scientific concepts, but creating laws is not their role.
Further, the law does not determine scientific facts, nor should it. For instance, many places allow for transgender individuals to change their sex marker on their government papers. This allows for some places to recognize individuals as "female" despite being biologically male.
"Sex Essentialism"
Sun and Ashley make the claim that "anti-trans" rhetoric is dependent on what they call "sex essentialism."
Essentialism is defined as:
“the perception of the objects, people, and other entities in natural world as emerging from invisible and immutable essences” (Rutjens & Preston 2020).
But Sun and Ashley describe "sex essentialism" as the belief that an individual can be defined by a "few immutable, unchanging traits." Perhaps what the authors are actually referring to is biological essentialism, which is the belief that a specific trait is both innate and natural. In this case, the specific trait is a person's sex (Chandler & Munday 2011).
Is "anti-trans" rhetoric dependent on biological essentialism? The authors claim that "anti-trans" advocates use biological essentialism when they make the claim that a person's sex is based on the production of gametes. The authors also claim that no consensus exists as to what truly determines sex, that sex is not a binary determination, and that sex is determined by five basic characteristics: hormones, anatomy, physiology, behavior, and psychology.
Scientific Consensus on Sex
Unfortunately for Sun and Ashley, this is not the case. According to the Endocrine Society, an organization of over 18,000 of the world's most renowned clinicians and researchers who are experts in hormone disorders and disease processes, there are exactly two sexes (Bhargava et al. 2021).
In fact, nearly every biological and medical association recognizes that there are two sexes.
Why do these organizations say there are two sexes, and why do they claim that they are based on gamete production?
According to evolutionary biologists who study how anisogamy (the difference in sizes of gametes within a species) evolved, sex is defined as "the mixing of genetic information to create an offspring" (Yasui & Hasegawa 2022). This is different from species that reproduce asexually (without mixing of genetic material). Asexual reproduction is commonly referred to as cloning. Thus, gametes are the vehicle through which genetic information is mixed to produce offspring. So, when we refer to a person's sex, we are actually referring to a person's sex role.
In all anisogamous species, one type of gamete holds nearly all of the cellular organelles and energy required to start development of the offspring. This gamete is the female gamete. The other gamete, which is typically small and motile, is the male gamete. These basic principles define the sex roles as male or female.
Two gametes.
Two roles.
Two sexes.
As it turns out, it is not biological essentialism, but rather biological definition that "anti-trans" activists use. A common counter argument is that there are individuals who do not produce gametes and such individuals would be considered sexless because sex is defined by gametes. This fails to acknowledge how intertwined gamete production is with physical anatomy. The gonads, which produce gametes, and the hormones produced by those gonads also shape the reproductive system. This shaping of the reproductive system happens whether the individual is capable of producing gametes (currently or in the future) or not. Thus, we can say that a person's reproductive system is also representative of a person's sex in the absence of gamete production (Rey, Josso, and Racine 2020).
Sex Determination
In humans, sex determination is genetic. Although many genes are involved in the process of sex development and differentiation, in roughly 99% of cases the most important gene is SRY (Hake & O'Connor 2008). The SRY gene is located on the short arm of the Y chromosome. It is because of this gene that the Y chromosome is considered to be a sex determining chromosome. As a result, we recognize that for the vast majority of humans, XX chromosomes result in female development and XY chromosomes result in male development.
Because a person's sex is determined by genes, we can definitively make two claims: a person's sex is an inherited trait and a person's sex is a phenotype. Is this an oversimplification of the process of sex determination? Yes. Is this an attempt to mislead people into “anti-trans” rhetoric? No, I just do not have the time or the energy to give a university level explanation of the details of every gene involved in the process of sexual differentiation, nor would any of that knowledge be relevant to most people, with the exception being those who research these processes.
As for the claim that sex determination is not binary, of course it is not. There are many factors that contribute to the development and differentiation of sex. However, there are only two outcomes: male and female.
