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No Laughing Matter

John Oliver badly botches the “gender-affirming care” debate. October 17, 2022
The Social Order
Health Care

Yesterday, John Oliver devoted an episode of Last Week Tonight to transgender rights, specifically the controversy over “gender-affirming care” for minors. Along with Jon Stewart, who recently aired a similar episode, Oliver appears uninterested in doing actual investigative reporting. The timing is no coincidence: a two-week trial in federal court begins today over Arkansas’s Save Adolescents from Experimentation (SAFE) Act, and the left-leaning comedians possess immense power to shape public opinion. But Oliver’s argument, like Stewart’s, was little more than a misinformed genuflection to activists.

Oliver demonstrates his lack of critical thinking at the outset, when he informs his audience that he is about to discuss “LGBTQ rights.” Other than a 1967 CBS clip on homosexuality, which Oliver opens with in order to plant in his viewers’ mind the tenuous analogy, the entire episode is devoted to the trans issue. This is yet another example of activists using “LGB” as a cover for the “T”—exploiting public sympathy for the former to conceal the radical nature of the latter.

According to Oliver, it’s a good thing that more people, and specifically youth, have come out as trans of late. The explanation favored by trans activists, and by Oliver himself, for the meteoric rise in transgender identification among Generation Z is that society is now more accepting of transgender and “gender-nonconforming” behavior and identity. Yet the same activists, and again Oliver himself, also seem to regard America in 2022 as exhibiting unprecedented levels of hostility toward trans people. Oliver rails about the “anti-trans” bills proposed in red states in recent years. He even suggests that it is conservative Republicans, not progressive Democrats, who have made the trans issue into a focus of national furor, a statement so demonstrably false one doesn’t even know where to begin to debunk it. (A good place, though, would be with the story of how bureaucrats in the Obama Department of Education and lawyers in advocacy organizations exploited a highly opaque administrative process in order to change how schools must define “male” and “female.”)

Oliver can’t have it both ways. If “trans kids,” including teenagers like Dylan Brandt, the named plaintiff in the Arkansas lawsuit, are coming out in droves because of warming social attitudes rather than “social contagion” (an explanation Oliver dismisses as “horse shit”), it cannot also be the case that America is increasingly a hellhole for “LGBTQ” people. This is just one of many tensions that Oliver and other media cheerleaders refuse to acknowledge, much less interrogate, in the trans movement’s narrative.

Oliver’s next argument takes another page out of the activist playbook. He attributes all opposition to the trans movement to “the Right,” as if feminists, gay-rights activists, and even some transgender (or transsexual, as some prefer to be called) individuals and groups are not key constituencies in the opposition to medical transition for minors. This framing is clearly intended to persuade moderates and liberals that they are safe in supporting “gender-affirming care” because only “those people” oppose it—never anyone with secular, progressive values. Oliver’s suggestion that Republicans have taken up (“demagogued”) the trans issue only to win elections is equally indefensible. Have Democrats not taken up this cause to curry the favor of influential interest groups like the ACLU and the Human Rights Campaign, attract donations from deep-pocket donors, and win elections in progressive districts? Attributions of bad faith and base electoral motives can work in both directions.

“Anti-trans” bills have proliferated across the nation, Oliver insists, and they have done so against a backdrop of “attacks and harassment” of hospitals providing “gender-affirming care” to youth. I am unaware of any “attacks” against hospitals or their employees. One bomb threat was issued against Boston Children’s Hospital and was thankfully investigated and addressed by local police. But this again is a rhetorical tactic taken out of the trans movement’s playbook: use a single example of extreme, unlawful conduct and claim that it is representative of all criticism, even skepticism, toward a movement making radical claims about human nature and society.

