Transgender health care misinformation

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False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used to deny healthcare to trans people. [1] [2] These include claims that most pre-pubertal transgender children "desist" and cease desiring transition after puberty, that most people who transition regret it, that gender dysphoria can be socially contagious, and that gender dysphoria is caused by mental illness, among others. [3]

Contents

Propomotion of this misinformation have included various conservative religious organisations, as well as pseudoscientific or discredited researchers, and anti-trans activists.

Origins

Transgender healthcare misinformation primarily relies on manufactured uncertainty from a network of conservative legal and advocacy organizations. [4] [5] These organizations have relied on similar techniques to climate change denialism, generating exaggerated uncertainty around reproductive health care, conversion therapy, and gender-affirming care. [5]

The Southern Poverty Law Center stated the hub of the pseudoscience movement was the Society for Evidence-Based Gender Medicine, which was closely related to Genspect and Therapy First. [6] A Yale School of Medicine report described them as spreading "biased and unscientific content" and "without apparent ties to mainstream scientific or professional organizations". [5]

Other notable producers of anti-LGBTQ misinformation and disinformation include the evangelical organizations the Alliance Defending Freedom, American College of Pediatricians, and Family Research Council. [6] [5] These efforts have been aided by scientists who were once dominant in transgender care but are now fringe such as Ray Blanchard, Stephen B. Levine, and Kenneth Zucker. [7] [5] Misinformation and disinformation about transgender health care sometimes relies on biased journalism in popular media. [3]

Common misinformation

Desistance myth

Some have argued that the majority of pre-pubertal youth diagnosed with gender dysphoria will "desist" and stop desiring to transition by adulthood without intervention. [3] [4] [8]

These claims stem from a commentary by James Cantor in 2020 who argued based on outdated studies that most children diagnosed with gender dysphoria will grow up to be gay and lesbian adults if denied gender-affirming care. [3] [4] The studies had serious methodological flaws such as low sample sizes, outdated diagnostic frameworks that conflated gender non-conformity with transgender identity, usage of conversion therapy on the sample population, and poor definitions of desistance. [3] [4] Most youth sampled in them never identified as transgender or desired to transition, but were counted as desisting. [4]

Recent work has found the vast majority of pre-pubertal children who express transgender identities and socially transition with parental support continue to do so in adolescence. [3] [8]

Detransition and regret

Some have claimed that the majority of transgender people regret or reverse their transition by relying on anecdotes and misinterpreted studies. [3] [8]

Transgender identity as a mental health condition

Some argue that gender dysphoria is caused by underlying mental illness, trauma, or neurodivergence, such as autism, and ADHD. [3] [8] [2] Though transgender people have higher rates of mental illness, there is no evidence these cause gender dysphoria and evidence suggests this is due to minority stress and discrimination experienced by transgender people. [3] [8]

The American Psychological Association stated "legislative efforts to restrict access to care have involved the dissemination of misleading and unfounded narratives [...], creating a distorted perception of the psychological and medical support necessary for these youth and creating a hostile environment that adversely affects their mental health and wellbeing" and has stated such misinformation is frequently spread though a varitey of networks and organisations. [2]

Others have argued that transgender youth are incapable of providing informed consent. However, transgender children require their parents to consent to their medical treatment and scientific literature demonstrates that transgender youth with mental health conditions can competently participate in decision-making. [8] [3]

Psychotherapy and conversion therapy

Some have argued that youth with gender dysphoria should receive psychotherapy, including the form of conversion therapy gender exploratory therapy (GET), instead of medical treatment. [8] Practitioners of GET often view medical transition as a last resort and propose their patient's dysphoria is caused by factors such as homophobia, social contagion, sexual trauma, and autism. [9] [10] Some practitioners of GET avoid using their patients' chosen names and pronouns while questioning their identification [11] States that have banned gender-affirming care for minors in the United States have called expert witnesses to argue that exploratory therapy should be the alternative treatment. [12]

There are no known empirical studies examining psychosocial or medical outcomes following GET. [11] [13] Concerns have been raised that by not providing an estimated length of time for the therapy, the delays in medical interventions may compound mental suffering in trans youth, [9] [11] while gender-affirming model of care already promotes individualized care and gender identity exploration without favoring any particular identity. [11] Commenting on gender exploratory therapy in 2022, bioethicist Florence Ashley argued that its framing as an undirected exploration of underlying psychological issues bore similarities to gay conversion practices such as "reparative" therapy. [14]