Characteristics of Sex
The authors referred to five factors that they claim determine sex: hormones, anatomy, physiology, behavior, and psychology. The basis of this argument is that males and females have typical characteristics within these categories that are different from the other sex.
Let's use height as an example. According to the CDC, the average height of a male over the age of 20 is 69 inches, or 5’-9”. The average height of a female of the same age is 63.5 inches, or 5’-3.5” (CDC Body Measurements). On average, we can say that males are taller than females. But does height determine sex? Is a person over 5’-9” automatically male because of the average height of males?
This becomes a problem of correlation versus causation (Altman & Krzywinski 2015). Correlation is a term used to describe two variables that are associated with each other, just like height and sex. Causation is a term used to connect two values as having a cause and effect relationship.
As an example, a theoretical study finds that people who consume four or more cups of coffee a day are less likely to develop skin cancer. Does this mean that coffee prevents skin cancer? This seems unlikely, so is there another factor not listed that could be considered? In fact, by looking at other observations about the situation, we can find a cause and effect relationship between other variables. In this case, maybe the cause is limited exposure to the sun. People who work indoors are more likely to have access to a coffee machine, and are more likely to drink more coffee. Being indoors means less sun exposure and we know that excessive sun exposure can cause cancer. The relationship between coffee and skin cancer is a correlation. The relationship between sun exposure and skin cancer is causation.
Let's go back to the example of height and sex. Does a person's height cause a person's sex? Of course not. Males and females come in a wide range of heights. It is this wide and overlapping range of height values of males and females that lead to the argument that sex is a spectrum or that sex is bimodal. The reality is that variations in anatomy, physiology, hormones, psychology, and behavior have a correlation to sex, not a causation to sex.
The exception to this is the anatomy and physiology of one's reproductive system.
Explaining the Unexplained
Sun and Ashley go on to claim that “sex essentialism” cannot explain a plethora of things. All of these things are wonderfully-dressed strawman arguments that imply more than what defines sex from the “anti-trans” perspective.
But, let's go through these claims quickly.
“Sex essentialism struggles to make sense of how ‘female’ hormones like estrogen are necessary for sperm production”
This is because estrogen is not a “female” hormone. All humans, both male and female, have testosterone and estrogen within their body, but these levels differ depending on sex. Thus, the levels of estrogen and testosterone are correlated to sex, but they do not define sex. In fact, studies have demonstrated that estrogen plays a role in cognitive and neurological health (Hara et al. 2015), cardiovascular health (Murphy & Kelly 2011), and bone health (Streicher et al. 2017) in both sexes.
“how some animal sexes are infertile”
Yes, some animals have their fertility modulated through pheromones, most commonly seen in social insects like ants and bees. This does not mean those individuals are incapable of reproduction nor does it mean they are sexless (Ge et al. 2020).
“how the genetics of sex are not binary”
As explained before, genetics of sex are complicated. This does not dispute that there are still only two sexes.
“how animal sex arises in countless ways. For instance, many fish change sex during their life”
Yes, sex development in humans is different from sex development in other animals. A good example is in some reptile species, like turtles, sex is determined by the temperature of the incubating eggs (Gilbert 2000). This does not change the fact that there are two sexes.
And, yes, there are some species of fish that can change their sex, typically in response to environmental factors. Even further, some fish species use hermaphroditism, meaning that an individual of that species can produce both gametes during their lifetime. Humans, on the other hand, have gonochorism, meaning that one individual remains one sex throughout their lifespan (Godwin 2011).
With these adequate answers that do not contradict the definition of sex, we can easily tackle the next few oddities that Sun and Ashley use to describe the diversity of sex.
“researchers are finding species of rodent with three combinations of sex chromosomes”
Chromosome combinations are strongly correlated with sex, but each chromosome combination is not an individual sex. Cases of odd combinations still result in individuals who are either male or female. For example, take a disorder of chromosome number called Trisomy X. In this condition, the individual has three X chromosomes instead of just two. If chromosome combinations were different sexes, then Trisomy X would be different from typical XX females. However, Trisomy X is only seen in females. Females with Trisomy X are fertile and with accommodations for their learning disabilities and muscle development can lead perfectly normal lives (Trisomy X, Rare Diseases).
