Recently, I received a broadcast message from my online neighborhood chat room news feed. An autistic neighbor was soliciting donations for “medically necessary and lifesaving” top surgery.1 Before researching this article, I would have had no idea what “top surgery” was. Essentially, plastic surgeons transform a biological male chest into a transgender female chest, or vice versa. (Many transgenders undergo “bottom surgery” too.)2

Two neighbors responded online. The first suggested therapy first as a young person is likely to change their mind a lot by middle age. The second asked how top surgery was “lifesaving.” In response, the trans neighbor suggested the questioner research transgender suicide rates.

My libertarian bias tells me that if an adult wishes to undergo gender transition, and they pay for it themselves, more power to them. Turns out, insurance was paying for most of my neighbor’s top surgery; even Medicare will pay for transgender surgeries. Donations would pay for some uncovered medical procedures, such as the anesthetization, and travel expenses.

My empathic bias tells me that if someone is willing to put themselves through all the hassle, including drug and hormone treatments, social stigma, incapacitation time, as well as the major surgeries — removing body parts, or fabricating new ones from skin grafts — they must feel genuinely compelled.

But I would not agree that gender transitions represent just another instance of an oppressed group fighting for equal rights, as have native Americans and African-Americans, women, and gays. For two reasons: (1) if transitions are financed by the public through insurance, the public does have standing to participate in the policy debate; and (2) if the person transitioning is legally a minor, adults remain responsible for their welfare.

Moreover, transitions aren’t the only source of transgender controversy. There is also the hot-button issue of trans youth participating in competitive sports. Here, again, others have standing in the policy debate. Some girls have complained that trans girls (that is, transgenders who were classified as male at birth) enjoy unfair physical advantages in many sports.

The AERA

Enter the American Educational Research Association (AERA), a professional organization dominated by education school professors. AERA leaders issued a statement in April calling on members to “use what we know to eradicate transphobia in our larger society.”3

The statement opens with a declaration of original sin: all of us share responsibility for bad thoughts and behaviors.

” … we call for AERA members and all others who work in education to accept responsibility for transphobic attitudes, cultures, practices, and policies that threaten and inflict harm on transgender and non-binary students and educators.”

The AERA leaders take a side in the transgender debate and exhort association members to join them.

“Many states are presently considering laws that would be educationally harmful and otherwise devastating to transgender citizens in and out of schools. … We [ask] our 25,000 members to leverage their research, platforms, and networks in pursuit of justice for transgender and non-binary persons.”

One might have expected that scholarly research should be objective and impartial. Not apparently in the AERA, where conclusions formed by social justice imperatives come first, and the rest of the research process shapes to fit.

“Given the guaranteed consequences of pending anti-trans bills across states, decisive action is urgently needed to confront the educational, psychological, and physical violence that trans communities will surely endure if existing transphobic public policies are upheld and new ones are passed.”

Perhaps you thought that the “educational research” embedded in the organization’s title comprised investigating, say, teaching and learning. No time for that; there are more important things to do.

“We have an immediate responsibility to extend the reach of our research expertise on gender, trans people’s experiences and outcomes, public policy, and related topics beyond conference papers, scholarly symposia, and academic journals. Research organizations like ours have the expertise and data that matter.”

I was an AERA member for many years, until I wearied of its intolerance. I researched educational testing, a bogeyman widely reviled among education professors, but one of the few means by which those outside the public school system can gauge objectively what is happening inside. Apparently, I would feel no more welcome in the organization today, as its current president considers educational testing an instrument of white supremacy.4

By the way, as a “leading expert on diversity, equity, and inclusion,” AERA president Shaun Harper stands to profit from the activity he encourages. From his slick website:

“He has spoken and facilitated high-quality professional learning experiences for employees across all levels at more than 400 corporations, firms, agencies, and educational institutions. Executives often seek and benefit from his expertise in moments of racial crisis.”5

Little is defined in the AERA statement, even while all is already decided. The casual reader might conclude that pretty much anything and anybody could be considered transphobic, which may discourage any inclination to offer even nuanced disagreement.

Trans advocates claim to speak for persons who have genuinely been marginalized and persecuted. Some of their treatment has been cruel. The resulting sympathy, guilt, and shame inhibits opposition and emboldens some trans advocates to push past normal boundaries of politesse. Piling on celebrities, such as J. K. Rowling, Caitlin Jenner, and Martina Navratilova, for alleged transphobia represents just a few among many of the current tactics employed.

