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False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used to deny healthcare to transgender 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]

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

Origins

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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

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Desistance myth

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The theory that majority of pre-pubertal youth diagnosed with gender dysphoria will "desist" and stop desiring to transition by adulthood without intervention relied on studies that had serious methodological flaws such as low sample sizes, outdated diagnostic frameworks that conflated gender non-conformity with transgender identity, usage of conversion therapy on the sample population, and poor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][8] Most youth sampled in them never identified as transgender or desired to transition, but were counted as desisting.[4]

The claim has often been used to support the criminalization of gender-affirming care.[9] It primarily stems from a commentary by James Cantor in 2020, who argued based on the outdated studies that most children diagnosed with gender dysphoria will grow up to be gay and lesbian adults if denied such care.[3][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

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Anecdotes and misinterpreted studies have been used to claim that the majority of transgender people regret or reverse their transition.[3][8]

Transgender identity as a mental health condition

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Legislative efforts to ban gender affirming care in the United States have relied on the unfounded narrative 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 "misleading and unfounded narratives" such as "mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence" have created a hostile perception for trans youth.[2]

Social contagion and rapid onset gender dysphoria

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Main article: Rapid-onset gender dysphoria controversy

In 2018, Lisa Littman authored a heavily corrected study, arguing 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][10] The study 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][10]

While there is no empirical evidence to support the hypothesis, it has been heavily referenced in discourse about transgender youth.[10][3][11] In 2021, a coalition of psychological professional bodies issued a position statement on ROGD that supported eliminating the use of ROGD, clinically and diagnostically, "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" led to "over 100 bills under consideration in legislative bodies across the country that seek to limit the rights of transgender adolescents" predicated on it's "unsupported claims".[11]

Psychotherapy and conversion therapy

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See also: Gender identity change efforts

Proponents of bans on gender-affirming care in the United States have argued that youth should receive psychotherapy including Gender exploratory therapy (GET), a form of conversion therapy, instead of medical treatments.[8][12] Practitioners of GET frame medical transition as a last resort and argue their patient's geneder dysphoria is caused by factors such as homophobia, social contagion, sexual trauma, and autism.[13][14] Some practitioners avoid using their patients' chosen names and pronouns while questioning their identification. [15]

There are no known empirical studies examining psychosocial or medical outcomes following GET.[15][16] 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,[13][15] while gender-affirming model of care already promotes individualized care and gender identity exploration without favoring any particular identity.[15] 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.[17]

Multiple groups exist worldwide to promote GET and have been successful in influencing legal discussions and clinical guidance in some regions.[18] 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".[19] [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.[19] GETA also shares a large overlap with the Society for Evidence-Based Gender Medicine (SEGM), which promotes the same position.[6]

Untrustworthiness of medical organizations

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Though every major medical organization endorses gender-affirming care, proponents of gender-affirming care bans in the United States 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]

Children are transitioned too quickly

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In the United States, proponents of gender-affirming care bans have argued that transgender youth are incapable of providing informed consent to medical transition. 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]

In a June 2023 statement, the Endocrine Society noted

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.[20]

Schools are medically transitioning children

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In 2024, former United States president, 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.[21][22]

Impact

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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[23]

In August 2022, Chaya Raichik claimed on the far-right social media account Libs of TikTok that Boston Children's Hospital (BCH)[24] and Children's National Hospital (CNH) were providing gender-affirming bottom surgeries to minors.[25] With the BCH-related content, Raichik included a BCH video that featured one of the hospital's gynecologists explaining the procedure.[24] While USA Today,[26] NPR,[25] and PolitiFact[27] concluded that BCH claim was false, several conservative outlets—including The Daily Caller and The Post Millennial—republished the claims.[28][29][26][30] After the Libs of TikTok posts, each hospital's employees were subject to harassment,[31] and both BCH and CNH were subject to bomb threats,[37] though it was unclear whether each of the threats were related to the harassment.[33] NBC News described Libs of TikTok as "one of the primary drivers of the harassment campaign" against BCH.[38]

Responses from medical organizations

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In June 2023, The Endocrine Society released a press release stating "widespread misinformation about medical care for transgender and gender-diverse teens" had resulted in 18 US states banning such care, including for adults. They stated "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."[20]

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."[20]

