SIO315: Lisa Littman's Latest Trans Study is Garbage

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:12 Thomas: And welcome to Serious Inquiries Only. This is episode 315. This is part 2. I almost said "the end of gender part 2," it's not, it is related. It is debunking awful science from Littman part 2, I'm finally getting to the study that has lately made the rounds on the anti-trans Twittersphere, I suppose, about detransitioning. Curious to see if this study is even half as bad as Littman's first attempt at transphobic science. So, oh, first off, how are you doing, Lindsay?

0:00:21 Lindsey: Yeah.

0:00:48 Thomas: Still have a cold.

0:00:47 Lindsey: Still have a cold. But yeah,

0:00:49 Thomas: This is Dr. Lindsay Osterman, of course, best science person in the biz, giving us the science breakdown. All right. I think since it is another episode, we should probably issue another content note that uh we'll be discussing awful transphobic pieces of crap and their attempts at uh laundering their opinions through junk science. Any other particular content notes you want to put on that?

0:01:07 Lindsey: Absolutely. Nope. I think that that covers it. Yeah.

0:01:14 Thomas: Oh, Geez, well, why don't we get to uh Lisa Littman's second, more recently published, study on detransitioning.

0:01:25 Lindsey: Just this week. This is hot off the presses. Minted here. I really I'm very curious about whether she learned any lessons from the corrections from the first paper. I really hope so. She's had a couple of years to think about what she did and try to do it better. But yeah, so this was titled Treated for Gender Dysphoria with Medical and or Surgical Transition, Who Subsequently Detransitioned, colon, A Survey of 100 Detransitioners. It's quite a title.

0:01:26 Thomas: Oh, yeah. Wow.

0:01:52 Lindsey: Before we get into this paper, I think we should define detransition because it's a pretty broad term. The way that Littman and others use this term is to describe situations in which someone someone initiates, at least initiates a social and or medical transition to a gender other than the one that they were assigned at birth, and then they either halt, stop, or take steps to reverse that transition, right? So it's pretty broad, right, if somebody after transitioning then changes their hair and clothing to be more consistent with their sex assigned at birth, right that would count as a detransition. If someone surgically reverses a previous gender affirming surgery that would also count as detransition, so it's broad. The paper starts by discussing some evidence that detransition is becoming more quote-unquote visible than it was a few years ago. She very carefully does not say more common, but more visible.

0:02:41 Lindsey: And so she talks about blogs and articles that started appearing between 2015 and 2017 about detransitions, support groups forming for detransicioners, and she also references a member poll in a subreddit, so it's r/detrans estimating that one-third of the members responding to the poll were desisters or detransitioners, right. And desistance, if anybody doesn't know, is refers to the cessation of distress due to the disconnect between one's sex assigned at birth and one's gender identity. Um,

0:03:13 Thomas: Desistance? Sorry, I don't think I understood that.

0:03:14 Lindsey: If, if, if someone desists, it means that they're like no longer experiencing gender dysphoria or yeah. Yeah. So, The way that people like Littman use that, right, is they're saying, well, these are the people who thought they were trans and then they desisted, right. They figured out that they weren't really trans. Yeah.

0:03:19 Thomas: Oh. Okay. Sounds good. Is that good?

0:03:32 Thomas: It's more like in a conversion, gay conversion therapy type way that they mean this. Ah, okay. So that's not good.

0:03:37 Lindsey: Yeah. And they tend to, like, you know, Deborah Soh talked about desistance a lot in her book too, right? It's like these folks like to point to examples of people desisting, right, in their gender identities, and then say, "See, you can't know who's quote unquote really trans." And so you should be very, very cautious about, oh, you know, gender under affirmative care. That's how they make these arguments.

0:03:59 Thomas: Yeah, like see, this priest says he doesn't have gay feelings anymore. So therefore, your son could also be not gay, like that kind of thing. Just to put it in perspective. I think that's pretty universally rejected among most people now. So yeah.

0:04:10 Lindsey: Yes. Right. Yeah. -hmm. Yeah, and we're going to talk about that more. There's some sort of, like, subtle sorts of nuances in terms of the ways that they're making these kinds of claims and the way that they've been addressed by other scholars in this literature. So, so Lippman says that the prevailing cultural narratives, and I'm quoting now, so quote, "the prevailing cultural narratives about detransition are that most individuals who detransicion will retransition and that the reasons for detransition are discrimination, pressure from others, and non-binary identification," close quote. So this is a narrative that she is critical and skeptical of.

0:04:54 Thomas: What about, like, economics? By the way, isn't that usually a problem, like, you it's expensive and people might lose health coverage, or is that a common reason, but not listed, I guess, okay.

0:04:57 Lindsey: Yeah. Mm -hmm. That is the thing that has been identified, yeah, In other studies, right? Like the way that she's sort of describing this narrative, I think, is actually a little bit too narrow. I think it's worth spending a little bit of time talking about the ways in which detransition has actually been talked about from this perspective. So first of all, it's worth saying that there is not a ton of research on this question of, like, how many folks detransition and reasons for detransition, and the studies that do exist have limitations that make it tough to tell what the true rate is, right? That said, the existing evidence does point toward a low rate, right? So all of that said, there is a more important point to make here in terms of why people detransition. So as Lippman says, discrimination and other external pressures like pressure from family and spouses and non-binary identification have been identified in some studies as commonly reported reasons for detransition.

0:05:05 Thomas: Hmm.

0:05:54 Lindsey: But I've read views that are a lot more complex than the claim that these are, you know, the only causes, right? For example, I read one really good article that I recommend to people by McKinnon and colleagues, also published just this year, 2021, the view that they articulate is a lot more nuanced than the view that Lippman summarizes here. Their argument is that the hyper focus on desistance and detransition as indicators that the original transition was or was not appropriate or successful overlooks the fact that people's identities are dynamic across their lives and that making a choice at time B that differs from time A should not necessarily be considered a bad outcome or a sign of regret because it often isn't, you

0:06:33 Thomas: Well, I think I kind of brought that up in the beginning of the last episode, yeah, okay, because who knows, I mean, somebody could, and then, like I said last episode, somebody could have gender dysphoria and, and you go through some changes, go through some, you know, searching as to, as that dysphoria exactly is, and could arrive at a different outcome later, right? I mean, it wouldn't be a reason to deny them treatment at any point in that process.

0:06:36 Lindsey: Did yeah, yeah, Exactly. Yeah. And that's fine, right? It would not. And that is centrally McKinnon and colleagues' point, right, this gets trotted out as an argument, you know, to increase gatekeeping, right. Which is exactly what Littman is doing in this study, not to jump the gun too much. And it's a bad reason to make that argument. It's a very bad reason. So McKinnon and colleagues also discussed the fact that desistance, dissatisfaction with a particular surgical outcome, transition regret, and detransitioning are all distinct concepts that often get conflated.

So in other words, if someone detransitions, regret and desistance are sometimes assumed to be driving that decision. And that may very well be an incorrect assumption in a lot of cases, right? So to illustrate that point, they described a case in which a patient got a mastectomy as part of a gender transition, physician and then years later decided to get breast implants, but they said they had no regrets about the initial surgery. So these things are things that need to be parsed out carefully And a lot of times they get conflated in these conversations. Similarly, right, some folks express dissatisfaction with a particular surgery, and out of context, that could be interpreted to be a sign of regret, but it need not be, right? So if someone is disappointed with a facial feminization surgery that didn't meet their expectations, they may not regret the surgery, surgery, right, they may

0:07:52 Thomas: Yeah. Yeah.

0:08:12 Lindsey: Not not want to detransition, they're just disappointed with the outcome of that surgery, yeah.

0:08:15 Thomas: Yeah. Like, so it could have been a bad surgeon, right. I mean. Or something could have gone amiss.

0:08:19 Lindsey: Right. Or, you know, maybe the effects weren't, you know, what they were expecting or something, um, their point with bringing up these cases is that the numbers that are reported in these studies often don't capture these different outcomes, right, and so some of these things get lumped together. So McKinnon and colleagues, uh, own the fact that as with any form of clinical intervention, there will be some, hopefully minimal, rate of dissatisfaction and regret that occurs, right? We talked about that in the last episode too, and that that has to be weighed against the good that the intervention does, right. The point is, when we're discussing this article, I want to try not to play Littman's game here, because as we'll see later, she's going to try to suggest that desistance and detransition rates, which she does not capture, by the way, are relevant to arguing against gender affirmative care, especially for young people.