One result is a lopsided political power imbalance. Trans advocates not only enjoy the political and financial support of the ACLU but of a wide panoply of corporate America, sensitive to the appearance of discrimination and to potential consumer boycotts of their products and services. Corporate intervention in some statehouse debates has been decisive.6

Representing the opposition in court cases, by contrast, is the Alliance Defending Freedom, a small Scottsdale, Arizona-based nonprofit opposing abortion and defending businesses wishing to discriminate among customers on religious grounds.7

The Press

A tiny sample of recent press coverage on trans issues lines up discouragingly to stereotype. National Public Radio (NPR) and MSNBC correspondents, for example, grilled West Virginia governor Jim Justice over his support of a bill restricting trans students from competing in girls’ sports.8 9 Both demanded he provide, on the spot, an example of a trans athlete in West Virginia who had an unfair advantage. When Justice couldn’t recall an example, on the spot, the reporters declared a total absence of evidence.

From NPR:

“I’m also asking you for the evidence behind it. You know, you’ve had collegiate and professional sports organizations that have had trans-inclusive policies for years without incident. Why would West Virginia need the special ban? … Trans girls are girls, and they would be competing, you know, within their cohort.”

From MSNBC:

“Can you give me one example of a transgender child trying to get an unfair advantage? Just one in your state, you signed a bill about it. … Please come back when beyond anecdotal feelings as a coach you can show me evidence where those young women are being disadvantaged in your state.”

I find a few of the reporters’ assumptions disconcerting. The first is the claim that there have been no incidents — no empirical evidence — of trans athletes enjoying an unfair advantage. The second is the supposition that “an unfair advantage” for a trans athlete is a matter of “trying,” as if trans girls typically restrain themselves from a full athletic effort. Finally, there is the argument that with enough surgeries, hormones, and drugs a trans girl becomes just like any other girl in all the factors that matter on the athletic field.

As common sense might suggest, none of the three assumptions is quite accurate. It requires all the effort of retrieving a Wikipedia entry for “Transgender people in sports” to cast doubt. In 2017, a teenage wrestler was required to compete against girls while undergoing testosterone therapy, despite his own desire to compete against boys. He ended the season at 52-0, winning the state championship.10 The following year with more experience, but competing in the boys’ division, he did not perform as well.11 Then, there was the much-publicized case in Connecticut, where two trans girls in their first year in high school “amassed 15 different state championship titles that were held by nine different girls across the state.” 12 From my readings, other than Olympic Games committees, most collegiate and professional sports organizations have yet to meaningfully confront the issue of transgender athletes’ participation.

As for the “trans girls are girls” assertion, in her autobiographical account, British activist Keira Bell disagrees. She writes in some detail about unanticipated (i.e., not properly forewarned) physical side effects resulting from her own gender transition process, “I was an unhappy girl who needed help. Instead, I was treated like an experiment.”13 Articulate counterpoints can be found outside popular media outlets, in more specialized forums, such as Quillette. 14 Also, the Gender Dysphoria Support Network offers a list of resources from journals and blogs.15

The States

The transgender legislation, both proposed and passed, refers to minors: those under 18 years old, in most states. To my mind, allowing an extensive, non-reversible physical transition based largely on a teenager’s say-so represents a greater risk than allowing youths at whatever stage of gender transition to compete in sports. Yet, as of this writing, several states have now passed laws restricting transgender participation in competitive sports, but only one — Arkansas — has passed a law restricting gender transitions themselves, and then only by overriding a governor’s veto. Perhaps that is because athletic competition is more public and involves a natural opposition constituency (i.e., the losing athletes).

Perhaps concerned about being perceived a ‘Chamber Republican’, Arkansas governor Asa Hutchinson eschewed business rationales in explaining his veto, citing instead an aversion to government overreach into citizens’ private lives, including “parental rights”.16

Given the bandwagon of institutional power aligned against them, it could be considered surprising that any politicians support trans restrictions. Ninety-five – inevitably, large –  corporations have signed onto the Human Rights Campaign’s “Business Statement on Anti-LGBTQ State Legislation.”

“Laws that would affect access to medical care for transgender people, parental rights, social and family services, student sports, or access to public facilities such as restrooms, unnecessarily and uncharitably single out already marginalized groups for additional disadvantage. They seek to put the authority of state government behind discrimination and promote mistreatment of a targeted LBGTQ population.”17

Among the medical science heavyweights opposing current state initiatives to limit gender transitions are the American Academy of Pediatrics (AAP), the American Medical Association, the Endocrine Society and the American Psychiatric Association. Of course, their concerns may extend beyond the bounds of science or patient care as some of the potential state laws: (a) would insert state authority into the relationship between doctor and patient, which could be unsettling to doctors used to having a free hand; and/or (b) would hold their members criminally liable for conducting gender transitions.

