Leor Sapir on The Controversy over Pediatric Gender Medicine in the United States

hello everybody it's a lovely fall day in New England and this is a program on constitutional government at Harvard I'm Harvey Mansfield with my wife on Our Guest today is leor sapir we are is a fellow at the Manhattan Institute he's an Israeli and he went to college at the University of paifa and he got his PhD at Boston College he's also had a postdoc here at the program on constitutional government at Harvard and he's written a dissertation on Title IX especially on gender identity and trans uh transgenderism so this dissertation is unusually comprehensive and deep because it considers not only policy but also constitutional law and even political philosophy for City Journal though he has an article in the latest National Review called school to Clinic pipeline and the title of his remarks today is the controversy over pediatric gender medicine in the U.S and I'm going to translate that is as should kids have a sex change maybe he'll object to that but anyway go ahead lior yeah okay well uh thank you Harvey and um Andy and and Anna for having me here um it's always a pleasure to be back in this forum um uh as Harvey mentioned I wrote my dissertation on the institutional and Legal Foundation of um the encroachment of Title IX regulation into the trans issue um and it drew quite a bit on uh on on political philosophy but around 2020 um I started to get sucked into the medical debates themselves over pediatric gender transition or sex changes for uh for children um and um ever since you know it's one of these topics where once you look you can't look away um because I am convinced that this is one of the greatest medical scandals in American history um it may not be on the scale of let's say the opioid epidemic which at its peak claimed 70 000 lives in one year um but because it involves children um and because it involves thousands if not tens of thousands of children who have already gone through the medical track um uh and considering the extremely weak to non-existent evidentiary basis for these procedures which I'll get into um I think this really is one of the biggest scandals um unfolding um and I I've been working not just to to try to clarify what's been going on but also to try to get policy makers to pay attention um follow the science where it actually leads um and and do what they should be doing so I'm going to be sharing my PowerPoint presentation um let's just make sure that this works okay all right can everybody see okay great okay so the topic of my talk is the controversy over pediatric gender medicine in the United States um it's going to have some comparisons with other countries but um it's obviously going to focus on the United States uh now the background to this is skyrocketing rates of transgender self-identification among youth um so just in terms of definitions the word transgender is is used very very Loosely these days it tends to mean quite a few things sometimes some of some some of them uh not always consistent with each other um so it's sometimes used to uh to talk about people who cross uh between one sex and the other or claim to across from male to female or female to male um but it could also refer to just a variety a kind of garden variety gender non-conformity rights of you know the teenage girl who's a tomboy for example um can today consider herself transgender and she will be considered transgender on surveys in schools by medical professionals um all these new labels like non-binary gender fluid anybody who is not as they like to put it cisgender meaning anybody who doesn't um who isn't a man and defines himself as a man or a woman and defines herself as a woman is nowadays a potential candidate for being transgender um a Gallup poll from earlier this year found that among Generation Y so those born after 1997 2.1 percent identify as transgender and that's in comparison to one percent of Millennials 0.6 percent of Gen X and 0.1 percent of Boomers so you can see that the rates are are skyrocketing um but even this doesn't tell the whole story because when you start to look at particular places in the country it's going to surprise no one that the more Progressive the place the higher the the level of self-identification you start to see even higher numbers so there's one study by a kid at all in 2018 of a school district in Pittsburgh that found 9.2 percent of the students in that school district um had a and these are their words had a gender identity that was different from the sex assigned to them at Birth so Tech technically transgender all right so one in ten kids born in the wrong body and so this raises the question um what are we seeing are we seeing what what explains this dramatic surge in transgender identification among young people and there are two hypotheses one is the social acceptance hypotheses that basically says um you know these kids have always existed the rates that we're seeing are completely normal um the only thing that's changed that Society has become more tolerant more accepting and therefore these kids feel more comfortable coming out and and telling everybody who they truly are so that's the social acceptance hypothesis but then there's also the social contagion hypothesis which says that trans identification is primarily or exclusively um a fad um you know a kind of a thing that teenagers influence each other into doing um that they're all these kind of cultural cues and social incentives that that get kids in the particularly girls will get into that um to identify in this way um and that's known as the social contagion hypothesis okay so let's get into some of the evidence for each one of these so the social acceptance hypothesis as I said assumes that um that trans kid that first of all that there is this category of individuals called trans kids um that people are born like this um they they're born with a gender identity that doesn't match their their sex um usually this is couched in the analogy to gay rights just as gay people are born that way so too trans people are um especially in the