0:09:08 Lindsey: And for more gatekeeping and gender-affirmative care in general. And McKinnon and colleagues would strongly disagree with this move, and I agree with them. Back to the article. Littman goes on to say that case reports indicate a broad range of experience of detransitioners, and that recent large-scale surveys of the reasons for detransition have yielded conflicting results about the most common reasons for detransition, right? Right? So for example, there's an article by Turban and colleagues that was published this year as well, in 2021, which suggested that the primary reasons for detransition were external. So for example, getting pressure from family, experiencing discrimination as a result of transition, right, as being reasons for people deciding to detransition. There was another study by Vandenbussche and colleagues, also 2021, that suggested the most common reasons for detransition were internal.

0:09:57 Lindsey: So realizing that gender dysphoria was related to another issue, or realizing that the transition did not help with their dysphoria. She also notes that both of these two studies were based on convenient samples, which is a point that we'll come back to toward the end of the paper. So Littman describes the objective of her study, this current study, as, quote, "to describe a population of individuals who experienced gender dysphoria, to undergo medical and or surgical transition, and then detransitioned by discontinuing medications, having surgery to reverse the effects of transition, or both." And she says that her study differs from the previous two by Turban and Vandenbussche in that she focused on individuals who transitioned and detransitioned medically, surgically, or both, whereas the other two studies included folks who had socially transitioned and detransitioned.

0:10:47 Lindsey: Littman further says, and this does appear to be a lesson she's learned from the previous thing, that her study was not designed to assess prevalence of detransition, but to assess reasons for detransition in a sample of individuals who pursued it. And I was so glad to read that. That being the case, let's hope that Littman doesn't end up inappropriately generalizing her claims. Or, you know, things that you wouldn't want to do if you're not Ex - yeah, exactly. So what did she do here? So between December 2016 and April 2017, which was shortly after her data collection from the 2018 study, by the way, or the 2018 paper, December '16, April '17, 101 participants were recruited on, quote, blogs that covered detransition topics and shared in a private online detransition forum in a closed detransition Facebook group and on Tumblr, Twitter, and Reddit. It so that's where she says she got her participants, not very specific. Yeah.

0:11:09 Thomas: Yeah. Watch this space. Yeah.

0:11:44 Thomas: Now already? Is that cool, like, as a scientist, are you just able - did we - did you already - did we talk about, like, where this was published versus where the last one was published, a-

0:11:45 Lindsey: Oh.

0:11:57 Lindsey: This was - this was published in the Archives of Sexual Behavior, which is a - a reputable journal, yeah.

0:12:01 Thomas: Reputable journal, so, you know, not a pay-for-play conceptual penis hoax or anything.

0:12:06 Lindsey: Nope. Yeah.

0:12:07 Thomas: Okay, we're in a reputable journal, is it normal or okay to just be like, "Asking you where you get your data," or if you're supposed to put it in your paper to just be like, "Yeah, the internet," vaguely. Is that cool?

0:12:17 Lindsey: No. It's, uh, this is not the kind of detail that I would omit, and it is the kind of detail that I - I, you know, I frequently see in articles, it's hard for me to give you an off-the-cuff response of what percentage. But, like, no, this is, it is standard practice to report on exactly where you were recruiting your sample, especially if it's going to be really important to understanding something about your results, which I think it is here. Yeah, so she doesn't, as you say, she just sort of says, yeah, these social media, kind of, right? Folks have been doing some sleuthing, and I have to ask, or I have to give Erin credit for this, because I don't know if I would have found this stuff. People have been sleuthing as to where these studies were originally posted.

And apparently she was posting this in subreddits and tubblers and so on that describe themselves as gender critical, which is language associated with trans exclusionary radical feminists or TERFs. And Erin actually sent me, you know, a number of the places where it was posted. And I've got those links and we can put those in the show notes for people to look at.

And one of the links, there's a thread here that indicates that whoever was posting the study, which apparently was not Littman, it was somebody who was working with her. But whoever was hosting the study was

0:12:42 Thomas: Yeah.

0:13:27 Lindsey: Trying to post it in more inclusive trans subreddits, but seemed to be having difficulty. Right? So it seemed like they were...

0:13:34 Thomas: Unable to even find those kinds of things. I don't know where to go to find non -transphobic Reddits.

0:13:36 Lindsey: No. No, they tried to post it in some more inclusive subreddits, but they apparently were like violating the terms of those subreddits, and so the posts were being removed. So it's not, it's no, it's, it's a, it's not clear whether they were ever successful in putting it on those, you, with more quote-unquote diverse views, which is what she claims to have done in her recruitment. She says that she recruited.

0:14:00 Thomas: Oh, So Like the way they posted it, or the study itself, or the description, or something thing was like so offensive that they weren't allowed to post it in non -transphobic spaces, possibly. Oh,

0:14:08 Lindsey: I think it was even more benign than that. It was like they didn't ask permission from the moderators before they posted it or something.

0:14:15 Thomas: You kidding me? So like just ask permission and do it, I mean so they're like, I'm gonna try exactly once to know to source some, uh, some data from non-transphobic Reddits, and no more times. That's that's my work ethic as a scientist. I'm going going to try one time, oops, I didn't ask permission, done, can't, well, I can't try again, agreed

0:14:19 Lindsey: Yeah.

0:14:35 Lindsey: Maybe. So I actually I don't know how that ended up. I don't know if that ended up making it into any of these other subreddits. But it would have been really helpful for her to provide information on where her participants were coming from, because then we would know the answer to that. So all we have documented is that she's posting in these sort of like turf groups. And that's all we know. A problem.

0:14:57 Thomas: Right off the bat that's a problem, not

0:14:57 Lindsey: Okay. She was recruiting sort of from social media things. She also shared her study link on several professional listservs, which are email lists associated with particular professional groups, and the ones that she targeted were about research on sex, sexual orientation, and gender. However, from a table in her paper, it appears that a maximum of 11 out of her final group of 100 participants actually came from those listserv. So 90% said that they heard about the study from detransition blogs or, quote, other social media, and only 11 were reported in her paper as coming from hearing about the study from someone they knew or from a other source. And so I think maximally those 11 people might have been referred from the listservs. But it seems to me like a majority of her participants came from social media sites. And it seems like a lot of the social media websites were these gender critical groups, right? What we know about her sampling.

0:15:48 Thomas: Not great as a scientist. How do you rate that? Oh,

0:15:52 Lindsey: Right? Right, she doesn't provide specific recruitment language from her study postings, which we talked about last time as being a very important thing, right? Because you don't want to give away hypotheses, but the recruitment ad was screenshotted in some of the places that the study was posted. So for instance, the recruitment ad was posted in a gender critical subreddit. And from the language that was used, it appears that the recruitment for this study had exactly the same problems as the 2018 paper.

She's implying her expectations in the recruitment language. So here's an illustrative snippet. Quote, although previous research shows that the satisfaction rates for transgender individuals who transition is generally high and the regret rates are low, several individuals have recently begun to describe unsatisfactory experiences with transition and have been posting about their experiences of transition and detransition on social media, close quote, right? As we discussed with the last study, this is the exactly the kind of thing that you don't want to post in your recruitment materials. It implies what you expect to find, and it is going to disproportionately turn off people who did not have negative experiences, and it will selectively appeal to people who didn't. So you will end up with a final sample that confirms your original expectations, which are clearly that detransitions experiences are being underreported.

0:17:09 Thomas: So You still didn't learn from your first failed study, okay, yeah

0:17:13 Lindsey: Yeah, right. Now, I will say this. If you specifically wanted to do a descriptive study on negative experiences with detransition, which would be completely legitimate, saying this kind of thing is fine. But then you're going to have to be very clear throughout your paper that we set out to study negative experiences. And we recruited people specifically who had negative experiences, and we recognize that these findings in no way imply anything about the typical detransition experiences that people have.

0:17:43 Thomas: Which could be useful information. I would want to know about people who had negative experiences and why.