Incidentally, there exists precedent for holding medical professionals criminally liable for conducting state-prohibited surgeries on minors considered too young to understand the implications. Some US states have passed laws applying criminal penalties to doctors performing female genital mutilation after a board-certified physician in Michigan was found innocent (for lack of an applicable state statute) in court after having circumcised some young girls at their parents’ request.18

The Evidence

Ultimately, however, the entire “gender affirming” process with its myriad of quite consequential activities unfolds from nothing more than a teenager’s expressed desire for it. The youth is not physically ill, and the ‘medical’ decision for transition is not based on a physical diagnosis.

Good parents don’t always give their children what they want; neither do good societies. In its web page titled, “The Teen Brain: 7 Things to Know,” The National Institute of Mental Health asks us, “Did you know that big and important changes are happening in the brain during adolescence?”19 Actually, yes, many of us did know, based on our experiences teaching, parenting, coaching, and growing up ourselves.

The ‘life-threatening’ rationale stems from a belief that gender dysphoria causes suicide. The evidence comes from social surveys revealing higher levels of suicide ideation and attempts among the gender dysphoric. (Lacking are long-term longitudinal studies and randomized clinical trials.) This rationale justifies the insistence that the ‘gender affirming’ process should begin as soon as a youth is labelled gender dysphoric.

But wait, are all youths who desire a gender transition suicidal? What became of gender dysphoric teenagers in the millennia before gender transition was physically possible? Did they commit suicide en masse? Or is gender dysphoria uniquely modern or even, in some quarters, fashionable?20

One publication supportive of transgender athletes printed this:

“The people now pushing to ban trans athletes from participating as their gender in high school sports are literally risking the lives of trans youth. 80% of trans people have thought about taking their own lives, and 40% of them have actually tried.”21

The reference takes one to a research synthesis of studies on suicide among transgendered adults — that is, those who had already successfully completed their gender transition. The author was suggesting that participation in sports can help reduce thoughts of suicide.22 But the study also obviously casts doubt on the promise of gender transition as a cure for suicide ideation. Similarly, CNN cites the results of a mental health survey in the journal Pediatrics to support adolescent gender transition on demand, yet links to a page of comments that are as critical of the study’s methods as supportive.23 24

Some quieter voices argue that a teenager considering suicide probably has more problems than gender dysphoria alone. A pause for an extended period of intensive talk, cognitive, and drug therapy might help to isolate the dysphoria from other, more hidden problems.

As for non-suicidal youth, if one of them desires a gender transition but is otherwise emotionally content, can the process not wait until they reach adulthood?

The Debate

Speaking of depression, I found it depressing combing through the tit-for-tat on the internet between the more settled opinions from the two opposing sides.

Some on each side claim:

– that science is on their side;

– they are the victims;

– their point of view represents the safe path, the natural order of things; and

– they are preserving individual rights against overreaching authority.

Some on each side claim that the other side:

– is disingenuous, deviously hiding their true, mendacious motives;

– thinks narrowly in only binary terms;

– is overreacting to what is actually a very small number of cases;

– sees the issue simplistically, emotionally;

– has no evidence to support its claims; and

– is being reckless, while bullying those who disagree.

The uncompromising statement of the American Educational Research Association certainly fits one of the polar camps. (Though, unlike Governor Hutchison and the Human Rights Campaign and their hundred corporate allies, the AERA makes no mention of parental rights.) AERA hyperbole — “devastating,” “guaranteed consequences,” and “educational, psychological, and physical violence that trans communities will surely endure” — leaves no room for discussion. Who would volunteer to expose their reputations to those who feel no rhetorical restraint?

AERA will boycott any state passing an “anti-trans” law. Four states considering transgender legislation have hosted AERA conferences in the recent past — Georgia, Louisiana, Pennsylvania, and Texas.

I empathize with those who grind no axe but cannot hide on the sidelines, either because they must cast a vote in a state legislature or craft a legal opinion from a court bench. Despite what many say, the issues are complicated, and the science is far from settled.

In one of her weekly Critically Speaking podcasts (“where we separate facts from fallacies at the intersection of science and society”), geneticist Therese Markow interviewed Alan Rogol, a professor emeritus of pediatrics and board-certified endocrinologist (i.e., hormones) and advisor to the United States Anti-Doping Agency.25 Their discussion focused on testosterone; until only very recently, testosterone level was the only measure widely used by sports associations to determine if an athlete should be prevented from competing with his or her chosen gender. Ironically, though the motivation for testosterone level measurement was to identify trans females with unfairly high levels of testosterone, it also identifies cisgender (i.e., biological at birth) females with naturally occurring higher levels of testosterone. Should the latter be allowed or prevented from competing as females?