context of civil rights regulation in the federal courts advocacy organizations have made claims about brain sex meaning that gender identity has a neurological Foundation um but there really is no good evidence for these claims um the the claims on behalf of a neurological basis are based on um uh studies with a very very small cohort um the most famous of them having examined only six adult transsexuals um and and even then it could not control for confounding factors like homosexuality um so there really is a very very weak basis for the neurological explanation and so instead um it's inferred psychologically um by the consistency or the tenacity of a person's assertions right and this also appears in psychological literature they acknowledge this point that we don't we don't yet know what causes a person to reject their sex all we can know is is uh you know we can infer Things based on their behavior um and another reason to doubt the kind of the the neurological or innate explanation of of gender identity is that the vast majority of kids who exhibit these behaviors and who are diagnosed with gender dysphoria historically um uh 11 Studies have shown will desist meaning they'll come to terms with their sex by puberty um and um and the vast majority of them by the way will come out as gay or lesbian whereas in contrast close to zero percent of gay or lesbian people spontaneously become heterosexual right so that's kind of more evidence that the whole gender identity being brain sex explanation lacks evidence um I should also note that there's a tension within the social acceptance argument which is that um the the same people making that argument often claim that we are living in times of unprecedented hostility towards trans people um and and for exactly that reason we need a robust civil rights program um to protect trans people from from social from growing social hostility so it's not clear how those two um arguments can fit together that more kids are coming out because society's more welcoming but Society has unprecedented levels of hostility and therefore we need civil rights protections and usually there's a a comparison made with left-handedness if any if anybody you um happen to see John Oliver's segment on this from the other day which was very uh wildly popular uh in the media um this is a common comparison right the argument is that um left-handedness used to be discouraged in schools um and when it was only four percent of students were left-handed but when it was permitted when teachers allowed students to write with their left hand um by 1960 12 of students wrote and uh and did everything with their left hand so a rise of 300 percent um but looking at the numbers alone as as I list here shows that that that analogy is highly implausible um just among just if you take transgender self-identification the numbers have risen by two thousand one hundred percent between the baby boom generation and Generation Y right so already we're talking about orders of magnitude bigger and then if you look at gender dysphoria which is the clinical diagnosis of a mismatched self-perceived sex and actual sex accompanied usually by distress or social impairment you see that the uh that the rates since 2013 when the diagnostic and statistical Manual of mental health disorders first listed them um the rates similarly have skyrocketed and this is based on data recently released by Komodo health I'm not going to go through all the statistics here all the data but I did some number crunching and suffice to say that among males the rates of gender dysphoria and youth have gone up between 428 percent in one thousand two hundred percent and among females the rates of gender dysphoria have gone up um between four thousand and six thousand percent so we're not talking about the same degree of rise in in uh as we saw with left-handedness and keep in mind that unlike with left-handedness where the 300 increase happened over a period of 60 years here these um very dramatic numbers happened over the course of 10 years right so this is not Smoking Gun evidence of social contagion but it strongly suggests that something more than just social acceptance is a foot something else has to explain why so many kids have come out as trans or are being diagnosed with gender dysphoria in such a short period of time and one of the another indicator I think of evidence of social contagion is number one that we know of other historic examples of social contagion incidentally social contagions with which have affected the exact same demographic as the trans slash gender dysphoria social contagion which is young young females young female adolescents and young women right that's the primary group affected by this so the Salem Witch Trials um uh there was a social contagion in bulimia in the 1980s and 1990s same with anorexia during the same period nowadays there's another social contagion known as spoonies this is when teenage girls and young women self-diagnosed with um with health conditions that they don't have and they live a life of somebody who is completely impaired and unable to do anything even though they're perfectly healthy um and then of course in the 1990s we had the recovered memory move movements right the claim that young women who experience anxiety depression any form of mental health problems it's probably because of some past sexual abuse that they've repressed and can't remember so this turned out to be a whole Scandal but but it spread like a wildfire over the course of about a decade among young teenage girls and young women we also are seeing celebration of the trans identity and pop culture um so you know Brands like jazz Jennings who produce books and movies and TV shows for kids um you can see it in the language in which mainstream media and political leaders talk about um uh gender issues so for example to be transgender by definition according to most advocacy organizations mainstream media journalists by definition being trans means not conforming to expectations regarding your sex right so this sends a message to kids who are very concerned about questions of