Multiple groups exist worldwide to promote GET and have been successful in influencing legal discussions and clinical guidance in some regions. [15] Therapy First, previously named the Gender Exploratory Therapy Association, asserts that "psychological approaches should be the first-line treatment for all cases of gender dysphoria", that medical interventions for transgender youth are "experimental and should be avoided if possible", and that social transition is "risky". [16] [12] All of GETA's leaders are members of Genspect, a "gender-critical" group that promotes GET and argues that gender-affirming care should not be available to those under 25. [16] GETA also shares a large overlap with the Society for Evidence-Based Gender Medicine (SEGM), which promotes the same position. [6]

Social contagion and rapid onset gender dysphoria

Some have claimed that modern youth are experiencing a new type of gender dysphoria, "rapid onset gender dysphoria" (ROGD), which is spread through social contagion and peer groups. [3] [8] [7] [17] The concept stems from a heavily corrected study by Lisa Littman in 2018, which relied on anonymous parental reports on transgender children collected from websites known for anti-trans misinformation and gender-critical politics who were informed of the study's hypothesis. [3] [8] [7] [17]

While there is no empirical evidence to support the hypothesis, it has been heavily referenced in discourse about transgender youth. [17] [3] [18] In 2021, a coalition of psychological professional bodies issued a position statement on ROGD that "supports eliminating the use of Rapid-Onset Gender Dysphoria (ROGD) and similar concepts for clinical and diagnostic application given the lack of rigorous empirical support for its existence." It stated that "there is no evidence that ROGD aligns with the lived experiences of transgender children and adolescents" and "The proliferation of misinformation regarding ROGD is also infiltrating policy decisions. Currently, there are over 100 bills under consideration in legislative bodies across the country that seek to limit the rights of transgender adolescents, many of which are predicated on the unsupported claims advanced by ROGD". [18]

Untrustworthiness of medical organizations

Though every major medical organization endorses gender-affirming care, proponents of gender-affirming care bans argue the mainstream medical community is untrustworthy, ignores the evidence, and that doctors are pushing transgender youth into transition due to political ideology and disregard for their well being. [8] [3] This extends to claims that standards of care and guidelines from reputable medical organizations do not reflect clinical consensus. [3]

Medically transitioning children in schools

In 2024, Donald Trump attended a Moms for Liberty rally and stated children were being given gender-affirming surgery at school, and continued to repeat the claim. There is no evidence any school has ever provided a student gender-affirming surgery. [19] [20]

Impact

Boston Children's Hospital, which was subject to bomb threats following disinformation about the hospital's gender-affirming care was promoted by Chaya Raichik Tch-boston.jpg
Boston Children's Hospital, which was subject to bomb threats following disinformation about the hospital's gender-affirming care was promoted by Chaya Raichik

Misinformation and disinformation has led to proposed legislative restrictions on gender-affirming care across the United States and in the United Kingdom through claims in and regarding the Cass Review. [1] False claims have also had a negative impact on gender-affirming healthcare, an increase healthcare discrimination against LGBT people [21]

In August 2022, Chaya Raichik claimed on the far-right social media account Libs of TikTok that Boston Children's Hospital (BCH) [22] and Children's National Hospital (CNH) were providing gender-affirming bottom surgeries to minors. [23] With the BCH-related content, Raichik included a BCH video that featured one of the hospital's gynecologists explaining the procedure. [22] While USA Today, [24] NPR, [23] and PolitiFact [25] concluded that BCH claim was false, several conservative outlets—including The Daily Caller and The Post Millennial —republished the claims. [26] [27] [24] [28] After the Libs of TikTok posts, each hospital's employees were subject to harassment, [29] and both BCH and CNH were subject to bomb threats, [35] though it was unclear whether each of the threats were related to the harassment. [31] NBC News described Libs of TikTok as "one of the primary drivers of the harassment campaign" against BCH. [36]

Responses from medical organizations

In June 2023, The Endocrine Society stated in a press release:

Due to widespread misinformation about medical care for transgender and gender-diverse teens, 18 states have passed laws or instituted policies banning gender-affirming care. More than 30 percent of the nation’s transgender and gender-diverse youth now live in states with gender-affirming care bans, according to the Human Rights Campaign. Some policies are even restricting transgender and gender-diverse adults’ access to care.