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

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References

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  1. ^ a b Kim, Hyun-Hee; Thayer, Nova; Bernstein, Caryn; Cruz, Roxana; Roby, Christopher; Keuroghlian, Alex S. (2024). "On the Frontlines: Protecting and Advancing Gender-Affirming Care in a Hostile Sociopolitical Environment". Journal of General Internal Medicine. doi:10.1007/s11606-024-09080-3. ISSN 1525-1497. PMID 39384688.
  2. ^ a b c d "APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science" (PDF). www.apa.org. American Psychological Association. February 2024. Retrieved 2024-12-03.
  3. ^ a b c d e f g h i j k l m n McNamara, Meredithe; McLamore, Quinnehtukqut; Meade, Nicolas; Olgun, Melisa; Robinson, Henry; Alstott, Anne (2024). "A thematic analysis of disinformation in gender-affirming healthcare bans in the United States". Social Science & Medicine. 351: 116943. doi:10.1016/j.socscimed.2024.116943. ISSN 0277-9536. PMID 38759383.
  4. ^ a b c d Cravens, R. G.; McLamore, Quinnehtukqut; Leveille, Lee; Hodges, Emerson; Wunderlich, Sophie; Bates, Lydia (December 12, 2023). "Manufacturing the doubt that fuels the network". Southern Poverty Law Center. Archived from the original on 28 December 2023. Retrieved 2023-12-31.
  5. ^ a b c d e Wuest, Joanna; Last, Briana S. (2024). "Agents of scientific uncertainty: Conflicts over evidence and expertise in gender-affirming care bans for minors". Social Science & Medicine. 344: 116533. doi:10.1016/j.socscimed.2023.116533. ISSN 0277-9536. PMID 38401237.
  6. ^ a b c Cravens, R.G.; McLamore, Quinnehtukqut; Leveille, Lee; Hodges, Emerson; Wunderlich, Sophie; Bates, Lydia (December 12, 2023). "Group dynamics and division of labor within the anti-LGBTQ+ pseudoscience network". Southern Poverty Law Center. Retrieved 2023-12-21.
  7. ^ a b c Cravens, R. G.; McLamore, Quinnehtukqut; Leveille, Lee; Hodges, Emerson; Wunderlich, Sophie; Bates, Lydia (December 12, 2023). "Foundations of the Contemporary Anti-LGBTQ+ Pseudoscience Network". Southern Poverty Law Center. Archived from the original on 28 December 2023. Retrieved 2023-12-31.
  8. ^ a b c d e f g h i j Alstott, Anne; Olgun, Melisa; Robinson, Henry; McNamara, Meredithe (2024). ""Demons and Imps": Misinformation and Religious Pseudoscience in State Anti-Transgender Laws" (PDF). Yale Journal of Law and Feminism.
  9. ^ Criminalizing Gender Affirmative Care with Minors: Suggested Discussion Points With Resources to Oppose Transgender Exclusion Bills (Report). American Psychological Association.
  10. ^ a b c Lockmiller, Catherine (2023). "Decoding the Misinformation-Legislation Pipeline: an analysis of Florida Medicaid and the current state of transgender healthcare". Journal of the Medical Library Association. 111 (4): 750–761. doi:10.5195/jmla.2023.1724. ISSN 1558-9439. PMC 10621716. PMID 37928129.
  11. ^ a b "ROGD Statement". Coalition for the Advancement & Application of Psychological Science. 26 July 2021. Retrieved August 4, 2021.
  12. ^ a b Pauly, Madison; Carnell, Henry (July 2024). "First they tried to "cure" gayness. Now they're fixated on "healing" trans people". Mother Jones. Retrieved 2024-06-05.
  13. ^ a b Lawson, Zazie; Davies, Skye; Harmon, Shae; Williams, Matthew; Billawa, Shradha; Holmes, Ryan; Huckridge, Jaymie; Kelly, Phillip; MacIntyre-Harrison, Jess; Neill, Stewart; Song-Chase, Angela; Ward, Hannah; Yates, Michael (2023). "A human rights based approach to transgender and gender expansive health". Clinical Psychology Forum. 1 (369): 91–106. doi:10.53841/bpscpf.2023.1.369.91. ISSN 1747-5732. S2CID 265086908. Archived from the original on 24 September 2024. Retrieved 1 January 2024.