0:17:48 Lindsey: Sure, me too, right? We're going to learn about that here, right? She has some stuff that I think is genuinely interesting here. She's just once again drawing some very bad conclusions from it. Okay, just to draw a line on this, under this, who is the sample? Because this is always important in terms of deciding generalizability. These are folks who medically transitioned and later medically detransitioned and they are likely to disproportionately have had negative experiences with that process. And they are disproportionately likely to be folks who frequent gender critical social media groups, right? Most generous reading of this is that she's telling these specific folks stories and that is valuable as long as she's not over claiming, right. So I hope she's Not.

0:18:27 Thomas: Okay, I will give it this. So it has the slight upgrade from the last study that it's not asking people's parents about them. It's actually the people.

0:18:35 Lindsey: It actually the people this time.

0:18:36 Thomas: Okay. That's significantly better at least.

0:18:37 Lindsey: Yeah. No, that's true. Okay. Here are her demographics, um, for the sample. So this sample, uh, had an average age of 29 years old. 69% of the sample was assigned female at birth. 90% of the sample was white. 93% of the sample supported marriage equality, right? So again, she's trying to preempt the claim that these are all just right-wing folks, right. Um, didn't include the question about trans rights in this study for some reason. I don't, I'm not sure why she didn't do that. Overview of measures, and then we'll just get into the results and talk about some of the more specific measures. So she assessed demographic information, obviously. She assessed diagnosed psychiatric disorders, neurodevelopmental disabilities, trauma, and non-suicidal self-injury prior to the onset of gender dysphoria. And she's assessing these things for the same reason that she did in the first study.

0:19:27 Lindsey: She's trying to establish that, you know, these pre-existing conditions could be a primary cause of gender dysphoria. She also asked a variety of questions pertaining to participants' experiences of gender dysphoria, their transition, their detransition, and their post-transition experiences, right? One specific thing that I wanted to point out that Lippman did here is that a lot of the questions she's asking are close-ended. So people are, you know, selecting ratings on a scale or they're selecting options from a checklist or whatever about their transition and detransiton experiences. But she also collected open-ended responses first, so before asking specific questions about their transition, she just asked participants the following question. She said, "Please describe why you decided to transition, how you identified at that time, and what you hoped would happen with your transition," right?

0:20:17 Thomas: Okay?

0:20:17 Lindsey: And then she asked all the specific questions, and then she did the same thing with detransition. She asked an open-ended question that was very much like that first one, and then she asks a bunch of specific questions. Now, that's actually a really good idea to get an open ended answer before you're before you're sort of prompting people with specific things that you want to know about Because yeah, right, it allows you to see what people just free generate without any kind of queuing, right? However, it would have been better, I think, if she'd asked both ended open-ended questions prior to any of the other questions. And what she asked actually did, if I'm inferring correctly from the survey order, is ask the open-end-to-transition question first, and then all those specific questions about transition, and then the open ended detransition question, and then all those.

So it's possible that some of what she's getting in the open-ended detransition question was affected by the specific transition questions that she asked previously, right? It's an issue of like survey order that, again, is very important if you're trying to prevent people's responses from being contaminated by prior questions, if that makes sense.

0:20:34 Thomas: Yeah, it makes sense.

0:21:19 Thomas: Yeah, gotcha. It's kind of the order you ask stuff really matters because you might prime people a little bit is That it, okay, which

0:21:25 Lindsey: Yeah. Exactly, right. Also, it wasn't clear to me whether the open ended questions were on a a separate page from the specific questions or whether people could sort of see them all at once. And if they could, this kind of diminishes the utility of asking the open -ended thing ahead of time. But anyway, I wanted to throw a bone on doing the open ended one first, but it did have those drawbacks. What did she find?

So first she summarizes the demographics about the age of gender dysphoria onset and the prevalence of mental health and neurodevelopmental disabilities prior to the onset of gender dysphoria. And so some examples of some of the things that are represented here are diagnoses of depression, anxiety, ADHD, PTSD, eating disorders, autism spectrum disorders, and there's several other ones, right? So the most commonly reported diagnoses, again, this is people reporting that they were diagnosed prior to the onset of gender dysphoria, were depression, 32%, anxiety, 27%, followed by ADHD, PSD, eating disorders, and autism spectrum disorders and bipolar disorder and OCD, all of those were around 10%. So as in the first article, she's trying to make the point that other pre -existing issues could be a cause of gender dysphoria rather than an effect, right? And she says as much, right, but these data don't necessarily suggest that, right. If people are getting the timeline right, right? And I think, you know, you could probably, probably assume that are. What this rules out is that gender dysphoria caused the pre -existing conditions, right? Unless maybe people were wrestling with gender identity before they could articulate it. But

0:22:56 Lindsey: The converse is not necessarily implied. It does, it does to me, right. Even, even if that's not the case, the converse is not implied there. Just because something happened before doesn't mean it caused the thing that happened later there's a nice Latin phrase for that, I believe, post hoc ergo proctor hoc, I think, yeah. So that, but that's how she's interpreting that. The first key results that she reports summarize participants' stated reasons for transitioning, and this was a select all that apply question. So some of the most commonly selected answers were wanting to proceed, be perceived as the target gender, believing that transitioning was the only way to feel better, that their body felt wrong the way it was, not wanting to be associated with their sex assigned at birth, and all of those were endorsed at around 70% rates or higher by the participants. More than 60% of participants reported believing that transition would eliminate or decrease their gender dysphoria and believing that transition would allow them to become their true selves.

0:22:56 Thomas: That seems plausible though yeah okay right right hmm what yeah

0:23:49 Lindsey: Not so far, I think. She summarizes participants' reports of what or who encouraged them to transition, and social media and online groups were the most commonly reported sources of transition encouragement. So this is another select all that apply question, and the most common reported um source was YouTube transition videos, 48% of participants reported that, blogs 46%, Tumblr 45%, and other online communities 43%, I

0:23:50 Thomas: Normal stuff yeah Why would you expect anything different, like

0:24:22 Lindsey: Know

0:24:22 Thomas: When I'm gonna do anything, like, forget, set aside the loaded question of gender dysphoria and all that, set all that aside, um, I'm gonna, like, I, my broken window frame that I, sorry, houses are on the mind, the first thing that I'm going to do is read about it online, check some YouTube videos, you know, like, that's just how people work, right? Like, no matter what you're going through, the internet is a great resource to just say, "Hey, who else is going through the following thing," ranging from something serious like gender dysphoria to anything else, not serious, I wouldn't then be like there's this epidemic of people repairing their windows and it's only happening because other people are talking about it online and encouraging them to

0:24:56 Lindsey: Yeah, I totally agree.

0:25:08 Lindsey: Exactly. And that is the subtext. Yeah. I so those are the most common ones. People also commonly identified offline contacts, like therapists at 37%, someone they knew in real life, 28%, or a group of friends in real life, 27%. Okay. She summarizes reports on friendship group dynamics. So these are the same variables that she assessed in the rapid onset gender dysphoria paper. Participants reported the friendship group dynamics that Littman was looking for in the other paper, although they reported it at much lower percentages. So if you remember, parents were reporting these specific dynamics at something like 60%. In this sample, she found that 22% of participants reported belonging in a friend group that mocked people who were not transgender. 36% having one or more friends that transitioned before they did. And 20% reported

0:25:11 Thomas: It's ridiculous yeah

0:25:58 Lindsey: An increase in popularity after announcing transition. Again, we compare that with the 60% rates and she's clearly getting, you know, somewhat different patterns here.

0:26:05 Thomas: It's funny that it kind of contradicts her first study, right, at least a little bit

0:26:08 Lindsey: I don't think she interprets it that way. She also asked questions about pressure to transition. 28 participants out of the hundred, out of a total hundred answered an open-ended question about from whom or what they felt pressure to transition, if they felt pressure. And many of the sources that they reported were social. So they said they felt pressured by clinicians, partners, friends, and society to transition. And some of the responses they got were non -social. So, they quoted a few examples here. So quote, one person said they felt pressured by my ability to function with dysphoria. And another person said that they they felt pressured, quote, not by people, by my life circumstances. So it's a little tough to know what those folks mean by that, right? But those were non -social responses. But most of the responses they got from that open -ended question were social sources of pressure.

