Programming note: Mark continues his of week hosting Fox News Primetime. Catch him on Fox News tonight at 7:00pm ET. In the meantime, here's Tal Bachman...
One objection to my last piece might be that it made too much of too little.
This objection might go as follows:
You mentioned Caitlyn Jenner, Kataluna Enriquez, and Laurel Hubbard. But what does it matter, in the grand scheme of things, that a few men had their genitals amputated, took estrogen, and won a few awards intended for women? Yes, a few biological women lost a few competitions to the transgenders. But only a few.
The much more important thing is that through the wonders of medical science, Caitlyn, Kataluna, and Laurel—along with many thousands of others—are now finally at peace. Transgenderism/gender dysphoria, sex reassignment surgery (a.k.a., gender affirmation surgery), the hormone treatments—these aren't things to feel reservations about. They're things to celebrate. Somehow, male and female souls, or 'essences', got trapped inside the wrong bodies. Thankfully, science has now liberated those souls by correcting the sexually 'incorrect' bodies which housed them. Our modern world has brought wholeness to the victims of nature's cruel trick. It has enabled these people to fully experience their 'unalienable right' to 'the pursuit of happiness'. And it's worked. Everything about this entire thing is a feel-good story endorsed by the Declaration of Independence itself. Looked at from this perspective, sex reassignment surgery is as American as Mom, baseball, and apple pie. The bottom line is, these people were sad. Now they're happy. End of story.
And maybe there would be something to this objection, if that were indeed "the end of the story". But it's not. It's not even the beginning of the story. Or the middle. Despite its popularity, it's a glib, callous, uninformed, misleading caricature of the story. As such, it harms people struggling with sexual identity by misleading them about effective treatment. This means that the compassionate thing to do isn't to keep repeating this caricature. It's to tell the truth.
One such truth is that gender affirmation surgery does not come close to providing the psychological, emotional, and spiritual benefits its proponents claim.
How do we know that?
Well, we can start with the most comprehensive, long-term study of post-surgery transgender health ever conducted. In that 2011 study, researchers from Stockholm's Karolinska Institute summarized data gleaned from post-surgery Swedish transgenders over three decades. The findings should have triggered a serious "pause and reflect" moment throughout the medical community. By "reflect", I mean a conscientious review of exactly what health care professionals know, and do not know, about "gender affirmation surgery", and reconsideration of whether it is really the best solution—or any solution at all—for those struggling with sexual identity. Alas, it didn't.
That is tragic, because the study revealed a number of serious problems resulting from, or at least persisting despite, the surgery. These included ongoing psychiatric problems, increased incidence of violent crime, and increased risk of cardiac arrest. But the most alarming revelation was the astronomical rate of suicide among post-surgery transgenders, particularly after a decade. The post-surgery suicide rate wasn't 25% higher than normal, which would have been disturbing enough. Nor was it 50% higher. Nor was it 100% higher. It wasn't even 250% higher, which would have been, or should have been, a screaming alarm for the medical community and public alike.
Nor was it 400% higher, or 600% higher. It was nearly two thousand percent higher.
Now, to be sure, the Karolinska study doesn't show that the surgery caused the suicides. It only shows the suicides followed the surgeries. Maybe the suicides would have happened anyway.
And as it happens, one data point suggests they might have. The United States Department of Veterans Affairs keeps track of (non-surgeried) veterans with gender dysphoria, as well as their suicide rates. Guess what the suicide rate for veteran gender dysphorics in America is? It's 2000% above average—the same as for Swedish transgenders.
I assume that's not a coincidence. And if it's not, it means that the radically invasive, fertility-destroying, potentially life-threatening surgery in question is an ineffective, or at least, profoundly insufficient, treatment for gender dysphoria. In a word, it means the surgery's a fraud: it doesn't remotely accomplish what all those thousands of pro-surgery counselors, GPs, surgeons, activists, and researchers claim.
It's not only the Karolinska study which indicates the surgery's ineffectiveness. Seven years before the Karolinska study, researchers at the University of Birmingham reviewed over 100 studies on post-surgery transgenders. Their conclusion? As The Guardian newspaper summarized it:
"Sex changes are not effective...There is no conclusive evidence that sex change operations improve the lives of transsexuals, with many people remaining severely distressed and even suicidal after the operation...The review of more than 100 international medical studies of post-operative transsexuals by the University of Birmingham's aggressive research intelligence facility (Arif) found no robust scientific evidence that gender reassignment surgery is clinically effective."
Of course, the University of Birmingham conducted that review a long time ago now. Surely, one might think, more recent research indicates something different.
The American Psychiatric Association (APA) implied as much only two years ago. In a 2019 study published in the APA's official journal, the American Journal of Psychiatry, researchers Richard Bränström and John E. Pachankis claimed their research "lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them". Pachankis even acknowledged he hoped the piece would "help influence policymakers".
You can imagine the exultation among the medical establishment after the piece appeared. Finally, after half a century of surgeries, a couple of heroes had supplied some solid proof they helped solve the psychological and emotional struggles of gender dysphorics. Finally, they could all begin shouting "follow the science!" any time anyone expressed reservations about wholesale genital amputation for what looked like a psychological struggle best treated by expert therapy. Even mainstream media trumpeted the great news—ABC, NBC, WebMD, and more.
But as it turned out, the long-awaited canonical support for the surgeries relied on egregious methodological oversights (presuming they were, in fact, "oversights", as opposed to strategic manipulations of data.)
Called out with nowhere to hide, the APA finally had to acknowledge the article's conclusion bore no relationship to the data presented. Far from supporting the surgery, the APA's retraction now conceded that "the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits, or prescriptions, or hospitalizations following suicide attempts".
As the detransitioned activist and blogger Helena Kerschner wrote afterward, "this is a complete reversal of the original finding." Why, yes. It is. Kerschner further noted that "a study that co-author Pachankis hoped would 'help influence policymakers' was only able to recommend 'gender-affirming surgery' when it abandoned the very basics of the scientific process. Once the scientific process was restored and the study was made subject to proper rigor, the recommendation of 'gender-affirming' surgery was removed." Again, yes.
Kerschner had more to say:
"Why would two career academics in the field of public health research conduct a study that they clearly would have known was flawed and whose conclusions were deeply dishonest?...Why, if cross-sex hormones and gender surgeries are 'life-saving' healthcare, does nearly every study into the efficacy of these medical interventions, as well as into detransition, take elusive and manipulative measures to reach fraudulent conclusions that support a pre-existing ideological conviction?".
I think that last question contains its own answer. More on that next time.
Tal will be back here next week to continue the conversation. Mark Steyn Club members can weigh in on this column in the comment section below, one of many perks of club membership, which you can check out here.