Part III: McHugh/Mayer — Politics, Not Science

[Part 1] [Part 2]

By Dana J. Bevan, Ph.D.

When we last left the McHugh/Mayer article review, the writers had just trashed the idea that gender behavior is separate from sex. They wanted to replace gender with the term “sex-typical traits and behaviors” (page 93). In the remainder of their article, they elaborate on this theme. They first attack the term “gender dysphoria,” then provide a biased review of some of the biological correlates of gender behavior and finally provide a biased review of the efficacy of transsexual transition. I will wind up this series of blog posts with some conclusions about this article.

I almost agree with some of their attacks on the term “gender dysphoria,” In previous posts, I have urged that this pathological term as well as “gender identity disorder” be committed to the dust heap. However, their aim is not to depathologize, but instead to obliterate gender as a term and subsume all that we have been calling gender behavior for the past 60 years under the term sex. They want to replace “gender dysphoria” with “sexual dysphoria,” Gender dysphoria is an easy target because it is typically based on the concept of “gender identity,” Gender identity is a psychiatric and sociological concept that is subjective and cannot be directly observed scientifically. So it is a soft place to undermine “gender dysphoria.” Possibly without realizing it, McHugh is attacking his own field of psychiatry that deals with such unobservables. I believe that the proper scientific way to define being transgender is to refer to observable and reportable behavior. People may express their “gender identity” as a short hand way of referring to their previous behavior or to their introspections or their affiliation with other transgender people. These verbalizations cannot be ignored but they are weaker scientific evidence than objective behavior.

The authors then provide a biased review of the biological literature on being transgender. They do not cite the many peer-reviewed studies that show anatomical differences between transgender and non-transgender people. Instead they cite a tertiary-source Wall Street Journal article and then trash the ideas expressed as “outside of the scientific mainstream.” Rather than cite the many studies that describe abuse of transgender children they cite only one clinical study, which they describe as not strong evidence for biological causation.

Bringing up childhood abuse is a dog-whistle. For a long time, psychiatrists have tried to convince us that being homosexual and transgender and a host of other behavioral phenomena are due to childhood abuse. Sometimes they claim that abuse did occur but the patient has repressed its memory. Some conversion therapies rely on the assumption that being transgender is based on early trauma, rather than the conflict between biology and cultural constructs.

The authors cite only a few of the MRI studies that show that there are differences in brain functional patterns between transgender people and other people. Their standard is that the patterns have to resemble those of the opposite sex in order for them to support biological differences. As I argued in Part I, differences do not have to show any particular pattern to be good evidence. Nature does not always conform to human expectations and the brain is complex. Their argument is consistent with their political position that gender and sex are not separate.

The authors conclude their biased review of the literature with the bold quote:

The consensus of scientific evidence overwhelmingly supports the proposition that a physically and developmentally normal boy or girl is indeed what her or she appears to be. The available evidence from brain imaging and genetics does not demonstrate that the development of gender identity as different from biological sex is innate.

This quote is based on their biased, incomplete review of the scientific literature on the biology of being transgender. They ignore the preponderance of evidence from genetic, epigenetic, neuroanatomical, MRI and biomarker studies. If you want a real review of the literature, go to my books which include presentation and analysis of hundreds of scientific studies. This is not a self-serving plug. I wrote those books to capture the scientific evidence to guide me in my transgender progression because, as a scientist, I could only be convinced by scientific research.

The word “consensus” in the above quote also bothers me. Only people can come to a consensus. It does not apply to evidence. One usually hears this word in scientific studies as the outcome of a process of experts who weigh the evidence on some topic such as global climate change or whether a particular medical treatment should be continued. The authors are clearly trying to allude to a non-existent consensus of scientists which agrees with these quoted statements in an attempt to add false weight to their arguments.