Conformity and authenticity that if you're not trans it's because you're conforming and if you are trans it's because you're being authentic which is another watchword and I included here um on the left you can see um the gender Spectrum um it's really a meme because it's used everywhere now but um this is uh it comes from a training material from the UK's uh most important transgender advocacy organization called mermaids um and what's interesting in this meme is that you can see the the way in which they Define male and female right so the so-called gender binary and you can see on the left to be a woman means to be a Barbie right it means to to want to have for oneself all of the most two-dimensional stereotypical features of femininity and to Define oneself as a man means to be a GI Joe right um and if you're not a Barbie or GI Joe then that means that you're something other than male or female right so you're somewhere in the middle you're on the Spectrum all these metaphors about sex being a spectrum um and you know so this is shown to kids as young as kindergarten and it's impressed upon them that if you don't see yourself as being either a Barbie or a gho that probably means that you're trans that is the messaging so given this language it's not surprising that more and more kids who say to themselves well I don't feel like Barbie um therefore I must be trans right so um this is just some of the stuff that's appeared in recent years in pop culture you know National Geographic celebrating trans kids on its cover you can see here um this right over here if you can see where my mouse is um that is from a book called bodies are cool it's a book for kids age kindergarten and up and you can see that they are celebrating a clearly young woman who had a double mastectomy that's what these scars are right here um and this is marketed to kids um over here on the bottom right you can see this appears from a very popular Reddit thread these two young girls who clearly had double mastectomies um again marketed to young kids as being authentic and courageous um and then you can see these other uh pictures from from popular children's books these days these are books that appear in Barnes and Noble and Amazon um they're very very easy to find and get Okay so uh one of the ways in which we have come to know the social contagion hypothesis is through this new clinical um category called rapid onset gender dysphoria rogd and this has become the source of major controversy and the um debate over pediatric gender medicine um Abigail schreier drew it attention to it in her book irreversible damage that appeared a couple years ago um but the concept comes from a research paper by Lisa Littman in 2018 where she surveyed parents of these teenage girls primarily girls um who all of a sudden exhibited these dysphoric behaviors um in in or after puberty right so these are not kids who've had a long history of um of having dysphoria and childhood they're mostly teenage girls who just all of a sudden um started exhibiting these these signs and symptoms and what Littman found is that there were some pretty common patterns these were young girls spent an enormous amount of time on social media especially in the months leading up to their trans identification um many of them had were socially isolated um were socially awkward and probably for that reason socially isolated um and they were deeply immersed in social justice culture so they were constantly thinking and talking about victimhood and oppression uh intersectionality that was a a major watchword there um they were constantly concerned about hierarchies um social hierarchies you know I have to say uh one of the articles I wrote for City Journal I interviewed um about a dozen parents from California whose kids had gone through this and one of the consistent themes that these parents told me is that their kids in the months leading up to their identification they're coming out as trans and they're they're wanting to do some form of transition um you know they got a lot of messaging on the kind of the racial issue right that that um Society is um is inherently racist uh white supremacist that as young white girls they are inheritors of a system of privilege um that they need to be quiet and listen to and defer to people of color um uh and what these young girls started to notice according to their parents is that it was very easy for them to opt out of being at the very bottom of the totem pole of a victimhood right all they had to do was declare themselves queer or non-binary that doesn't require anything on their part it just means all they have to do is say from now on I'm just queer that's it and all of a sudden they they go one up on the ladder um and what we've come to know since then is that these identities queer non-binary gender fluid are almost always Stepping Stones to trans to want to cross the barrier and identify as males partly because teenage girls say well if you're really committed to this you'll show it and you'll show it by by demanding hormones and puberty blockers and and mastectomies and all these things right so teenage girls pressure their one one another into um showing that they're committed to this now I should point out that litman's paper was not supposed to be you know definitive proof of social contagion it's often presented that way as a straw man to say that because she didn't prove it it's not true um it was always meant to be a hypothesis generating paper she writes that explicitly she said you know here's the phenomenon that I'm seeing it's pretty common we need a lot more research before we carry forth with all these medical procedures and in the years since Lisa's um um paper came out her hypothesis has been confirmed in a number of ways one is by the experience of clinicians on the ground in a variety of countries in Finland and Sweden the UK Canada and here of course in the United States um what these clinicians have noticed is a flip and this appears in the in peer-reviewed research too um a flip in the sex ratio so that until about a decade ago the majority of of miners being referred