The nation's most prestigious newspaper insists on asking a very stupid question. So for this month's bonus episode, we decided to answer it.
To hear the rest of the show, support us on Patreon:
https://www.patreon.com/IfBooksPod
As we mentioned at the top of the episode, we're donating this month's support to three of our trans journo-friends! They've been unbelievably patient with Mike as he's navigated the science and politics of this issue over the last year. Here's where to find and support their work:
The nation's most prestigious newspaper insists on asking a very stupid question. So for this month's bonus episode, we decided to answer it.
To hear the rest of the show, support us on Patreon:
https://www.patreon.com/IfBooksPod
As we mentioned at the top of the episode, we're donating this month's support to three of our trans journo-friends! They've been unbelievably patient with Mike as he's navigated the science and politics of this issue over the last year. Here's where to find and support their work:
Michael: Hey, gang. Just a quick note before we get started. As usual, we are releasing a teaser of this month's bonus episode in the main feed. We recorded this a couple of weeks ago, so that's why we don't cover any of the recent events in the question asking industrial complex. As we've been editing this, we started to feel increasingly weird about making any money on anything related to this issue right now. So, we decided to donate all of the support we received from this episode to the three trans journalists who have been extremely helpful in walking me through this issue for the last year. They are in the description. We're also including links for you to support them directly. Please go do that. Also, we know that eggs cost like $12 right now, so if you're not in a position to support us, that's also totally fine.
This teaser is kind of a condensed version of the full episode, so it has all of the most important messages and statistics in it. So hopefully, you can share that with people who haven't been following this issue as closely. Thanks for listening. Thanks for supporting our trans friends and we will see you next week.
Peter.
Peter: Michael.
Michael: What do about the New York Times' war on trans people?
Peter: All I know is that conservatives only have one joke, and The New York Times only has one op-ed piece.
[If Books Could Kill theme music]
Michael: Peter, how much do you know about the “debate" over whether too many kids are transitioning too fast?
Peter: I think not as much as I would have liked to. The more prominent this has gotten in our culture war debates, the more behind I feel on the substantive content.
Michael: This is sort of the inspiration for this episode too that I feel like there's a huge number of people in your position who are generally nice and smart liberals, but who don't really know very much about this issue or who haven't really thought that, "This is my issue to follow very closely." All of a sudden, this is like the fucking only thing that America is talking about. And the media has not informed people of what is actually going on. That is what I am trying to do.
Peter: Right. I think that I'm a little bit ahead only because I simply do not trust The New York Times to handle these issues.
Michael: You also see my tweets about Jesse Singal, so I feel like you've kind of been spoiled.
Peter: That's true, although I will say that is in a genre of Hobbes tweet that I don't always go through the whole thread of.
[laughter]
Michael: This is like your sports tweets, Peter. "You know what? He's having thoughts on things."
Peter: Similar to how the actual Super Bowl is like a day from when we're recording this. Your Super Bowl, of course, happened this week when you got into an online screaming match with Jesse Singal.
Michael: The yearly ritual in my life.
Peter: Yeah, I guess if the Super Bowl happened twice a month.
[laughter]
Michael: So, are you ready to talk about The New York Times?
Peter: The Old Gray Lady.
Michael: The Transphobic Mean Gray Lady. Yes. In 2022, The New York Times published six front page stories, essentially asking exactly the same question. In January, we have "Doctors debate whether trans teens need therapy before hormones." There's not a debate. Everyone says they need therapy before hormones. In May, we get few transgender children change their minds after five years, study finds. So, "Eh, people say they're trans, they stay trans for five more years." Subheadline, "But the study, which began in 2013, may not fully reflect what's happening today, when many more children are identifying as trans." I don't know if there's a huge difference between 2013 and now, but okay.
Peter: No, no, no, the kids are out of control now.
Michael: And then in June, we get a feature story called What Lia Thomas Could Mean for Women's Elite Sports. I didn't read that one because it's related to sports. In June, we get a front-page story called The Battle Over Gender Therapy. Okay. Then, [laughs] you're going to like this one. In June, we get a front-page story called A Vanishing Word in Abortion Debate: ‘Women.’
Peter: Yes. It's unfair for me because I love to erase women, so I will say pregnant people just to do that.
Michael: In September, we get another front-page story, More Trans Teens Are Choosing ‘Top Surgery.’ The following month, we get another front-page story, They paused puberty, but is there a cost? And then in January, we get another one, When Students Change Gender Identity, And Parents Don't Know.