One can define the genders based on the functionality of the bodily equipment they carry for sexual reproduction, though even then there exist exceptionally rare exceptions — babies born with equipment that is not so easily classifiable.26 But, even when the function of the body parts is clear, the genetic instructions for the endocrine glands may not be aligned. There exist some rare (or, rarely expressed), disruptive genes that can affect an individual’s sexual function or athletic ability in ways that deviate from the norm, for better or worse. Though unusual, all are natural in the sense that the individuals who have them are born with them.

For transgender youth seeking treatment, the Human Rights Campaign’s Karen Tang argues:

“it’s almost all supportive care, counseling and medical treatments … like pubertal suppressants or gender-affirming hormonal treatments, which almost always are reversible. And they decrease the distress of the gender dysphoria, so children or adolescents can have time to confirm their gender identity and make decisions about things that are permanent, like surgery.”27

The two “almosts” do not reassure. But otherwise, Tang’s assertion outlines a possible compromise. That is, before the age of legal adulthood, allow only non-surgical and other treatments that are genuinely fully reversable without imposing a future financial burden. The Australian‘s Bernard Lane would disagree that puberty blockers and other hormone treatments are so innocent, citing some evidence of possible long-term side effects, such as infertility and osteoporosis.28

At least some, and perhaps most, aspects of gender transitioning are not fully reversible. Other aspects may technically be reversible but extremely expensive for a trans-individual who wants to de-transition later.29

To my mind, erroring on the side of caution means holding off on gender transition therapy until individuals can legally make the decisions for themselves as adults. As for health insurance support of adult gender transition, I’m not convinced that the issue is genuinely medical, rather than simply a matter of personal preference, like much plastic surgery. Many would disagree; some might call me an insensitive bigot.

Richard P. Phelps is founder of the Nonpartisan Education Group and editor of its peer-reviewed journal, the Nonpartisan Education Review, a Fulbright Scholar, and a fellow of the Psychophysics Laboratory. He has authored, or edited and authored, four books on assessment policy — Correcting Fallacies about Educational and Psychological Testing (APA); Standardized Testing Primer (Peter Lang)Defending Standardized Testing (Psychology Press); and Kill the Messenger: The War on Standardized Testing (Transaction) – and several statistical compendia. Phelps has held positions with several organizations working in assessment, including ACT, AIR, ETS, the OECD, Pearson, and Westat. He holds degrees from Washington, Indiana, and Harvard Universities, and a PhD in Public Policy from the University of Pennsylvania’s Wharton School.

Picture by Jeswin Thomas via Unsplash.