to Pediatric gender clinics were male whereas now the vast majority are female um whereas up until about a decade ago the vast majority had early onset gender dysphoria meaning it started uh well before puberty um nowadays it starts around or a little after puberty for the vast majority of people and um these young girls had extraordinarily High rates of co-occurring psychological problems including anxiety depression eating and learning disorders um uh autism um actually the UK's Tavistock clinic in a review um it was found that up to one-third of all the girls referred to the Tavistock had either autism or some other kind of neurodivergent condition um so so something is going on here and um Ken Zucker who's one of the most prominent world-renowned researchers on pediatric gender dysphoria wrote in a peer-reviewed article in 2019 that the observations that Litman had made um comport with what he was seeing with the majority of his patients um and it's also confirmed by first-hand accounts of parents and teachers and a lot of the kids who have gone through this and come out the other side and said you know what have I done and so there are all these new kind of parent groups like Pitt is the parents for inconvenient truths about trans uh parents of rogd kids and so on and so forth all these parent groups have formed in response as support networks in response to this problem and these are just two diagrams for what we've been seeing in uh Based on data collected at gender clinics from other countries and I should note one of the big problems we have in the United States is that we don't collect good data because our system is so decentralized um but in countries that have centralized Healthcare systems that do collect data there's a a clear Trend here and you can see on the left here this is from the Tavistock Clinic which has since been ordered to close you can see that the share of adolescent females with no history of um of early onset uh um dysphoria uh began to Skyrocket around 2012. um and you know by 2016 they made up the Lion's Share of referrals and the same thing happened in Sweden okay so with this in the background this kind of debate of what's causing all these young people to identify as trans and seek and many of them to seek medical transition um what is gender affirming care let me lay some assumptions and some definitions on the table um let's first deal with the philosophical assumptions um the word identity here is used to refer to a person's core sense of self or as activists like to call it knowledge of course the whole uh one of the big arguments is whether this sense which is a kind of an Intuition or a feeling does in fact amount to knowledge um uh or or is it opinion or some kind of feeling um but regardless uh identity is is conceived here as as the locus of human dignity um is something that's in intrinsically valuable and worth um uh protecting preserving asserting recognizing um gender is used to mean an essential natural and good trait it's not meant in the way that let's say queer Theory means it if you read uh Judith Butler for example which is something like a system of social oppression um right so when people talk about gender ideology and say that gender ideology has infiltrated into medicine that's not exactly true or at least it requires some clarification because if people like you know Michelle Foucault and Judith Butler are to be consulted um I think you can see pretty clearly on the basis of their writings this idea that kids are born with a the brain of the opposite sex and need to be medically managed and transitioned to be so to speak authentic um goes against the grain of what queer Theory argues um but in any case um the idea is that all humans have a gender identity um and that this identity is innate potentially even biological that it's knowable through intuition a kind of a lived experience even from a very very early age and that it's not subject to change once it emerges so you have the influential um Bay Area child psychologist Diane arensoft making claims like children as young as to know who they are and when it comes to to gender children are our teachers right that's there those are the kinds of arguments that she makes meanwhile sex is regarded as a social construct um therefore the use of the language that sex is assigned at Birth um and it's therefore also arbitrary and potentially oppressive unless it's autonomously chosen chosen of course by that self that has a gender right of the gender identity um further it's conceived that the alignment or misalignment of gender identity and sex is an accident of birth right one is born with alignment or misalignment there's nothing one can do about it and misalignment is not pathological it's not unnatural in the sense of abnormal um and that's why uh uh the term gender identity disorder which appeared in the DSM three and four um was replaced in 2013 with a more neutral term gender dysphoria um and the reason was that they wanted to retain a clinical diagnosis in order for insurance purposes but they wanted to try to destigmatize it as much as possible so the word disorder was was dispensed with and of course in any clash between gender identity and assigned sex um gender identity always has to Triumph okay so these are the the basic philosophical assumptions behind gender affirming care um just to kind of uh uh polish some of what I was saying earlier the diagnosis of gender dysphoria according to DSM-5 requires two components there has to be some kind of persistent cross-gender behavior and interestingly the DSM-5 speaks explicitly of stereotypes one has to conform to the stereotypes of the opposite sex in one's desires and and behavior but there also has to be clinically significant distress um or so some kind of social impairment like dysfunction at school now in theory gender dysphoria is distinct from transgender right um the trans movement constantly insists that not all transgender people have gender dysphoria that one shouldn't have to have a diagnosis in order to be considered trans but in practice if we look at the politics of civil rights