Peter: That could be a fun romp if they were taking the right angle. That's a cool, early aughts movie about a teen having fun with gender identity.
Michael: Yeah. I really feel like the potential for hijinks on this issue has not been adequately explored. I want to talk about a couple of the tendencies of these articles. We're not going to go through every single one individually because they're all basically identical and they're all doing the same few things. The first tendency that I want to talk about is that they never include examples of their central premise. I have read all of these feature articles. I have read all of the panicked stuff about too many kids transitioning too fast. None of these stories include kids who transitioned too fast.
In the original Atlantic article from 2018, it says, "Carrie Stella is the author of a blog called Guide on Raging Stars. Stella, now 24-" listen closely, "-socially transitioned at 15, started hormones at 17, got a double mastectomy at 20, and detransitioned to 22."
Peter: If that length of time between the ages of 15 and 20 is not long enough such that there should be, for example, government intervention preventing it from happening, then you're just saying that transitioning is illegal.
Michael: The next example is from More Trans Teens Are Choosing ‘Top Surgery.’ This article that pretends to be kind of a sober overview of just the rise in the number of mastectomies among minors over the last couple of years. But it's very clear that the article is trying to invalidate these surgeries. For no reason profiles, a plastic surgeon who's on TikTok and uses the hashtag, #yeettheteat, to basically imply, "Look at all these grifters in this sector," even though this plastic surgeon essentially doesn't do surgeries on minors.
The nut graph, the kind of summary of the article. It says, "Some clinicians have pointed to the rising demand and the turmoil of adolescent development as reasons for doctors to slow down before offering irreversible procedures. Although medical experts believe the likelihood to be small, some patients come to regret their surgeries." The article opens with this anecdote.
Peter: All right. “Since hitting puberty at age 10, Michael said he felt a gnawing discomfort about his breasts. By the time he was 12, he wore hooded sweatshirts every day in their Miami suburb. He came out to his parents as a transgender boy when he was 14. A year later, at the start of the pandemic, he started weekly testosterone injections while doing remote school. Michael started in-person school feeling 10 times happier, he said, but his chest still tormented him. When Michael was 17, Annie said she decided that waiting another year for surgery would put him in too much pain. Because her insurance covered the procedure only for adults, she took out a loan to help pay for it.”
Michael: He comes out at 14, spends a year waiting for hormone injections, and then gets surgery at age 17.
Peter: Right. And it's been seven years since the onset of these dysphoric feelings surrounding puberty.
Michael: So, the whole article is framed around, the worrying rise of these surgeries. They're being given to kids and there's, hashtags involved. It's like, "Oh, also this kid got assessed and got gender surgery and his mom had to pay out of pocket and he's really happy." Why isn't the story about how top surgeries have allowed people to be themselves and be happy?
I have spent the last year interviewing trans kids and parents of trans kids and doctors and researchers, and I am doing the thing that other journals don't seem to want to do, where I'm trying to actually answer this question. Are a lot of kids transitioning without assessment? All of the indication that I've gotten is that the answer is a very firm no. So, the first reason to think that this is not an issue worth the amount of hand-wringing attention it has received, is just the sheer numbers.
Earlier this year, in one of these panicked, long feature stories, Reuters actually got a database of patient records from an insurance company. I'm sure it's not perfect, but it gives a pretty good ballpark of how many kids are getting these procedures. There's somewhere around 30 to 40 million kids in the ages at which they would be getting these procedures, somewhere between 10 and 17. Among those 30 to 40 million kids, in 2021, 1390 kids got puberty blockers. 4231 got hormones. For top surgeries, in 2021, there were 282 mastectomies performed on minors. These are fractions of a fraction of a fraction of a percent.
Peter: Those numbers are so low that I feel like the Hollywood elite need to step their game up.
Michael: I know.
Peter: You know what I mean?
Michael: Get involved.
Peter: What is Hollywood there for if not to push our evil liberal agenda? And if they're not doing it, who's going to do it?
Michael: We should also note that you're constantly hearing this thing from the right about like, "Wow, they're mutilating kids." Bottom surgeries are essentially prohibited. All of the guidelines say that doctors are not supposed to do them. The numbers from the Reuters report say that 56 genital surgeries were performed on minors over three years. So, that's fewer than 20 per year. And also, we don't have the specific details of those, so those might be something like intersex surgeries. So, it's extremely likely that there are more articles about genital surgeries on kids than there are genital surgeries on kids.
