The transgender misinformation machine is at it again. The New York Times recently published an extensive essay arguing against screening before medical transition — if someone says she wants hormones or surgery, doctors should immediately break out the syringes and prep the operating room.
The article, by Alex Marzano-Lesnevich of Bowdoin College, exemplifies how the transgender movement uses misinformation to advance its agenda. Marzano-Lesnevich asserts, “That gender-affirming health care saves lives is clear: A 2018 literature review by Cornell University concluded that 93 percent of studies found that transition improved transgender people’s heath [sic] outcomes, while the remaining 7 percent found mixed or null results. Not a single study in the review concluded negative impact.”
That seems dispositive — unless you look at the studies. The cited literature review was titled the “What We Know Project” and was directed by the LGBT scholar and activist Nathaniel Frank, who cited it in his own New York Times piece on transgenderism a few years ago, writing that “Our findings make it indisputable that gender transition has a positive effect on transgender well-being.”
These proclamations that the science is settled are a bold facade on rickety scaffolding. When this New York Times article invokes the authority of science, it seeks to evoke the image of careful statisticians sifting through data collected by diligent doctors.
But it is actually appealing to self-selected online surveys with cash prizes, studies with tiny samples, and studies that are missing more than half of their subjects. Stacking a bunch of weak studies on top of each other doesn’t provide a strong result, but The New York Times presumes readers won’t bother to check the details — the editors certainly didn’t.
Back in 2019, I took a closer look at the studies the What We Know Project cites, and found a methodological mess. Many of the studies had serious flaws, beginning with small sample sizes. As I noted, “Of the fifty relevant papers identified by the project, only five studies (10 percent) had more than 300 subjects, while twenty-six studies (52 percent) had fewer than 100. Seventeen studies (34 percent) had fifty or fewer subjects, and five of those had a sample size of twenty-five or less.”
The flaws extended far beyond small sample size, and the largest studies tended to be the weakest, often consisting of little more than online surveys with a self-selecting sample. Nor should we put much faith in a study that recruited subjects for an online survey by advertising “on online groups and discussion forums that were dedicated to FTM [female-to-male] members. . . . Upon survey completion, participants were entered into a lottery drawing for cash prizes.”
Even the better-designed long-term studies were often plagued by poor response rates. A European study had 201 out of 546 respond — just 37 percent. And though missing data is, by definition, missing, it is reasonable to suspect that those with poor outcomes are overrepresented among those who could not or would not respond.
Nor did The New York Times check Marzano-Lesnevich’s claim that “gender-affirming health care has some of the lowest rates of regret in medicine. A 2021 systemic review of the medical literature, covering 27 studies and 7,928 transgender patients, found a regret rate of 1 percent or less.” But read the paper and it is quickly apparent both that the review has significant weaknesses and that The New York Times allowed its conclusions to be misrepresented.
Of the 27 studies used in their analysis, the review authors ranked only five as “good” and only four as having a low risk of bias. Many of the studies had the same flaws as those examined in the What We Know Project (indeed, some studies were used in both).
Another problem is that the majority of the data in the 2021 review came from a single study conducted by a Dutch group retrospectively examining the records of their own gender clinic. But a retrospective review of medical files will only identify regrets from patients who shared them with the gender clinic that performed their surgeries. Furthermore, the study only identified regrets following gonadectomy, and not those who regretted other surgeries, or who never had surgery but did regret taking cross-sex hormones or puberty blockers.
In addition to the problem of allowing a flawed data set to dominate the 2021 review, this illustrates another persistent difficulty with studies of transgender regret, which is that they are often conducted by those who provide medical transition, rather than independent researchers. People whose livelihoods and reputations depend on facilitating medical transition might be less than diligent and rigorous in looking for regret.