According to Oliver, Democrats who have not hopped on the trans bandwagon have done so purely out of fear of electoral repercussions. To illustrate, he provides a clip of former New York City mayor Michael Bloomberg expressing concern about people who use “it” pronouns and sneers that Bloomberg can “fuck all the way off with that shit.” In fact, ample evidence indicates that school districts are asking children to consider whether they identify as something other than male or female and encouraging those who do to use “neopronouns,” of which there are infinite varieties—including “it.” In 2021, the prominent LGBT advocacy group Trevor Project conducted a national survey and found that “it/itself” pronouns were the “second most commonly used set of neopronouns after xe/xem.” That same year, Yahoo News ran an article celebrating youth who use “neopronouns,” including “it.” The Evanston/Skokie School District 65 (where I went to school as a kid), has encouraged students to consider whether they identify as trees and want to use “tree” as a pronoun. And honestly, is the far more popular “they/them” any more sensible than “it/itself”?

Had Oliver bothered to look at City Journal contributing editor’s Christopher F. Rufo’s writing, which amasses evidence of this ideological takeover in K-12, rather than tear into Rufo for his stance on critical race theory, his willingness to be forthright about his preferred public-advocacy strategy, or his supposedly ugly face (yes—that’s the level to which Oliver stooped here), he could have seen this for himself. (When I was an instructor at Wellesley College, I received this link to a website containing a database of pronouns divided into categories that include “creature” and “animal.”)

The broader point is that trans-rights activists have indeed made absurd demands regarding the recognition of non-human identities and the use of made-up words as pronouns. Where they haven’t done so explicitly, they have expressed general support for all people to identify as they please and be treated, without question or criticism, in whatever “gender expression” feels most comfortable to them in the moment. When a male Canadian teacher showed up to work at the Halton school district near Toronto with a pair of enormous prosthetic breasts, the district refused to condemn what was either a hoax or an expression of sexual fetishism wrapped up in misogyny. In fact, the school authorities decided to “stand behind” the teacher, emphasizing their commitment to “equitable treatment without discrimination based upon gender identity and gender expression.”

The logic of the trans rights movement’s own arguments renders it impossible to question anything that travels under the banner of “gender identity” or “gender expression,” however grotesque or offensive it may be. Having committed itself wholeheartedly to “authenticity”—defined as each individual’s “right” to express outwardly whatever gender-related feelings one has internally, irrespective of its antisocial intent or consequence—the trans movement has no limiting principle.

In the episode’s main segment, Oliver promises that he will take the arguments of critics of the trans movement seriously, but not as made in good faith. Unfortunately, he continues to obscure the truth.

Start with the issue of athletics. Oliver suggests that laws limiting participation in women’s sports to biological females are mere smokescreens for bigotry and hate. His reason? No examples exist of trans girls and women taking athletic achievements or opportunities away from girls. Oliver attributes to proponents of such laws a single motive: they believe that boys are changing gender in order to take victories away from girls. I have been immersed in these controversies for several years now, and only rarely have I come across someone who actually thinks that. These athletes’ identification should be presumed sincere; the real question is, and has always been, whether that sincerity, and the presumed therapeutic benefits that come from its recognition, are enough to qualify as a “female.”

It is extremely revealing that in his sports discussion, Oliver never once mentions Lia Thomas, the University of Pennsylvania transgender swimmer who won Ivy League and NCAA medals. Nor does he bring up the names Terry Miller and Andraya Yearwood, the two male-bodied but female-identified high school runners from Connecticut who won a combined 15 state championship titles in the girls’ category between 2017 and 2020. Indeed, the only example of a trans athlete appearing in Oliver’s segment is Mack Beggs, a female-to-male wrestler from Texas, who stirred up controversy for beating girls while on low-dose testosterone. Call me naïve, but when it comes to transgender participation in sports, male-to-female athletes, not female-to-male ones, should be the focus of discussion. In short, Oliver’s entire treatment of efforts to limit girls’ sports to biological females—which, recall, supposedly serves as a representative case for the motives of the trans movement’s critics—is pure gaslighting.

Next, the comedian discusses the weightier topic of social contagion. He dismisses the social-contagion hypothesis as “total horseshit” on the grounds that Lisa Littman, the researcher who first propounded the theory, used interviews conducted with parents recruited from support groups of those skeptical of childhood gender transition. Littman never claimed her study was representative of the broader youth population adopting a transgender identity; to suggest otherwise is dishonest.