Hang in there; we are on the last laps of this article wherein the authors attack medical treatment for transgender children and adults. Citing the few longitudinal studies of transgender children, they conclude that being transgender does not have a high rate of continuation over a lifetime, so conversion therapy treatment just helps the process along. I have critiqued these studies in prior posts. They suffer from clinical selection bias, multiple problems associated with those going to a gender clinic, high drop out rates and pressures for children and adults to deny their transgender behavior. They then present the results of a study by Zucker that indicated his success with conversion therapy in 23 of 25 transgender children in his clinic. You probably know his clinic was shut down and he was discharged from the Center for Mental Health and Addiction in Toronto last year. Even if you believe in Zucker’s sincerity, given the immense pressure directly exerted by Zucker and indirectly through families in conversion therapy, wouldn’t most children conform to their assigned gender even if for the duration of treatment? To be extremely chartable, Zucker and other conversion therapists may just be fooling themselves into thinking that the treatment resulted in long-term behavioral change.

So are new treatments for transgender children beneficial and efficacious? Treatments for transgender children that include affirmative counseling, social transition, and hormone blockers are early in their history. Yes, it is easy for McHugh/Mayer to poke holes in the preliminary reports but the definitive results will not come for a few more years.

Well, what about transsexual gender plastic surgery in adults? McHugh/Mayer cite a tertiary-source article in the Guardian newspaper that says that none of the 100 studies reviewed provide “conclusive evidence that gender reassignment is beneficial for patients.” But the author of these studies assumed that a conclusive study would require control groups and longitudinal data collection. These are experimental design features that are not practical in this case and may be unethical for assessing whether gender plastic surgery is appropriate. No transsexual is going to accept being put into a control group wherein they will not receive treatment. They will just go elsewhere. I am reminded of a quote from Jan Morris, one of the best transsexual writers:

Dr. Benjamin, an endocrinologist, had come later in life to the study of sexual anxieties, and by the 1950s was deep in the problem of gender confusion . . . . He had explored every aspect of the condition (being transsexual) and he frankly did not know its cause; what he did know was that no true transsexual had yet been persuaded, bullied, drugged, analyzed, or electrically shocked into an acceptance of his physique. It was an immutable state.

—Jan Morris, Conundrum (New York: Harcourt, 1974), 114.

All the studies I have seen indicate that transsexual lives improved after surgery. Because of these studies, continuation of studies that maintain control groups may be considered unethical. In medical research where control groups are used, if the treated group shows solid improvement, the study is automatically modified such that all patients can receive such treatment.

McHugh/Mayer cite several studies indicating that genital plastic surgery is associated with negative health outcomes. The studies they cite are refuted by other studies that they do not cite. Gender plastic surgery does not solve all of a transsexual’s problems and may add a few new ones but on balance the surgery is beneficial. Most all of the studies that I have read do advocate that post-op transsexual people should continue to have access to mental health counseling.

And finally, as I stated in Part I of these blogs, the authors cited only a subset of the data from the Murad study which was negative and did not quote the overall conclusion of the larger study which said that:

Pooling data across studies showed that, after receiving sex-reassignment procedures, 80% of patients reported improvement in gender dysphoria, 78% reported improvement in psychological symptoms, and 80% reported improvement in quality of life.

Admittedly, gender plastic surgery does not solve all of a transsexual’s problems but only about .3% report dissatisfaction with getting the surgery.

So what must we conclude about the McHugh/Mayer article?

1. It is a political article masquerading as a scientific article. It is aimed at subsuming gender behavior under sex in accordance with their cultural and religious beliefs. They would have us refer to gender as “sex-based traits and behavior,” McHugh is a devout Catholic and his church just declared that transgender people are a “threat to the order of creation” and compared transgender people to “nuclear weapons.”
2. The authors are either limited in their knowledge of the scientific research that is available or they are selectively reporting it. In either case, they are not in any position to make “scientific” conclusions about being transgender.
3. The authors deliberately distort the “scientific record” by citing studies and ideas that are strawmen and are easily refuted by McHugh/Mayer in order to reach political conclusions they prefer.
4. The authors selectively mischaracterize and report the results of scientific studies. This is unethical in science. But this is not actually a scientific article.
5. Their call for increased research support appears to be disingenuous. If decision makers believe the political conclusions in this article, there is no need for research and it might be considered unethical. For example, McHugh/Mayer question the appropriateness of research for such things as trying new treatments for transgender children.

Tags: featured, Paul McHugh, The New Atlantis, Transgender

Category: Transgender Body & Soul, Transgender Politics