“female moles with ovotestes”
Ovotestes is a very rare developmental anomaly that results in mismatched gonads. The combinations can include a single ovary and a single testis, or an ovotestis. An ovotestis is a single gonad with both ovarian and testicular tissue. Individuals with this condition are almost always infertile and have one path of sexual development that is more dominant (Ovotesticular DSD, Rare Diseases). This means that individuals with this condition are still either male or female.
“hermaphroditic pigs”
Remember that the definition of hermaphroditism is that an individual produces both types of gametes in their lifetime. The text cited by Sun and Ashley for proof of these hermaphroditic pigs is a case of sex reversal (Parma, Veyrunes, & Pailhoux 2016). I have written an article on the process of sex reversal that explains the complexity involved in sex reversal that you can read (Nava 2023a). The short version is that sex reversal is a type of disorder of sex development (DSD) and refers to a change in the developmental pathway of one sex to the other. It is not a case of hermaphroditism, which does not exist in mammals. Some DSDs are referred to as pseudohermaphroditism, but true hermaphroditism where the individual can produce both gametes in their lifetime does not exist in humans.
Intersex, nonbinary, trans, and queer people may be uncommon, but they are natural outcomes of biological complexity.
The term intersex is a misnomer. There are no humans who are “between” sexes. Even in the most extreme cases of mixed sex characteristics, individuals are still either male or female.
As for nonbinary, trans, and queer, these are all variations in humans, but not in biology. These individuals have a psychological difference in how they perceive themselves within the contexts of society. All trans, nonbinary, and queer individuals are either male or female.
Sun and Ashley quote evolutionary biologist Joan Roughgarden who gives this statement in her book, Evolution's Rainbow: Diversity, Gender, and Sexuality in Nature and People:
“The biggest error in biology today is uncritically assuming that the gamete size binary implies a corresponding binary in body type, behavior, and life history” (Roughgarden 2013).
But so-called “anti-trans” rhetoric does not make this conflation. It is, in fact, activists like Sun and Ashley who conflate these two concepts. When they claim that “each individual has a mosaic of female-typical, male-typical, and sex-similar characteristics,” they are saying that these characteristics are sex-specific. They claim that if a female has higher than normal testosterone, then that is a male trait in that person's mosaic. Ignoring that variation occurs within the binary, not outside of it, is particularly dangerous when it comes to hormones. For example, higher than normal levels of testosterone in a female can be an indication of an endocrine disorder (Chappell & Schutt 2018; Glintborg 2016) or cancer (Macut et al. 2019).
Pseudoscientific Research
The authors continue on their breakdown of “anti-trans” rhetoric by starting a critique into research presented that suggests that gender affirming care (GAC) is not suitable for the treatment of gender dysphoria.
The first attempt to discredit research involves the concept of social contagion and Lisa Littman's article, “Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria” (Littman 2018).
However, there are quite a few mistakes in discussing Littman's article.
The first is the claim that parents are unable to determine if their child was questioning their gender identity. Although parents are not able to read the minds of their children, there are observable behaviors that could be seen by parents or other adults in the lives of these children. The Diagnostic and Statistical Manual of Mental Disorders 5th edition with text revision (DSM 5 TR) describes several behaviors that parents can observe in their children with gender dysphoria, including toy preferences, friend and playmate preferences, clothing preferences, and cross-gender role playing (DSM-5-TR, APA).
The second mistake is the claim that the survey respondents were only recruited from “anti-trans” websites. While three websites could meet the author's definition of “anti-trans”, the survey was also shared to a private Facebook group called “Parents of Transgender Children.” This Facebook group has very positive views of GAC and boasts over 8,000 members. It is entirely possible that individuals from that group also responded to the survey, particularly because the survey itself did not actually ask about the parents' opinions on gender dysphoria treatment.