regulation the two are synonymous um so in any case uh you know any kind of federal litigation where the question of trans rights comes up um whether it's in the medical context or the Title IX context um the claim is always that that um if we if we don't uh do these policies people with gender dysphoria are going to suffer and probably kill themselves right so in practice the two are synonymous and here I just have some a visualization of the rates of gender dysphoria diagnosis among youth under 18. and what you can see is that between 2017 and 2020 there was a 20 annual growth which is pretty significant in itself and then between 2020 and 2021 that uh the the rates skyrocketed by 80 and these are new diagnoses so of course you know I think the most reasonable explanation is the pandemic the social isolation brought about the by the pandemic is probably the culprit behind the 80 percent um growth in one single year um and so that brings the current total to 121 882 cases of gender dysphoria among youth diagnosed um and keep in mind this is based on insurance claims so it very likely underestimates the true number okay so the gender affirming care protocol has four stages um social transition which is using a person's preferred name pronouns bathroom access sports teams access stuff like that um puberty blockers begin around age 11 or 12 depending um and their purpose is really to just suppress the emergence of secondary sex characteristics which are said to cause distress um following puberty blockers are cross-sex hormones so masculinizing or feminizing depending on the on the purpose um and um and and then finally surgeries and not everybody gets surgeries but um but they do happen um there's so to speak Top surgery which is a euphemism for a double mastectomy and bottom surgery which is a euphemism for phalloplasty or vaginoplasty as the case might be and surgeries are performed both top and bottom are performed on minors in the United States we've had politicians and activists deny it but we have hard evidence even from peer-reviewed medical journals where researchers proudly flaunt the fact that kids are getting these are getting these surgeries so they do happen and gender affirming care has the endorsement of pretty much the entire left of center Elite I know that sounds a little bit conspiratorial but it's a hundred percent accurate um the idea that gender affirming care is medically necessary and life-saving has received endorsement from 22 major medical associations including the American Academy of Pediatrics the American Medical Association of medical Psychological Association um it's the position it's the official position of the ACLU the Human Rights Campaign and of course the Democratic Party um but the United States has really become an outlier on pediatric gender medicine and one of the things that I've been trying to do in my work is number one explain this to policy makers um and number two try to understand why we've become such an outlier and I'll get to that at the end but um since 2009 Sweden Finland and the UK have done what are known as systematic reviews of the evidence for the mental health benefits of hormones to treat gender dysphoria and youth um and all three countries have come to the same conclusion that the benefits are too uncertain to justify the potential risks and so all three countries have drastically scaled back on medical transition they now recommend Psychotherapy as the first and ideally only line of treatment for Youth and distress and they permit exceptional cases to go through with medical transition but only under a strict research protocol um the UK uh NHS recently ordered its main pediatric gender clinic at the Tavistock to be closed um and treatment to be decentralized into Regional clinics where the hope is that uh mental health counseling will be more readily available as opposed to endocrine interventions what's interesting is that Dr Hillary Cass who's the former president of the UK College of Pediatricians and child health and who conducted the investigation of the Tavistock Clinic um she explicitly targeted uh um uh focused on the what she called the affirmative model of care which she said originated in the United States as being a lack of a reason behind the lack of child safeguarding at the Tavistock um so I thought that was that was pretty interesting um meanwhile France the uh medical authorities in France have also issued a statement urging great caution in the use of hormones to treat adolescence uh minors in distress given the lack of good evidence behind it but that's not the position that American Medical organizations I should say that the with very few exceptions that the medical American Medical establishment as a whole has taken um what's interesting is that when you start to dig into all of these pronouncements by you know the American Medical Association which is by far the largest of them what you notice is that they're basically based um they they they they only it's like an inverted pyramid at the bottom of which are really um two uniquely American organizations that have actually made claims based on any cited research and that's the American Academy of Pediatrics and the endocrine Society um the AAP which if any of you have been following my work you know that I've almost virtually gone to war with them um they based their recommendation on a single article published in 2018 um the article was not peer-reviewed appears to have not been peer-reviewed and it was written by a medical resident at the time with very little clinical experience and most importantly in a subsequent peer-reviewed fact check of the article of the 2018 article it turned out that um uh Dr Jason Rafferty was the author completely misrepresented all of the sources so when he said for example that children should never be automatically transitioned um it took all of the sources that he cited to in support of that claim said the exact opposite that it's they said children should not be automatically transitioned instead there should be a process known as watchful waiting where they're not affirmed in their