0:26:09 Thomas: Okay huh

0:26:59 Lindsey: Moving on to reports regarding experiences with clinicians, 57% of these participants reported that the medical evaluation they received prior to transition was not adequate. 65% reported that their clinicians did not evaluate whether their desire to transition was secondary to a trauma or mental health condition. 27 % believed that the counseling and information they received about the benefits and risks of transition were accurate, but 46% believed the counseling was overpositive about benefits, and 26% believed counseling was not negative enough about risks, which I thought was an interesting difference. So it's almost half are saying that it's overly positive about the the benefits, but only about a quarter are saying that it's not negative enough about risks. And Littman doesn't really explore this difference, like she doesn't really interpret it. But it's consistent with some things that I've read elsewhere, that the dissatisfaction with transition can often be due to like specific dissatisfction with the outcome of some procedures that they thought might be better, which is not synonymous with regret, again. It's with the fact that like very few folks, even in this sample, said that the risks were not adequately communicated, so yeah

0:27:17 Thomas: Yeah yeah Well also the one that seemed the most confusing to me was the one that was like, did their doctor ask them if this is secondary to some other trauma, what the hell is that, no I I get it, but like, what doctor in their right mind would ask that? Like, if I, if I go in and I'm like, I have gender dysphoria, I want to transition, I would hope that they, doctors don't go, "Yeah, but really, like, are you sure there's not just something else going on," you know, like, that strikes me as kind of like, if any, if I have any medical problem, I would would hope that that wouldn't really be their, someone's response, but that's just, is that just me, sure

0:28:15 Lindsey: Well but that's, that's her position, right, she thinks that you know uh no It's not just you, um, but I think, you know, people like, like Littman, are making the point that in gender affirmative care, they're not doing enough exploration of gender prior to recommending transition, this does not appear to be a real claim, but, like, I agree with you that the way that she's asking this question is likely to give her the response that she wants, right? So even if there was, yeah, mm

0:28:59 Thomas: Yeah that's that's what I'm saying, yeah, like it, it's this is this, I don't know why this question would be valid in any sense, like that shouldn't be how it is, but also, um, I just want to remind everybody that we're talking about people who were recruited from specifically some places where they would be like, you-transition, or would have have detransitioned, or what, right?

0:29:23 Lindsey: -hmm, yeah.

0:29:28 Thomas: I mean, so all of this is, this is not, these might be interesting questions to ask, some of them might be interesting questions, to ask a non -cherry -picked sample, right, but this is a cherry -pick sample, so it's like, how can any of this really tell us much?

0:29:38 Lindsey: Mm -hmm. No, that's exactly right, right. And I mean, it's, I'm glad that you said that because again, like if I didn't have to keep coming back to what is Littman trying, what is the story she's trying to tell with these numbers, I would probably be able to, I don't know, like there's something, there's nothing interesting here, right, that it's worth knowing about the experiences of folks who end up reporting negative experiences with transition, right? Part's interesting. But like, it's so hard to focus on that when you're constantly having to be like, okay, but I know what she's doing with that question.

0:30:11 Thomas: Yeah, Yeah, exactly, I mean I know that you're, you're often looking at like, okay, what is the, the, what is the actual good information we can still get from the study, and I get that. I and I think just as a, um, as a, I was about to say customer service, but like almost as any sort of, um, uh, any sort of treatment, you would want to know, you know, as an exit survey, like who's having bad reactions, who's not satisfied with their care, where and why.

0:30:45 Thomas: But like, I know you're trying to find that spin on all this, but this is not that. This is someone with a specific ax to grind, cherry picking a sample and asking them loaded questions to try to get the answer she wants, right?

0:30:27 Lindsey: Yeah. Yeah, yeah. It's not.

0:31:00 Lindsey: Yes, that's

0:31:01 Thomas: Just don't want to lose sight of that, that's all.

0:31:01 Lindsey: Right. I don't want to lose sight of that either. Yeah. Next she summarizes some information about people's transition to sort of demographically. So the average age when participants sought transition was 22 years old in this sample. % of participants reported taking cross-sex hormones and 33% of participants that were assigned female at birth had breast surgery, right? That was 23% of the total sample. And 6% of participants in the sample reported genital surgery, right?

0:31:31 Thomas: Six?

0:31:31 Lindsey: She reports 6%. Yeah.

0:31:34 Thomas: That's, huh, that seems really low, doesn't it?

0:31:36 Lindsey: Know. Yeah. Mean, it did, but I actually, I don'T know what the stats are in the general population.

0:31:36 Thomas: Oh, okay. So yeah, I mean, I am by no means any sort of expert on what kinds of surgeries people get for transitioning. I don't know. But like from you've read, it sounds so it was like 23 % got some sort of breast surgery and 6 % got somesort of genital surgery. So then what's the bulk of it? Is it like facial? Is it what would we be talking about?

0:32:02 Lindsey: This is all medical transitions, but, like, if people just took hormones, that would be enough to qualify for the study.

0:32:07 Thomas: Okay. Okay. Gotcha.

0:32:08 Lindsey: So that was the majority.

0:32:08 Thomas: Yeah. Just took her. Okay. Got it. Understood.

0:32:12 Lindsey: Yeah. Now we've got some results on detransitioning. Participants remained transitioned for an average of four years before deciding to detransition. And so they were an average of 26 years old when they decided to detransition. Most common reasons selected for detransitioning were, and, again, this was from a select all that apply question, that they became comfortable with their sex assigned at birth. That was 60% of the sample. They had concerns about medical complications. That was 49%. Transition did not improve mental health. That was 42%. They were dissatisfied with the results of the transition, 40%. And they discovered that trauma or mental health caused their gender dysphoria. That was 38% of the sample, right? Fewer people in the sample reported external causes such as discrimination, contamination that was 23 percent of the sample or worrying about paying for treatments that was 17 percent of this sample. Um, I thought was interesting the, uh, economic concern. Like, I think that you, as we've talked about in some some other studies, I think that that tells you more about the sample than anything else, right, because I, I don't

0:33:10 Thomas: That's what I was going to say. Why would we expect anything different from a cherry pick sample? Like I would expect that all of them would be like, yeah, I just, it was all in my head and I made it up and I changed back. Like if we're talking about, again, substitute this in for people who say, who claim, oh yeah, I used to be gay and then I, you know, got some gay conversion therapy and now I'm all better. Would you expect their answers to be? Yeah, it Was all in My head. It was just some mental thing I had. It Was, you Know, like that's none of this is surprising to me. I'm actually surprised it's not higher. I was surprised it was not 100% of them saying I was just wrong about being trans. Well,

0:33:11 Lindsey: Yeah yeah So I mean, I want to be, I want to be careful here though, because I think it's possible that some of these responses are, like, not in good faith or whatever. I don't think you have to make that assumption, though. I think that people could be talking about this very sincerely, right? They're, yeah.

0:34:02 Thomas: Yeah. I both those can be true. I mean, I welcome the pushback. I definitely don't want to be making any invalid claims here. But I think people who receive gay conversion therapy could genuinely think that that fixed their problem, quote unquote. Don't think they're lying.

0:34:14 Lindsey: No, it's a good point.

0:34:16 Thomas: Yeah. Yeah. I think it's just that you have a lot of other pressures. In the case of gay conversion therapy, you've got perhaps, probably, most likely, 99 % strong religious pressure in in your immediate circle that you aren't actually gay. And so therefore, people are able to, I think, have some cognitive dissonance, convince themselves of things. I don't know.

0:34:17 Lindsey: Yeah. -hmm.

0:34:40 Lindsey: Thinkthat that's true and that very well could be some proportion of the people that are represented here. But like, it also could be that like some proportion of these of these folks are, you know, just like we were talking about earlier, you transitioning, you know, realized like, actually, you know, maybe I'm non binary, and I don't want to, you know what I mean? So like, I think that, no, you're right. You're absolutely right. Like the sources do tend to be these these gender critical forums, right? I'm just, I'm, I trying to, I trying to be, I

0:34:58 Thomas: Well, I would agree with you, except then why did they get recruited into the study? Weren't the sites, I mean, didn't you, yeah.