In addition, the study admits that it is limited in its ability to determine correlation or causation. This type of study is called an exploratory study and is used to widely probe a topic in the formation of a hypothesis (Swedberg 2020). In this case, the study looked into the observations of parents of trans individuals to help form the hypothesis of Rapid Onset Gender Dysphoria (ROGD). This is often the type of study that forms the basis of hypotheses in a new academic area.
Sun and Ashley also cite another study that was retracted. The study was done by researcher Professor J. Michael Bailey and once again delved into the concept of ROGD. However, the study was retracted by the publisher, which claimed that consent was not properly given by the research team. This seems highly unusual given that Bailey has previously authored and co-authored over 100 scientific research articles. Bailey has stated a different reason for the retraction: bowing to the demand of trans activists.
It would not be the first time trans activists have come after him. In 2003, Bailey published his book, The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism, which painted a picture that the transgender community did not like: the aspect of autogynephilia that contributes to transgender identity (Carey 2007). What followed was an orchestrated assault of character against Bailey, involving accusations that he did not give proper consent to the subjects he used for his book and that there was sexual misconduct with one of the subjects. These accusations were organized and carried out by three prominent transwomen: Lynn Conway, Andrea James, and Deirdre McCloskey (Dreger 2008).
When Bailey's colleague, Alice Dreger, investigated allegations against him, she found all of them to be unfounded. When she came out in support of Bailey, the transgender activists went after her too. She and Bailey are attacked in an interview by transwoman Joan Roughgarden, who accuses Bailey of homophobia as well as transphobia (James 2007). Does the name sound familiar? It should, as it is the same biology researcher quoted by Sun and Ashley and repeated again previously in this article.
Bailey and Dreger are not the only ones who have been dragged through the mud by transgender activists.
In December of 2015, Dr Kenneth Zucker, the leading researcher in the field of sexology and gender dysphoria, was fired from the Center of Addiction and Mental Health (CAMH), one of the largest mental health research hospitals in Canada. He had previously led the Child Youth and Family Gender Identity Clinic and was considered very respectable. After an investigation, CAMH showed Zucker reports from supposed patients of Zucker's that claim inappropriate comments towards transgender patients. Zucker denied the accusations, but CAMH said that they were going to publish the accusations to their website (Singal 2016a).
The problem was that when investigating the incident, it was discovered that it could have never happened. The patient who made the complaint cited individuals who never worked at the clinic by name. In addition, the patient described an assessment that could never have happened as Zucker never made referrals for surgery or performed physical exams. The allegations were false (Singal 2016b). But why would someone go through the trouble of getting the doctor who led the team in forming the DSM 5 criteria for gender dysphoria fired from the clinic?
The answer is simple: the clinic did not follow the gender affirming care (GAC) model of treatment.
These are not the only people that have been dragged through the mud for opposing the GAC model of care. Littman, Bailey, Dreger, Blanchard… the list of professionals painted as transphobes goes on and on.
As for the claim of transgender identities could have a social contagious source, there is a lot of evidence to indicate that a social contagion is contributing to the change in demographics of those experiencing gender dysphoria, as it seems to also occur highly within social media spaces (Haltigan, Pringsheim, & Rajkumar 2023).
I have previously gone into painstaking detail on the evidence of social contagion, so I won't repeat that process again. If you want to learn more about social contagion, feel free to read my detailed article on the phenomenon (Nava 2023b).
Low Quality Evidence
Sun and Ashley claim that all “anti-trans” advocates try to discredit studies that support GAC by stating that these studies rely on “low quality evidence.” The authors fail to explain what is meant by low quality evidence. Although they correctly identify that it is a medical term they falsely claim that it means that a randomized-controlled study has not been done for a particular practice. Although randomized studies that use controls do represent the vast majority of what is considered high quality evidence, it is not what determines the quality of evidence (Guyatt et al. 2008).
What are the factors that reduce the quality of evidence?
A method of evaluating evidence known as Grading of Recommendations Assessment, Development and Evaluation (GRADE) outlines specific standards that result in higher quality studies vs lower quality studies. Factors that result in lower quality of evidence include study limitations, inconsistent results, indirect evidence, imprecise measures, and publication bias.