Peter: Yeah. This is something we're going to talk about in our upcoming Coddling of the American Mind episode. But this is when they're like, "Speakers are being disinvited from college campuses at record rates." And then, "How many?" "Oh, like 40."
Michael: Right. You might as well just name them at that point. It's not even like a statistic. Just give me the list.
Peter: List them out, tell me the circumstances, and I will draw my own conclusions.
Michael: And then, the second reason to believe that this whole thing is a moral panic is all of the various barriers there are to care. First of all, they have to have affirming parents. Kids cannot get procedures under 18 without the consent of their parents. Then, they have to go to the doctor. They have to actually get an appointment with a primary care provider, which means that they have to be linked up to the health insurance system, which we know in America lots of people aren't. They then have to get a referral to a gender clinic. America only has 60 gender clinics for all 50 states, and all of them are way overprescribed because as these panicked articles love pointing out, there's been a huge increase in the number of kids identifying as trans, and all of these gender clinics are swamped. If you talk to people who work at these gender clinics, we're talking about six months to a year waiting period. Just logistically, when they're like, "Oh, there's too many kids transitioning," how? Literally, how? The kids are not getting appointments. Once you get an appointment, you have to go through the whole assessment process.
One of the kids that I talked to outside of an East Coast city, she was lucky, and she got an appointment at the gender clinic in her city after around six months. I think her mom knew someone who worked there and she was able to get in early. But then, she spent 15 months going through assessments before she was put on hormones. She had a bunch of individual appointments. She had appointments with her parents. Her parents are divorced, and she had to bring both of them together to be in these tripartite psychology appointments. She had to meet with the endocrinologist to talk about the side effects of all of the hormones. From the doctors of these clinics that I've talked to, this is fairly typical, that it's between one and two years of assessment before kids get on hormones.
The next barrier is cost and insurance companies. These procedures cost tens of thousands of dollars. Many of them are not covered for children under 18. And if you want to get them covered oftentimes, you need three letters from three different doctors documenting the fact that you've socially transitioned young. So, if you socially transitioned but didn't tell a doctor, they might not believe you. This is why, in the category of these stories don't include examples of their central premise, all of these stories are built around, like, "What if kids are transitioning too fast? What if it's just a phase? Kids are getting these surgeries," very few people in these stories got surgeries as kids.
This is from one of the New York Times articles. "Others decide they want to fully detransition and return to their cis identities. Grace Lidinsky-Smith, who is 28, has written about her regret over taking testosterone and having her breasts removed in her early 20s." If adults are having surgeries that they later come to regret, that is a perfectly fair enough conversation to be having within the medical field. That is not something that needs to be a frontpage story of The New York Times six fucking times in one year.
Peter: This is a question I've always had. What are the downsides of puberty blockers in the event that you choose not to transition ultimately? Because on the right, they make it seem catastrophic. And from what I've seen on the left, they're basically saying, “No, it's harmless, or nearly harmless.”
Michael: The puberty blockers thing I find totally baffling. Puberty blockers have been prescribed to kids since the 1980s. They were originally a treatment for something called precocious puberty.
Peter: I knew a few of those.
Michael: I sort of was one of those kids too. But it's like you start going through puberty at like seven or eight, and there's various social and physiological reasons why it's just not a good idea to go through puberty that early. So, in the 1980s and 1990s, they started prescribing this medication to block puberty. So, you would take puberty blockers for like two years, and then you would stop taking them when you were like 10 and then you'd go through puberty at the same time as everybody else. And so, the very odd thing is that the main claim about puberty blockers on the right is that, "We don't know if they're reversible," but it's like the whole point of them is to be reversible. If they weren't reversible, we wouldn't have been prescribing them to kids going through precocious puberty for 30 years.
Peter: If you are of an age where you should be having puberty, if you're 13 or whatever, is one or two years of delaying it something that causes long-term damage of any type?
Michael: It does not appear so. I mean, there's this stuff about bone density. Apparently, when you go through puberty, your bone density increases really significantly. There's some evidence that when you block puberty, your bones kind of stay the same levels of density that they were before. But it's not really clear what that means in a practical sense, because typically when cisgender kids go on puberty blockers, they just also take a calcium supplement. The effects of that typically would only show up once you're in your 50s. All of our bones lose density as we get older. That's why old people fall down, and they break a hip and young people fall down and they don't. So, the idea basically is that the levels of bone density that all of us are going to have in our 60s, people who took puberty blockers for a long time, might have those levels of bone density when they're in their 50s.