  14. ^ Caraballo, Alejandra (2022). "The Anti-Transgender Medical Expert Industry". Journal of Law, Medicine & Ethics. 50 (4): 687–692. doi:10.1017/jme.2023.9. ISSN 1073-1105. PMID 36883410. Archived from the original on 1 March 2024. Retrieved 1 January 2024.
  15. ^ a b c d MacKinnon, Kinnon R.; Gould, Wren Ariel; Enxuga, Gabriel; Kia, Hannah; Abramovich, Alex; Lam, June S. H.; Ross, Lori E. (2023). "Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada". PLOS ONE. 18 (11): e0293868. Bibcode:2023PLoSO..1893868M. doi:10.1371/journal.pone.0293868. ISSN 1932-6203. PMC 10686467. PMID 38019738.
  16. ^ Leising, Julie (2022). "Gender-affirming care for youth—separating evidence from controversy" (PDF). BC Medical Journal. 64 (7).
  17. ^ Ashley, Florence (2022). "Interrogating Gender-Exploratory Therapy". Perspectives on Psychological Science. 18 (2): 472–481. doi:10.1177/17456916221102325. PMC 10018052. PMID 36068009. S2CID 252108965.
  18. ^ Amery, Fran (2023). "Protecting Children in 'Gender Critical' Rhetoric and Strategy: Regulating Childhood for Cisgender Outcomes". DiGeSt - Journal of Diversity and Gender Studies. 10 (2). doi:10.21825/digest.85309. ISSN 2593-0281. Archived from the original on 24 September 2024. Retrieved 1 January 2024.
  19. ^ a b Santoro, Helen (2023-05-02). "How Therapists Are Trying to Convince Children That They're Not Actually Trans". Slate. ISSN 1091-2339. Archived from the original on 21 January 2024. Retrieved 2024-01-01.
  20. ^ a b c "AMA strengthens its policy on protecting access to gender-affirming care" (Press release). Endocrine Society. June 12, 2023.
  21. ^ 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.
  22. ^ "Health Misinformation Monitor: Falsehoods About Transgender People and Gender Affirming Care". KFF. 2024-10-10. Retrieved 2024-12-03.
  23. ^ "Health Misinformation Monitor: Falsehoods About Transgender People and Gender Affirming Care". KFF. 2024-10-10. Retrieved 2024-12-16.
  24. ^ a b Gilbert, David (August 17, 2022). "Far-Right Extremists Are Threatening to "Execute" Doctors at a Children's Hospital". Vice News. Retrieved August 18, 2022.
  25. ^ a b Bond, Shannon (26 August 2022). "Children's hospitals are the latest target of anti-LGBTQ harassment". All Things Considered. NPR. Retrieved 27 August 2022.
  26. ^ a b Hudnall, Hannah (August 22, 2022). "Fact check: False claim about Boston Children's Hospital's transgender care program". USA Today. Retrieved August 24, 2022.
  27. ^ Reyes, Yacob (August 12, 2022). "No, Boston Children's Hospital doesn't provide hysterectomies for children". PolitiFact. Retrieved August 18, 2022.
  28. ^ a b 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.
  29. ^ 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.
  30. ^ 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.
  31. ^ 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.
  32. ^ McCausland, Phil (August 31, 2022). "Boston Children's Hospital faces bomb threat after right-wing harassment campaign". NBC News. Retrieved August 31, 2022.
  33. ^ a b Alfonseca, Kiara (August 31, 2022). "Boston Children's Hospital receives bomb threat following harassment over transgender care". ABC News. Retrieved August 31, 2022.
  34. ^ O'Laughlin, Frank (September 9, 2022). "Police investigating after another bomb threat made against Boston Children's Hospital". WFXT. Retrieved February 26, 2024.
  35. ^ Jamison, Peter (26 August 2022). "Children's hospital threatened after Libs of TikTok recording on trans hysterectomies". The Washington Post. Retrieved 27 August 2022.
  36. ^ Venhuizen, Harm (August 27, 2022). "D.C. children's hospital harassed over trans youth services". Associated Press. Retrieved August 28, 2022.
  37. ^ BCH bomb threats:[32][33][34] CNH bomb threats:[35][28][36]
  38. ^ 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.
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