Let's look at an example of what would be considered low quality evidence.
A study was published in the medical journal Plastic and Reconstructive Surgery in July of 2023. The article titled Regret after Gender-Affirming Surgery: A Multidisciplinary Approach to a Multifaceted Patient Experience, claims that the regret rate for gender affirming surgery is a tiny 0.3% (Jedrzejewski et al. 2023). This seems like a very tiny number, but how did they get this number? The study claims that their regret rate was measured by the number of individuals who requested a reversal of the surgery. But does this tell the whole story of regret?
Within the field of surgery, as well as psychological studies, there are tools to measure regret. In 2003, a study published by doctors in the Ottawa Health Research Institute found that a scale referred to as the “Decision Regret Scale” was statistically appropriate at determining the amount of regret experienced by patients who had undergone surgery (Brehaut et al. 2003). In addition, a new scale for demonstrating emotions was found to be statistically valid in a 2023 study (Marcatto & Ferrante 2023). This new tool is referred to as the “Regret and Disappointment Scale.”
Why should this study have used scales?
It goes back to the factors that produce a certain quality of evidence. Measuring regret by those who openly request a reversal of those surgeries is an imprecise measure. It doesn't cover the broad spectrum of emotions after surgery, nor does it account for individuals who do not speak up to their doctors about regret after surgery. These scales provide much more information and using them in such a study would increase the validity of findings.
So why didn't they use a scale?
The study came about as part of the OHSU Transgender Health Program “Regret and Request for Reversal” Workgroup. It came from doctors who work in the field of Transgender Surgery. The primary author, Dr. Breanna Jedrzejewski, is a plastic surgeon who specializes in “gender affirming” surgeries. She describes herself, not only as a surgeon, but as an advocate. This is an example of a publication bias. The primary author benefits from more individuals seeking surgery, so stating that the regret rate is 0.3% will only encourage confidence in these procedures.
So, despite the claims from Sun and Ashley, there are real and valid claims that such research is of low quality evidence. Systemic reviews, a type of study that evaluates the quality of evidence within a specific topic of research, have been done for much of the studies around “gender affirming care” (GAC). The results?
In 2020, the Council for Choices in Healthcare in Finland issued a series of recommendations about changes for GAC. They published their own study, which cited that individuals who underwent hormone therapy for gender dysphoria did not demonstrate improvement on a psychological level (Kaltiala et al. 2020). In addition, they cited the lack of evidence and knowledge around comorbidities of gender dysphoria. They described GAC as experimental (Medical treatment methods for dysphoria, 2020).
In 2022, the Swedish National Board of Health and Welfare published their systemic review and found that evidence of the effectiveness for GAC was of low quality and changed the recommended treatment protocol. They also cite a drastic change in demographics for those with gender dysphoria and could not state a clear conclusion as to why this shift took place (Linden 2022).
In 2023, Ukom, a review board for Norway's Ministry of Health dedicated to improving the quality of health care, published a statement stating that recommendations for gender dysphoria required change. Specifically, it referred to GAC as experimental and cited poor quality evidence and changing demographics (NHIB 2022).
And more countries are following suit. The Tavistock report, though currently still in progress, is already echoing what has been demonstrated in other countries. Florida, and other states, are doing their own studies to explore the evidence and creating legislation based on the findings.
The Facts
Sun and Ashley have worked really hard to claim that “anti-trans” advocates are manipulating scientific evidence to promote hate against trans individuals. They make claims that this is an attempt to actively harm trans people. But, from an objective standpoint, the more you look into GAC, the more it seems to fall flat.
Why do they and other trans activists push so hard to take such divisive stances?
The answer is simple. Sun and Ashley are trans. They defend this so intensely because their identity, who they see themselves as, revolves around being trans. They have more at stake than money. To see any of this evidence as true means that they have to question the very core of their identity. They have fallen into the sense of validation within a community of which breaking such a bond can cause serious mental distress (Hillman, Fowlie, & MacDonald 2023).
Cognitive dissonance is one hell of a drug.
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