That's not nothing. That's a meaningful side effect. Everybody says we should continue to study this. We should basically do baselines of bone density when kids are on this. This would be part of the ongoing monitoring process that you do every six months, get a scan for bone density to see if things are going okay. But then, what really frustrates me about this is that this is brought up as, "Oh, what about the side effects." As if this is the only medication prescribed to children that has side effects? There are bone density downsides of taking birth control. There are acne medications that reduce bone density. There are antidepressants and ADHD medications for kids that have pretty severe and pretty immediate side effects. What we do in every single one of these cases, we tell the parents what to expect. We tell the kids what to expect, and we let them make the trade-off.
The idea of, "I'm experiencing this debilitating gender dysphoria and I'm depressed and my body is changing in ways that cause me huge discomfort. And to alleviate that, what it costs me is my bones might be brittle 10 years earlier than they would be." That doesn't seem like a completely unreasonable trade off to me.
Peter: No, it's one that you would see with a lot of medications being taken at a young age.
Michael: I think it's also really important to talk about the benefits of youth transition. So, one of the trans ladies I talked to, she transitioned at age 28. What she said is when you transition at age 28, it's profoundly disruptive. You will probably lose your job. A lot of people have to fall out of their marriages. It affects their relationships with their kids. What we're talking about is getting these kids this care when they're younger. The way that she put it was, we're giving them the chance to have an adulthood. We're actually giving them a chance to start from scratch. One thing that really bugs me about all the “debate” about this is that there's a huge number of surveys of transpeople who have transitioned and the regret rates are less than 2%.
Peter: One thing I always think about when we're having these conversations is that minors can get breast implants in this country.
Michael: Yes. I was just looking at these numbers the other day. It's like 5000 minors get breast implants every year.
Peter: "Yo, can this kid have bigger titties?" And everyone's like, “Yeah, yeah, yeah." That's fine?
Michael: Then, the other tendency of these articles, which we've kind of covered, is what I call "but still," where they basically just include evidence against their premise, but just wave it off. This is from the article called Few Transgender Children Change Their Minds After 5 Years, Study Finds. This is based on a survey of kids who started transitioning in 2013 and you look, and all of them are still trans. It says, “The vast majority of the groups still identified with their new gender five years later, according to the study. Many had begun hormonal medications and adolescents to prompt biological changes to align with their gender identities. The study found that 2.5% of the group had reverted to identifying as the gender they were assigned at birth. The new study could suggest that transgender children, when supported by their parents, thrive in their identities. But it's also possible that some of the children who still identified as transgender by the end of the study, or their parents, felt pressure to continue on the path they started.” So, the evidence is that people who say they're trans are still trans. But what if they're being forced to stay trans?
Peter: What if every person who detransitioned was actually just being pressured by their parents to detransition?
Michael: Exactly.
Peter: And they are trans.
Michael: I was also reading this, I started identifying as gay when I was 12, and now I'm 40 and I still identify as gay. I don't have proof that's not due to social pressure. I don't know how you could possibly demonstrate that this isn't true.
Peter: You have to meditate while a guy is going down on you and gaze upon it from above. "Am I enjoying this?"
Michael: I have become super fucking pilled on this in the last two years because one of my very good friends, a guy that I grew up with, his daughter is trans. He's in Seattle. He's super affirming. His wife is super affirming. And it has been a huge fucking hassle. Like an unbelievable fucking hassle. They had to move day cares because they said to the head of the day care, whatever, like, “Our daughter's transitioning. What policies do you have in place or whatever.” And the principal was like, “Oh, this is our first trans kid. Do you mind writing an email to all of the parents explaining that she's trans? And then, if anyone has any questions, they can just contact you directly.”
Peter: Oh, shit. Love to be made to do the emotional but also actual labor of school administrators.
Michael: Yes, of physically sitting down and writing a long explanatory email and dealing with people's reply guy bullshit.
Michael: Right, right.
Peter: They had to move schools. There's been huge friction with the grandparents because the grandparents are like kind of Atlantic pilled, are like, “Well, what if it's just a phase?” He had to write an email to all the relatives, like the distant cousins. There's been some friction there. And this idea that it's like you're just going to fucking tell everybody you're trans and the whole world just lifts you up on their shoulders and it's just like, “Rudy. Rudy," just doesn't make any sense.
Michael: Right. The entire process is miserable. You're predicating a conspiracy around a really vague aimless, cultural pressure to do queer stuff, from what I can gather.
Peter: Another thing that has become very clear in my mind too, knowing my friend going through this process is the idea that some kid would say, "I'm trans," to get attention. Yes, I think it is extremely likely that someone would do that.