0:35:13 Thomas: So that's why I actually wanted to emphasize this, because it is kind of contradicting some points we made earlier. I think if we had a non-cherry-picked sample, you might find all those things. You might find people who are like, yeah, no, I identify differently now. Maybe I'm non-binary, so maybe I didn't want to transition, whatever it might be. But in this cherry pick sample of people who are in gender critical forums, I know why we should expect, you know, maybe there's somehow of some, some responses in here that are just legitimate, but like it seems like it's going to be a lot of cherry picking and people who possibly have some sort of ax to grind one way or the other here. Yeah.

0:35:51 Lindsey: I think that's, I think that that's totally possible. Um, I think that it could also be true that like let's say that somebody had that experience of like they started transition, they realized they were non-binary, but also they felt like the transition was a really negative experience, like that, that could be part of the reason that they end up in these groups in the first place. So I don't know, like I think that you can you can read this the

0:36:09 Thomas: Well, and maybe they got some bullshit medical care, like, is that entirely possible? Like maybe.

0:36:14 Lindsey: Apps, Absolutely.

0:36:14 Thomas: Somebody wanted to transition, got terrible care, because guess what, we have terrible health care sometimes in this country. Like, and then that uh, them off on the whole thing and made them and, and by the way, maybe somebody, uh, could imagine this hypothetical person, maybe somebody wanted to transition, got terrible care, and then was like, I want to get the word out, like, I don't want someone else to transition, maybe in their minds it's like that's everybody's experience, and so they want to protect other people from that. It could be a legitimate Yeah.

0:36:15 Lindsey: Yeah. Yes. Yes.

0:36:39 Lindsey: I Absolutely. Yeah.

0:36:45 Thomas: So, you know, because who knows. I, I never want to underestimate America's ability to give someone bad health care. Oh.

0:36:46 Lindsey: Yeah. No, I think it's a good point, and I, you know, I'm not, I'm saying that the, the kinds of people that you, you were talking about a second ago aren't represented in this study, but like, I don't, I, I can read this with maximum charity, and it still does not support the things that Litman is saying. That It does. So, you know, I'm gonna err on that side. But so then participants selected the sources they said encouraged them to detransition. As with transitioning, the most common sources were online, so 37% said blogs, 35% said Tumblr, 23% said YouTube detransition videos, and then there were, uh, other online sources like Reddit, Facebook, online friends, communities, that accounted for 50%, right.

0:37:05 Thomas: Of course. Yeah. I Just love that. This, I, and I mean that, uh, in an ironic sense, I love that Litman thinks this proves something. I really do, you know, like, I'm gonna make some cookies for Christmas, uh, guess what, I'm going to look online, I'm to watch a YouTube video, I mean, like, that's just what we do nowadays, days, that's not some like sign that, oh my God, there's an epidemic, people are being forced to make cookies only because of online, like how old is Litman, can I, okay, boomer, this person.

0:37:29 Lindsey: Yeah. Yeah. Yeah. I have no idea, I don't know. Then she, she, uh, so she said that 23% of participants reported pressure to detransition, which was close to the percentage of those that said they felt pressure to transition, which had, that was 25%, Yeah, so the, the 21 participants who provided open-ended responses on sources of pressure, 14 identified social pressure to detransition. And this was another place where there were some very heartbreaking open-end responses, like people being threatened that they would never see their children again if they didn't detransition.

0:38:10 Thomas: That's interesting. That's Oh. Geez, yeah.

0:38:29 Lindsey: Yeah, talking about being mocked in public, and they couldn't get a job, and so it was not okay to be trans, and so they detransitioned. That was the majority of the, the 21 people who responded to this question. Three expressed internal pressure. She did not provide examples of what that looked like, so it's not clear what those responses were. And four provided responses that were neither social nor internal, but were unclear. She doesn't provide examples that either. In terms of what specific behaviors participants did to detransition, the majority, 95%, said they stopped taking the hormonal treatments. 14% started taking hormones consistent with their sex assigned at birth. 63% returned to previous pronouns. 33% returned to previous names. 48% changed their clothing and hair presentations to be more consistent with their sex assigned at birth.

0:39:18 Lindsey: And 9% took surgical detransition steps. And finally, she reported some results regarding participants' experiences after transition, right? So she assessed their gender identity. At the time of survey completion, 61% of participants identified only with their sex assigned at birth, 14% identified only as non-binary, 8% identified only as transgender, and 13% selected multiple identifications. So they said non-binary and trans or non-binary and sex assigned at birth. Right. So that's interesting. Of course, she's going to focus on the fact that 61% of the participants identified only with their sex assigned at birth. Right? That's where she's going.

0:39:59 Thomas: Oh.

0:40:00 Lindsey: 24% of participants informed the doctor or clinic that facilitated their transition that they had detransitioned, right? You can maybe imagine how she's gonna use that. And in response to a multiple choice question in which participants selected the statement that best described their feelings about transitioning, 30% of participants said they wish they'd never transitioned. 45% said that they were either glad they had transitioned or that transitioning was a necessary part of their journey. Right?

0:40:25 Thomas: That's interesting. Like even in your own cherry pick sample that you're using to try to say people, people should not get this vital healthcare so easily. Even in your cherry pick sample, 45 % are like, no, it's still good that I did it. Like, what?

0:40:36 Lindsey: Yeah, right. And I don't want to be to be obscuring anything. So 11% said they were glad they transitioned. 34% said that transitioning was a necessary part of their journey for a total of 45%. But

0:40:55 Thomas: I mean, I don't think that changes the point at all. That's already what I thought you said. I think you're accurate with that. I mean, as you said, in one of these episodes, I know it's a blur of just bad transphobic science, but it could be part of your personal journey. And I think even if maybe somebody out there, their transitions later, realizes they want to detransition, that could be a completely legitimate personal choice having to do with them and their gender expression, and it would not mean that we should have denied them or prevented them or put more resistance in place for them getting that therapy to begin with. I

0:40:56 Lindsey: No. Yeah.

0:41:32 Lindsey: Absolutely. Absolutely, yes.

0:41:34 Thomas: Think that this data really backs up your point. That was your point that you made. I just wanted to re-emphasize it. And I think this data backs that up, even in their, our own cherry pick sample, by the way. Like imagine if this was a completely, you know, I don't know what the word is, but like random, I guess, just a random sampling of people who had transitioned at all, you if it was just a sample of people who had detransitioned, like, I think the numbers would be, um, different.

0:41:41 Lindsey: Yeah, Yeah, that's my suspicion too. I mean, we have yet to be able to really access that data in a way that satisfies everybody, but that's My suspicion as well. Yeah. The final response that they could have given to this question was that transitioning distracted them from something else that they should have been doing, which is a little bit vague, but she's trying to say, like, there was an underlying mental health issue that they shouldn't have been dealing with, and instead they transitioned and it distracted them from that. So 21% chose that option within the sample.

0:42:08 Thomas: Huh. Hmm. That's interesting.

0:42:31 Lindsey: Yeah. All right. So just a couple more questions. So in response to two questions about whether they had been helped or harmed by the transition, with response options of very much, a little, or not at all, 32% reported being only harmed by the transition, 17% reported only being helped. And the remainder, 51%, selected responses indicating that they had been both harmed and helped. So I had to go do some digging about how she arrived at these percentages. It wasn't clear to me. She's a little bit vague about it. But I think that the 32% who she's saying reported only being harmed were people who said that they were harmed very much or a little, and that they were helped not at all. And that the 17 % who reported only being helped would have been people who said that they were helped very much or a little and harmed not at all.

0:43:22 Thomas: Okay.

0:43:23 Lindsey: And that leaves 49% who could have had any combination of saying very much or a little on the harmed and helped. And she doesn't tell us what those breakdowns are.

0:43:29 Thomas: Yeah. I mean, hard to say. It's interesting if it's that that's half the people basically who it's a mixed bag. Again, in your already cherry pick sample, always want to emphasize that. But like, yeah, interesting. I mean, I could imagine even people who have a successful transition might be like, Yeah, yeah, well, there's ups and downs to it. I don't know.

0:43:38 Lindsey: Yeah, she Yeah.