These policies do not reflect the research landscape. More than 2,000 scientific studies have examined aspects of gender-affirming care since 1975, including more than 260 studies cited in the Endocrine Society's Clinical Practice Guideline.

Pediatric gender-affirming care is designed to take a conservative approach. When young children experience feelings that their gender identity does not match the sex recorded at birth, the first course of action is to support the child in exploring their gender identity and to provide mental health support, as needed.

Medical intervention is reserved for older adolescents and adults, with treatment plans tailored to the individual and designed to maximize the time teenagers and their families have to make decisions about their transitions. Major medical organizations also agree on waiting until an individual has turned 18 or reached the age of majority in their country to undergo gender-affirming genital surgery. [37]

The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Urological Association, the American Society for Reproductive Medicine, the American College of Physicians, the American Association of Clinical Endocrinology, GLMA: Health Professionals Advancing LGBTQ+ Equality, the American Medical Association (AMA), AMA's Medical Student Section cosponsored an Endocrine Society resolution "opposing any criminal and legal penalties against patients seeking gender-affirming care, family members or guardians who support them in seeking medical care, and health care facilities and clinicians who provide gender-affirming care." [37]

In February 2024, the American Psychological Association released a policy statement which included:

the spread of misleading and unfounded narratives that mischaracterize gender dysphoria and affirming care, likely resulting in further stigmatization, marginalization, and lack of access to psychological and medical supports for transgender, gender diverse, and nonbinary individuals [...] the APA opposes state bans on gender-affirming care, which are contrary to the principles of evidence-based healthcare, human rights, and social justice, and which should be reconsidered in favor of policies that prioritize the well-being and autonomy of transgender, gender-diverse, and nonbinary individuals

In the same statement, the APA urged that the spread of disinformation be curbed via greater and more easily accessible scientific research, describing it as essential for protecting access to gender-affirming healthcare. [2]

See also

Related Research Articles

Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder. The International Classification of Diseases uses the term gender incongruence instead of gender dysphoria, defined as a marked and persistent mismatch between gender identity and assigned gender, regardless of distress or impairment.

The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and gender dysphoria, and creating standardized treatment for transgender and gender variant people. WPATH was founded in 1979 and named HBIGDA in honor of Harry Benjamin during a period where there was no clinical consensus on how and when to provide gender-affirming care.

Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for distress caused by incongruence between assigned sex and gender identity in some pre-pubescent transgender and gender diverse children.

Stephen Barrett Levine is an American psychiatrist known for his thesis that gender dysphoria and being transgender are often caused by psychological issues that should be treated psycho-analytically as opposed to with gender-affirming care. He co-founded Case Western Reserve University School of Medicine's Gender Identity Clinic in 1974, served as the chair of the World Professional Association for Transgender Health (WPATH) drafting committee for the 5th edition of their Standards of Care (SOC-5) published 1998, and served on the American Psychiatric Association (APA) DSM-IV (1994) Subcommittee on Gender Identity Disorders.

In the United States, the rights of transgender people vary considerably by jurisdiction. In recent decades, there has been an expansion of federal, state, and local laws and rulings to protect transgender Americans; however, many rights remain unprotected, and some rights are being eroded. Since 2020, there has been a national movement by conservative/right-wing politicians and organizations to target transgender rights. There has been a steady increase in the number of anti-transgender bills introduced each year, especially in Republican-led states.

<span class="mw-page-title-main">Transgender youth</span> Children and adolescents who are transgender

Transgender youth are children or adolescents who do not identify with the sex they were assigned at birth. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, they face different challenges compared to adults. According to the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Pediatrics, appropriate care for transgender youth may include supportive mental health care, social transition, and/or puberty blockers, which delay puberty and the development of secondary sex characteristics to allow children more time to explore their gender identity.

Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay puberty in children with precocious puberty. Since the 1990s, they are also used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity under what became known as the "Dutch Protocol". They have been shown to reduce depression and suicidality in transgender and nonbinary youth. The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.

Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world. Gender affirming health care can include psychological, medical, physical, and social behavioral care. The purpose of gender affirming care is to help a transgender individual conform to their desired gender identity.

Detransition is the cessation or reversal of a transgender identification or of gender transition, temporarily or permanently, through social, legal, and/or medical means. The term is distinct from the concept of 'regret', and the decision may be based on a shift in gender identity, or other reasons, such as health concerns, social or economic pressure, discrimination, stigma, political beliefs, or religious beliefs.