Michael: Yeah, I thought I was anarcho-syndicalist.
Peter: I thought I was a libertarian. Significantly worse.
Michael: Way worse. Way worse.
Peter: But the idea that kids would say, "I'm trans," to get attention or gin up some sort of conflict or they're exploring their identity makes perfect sense to me. But would they persist in this for years? Going to medical treatments, their parents scheduling things, going to therapy and whatever initial burst of attention that you get by being like, “Daddy, I'm trans,” that wears off pretty quick. At a certain point, it's just like my normal daughter. All of this, what if it's a phase stuff, is an argument to make social transition as easy as possible. The best way for your kid to figure out if they're "really trans" is for them to live as a boy or a girl for a while to the point where it becomes normal and they see if it really does feel better.
And so, my friend has, of course, told his daughter like, “If in a couple of years, you decide that you want to be a boy, we love you no matter what. If you're nonbinary, we love you no matter what.” There's no excuse not to do exactly that. And this, to me, it reveals the fundamental bad faith of this entire panic because if what we're worried about is kids transitioning without knowing if they're really trans, we should want to make this stage of the process as easy as possible. And that's not what we're seeing. We're seeing huge pushback to schools. We're seeing huge pushback to any gender nonconformity and the materials or the books that kids are reading in school.
Peter: Conservatives switch back and forth between parental rights framings whenever it's convenient. They'll be talking about parental rights when it's them preventing their kid who wants to socially transition from doing so. But when it's like a more accepting parent being like, “Yeah, I think my kid's trans,” they're like, “Oh, do you? You liberal freak.”
Michael: And also, what's amazing to me is this thing where you use evidence against your thesis as evidence for your thesis. So, one of the talking points that comes up in right wing messaging on this is that 9 out of 10 kids who socially transition go onto puberty blockers, and 9 out of 10 kids who go on puberty blockers go on to hormones, and it's like, that's an indication the kids are trans.
Peter: Right. That literally means that the opposite of what you think is happening, where everyone is just, socially transitioning is happening. If it was like 2 out of 10, they would use that as proof that kids are being pushed into social transition.
Michael: Yeah, and that people do not socially transition lightly. People are doing this with a huge amount of forethought, and people are oftentimes really slow to do this. Like, I came out over the course of like five years, and I feel like coming out as gay is easier than coming out as trans.
Peter: Are you sure that it's not just an underlying mental illness and that's what caused you to be libertarian and then eventually gay? [Michael laughs] It's hard to imagine what The New York Times even thinks it's achieving here. Other than maybe getting the general sense that this is contrarian amongst portions of its audience and then therefore, deducing that they're doing good.
Michael: What I think is really interesting and really telling is how all of these articles are framed around the concerns of parents. "What would you do if your kid said she's trans?" Not, "What if you had been a trans kid and had been prevented from transitioning?"
So, I'm sending you the first couple paragraphs of the most recent feature story about this. We're going to do these anecdote things, and then we're going to do the nut graph.
Peter: All right. “Jessica Bradshaw found out that her 15-year-old identified as transgender at school after she glimpsed a homework assignment with an unfamiliar name scrawled at the top. When she asked about the name, the teenager acknowledged that at his request, teachers and administrators at his high school in Southern California had for six months been letting him use the boy's bathroom and calling him by male pronouns. Mrs. Bradshaw was confused. Didn't the school need her permission or at least need to tell her? It did not, a counselor later explained," because they knew that she might go to The New York Times, okay.
[laughter]
Michael: And be real fucking weird about it.
Peter: “It did not, a counselor later explained, because the student did not want his parents to know. District and state policies instructed the school to respect his wishes. 'There was never any word from anyone to let us know that on paper and in the classroom. Our daughter was our son,'" Mrs. Bradshaw said.
Michael: All right, here's the nut graph. This is a couple of paragraphs later, but this is like the main gist of the story.
Peter: "Dozens of parents whose children have socially transitioned at school told The Times they felt villainized by educators who seemed to think that they, not the parents, knew what was best for their children. They insisted that educators should not intervene without notifying parents unless there is evidence of physical abuse at home.” Okay, I'm getting pretty mad. “Although some didn't want their children to transition at all, others said they were open to it but felt schools forced the process to move too quickly and that they couldn't raise concerns without being cut out completely or having their home labeled unsafe.”
Michael: So, these are the people we're being asked to have sympathy with.
Peter: All right. I want to break this into its component parts.
[Transcript provided by SpeechDocs Podcast Transcription]