More importantly, many of the studies purporting to find that hormones benefit youth in gender distress do exactly the same thing: they rely on surveys conducted by transgender-rights groups, or on self-reports (which likely oversample young people with politically activist attitudes). For example, psychiatrist-activist Jack Turban’s claims about the mental-health benefits of hormones rely on a 2015 survey of transgender-identified youth. In that survey, one group of scholars points out, “the participants were recruited through transgender advocacy organizations and subjects were asked to ‘pledge’ to promote the survey among friends and family. This recruiting method yielded a large but highly skewed sample. While Turban et al. acknowledged that the [survey] may not be representative of the U.S. transgender population, they treat it as a valid source of data for major policy recommendations, disregarding the significant bias in the underlying data.”

Why are so many teenagers coming out as trans today? Oliver draws an analogy to left-handedness: just as more people “came out” as left-handed when schools stopped requiring students to write with the right hand, he insists, so, too, young people today are coming out as trans because it is more acceptable to do so.

Putting numbers behind this analogy is enough to cast doubt on its accuracy. In the graph Oliver uses for this part of the discussion, the percentage of Americans documented as left-handed rose from roughly 4 percent in 1900 to 12 percent by 1960, where it has remained ever since—in other words, a threefold rise over the course of about 60 years. What Oliver doesn’t tell his audience is that the rate of transgender identification among youth has risen by a factor of between 150 and 1,050 (using the DSM-5 statistics for adults listed in 2013 and a recent Gallup poll as metrics, and depending on the respondents’ sex). Even if we assume that gender dysphoria was severely underdiagnosed in youth by 2013 and the true rate was ten times higher (and we have no reason to believe this was the case), that would still yield an increase of between 15 and 105 times the previous rate. And remember, this happened over the course of less than a decade—not, as with left-handedness, 60 years.

Oliver also neglects to mention the change in the sex ratio of teenagers seeking transition (it was mostly boys; now it’s mostly girls) and the age of gender dysphoria onset (it used to be early-onset, with adolescent-onset being rare; now it’s primarily adolescent-onset). Firsthand reports from teachers, students, and parents on the ground lend further credence to the socially contagious nature of transgender identification. In one survey of a school district in the northeast, 9.2 percent of students were shown to have a “gender identity” other than the sex “assigned” to them at birth. Are nearly one in ten students “born in the wrong body”? These data points have been observed across countries and are part of what led medical authorities in Sweden, Finland, and the U.K. to conduct inquiries into state gender clinics and seek reform. Nor does Oliver mention the extraordinarily high rates of mental-health comorbidities of the teenage girls seeking transition—a key indicator of social contagion.

In short, Oliver’s dismissal of social contagion—which, to be sure, remains a working theory—is highly irresponsible, and disingenuous. Scholars with years of experience treating and doing research on minors with gender dysphoria have observed a dramatic rise in the sheer number of teens showing up for transition, a dramatic change in their sex ratios and in the age at onset of conditions, and high rates of mental health problems alongside gender distress. They have called for more research on “rapid onset gender dysphoria,” at times recognizing that the dominant clinical cohort at gender clinics nowadays may be very different from the one for whom medical transition was first developed.

Then, Oliver comes to the topic of “gender-affirming care.” Like other advocates, he is content to say that because major medical organizations support it, it’s science-based. But American medical organizations, including the American Academy of Pediatrics, have gotten the science wrong in the past—why couldn’t that happen again? The relevant question is why American organizations are increasingly out of step with health authorities in countries with a supposedly more progressive track record on “LGBTQ” rights. Oliver never once mentions Sweden and Finland, or the systematic reviews of the evidence that have led their health authorities to place severe restrictions on hormones. Nor, conveniently, does Oliver mention the World Professional Association for Transgender Health, which recently not only eliminated age minimums for hormones and surgeries, but also included “eunuch” among the list of valid “gender identities” that children can apparently know they have from a very early age.