0:43:49 Thomas: It could be totally normal, I would think.

0:43:50 Lindsey: Yeah And so and she she this is the kind of thing that like you would report some in text, but then you would have all of the data in a table and she doesn't provide that, not even in the supplementary materials. So we don't know what the distribution of responses looked like. And I would like to know. She also asked about satisfaction slash dissatisfaction with both transition and detransition, and found that 70% of people said they were dissatisfied with their decision to transition, and 85% were satisfied with their decision to detransition. Right? So this is another one where the measurement is Important. Yeah, I'll go back over it because it's weird. So these two questions were asked on six-point scales ranging from extremely dissatisfied to extremely satisfied. And the shades of responses that you could give were extremely, very, or somewhat. So extremely dissatisfied, very dissatisfied, and so on. And so when she says 70% were dissatisfied, it's slightly unclear what that means, but I'm guessing that it means that 70% selected either extremely, very, or somewhat dissatisfied.

0:44:22 Thomas: Wait, what?

0:44:53 Thomas: Yeah.

0:44:53 Lindsey: And I'd be very interested to know what the full distribution of responses was on this question, but she doesn't provide it anywhere, not even in the supplementary material.

0:44:58 Thomas: Well, because did I space out or did you also say there was a really high percentage that said they were satisfied?

0:45:06 Lindsey: No, no. So 70% were dissatisfied with the transition. 85% were satisfied with the detransition.

0:45:09 Thomas: Yeah. Detransition, okay, okay.

0:45:15 Lindsey: Yeah. But it's possible that most participants provided sort of middle of the road responses, like somewhat dissatisfied or somewhat satisfied. And it's also possible that the responses were really polarized with lots of people saying that they were extremely satisfied or dissatisfied, all those possibilities would paint very different pictures, and we don't know because she doesn't give us that information.

0:45:34 Thomas: I wonder why she didn't give us that information.

0:45:36 Lindsey: Me too. 50% reported strong or very strong transition regret, 30% reported mild regrets, and 20% reported no regrets in the sample. And so this was measured with the response options of no regrets, mild regrets, strong regrets, or very strong regrets. She reports enough in this paper for me to infer how many people reported mild versus no regrets, but she doesn't distinguish between the strong and the very strong, right? I'm a little less bothered by this ambiguity than I am by the satisfaction questions. But again, it points toward the fact that she's just doing these summary numbers and she's not providing the range of responses that typically you would in a paper like this. Last question, 65% of the sample reported that if they knew then what they know now, they would not have transitioned.

0:46:26 Lindsey: That's a pretty open and shut question. Not a lot of ambiguity there. That was a lot of results. So let's summarize the key things that Littman's taking away here. So some of the detransitioners in this study had pre -existing mental health conditions or neurodevelopmental disorders. Some of the participants connected their gender dysphoria with those pre -existing conditions. Some of the participants reported social pressure to transition or dynamics in their peer groups that may have influenced them to transition. The majority of participants identified with their sex assigned at birth at the time of their survey. So she would call these folks desisters, right? And many of these identified this as a reason for their detransition, right. More than half the participants recorded not receiving sufficient professional evaluation before beginning medical transition. And so she's going to leverage this this into a recommendation about gatekeeping, obviously.

0:47:13 Lindsey: And the majority of these participants had regrets about their transition, said they were dissatisfied with their decision to transition, they were satisfied with detransitioning, and given the choice, they wouldn't have transitioned if they'd known better.

0:47:25 Thomas: Again, those are the results of her cherry pick sample, okay? Okay.

0:47:28 Lindsey: Yeah, all right. How good a job does she do in interpreting these findings in the discussion? Did she learn anything from Her last study? Well, in the first paragraph she says, quote, "The findings of this study should not be assumed to be representative of all individuals who detransition." I was like, good for you, Lisa. Like, you're learning. And then one sentence later, she says, quote, "Only a small percentage of detransitioners, 24%, informed the clinicians and clinics that facilitated their transition that they had detransitioned. Therefore, clinic rates of dettransition are likely to be underestimated and gender transition specialists may be unaware of how many of their own patients have detransitioned. So again, no on no. That's not no. You just said that this isn't a representative sample, and it really, really isn't. I think the plain reading of her sentence there is that because 76% of this sample didn't inform their clinicians, that clinic reports are vulnerable to a high rate of underreporting.

0:47:35 Thomas: I

0:48:25 Lindsey: This just isn't the case. We have no idea from these results, or from the results of this study, what the rate of underreporting is. It could be much lower than 76%, or it could be even higher. You really, you can't tell from this very, very specific sample, right.

0:48:39 Thomas: Get, yeah, the only thing with about, I, I, you mentioned it could be higher or lower, I, that, that's, I don't love that number, you know, because it strikes me that people who are in a cherry pick sample of those who, you unsatisfied with their transition and then detransitioned, I would think they might be more likely to tell their clinician.

0:49:00 Lindsey: Really? Yeah.

0:49:00 Thomas: Well, it's like sort of how when you have a good experience you don't really mention it, when you have bad experience you, you complained everybody about it, like just that general principle. Of humans, maybe.

0:49:09 Lindsey: But Maybe not to the specific person, right? Like if, if I had a bad medical experience with a doctor, I would just not go back to that doctor. I

0:49:13 Thomas: That's True, yeah, good point. Well, it could go either way, I guess, and I, I guess it sucks that that number's that high. Anyway, I would hope that we would have this data, you

0:49:25 Lindsey: Know, and it's tough to get right. Um, yeah, I mean, but the other point I'd want to make about this is that studies vary in terms of how they estimate detransition rates from clinical reports, right? We talked about, about a study in the End of Gender episodes where they surveyed surgeons just about, you know, what, what percentage of the, um, the gender-related surgeries they did were for detransition. That would not be vulnerable to the same kind of underreporting that she's talking about.

0:49:26 Thomas: Right. Right.

0:49:51 Lindsey: It doesn't matter if they reported to their original clinician, right?

0:49:53 Thomas: Right, right, that's good point.

0:49:54 Lindsey: So? Yeah, okay, so then she talks about the, the complex plurality of experiences that underlie the decision to detransission that are represented in her sample. Sure, that's probably the most valuable thing about her study, honestly. And then she says that her findings suggest that, quote, "Failure to explore comorbidities and the context in which gender dysphoria emerged can lead to misdiagnosis, missed diagnoses, and inappropriate gender transition." So what she's calling for in this section is for there to be even more gatekeeping for medical transition than there already is, and her assumption that these cases indicate that the current practices are failing systematically just does not track. Even if the system is working pretty well, bad experiences are likely to be overrepresented in her sample, right?

0:49:54 Thomas: Yeah, yeah.

0:50:42 Lindsey: From what I've read, and we talked about this too in our second End of Gender episode, preventing transition regret is baked into the structure of gender affirmative care. The number of hoops that folks have to jump through in order to be approved for hormonal and surgical interventions are enormous. So her implication that these interventions are being just sort of doled out willy-nilly is not only one that her study can't support in principle, it's contradicted by other research. And also, I mentioned that 2021 article by McKinnon and colleagues earlier, they argued that preventing detransition and transition regret are actually overemphasized in gender affirmative care to a degree that is not evidence-based, is fueled by fears of litigation if a patient regrets a medical procedure, and actually, they argue, reflects cis-normative anxieties more than it serves the actual needs of transgender individuals.

0:51:33 Lindsey: So in other words, they're saying that cisgender individuals, right, can't fully identify with the needs of transgender patients and therefore project their own feelings of how devastating it would be if they went through a transition and regretted it, which contradicts how many trans individuals describe their own experiences with transition and detransition. And I just thought that that was a really interesting point. Mean, I realized that I had some assumptions that it was like reasonable to treat detransmission as a negative outcome or as an indicator of lack of success, and that that's probably problematic. Lippman also says that, you know, her study adds to existing evidence that gender dysphoria can be temporary and that gender identity can change. Yes, we know this, that's fine. And then she says, therefore, intervening too soon to medicalize gender dysphoria, gender dysphoric youths, risks iatrogenically derailing the development of youth who would otherwise grow up to be LGB.

0:52:28 Thomas: Gonna have to define iatrogenically.