Footnotes

  1. https://www.healthline.com/health/transgender/top-surgery
  2. https://www.healthline.com/health/transgender/bottom-surgery
  3. [3] AERA. (April 6, 2021). “Statement from AERA President Shaun R. Harper and Executive Director Felice J. Levine in Support of Transgender and Non-Binary Persons.” https://www.aera.net/Newsroom/Statement-from-AERA-President-Shaun-R-Harper-and-Executive-Director-Felice-J-Levine-in-Support-of-Transgender-and-Non-Binary-Persons
  4. He said, ” An evil education lies to children … It traumatizes students of color with White supremacist tests that tell them they are not smart or good or qualified.” AERA. (April 2021). “AERA 2020 President Shaun Harper Calls on Researchers to Accept Responsibility for Educational and Social Problems.” https://www.aera.net/Newsroom/AERA-Highlights-E-newsletter/AERA-Highlights-April-2021/AERA-2020-President-Shaun-Harper-Calls-on-Researchers-to-Accept-Responsibility-for-Educational-and-Social-Problems
  5. https://www.shaunharper.com/
  6. See, for example, https://abcnews.go.com/Sports/wireStory/south-dakota-governor-kills-transgender-bill-orders-ban-76758306, https://www.wibw.com/2021/04/22/governor-vetoes-transgender-athlete-bill-sb-55/
  7. There seems to be more diversity among oppositional organizations internationally, for example: Society for Evidence-Based Gender Medicine https://segm.org/news; Gender Dysphoria Support Network https://genderdysphoriasupportnetwork.com/; International Association of Therapists for Desisters and Detransitioners https://iatdd.com/.
  8. Cornish, A., et al. (April 30, 2021). “West Virginia Governor Discusses His $100 Offer To Young People Who Get Vaccinated.” National Public Radio.  https://www.npr.org/2021/04/30/992545248/west-virginia-governor-discusses-his-100-offer-to-young-people-who-get-vaccinate
  9. Vallejo, J. (April 30, 2021). “MSNBC host hammers West Virginia governor over ban of transgender athletes in female sports.” The Independent. https://www.independent.co.uk/news/world/americas/us-politics/msnbc-transgender-ban-west-virginia-b1840455.html; Baragona, J. (April 30, 2021). MSNBC Host Hammers West Virginia Guv for Signing Anti-Trans Sports Bill. Daily Beast.  https://news.yahoo.com/msnbc-host-hammers-west-virginia-150641663.html
  10. [10] “Transgender teenage wrestler Mack Beggs wins Texas girls title” ( https://www.theguardian.com/society/2017/feb/26/transgender-teenage-wrestler-mack-beggs-wins-texas-girls-title ). The Guardian. Reuters. 26 February 2017.
  11. Barnes, K. (May 29, 2018). They are the champions: In the face of fear and anger, two young transgender athletes fight to compete in the sports they love. ESPN. http://www.espn.com/espnw/feature/23592317/how-two-transgender-athletes-fighting-compete-sports-love
  12. “Trans Athletes Are Posting Victories and Shaking Up Sports” (https://www.wired.com/story/the-glorious-victories-of-trans-athletes-are-shaking-up-sports/ ). Wired. Retrieved 2020-08-31.
  13. Bell, K. (April 7, 2021). My Story: As a teen, she transitioned to male but came to regret it. Here’s how it felt to enter history in the trans debate. Persuasionhttps://www.persuasion.community/p/keira-bell-my-story
  14. https://quillette.com/ Look for authors Bernard Lane, Angus Fox, Stella O’Malley, Susan Evans, and Marcus Evans.
  15. https://genderdysphoriasupportnetwork.com/resources
  16. Greenfield, B. (April 14, 2021). Anti-trans bills aim to make it a crime to medically treat transgender youth. Experts say it will have ‘deadly consequences.’ Yahoo Lifehttps://www.yahoo.com/lifestyle/anti-trans-bills-aim-make-crime-medically-treat-transgender-youth-171807654.html
  17. https://www.hrc.org/resources/business-statement-on-anti-lgbtq-state-legislation
  18. The Economist (June 1, 2019). “The First Cut: Female Genital Mutilation,” p.25(US).
  19. https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know/
  20. Several commentators remark on the varying demographics of adolescents diagnosed with gender dysphoria over time — first, it was mostly males, more recently, mostly females — which suggests that gender dysphoria is not always innate and may be induced by cultural trends. Also, a recent Gallup Poll reveals widely varying percentages across generations of survey respondents identifying themselves as transexual (from 0.3 to 1.8) or LGBT (from 1.3 to 15.9). https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx
  21. Zeigler, C. (June 14, 2018). As trans high school athletes win state titles, parents petition to ban them. SBNation: Outsports. https://www.outsports.com/2018/6/14/17458696/trans-athlete-connecticut-high-school-ban-petition
  22. Adams, N., Hitomi, M., & Moody, C. (April 2017). Varied Reports of Adult Transgender Suicidality: Synthesizing and Describing the Peer-Reviewed and Gray Literature. Transgender Health, 2(1). https://www.liebertpub.com/doi/10.1089/trgh.2016.0036
  23. Krishnakumar, P. (April 15, 2021). This record-breaking year for anti-transgender legislation would affect minors the most, CNN Politics. https://www.cnn.com/2021/04/15/politics/anti-transgender-legislation-2021/index.html
  24. https://pediatrics.aappublications.org/content/early/2020/01/21/peds.2019-1725/tab-e-letters?versioned=true
  25. Markow, T. (June 26, 2019). “You go girl: Testosterone with Dr. Alan Rogol.” Critically Speaking. https://podcasts.apple.com/us/podcast/009-you-go-girl-testosterone-with-dr-alan-rogol/id1463016517?i=1000442798140
  26. Marinov, G. K. (May 2020). In Humans, Sex is Binary and Immutable. Academic Questions, 33, 279-288.
  27. Greenfield, B. (April 14, 2021). Anti-trans bills aim to make it a crime to medically treat transgender youth. Experts say it will have ‘deadly consequences.’ Yahoo Lifehttps://www.yahoo.com/lifestyle/anti-trans-bills-aim-make-crime-medically-treat-transgender-youth-171807654.html
  28. Lehman, C. (May 10, 2021). Bernard Lane on the Fight for a More Balanced Approach Toward Children Seeking Medicalized Gender Change. Quillette Podcast #148https://quillette.com/2021/05/10/podcast-148-bernard-lane-on-the-fight-for-a-more-balanced-approach-toward-children-seeking-medicalized-gender-change/
  29. https://www.healthline.com/health/transgender/bottom-surgery#cost

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