Rapid-onset gender dysphoria (ROGD) is a controversial, scientifically unsupported hypothesis which claims that some adolescents identify as transgender and experience gender dysphoria due to peer influence and social contagion, particularly those assigned female at birth. ROGD is not recognized as a valid mental health diagnosis by any major professional associations. The APA, WPATH and 60 other medical professional organizations have called for its elimination from clinical settings due to a lack of reputable scientific evidence for the concept, major methodological issues in existing research, and its stigmatization of gender-affirming care for transgender youth.

<i>Irreversible Damage</i> 2020 book by Abigail Shrier

Irreversible Damage: The Transgender Craze Seducing Our Daughters is a 2020 book by Abigail Shrier, published by Regnery Publishing, which endorses the controversial concept of rapid-onset gender dysphoria (ROGD). ROGD is not recognized as a medical diagnosis by any major professional institution nor is it backed by credible scientific evidence.

<span class="mw-page-title-main">Arkansas House Bill 1570 (2021)</span> 2021 Arkansas state law

Arkansas House Bill 1570, also known as the Save Adolescents From Experimentation (SAFE) Act or Act 626, is a 2021 law in the state of Arkansas that bans gender-affirming medical procedures for transgender people under 18, including puberty blockers, hormone therapy, and sex reassignment surgery. The law also bans the use of public funds for and prohibits insurance from covering gender transition procedures, while doctors who provide treatment in violation of the ban can be sued for damages or professionally sanctioned. The measure makes Arkansas the first U.S. state to make gender-affirming medical care illegal.

<span class="mw-page-title-main">Stella O'Malley</span> Irish psychotherapist and author

Stella O'Malley is an Irish psychotherapist and author, with three books on parenting and mental health. She is a regular contributor to Irish national newspapers, podcasts, and TV. She made a documentary about gender dysphoria in children for Channel 4, and is the founder of Genspect, a self-described gender critical organisation opposed to gender affirming care.

<span class="mw-page-title-main">Libs of TikTok</span> Far-right and anti-LGBT Twitter account

Libs of TikTok is a handle for various far-right and anti-LGBT social-media accounts operated by Chaya Raichik, a former real estate agent. Raichik uses the accounts to repost content created by left-wing and LGBT people on TikTok, and on other social-media platforms, often with hostile, mocking, or derogatory commentary. The accounts promote hate speech and transphobia, and spread false claims, especially relating to medical care of transgender children. The Twitter account, also known by the handle @LibsofTikTok, has over 3.5 million followers as of September 2024 and has become influential among American conservatives and the political right. Libs of TikTok's social-media accounts have received several temporary suspensions and a permanent suspension from TikTok.

<span class="mw-page-title-main">Genspect</span> Organization opposing transgender rights

Genspect is an international group founded in June 2021 by psychotherapist Stella O'Malley that has been described as gender-critical. Genspect opposes gender-affirming care, as well as social and medical transition for transgender people. Genspect opposes allowing transgender people under 25 years old to transition, and opposes laws that would ban conversion therapy on the basis of gender identity. Genspect also endorses the unproven concept of rapid-onset gender dysphoria (ROGD), which proposes a subclass of gender dysphoria caused by peer influence and social contagion. ROGD has been rejected by major medical organisations due to its lack of evidence and likelihood to cause harm by stigmatizing gender-affirming care.

<span class="mw-page-title-main">Transphobia in the United States</span> Prejudice against Americans of other gender identity than assigned at birth

Transphobia in the United States has changed over time. Understanding and acceptance of transgender people have both decreased and increased during the last few decades depending on the details of the issues which have been facing the public. Various governmental bodies in the United States have enacted anti-transgender legislation. Social issues in the United States also reveal a level of transphobia. Because of transphobia, transgender people in the U.S. face increased levels of violence and intimidation. Cisgender people can also be affected by transphobia.

<span class="mw-page-title-main">Society for Evidence-Based Gender Medicine</span> Group opposing gender-affirming care

The Society For Evidence-Based Gender Medicine (SEGM) is a non-profit organization that is known for its opposition to gender-affirming care for transgender youth and for engaging in political lobbying. The group routinely cites the unproven concept of rapid-onset gender dysphoria and mistakenly claimed that conversion therapy techniques are only practiced on the basis of sexual orientation rather than gender identity. SEGM is often cited in anti-transgender legislation and court cases, sometimes filing court briefs.