0:52:30 Lindsey: Yeah, so?

0:52:31 Thomas: What? Oh.

0:52:32 Lindsey: I, I had to look it up too. It means inadvertently caused by a physician or medical procedure. So they're saying, you know, this medical procedure is inadvertently going to derail the development of, uh, LGB youth, because they're not actually trans, right, they're LGBT according to her, yeah.

0:52:48 Thomas: She, she uses LGB in her science thingy. Oh. That's sort of a Turf.

0:52:50 Lindsey: Yeah Lesbian, Gay, Bisexual. I mean, I, I

0:52:55 Thomas: Tell I Think, yeah.

0:52:55 Lindsey: Think I Yeah, I think that she's, I think that she're doing that intentionally, right? Again, right, saying based on my data this means that people shouldn't be able to transition too early, she does not present the evidence necessary to make that claim. She actually collected some data that would be useful in maybe partly supporting this claim, putting the limitations of the sample aside. She could have examined whether age of transition was associated with regret or dissatisfaction or types of detransition behaviors or any variety of things. But if she looked at those relationships, she did not report them here. And that's the kinds of thing you'd need to make this claim. Claim.

0:53:32 Thomas: No, kidding. Also, why don't, do we not just get her data set too? Like, is that not how this works? Does

0:53:38 Lindsey: No, her data set is not publicly available as far as I know.

0:53:43 Thomas: Is that normal? Like, why don't you? Hmm.

0:53:45 Lindsey: Actually, not all journals have that as standard practice. Some of them do now, but not all of them. I mean, presumably,

0:53:48 Thomas: It Just feels like, you know, if you got nothing to hide here, give us your data and we can work around with it, right? That's

0:53:56 Lindsey: I agree. Right. So she didn't present evidence that would be relevant to this claim. And she's only supporting this claim with the fact that some proportion of her sample desisted and transitioned, right? That just does not speak to any claims about whether younger younger people should be able to transition. And in fact, you could make the argument that early transition has some advantages over later transition. If you intervene around puberty, many surgeries that might've been required later would not be right. And it implies, yeah.

0:54:25 Lindsey: And it implies that if it's at all possible that someone can just live as a cis person, that that's the preferable option. That's, that's really, you know, at the root of the argument that she's making. And I don't think I need to spell out what's wrong with that. Then she cast doubt, uh, we're gonna go back to that Turban study that she referenced earlier, right? She touches on this in the introduction. This was a large -scale national study of transgender individuals, it included thousands of participants, and Turban observed low rates of detransition in that sample, right? So, so she's casting doubt on that study here by pointing out that the Turbin sample, much like hers, used a convenience sample and used targeted recruitment and used anonymous data collection, and therefore that Turbin's results aren't generalizable, right? But, right, convenience sampling, and then there's convenient

0:54:23 Thomas: Definitely True, yeah. That's Wow.

0:55:11 Lindsey: Sampling. There are legitimate limitations, I think, you the data set that Turbine used, but they are far less severe than Littman's, right. So Turban was doing a secondary data analysis from the United States Transgender Survey, which in total surveyed over 27,000 participants who identified as transgender, non-binary, or genderqueer. And they recruited participants by coordinating with over 300 trans, LGBT, and allied organizations, as well as support groups, health centers, and online communities to distribute the survey to as many people as possible across the country. And in addition to making it available online, they also coordinated survey -taking events that were hosted by these local organizations, and they did this in order to reach individuals who either lacked internet access or might need a safe place to take the survey.

0:56:01 Lindsey: So this was a time and labor and money -intensive process, and again, it yielded over 27,000 responses across the U.S., and by contrast, Littman posted her survey in some subreddits and got 100 people. So glass houses is all I'm saying. But in all seriousness, yes, it is a limitation that it was not a nationally representative survey, and that they were, you know, largely reaching people connected to these activist organizations. It's also true that they limited their study to people who identified as transgender, non -binary, and genderqueer. So if there are a significant number number of folks who once identified as trans, transitioned, detransitioned, and now identify as cis, those folks would not have shown up in that data set, right?

0:56:14 Thomas: Yeah. Okay.

0:56:45 Thomas: And

0:56:46 Lindsey: That said, I think that expanding their recruitment language beyond transgender was smart, because they did have these questions about detransmission in it. And they did identify 2,242 people who reported ever detransitioning, even for a little while. And that was 13% of the 17,000 folks who reported transitioning in the first place.

0:57:06 Thomas: Just to clarify, this is a better study that you're referencing that she references?

0:57:10 Lindsey: I think so. There's lots of people online who are saying it's just as garbage as Litman's. I that.

0:57:11 Thomas: Okay. Yeah. I mean, it's the kind of thing where you try to turn it into a all or nothing thing, like either you have the the most perfect sample or you don't, where it's like, well, No, I mean, you could, it's hard to get the perfect data in anything it sounds like, but you can make an attempt, you can acknowledge what the data set is and what the limitations of it might be, or you can pull a Litman and just go on a forum and be like, "Here's my data, it's great." Hmm.

0:57:26 Lindsey: Yeah. Yeah. Exactly. Right. So, I mean, so including, you said that inclusive language about gender, though, I think was was important. Because, you know, this was true in Littman's data as well. Many folks don't identify as cis after detransitioning, right? So all those folks still would have shown up in the USTS survey, right? And so if the question is, you knows, how many people or how many people did USTS miss by excluding cisgender folks from their survey? Well, yeah, we still don't know that. Littmann's study surely doesn't cast light on that question, right.

0:57:58 Thomas: Yeah. Yeah.

0:58:16 Lindsey: She also says that, like, unlike her study, or no, she says that her study, unlike Turban's, recruited communities with diverse perspectives about transition and detransition, but did she, she doesn't tell us where she recruited from, and from what we've seen, right, from the digging that some folks have done, this seems to be cropping up in these gender critical groups, so she's just asserting that that the communities had diverse perspectives, I'm not going to take her word on that, you

0:58:38 Thomas: Why? Did this journal publish this? I'm somewhat disturbed by this, she's got a bad history, you know, her previous thing had to be revised, this is a bad science thingy, and you're saying this is reputable journal, I mean, Going, going on here? This seems terrible. Why would they publish this?

0:58:53 Lindsey: Know, it is. Yeah, I I don't know, because it seems, it seems very obvious to me that she is once again massively over claiming on the basis of what she actually did.

0:59:04 Thomas: Yeah. So can we do something about this? Is it, can, is there a way to, um, don't know, write some letters, fire off some emails, complain to, you know, like what's Can we make a stink about this?" Yeah.

0:59:17 Lindsey: I guess we could try. Yeah. Right. I mean because also just to circle back to a point we made earlier, I don't necessarily think that this needs to be retracted. I think that she needs to do a heavy rewrite because, again, there are some interesting things here. And if it was framed in the context of like I did this descriptive thing about people who said they had negative experiences, right, and she was really transparent about where she got that data from and she wasn't, you know.

0:59:26 Thomas: Hmm.

0:59:42 Thomas: I hear you. But again, like if, if we're seeing a consistent pattern of someone trying to make Turf points using studies and data that doesn't support that, it's a little rough. Again, I'm not the scientist, but it kind of sucks as just a person out there to to be like, well, you know, as long as we do some light revisions here and you statements a little more, that's okay, you can put out your anti -trans propaganda. Yeah.

1:00:08 Lindsey: No, no, no. No, I mean, I would want a very heavy rewrite. The thing that I wouldn't want to necessarily lose, I guess is all I'm saying, like from the perspective of somebody who values data collection being out there, it's possible that there's something in her data collection that would be useful to somebody else who's actually doing legitimate research. But in order for this to stand, yeah, I could do that. I would like to get rid of the horrible unjustified framing that she's putting around these results. That's my opinion on it.

