Episode 66: It Is A Bad Idea To Try To Shout Down Detransitioners

After Jesse discusses his imminent Upstate death, the hosts turn toward a 60 Minutes segment on detransitioners and the rather unhinged response to it. Then they talk about the lab-leak hypothesis of the coronavirus’s origins, which may have been preemptively debunked by overeager journalists seeking to protect us all from racism and Trumpism.

60 Minutes segment: https://www.cbsnews.com/video/transgender-health-care-60-minutes-video-2021-05-23/#x

More background on it:

https://www.cbsnews.com/news/60-minutes-transgender-health-care-issues-2021-05-23/

GLAAD freaks out: https://twitter.com/glaad/status/1396665047645138945

Chase Strangio also unhappy: https://twitter.com/chasestrangio/status/1396828255639019524

Jack Turban stuff:

-he wanted to know where 60 Minutes found its sources: https://twitter.com/jack_turban/status/1396992770733056001

-Turban’s Pediatrics study correlating desire/receipt of puberty blockers with suicidality:
https://pediatrics.aappublications.org/content/145/2/e20191725

“After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation,” but when it came to all the other variables examined in this model — “past-year suicidality, ... past-month severe psychological distress, past-month binge drinking, and lifetime illicit drug use” — the link was statistically insignificant.

In the episode Jesse slightly misdescribes this finding, making it sound like the researchers found a link between puberty-blocker access in this group and their general mental health. That link was non-significant, though. The significant link was between puberty-blocker access and lifetime (but not past-year) suicidality. This doesn’t affect Jesse’s argument that one could just as easily look at this data and conclude that some of these cases are explained by clinicians being unwilling to put actively suicidal kids on puberty blockers. There are plenty of other potential explanations, too — zeroing in on one particular causal story (in this case, the kids became suicidal because they couldn’t access hormones) is a common and well-known error when interpreting this sort of correlational finding.

From On The Media:

Transcript: https://www.wnycstudios.org/podcasts/otm/episodes/trans-formations-on-the-media

“There are a set of criteria that an adolescent needs to meet and they need to have this diagnosis of gender dysphoria. And that diagnosis requires identifying as a gender different than your sex assigned at birth for at least six months. Many clinics will, on top of that diagnosis, require much more assessment and evaluation before they'll offer any kind of medical interventions. Once kids reach, usually age 16, but in certain clear cases age 14, they might start estrogen or testosterone. General surgery is not offered until adulthood. Often these things are all conflated. You'll hear things like seven year olds having genital surgery or little little kids being given estrogen, but that's not how it works.”

One example of many of the surgery claim being false: https://pubmed.ncbi.nlm.nih.gov/29507933/

And we have numerous examples of kids being given blockers and hormones on a far hastier timeline than what Turban lays out here. There is no mention of providers who don’t follow the proper guidelines. That said, Turban is correct that some clinics go too far in the other direction.

“There are a very small number of people who do regret the interventions, but from all the research we have so far, this seems to be on the order of like less than 1 percent.”

There does not appear to be a single study published by an American affirming clinic on regret rates. This isn’t nitpicking, because there has been a genuine revolution in youth transgender care in recent years that is a major shift away from ‘gatekeeping.’ So past studies on regret rates, whether youth or adult contexts, simply can’t tell us much about how to gauge the performance of contemporary American gender-affirming providers.

There’s at least some evidence, from one very-well-known affirming clinic, of a high lost-to-followup rate — above 40% — which offers circumstantial evidence of kids discontinuing their hormonal treatment: https://pubmed.ncbi.nlm.nih.gov/29056436/

That said, it’s also possible they continued treatment elsewhere, or that some other explanation can account for this. Either way, a lost-to-followup rate of 40% is quite high and might be a warning sign.

-Turban has exhibited basic unfamiliarity with the DSM-IV versus -5 criteria for gender dysphoria, as he subsequently seemed to acknowledge by correcting one of his articles: https://twitter.com/jessesingal/status/1341502177920073731

Lab leak hypothesis:

Long NY Mag piece: https://nymag.com/intelligencer/article/coronavirus-lab-escape-theory.html

Chait: https://nymag.com/intelligencer/2021/05/lab-leak-liberal-media-theory-china-wuhan-lab-cotton-trump.html

Very in-depth forensic account from Yglesias of who said what when:

https://www.slowboring.com/p/the-medias-lab-leak-fiasco

NPR declares the theory ‘debunked’ more than a year ago: https://www.npr.org/2020/04/22/841925672/scientists-debunk-lab-accident-theory-of-pandemic-emergence

Slate: https://slate.com/technology/2020/02/coronavirus-bioweapon-conspiracy-theories.html

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