Quentin L. Van Meter is a pediatric endocrinologist and president of the American College of Pediatricians, a socially conservative advocacy group which is known for opposing gay marriage, gender reassignment surgery, and abortion. He has advocated and referred his clients to conversion therapy and is known for rejecting the medical consensus on the efficacy and safety of transgender health care.

<span class="mw-page-title-main">Cass Review</span> Review of gender identity services in England

The Independent Review of Gender Identity Services for Children and Young People was commissioned in 2020 by NHS England and NHS Improvement and led by Hilary Cass, a retired consultant paediatrician and the former president of the Royal College of Paediatrics and Child Health. It dealt with gender services for children and young people, including those with gender dysphoria and those identifying as transgender in England.

Therapy First, originally named the Gender Exploratory Therapy Association (GETA), is a group created in 2021 by members of the Society for Evidence-Based Gender Medicine (SEGM) and Genspect to advocate gender exploratory therapy, which experts consider to be a form of conversion therapy.

References

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  18. 1 2 "ROGD Statement". Coalition for the Advancement & Application of Psychological Science. 26 July 2021. Retrieved August 4, 2021.
  19. ↑ Lavietes, Matt (2024-09-09). "Trump repeats false claims that children are undergoing transgender surgery during the school day". NBC News . Retrieved 2024-12-03.
  20. ↑ "Health Misinformation Monitor: Falsehoods About Transgender People and Gender Affirming Care". KFF . 2024-10-10. Retrieved 2024-12-03.
  21. ↑ "Health Misinformation Monitor: Falsehoods About Transgender People and Gender Affirming Care". KFF. 2024-10-10. Retrieved 2024-12-16.
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  24. 1 2 Hudnall, Hannah (August 22, 2022). "Fact check: False claim about Boston Children's Hospital's transgender care program". USA Today . Retrieved August 24, 2022.
  25. ↑ Reyes, Yacob (August 12, 2022). "No, Boston Children's Hospital doesn't provide hysterectomies for children". PolitiFact . Retrieved August 18, 2022.
  26. 1 2 Villarreal, Daniel (August 29, 2022). "Children's hospital gets death & bomb threats after Libs Of TikTok claims kids are sterilized there". LGBTQ Nation . Retrieved August 30, 2022.
  27. ↑ Halpert, Madeline (31 August 2022). "Boston Children's Hospital Bomb Threat: How Right Wing Media Escalate Harassment Of LGBTQ-Friendly Places". Forbes . Retrieved 31 August 2022.
  28. ↑ Hawkins, Derek; Venkataramanan, Meena (August 17, 2022). "Boston Children's Hospital says it faces threats after right-wing tweets". The Washington Post . Retrieved August 21, 2022.
  29. ↑ Lorenz, Taylor; Dwoskin, Elizabeth; Jamison, Peter (September 2, 2022). "Twitter account Libs of TikTok blamed for harassment of children's hospitals". The Washington Post . ISSN   0190-8286. Archived from the original on 2 September 2022. Retrieved 2022-09-02. After gaining a large Twitter following in the spring as she baselessly accused LGBTQ teachers of being pedophiles and 'groomers', Raichik began criticizing children's health facilities earlier this summer, targeting a hospital in Omaha in June and another in Pittsburgh in August. The attacks resulted in a flood of online harassment and phoned-in threats at both hospitals.
  30. ↑ McCausland, Phil (August 31, 2022). "Boston Children's Hospital faces bomb threat after right-wing harassment campaign". NBC News . Retrieved August 31, 2022.
  31. 1 2 Alfonseca, Kiara (August 31, 2022). "Boston Children's Hospital receives bomb threat following harassment over transgender care". ABC News. Retrieved August 31, 2022.
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  34. ↑ Venhuizen, Harm (August 27, 2022). "D.C. children's hospital harassed over trans youth services". Associated Press . Retrieved August 28, 2022.
  35. ↑ BCH bomb threats: [30] [31] [32] CNH bomb threats: [33] [26] [34]
  36. ↑ Zadrozny, Brandy; Collins, Ben; Winter, Tom (September 15, 2022). "FBI charges Massachusetts woman with Boston Children's Hospital bomb threat". NBC News. Retrieved September 15, 2022.
  37. 1 2 "AMA strengthens its policy on protecting access to gender-affirming care" (Press release). Endocrine Society. June 12, 2023.
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