Turning to the “affirming” protocol itself, Oliver makes the misleading claim that “social transition” (using a child’s preferred name and pronouns) is totally harmless. In fact, all available research suggests that this seemingly innocent act of support is an active psychosocial intervention with potentially iatrogenic (an intervention that itself causes illness) consequences. In the report bearing her name, Hilary Cass, the pediatrician tasked by the NHS to review its gender clinic at Tavistock, went out of her way to caution that social transition should be thought of as “an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning.” As such, social transition “is not a neutral act.”

Are puberty blockers reversible? Oliver says so, but the evidence strongly suggests otherwise. “96-98 percent of children who undergo puberty suppression continue to cross-sex hormones,” according to Oxford researcher Michael Biggs’s review of the medical literature. Lagging behind your same-sex peers in physical development has obvious psychosocial consequences that cannot be reversed the second you stop taking puberty blockers. To assert otherwise is to exhibit profound naivete about the dynamics of adolescence. The claim about reversibility is based entirely on the original use of these drugs, which is to treat central precocious puberty in very young children.

Oliver’s claim that sterility “can happen” as a result of cross-sex hormones is also misleading. When taken as a follow-up to puberty blockers, sterility is virtually guaranteed, since the organs responsible for producing sex gametes (ova and sperm) are not allowed to develop. These procedures also impact sexual function. Transgender surgeon Marci Bowers infamously conceded that of the 2,000 or so people on whom she has operated, none has been able to achieve sexual satisfaction. Is renunciation of all future reproductive capabilities and sexual function something a 12-year-old can give valid consent to? Perhaps Oliver should have raised this question.

As for surgery, Oliver’s insinuation that critics of the trans movement claim that kids are just “dropping by” at their doctors’ offices and getting double mastectomies on demand is a straw man. Surgeries are performed after consultations, and it is highly unlikely that any teenager or medical professional takes these decisions lightly. That doesn’t mean, however, that these procedures are done on the basis of good science. Claims about low rates of regret are based on surveys of adults who received these procedures as adults; the surveys suffer from serious methodological shortcomings, such as narrowly defined outcome measures and laughably low follow-up times (e.g., three months).

When Oliver moves from the “affirming” protocol to the question of regret and detransition, his narrative turns cynical. He features several interviews with transgender-identified kids and teenagers throughout the episode, but not a single one with detransitioners. Perhaps he fears that if allowed to tell their story, they will elicit sympathy and skepticism toward the medical professionals who rushed them into irreversible harm. Oliver cites a statistic that only 2 percent of people who transition end up regretting it and detransitioning and insists that the majority of those who take this step do so because society or their families did not accept them.

The 2 percent statistic is taken from studies on those who transitioned as adults or under the Dutch protocol, but certainly not minors who were transitioned under the current “affirmative” protocol. Studies on rates of regret for the latter don’t yet exist because the protocol has only been widely available for around a decade and the average time to regret, according to two studies, is about ten years (and again, remember that most of the subjects in these studies were adults when they transitioned, and therefore had a more consolidated sense of self). We simply don’t know how many of those who were transitioned as teenagers will regret it, but the number is likely to be much higher than 2 percent given the “affirmative” model’s hostility to medical gatekeeping.

As for the minority-stress hypothesis, it has been adopted blindly from the literature on homosexuality on the supposition that sexual orientation and gender identity are similar phenomena. But that assumption is commonly contradicted by trans activist-researchers themselves. And indeed, the minority-stress hypothesis is a convenient insurance policy for advocates of “gender-affirming care,” since society is unlikely ever to be fully welcoming toward transgender people (by activists’ standards). Regret, then, can always be attributed to lack of acceptance for gender transition.

Oliver concludes by emphasizing that “kids should not have to be activists.” I agree. They wouldn’t have to be if influential commentators like Oliver were willing to report on this issue with integrity, appreciating its complexities and nuances. Instead, Oliver and others too often serve as a mouthpiece for gender ideologues.

Photo by VALERIE MACON/AFP via Getty Images

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