1:00:36 Thomas: I, I don't know what needs to happen. If some science people need to write an open letter and have other science people sign onto it, but I, I'm pissed at this journal personally as a, I'm not the science person, but this seems frustrating, like she has this clear demonstrated history, you know, like how could you just do this again, is

1:00:54 Lindsey: Yeah, Got no answers for you. I wish I did. Thoughts, right, we need more research on the experience of folks who detransitioned and, you know, the experiences of folks who have negative detransiton experiences? Absolutely, I'm all about that, right, like any other medical intervention, intervention, this needs good high quality research on it, we need to understand these folks' experiences. But I think it's pretty clear that Lipman studies are not that. They're low quality and they're only serving to fuel like parents' anxieties about what it means if their child tells them that they're gender conforming and to fuel the system, which some have argued is already has like too high a threshold in terms of gatekeeping on transgender care. Right. A bad science thingy, I think is my conclusion.

1:01:40 Thomas: A bad Science. Thingy.

1:01:41 Lindsey: Conclusion, yeah.

1:01:41 Thomas: What was, I what was your rating system, palps, three five, four palps down, I don't know, no, I can't remember. I actually don't remember, I was hoping you would.

1:01:44 Lindsey: Oh, Is that it, because that's really good, all palps down, yeah.

1:01:52 Thomas: All palps, I guess you only get a maximum of two, right?

1:01:52 Lindsey: Well, okay, I'll leave yeah I'll leave one palp up just for the the content of the experiences that are being captured, and then all the other palps down for what she's doing with that information, it's a bad science thingy.

1:02:06 Thomas: It's a bad science thingy, and frankly, it's transphobic nonsense that people are sharing inappropriately, and again, that Debra So is writing about, at least that last study, in a completely inaccurate framing. You know, it is just frustrating. Like, time and time again, it's presented as, well, these woke people are denying the science, and we, the rational non -woke people, are the ones who are just calling balls and strikes on the science. And it's the exact fucking opposite. You know, like, the TERF people are stretching and bastardizing science in order to make their TERF points, and too many people are going along with that.

1:02:35 Lindsey: Yep. I agree, yep.

1:02:46 Thomas: Guess thus concludes our two -part series on Lisa Littman's garbage junk science, transphobic science. Come from the future, this got an addendum, Lindsay, what's going on here?

1:03:01 Lindsey: Um, we finished the last recording, uh, I looked and saw that Aaron had sent me a message, um, he, he somehow tracked down the entire survey from this study, from this 2021 study.

1:03:11 Thomas: Breaking news.

1:03:12 Lindsey: Breaking news, um, uh, yeah, so I, I took a look at it and there were just some really interesting things that ended up getting left out of the final paper, and I thought folks might be interested to know about them. Yeah. Right, so one, one question that we were talking about in in the recording was, uh, the fact that her reporting on where participants heard about her survey was pretty vague in the 2021 paper.

1:03:22 Thomas: Okay. Right.

1:03:35 Lindsey: Um, so she says that, you know, they, she, like, reported it as, you know, people heard about it from blogs, um, social media, from a person they knew, or something else. But from looking at the actual survey, the question was slightly more specific than it was reported to be. The first option was, so the question was, how did you first learn about the study, the first option was Third Way Trans, or Guide of Raging Stars blog, so both of these are blogs about detransitioning and they have a very specific perspective on that, right, um, so these are both blogs by by folks who regretted transitioning. Um Other things are still, are still pretty vague, right, but I just, I thought it was interesting that it was left out, like if she had recorded this information that was more specific, I thought I was interesting that it got left out what specific blogs those were.

1:04:21 Thomas: Yeah, that seems, how, is that the norm for a survey?

1:04:24 Lindsey: No, I'd say not, yeah.

1:04:27 Thomas: Okay. Almost like she was trying to obscure it a little bit.

1:04:30 Lindsey: That's what it seems like to me, and I mean I think that's that's supported by the fact that she was more specific about recording where she recruited folks from in the 2018 paper, and then got that correction to report even more information about her recruitment site. So the fact that she's omitting it here, I just, I doubt it's a mistake. Um, yeah, um, then additionally there were a bunch of questions in this survey that she doesn't end up mentioning, mentioning in the final paper at all.

And, you know, that in and of itself, I don't think is necessarily a bad sign, I mean, sometimes you'll do a survey that's like broader than the goals that you have for a specific paper. There were a few questions that she asked that direct that were directly relevant to some claims that she made in the paper. And I'm very curious about why they weren't included. So if you remember, like one of the things that she focused on was was the fact that the folks in her survey, a majority of them said that they didn't feel like they'd received sort of adequate counseling prior to going through transition.

It turns out, she asked a bunch of very specific questions about what kinds of care they received prior to transition, and none of those made it into the final paper for some reason. For instance, there were three questions where she asked about whether the participants received a variety of treatments and referrals during their first visit, during their second visit, and during their third visit.

1:05:03 Thomas: Mm -hmm. Yeah.

1:06:00 Lindsey: So those were three separate questions, and the checklist included things like a prescription for puberty blockers, a prescription for anti -androgens, a description for cross -sex hormones, a referral to a mental health professional, a for a little to a surgeon, and so on. And I think like based on the context, I'm thinking that the reason for including this is to sort of see like, you many appointments do they have to go through before they get these recommendations for these different interventions, right? Of those responses made into the paper. She doesn't even mention that she assessed this. That was one. Here's some other questions that were relevant to this. So one was, did you receive therapy before starting your transition? It was yes or no. If you received therapy before transitioning, was it required?

1:06:47 Lindsey: Was, if you receivedotherapy before starting transition, how many sessions did you receive prior to beginning your transition? Did your doctor or mental health professional recommend to you any other ways to alleviate your gender dysphoria besides medicine and surgery before starting transmission? How many appointments with a doctor or clinic did you have before receiving a prescription for medications to transition or surgery? There's a number.

1:07:10 Thomas: Given how much we've seen that she is very much trying to make a political point with this or whatever, anti -trans health care point, it's hard to not conclude that these results would have gone the opposite way of what she was wanting, and that's why she kind of swept him under the rug. Yeah.

1:07:17 Lindsey: Yeah.

1:07:29 Lindsey: Mean, you know, we don't know. We don't have the data. But, like, you know, it seems like if these had gone the way that she wanted, it only would have helped her to report both these more objective questions in the paper, in addition to that more subjective question of whether they thought they received adequate care. The fact that these didn't make it into the final paper, I just, you know, I'd like to see the data. That's all. It's

1:07:52 Thomas: The whole I think we said that originally too, having access to this data set would tell us a lot and would be helpful. Alright. Well, I consider this episode addended. Or was there anything else? Yeah.

1:07:53 Lindsey: Mm -hmm. Yeah. Um, no, no, I think that those were the... Oh, actually, there was just one more question that I thought was interesting that didn't make it in. Uh, so this was toward the beginning, it was right in the same section where she's asking about, uh, views on marriage equality, and whether actually there's another one about whether, um, gay and lesbian being called couples should be able to raise kids, that didn't make it into the paper either. Um, there was one in that same section that was, uh, which of the following statements best reflects your beliefs about transitioning with cross -sex hormones and or surgery. And the three response options were: almost all of the people who take cross -ex hormones and/or have surgery to transition or helped by doing so; almost none of the people who take Cross -Ex hormones and or have surgery to transition are helped by so; and then some of the who take take cross -sex hormones and or have surgery or to transition or help by doing so.

1:08:51 Lindsey: And that didn't make it into the paper either. And I would legitimately be interested in knowing what people's general attitudes about transitioning beyond their own experiences was in this survey. It seems like that could really tell us something about the sample, but again, not in there. So,

1:09:08 Thomas: Well, this thing sucked. Yeah, but good detective work by Aaron. Thanks again to Aaron for that so much, Lindsay, for that breakdown. I hope this gets out there. Please share this if you're seeing anybody sharing these Littmann studies and think they might be reachable. I mean, this is making a splash in the anti -trans online space. Like, a lot of people are talking about it, and maybe, maybe not, you might not be seeing it if you don't follow those people, which is probably good, but it is kind of a big deal in those spaces. And let's, let's try to fight back with the right information. All

1:09:11 Lindsey: Yeah. Yes. Thank you, Aaron. Yeah, yes agreed thank

1:09:47 Thomas: Thanks so much for listening. Once again, any questions for Lindsey, uh, to the Patreon Q&A thread for the the month of Spooktober, and we'll answer those questions in the next Q&A. Um, again, for listening, thanks so much to Lindsey for the breakdown, and share this out

1:10:02 Lindsey: You well

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