gender identity and and the medical transition should be delayed as much as possible um and another thing that Rafferty did was omit all studies that show that affirmation is not the right thing to do there were 11 such studies that showed that the vast majority of kids if they're just left alone will come to feel comfortable in their bodies and will not seek transition anymore and he just doesn't mention those studies um so that's that's the evidentiary basis of the AAP um regarding the endocrine Society it's important to recognize number one that their their recommendations are not for whether minors should be transitioned instead they say if you decide to transition a minor here's what we recommend here's how we recommend to do it so they're they're they're technicians um and um the endocrine Society interestingly in 2017 um issued its guidelines and it rated the evidence behind its own recommendations as being of quote low or very low quality um and it's called its own recommendations week um and I should point out aside from these uh sorry including these uh two organizations no American Medical Association has ever done a systematic review of evidence for um for medical interventions um why is this important because a systematic review of the evidence of the kind that UK Sweden and Finland have done is uh designed to prevent the kind of thing that Jason Rafferty did with the AAP which is to cherry pick studies in order to produce convenient conclusions that's why we do we have systematic evidence reviews and right now American Medical Practice is not based on a systematic review of The Evidence The Only Exception is actually the State of Florida which as we speak is holding hearings to finalize its rule to ban pediatric transitions subject to certain limitations okay so what does the research on puberty blockers and cross-sex hormones actually say and here there's two relevant categories of research I'm not going to get into it because it's I can if you want in the Q a but it's it's very very dense and complicated but suffice to say that there's two bodies of evidence one is the famous famous Dutch study um that came out of the Netherlands uh its results were published in a number of Articles most importantly ones in 2011 and 2014 um and the other is uh includes uh about a dozen or so studies that have been published since the Dutch study um uh but both of these Bodies of Evidence are extremely weak the Dutch study is weak because It suffers from um bias so to give just a couple examples it utilizes what's known as the Utrecht gender dysphoria scale so essentially what it does is it takes a bunch of boys it gives them puberty blockers and cross-ex hormones and then at the end of the process it asks them um do you feel uh how do you feel about um getting your period and of course none of them are getting periods so um so they write zero meaning it doesn't bother me at all but these same boys got the questionnaire for boys not for girls at the beginning of the process and when they got the questionnaire for boys questions like how do you feel about having a penis um they rated their dysphoria or their distress as being extremely high so by changing the questions from boy centered questions to girl-centered questions the researchers got a a reduction of dysphoria from very very high to almost non-existent so they've come under a lot of criticism for this but that's they they're sticking to their guns um and there are a number a number of other problems with the Dutch study and did not control for Psychotherapy so all the kids who got hormones also got Psychotherapy and there was no way to know which of those two interventions was causing the Improvement they had very short follow-up time from the um completion of transition only a year and a half um and um the only attempt so far to replicate the duck study happened in the UK a couple years ago and the attempt failed um and we know that replication is essential to medical research um to scientific research uh interestingly the researchers who tried to replicate did not want to publish their findings um but were eventually forced to and then the final problem with the Dutch study is that because of all the criteria for eligibility for which kids are allowed and not allowed to participate in the hormones um if you look at the criteria for for eligibility they don't apply to the vast majority of teenagers showing up today at gender clicks um and so that means that to the extent that you do think the duck study is a good one you don't think that it applies to the vast majority of kids who are actually getting hormones today and surgeries we could talk more about that if you'd like in the Q a um regarding the subsequent studies um some of these study studies have showed no improvement in mental health some of them showed Improvement but um they were they either had very short follow-up times anywhere usually anywhere between three months and one year which is not nearly enough to know if they actually improve quality of life in the long run they had confounding variables so they had the same problem with not no ability to control for Psychotherapy and they had biased samples meaning only those kids who were somewhat mentally stable we're allowed to get the hormones in the first place whereas those kids who had a lot of mental health problems anxiety depression things like that we're not allowed to get hormones and then by the end of the study the researchers say see those with hormones do much better than those without hormones right but they're just measuring what they their own criteria for eligibility uh not not the causal effects of hormones on Mental Health so I'm not going to go through this too much suffice to say that puberty blockers have a number of risks some of them are known some of them are unknown they include cognitive impairment osteoporosis early in life sterility anxiety and depression what is important here is that a a major claim made on behalf of the gender affirming care is that puberty blockers are fully reversible is that the second I don't know if any of you have ever heard this claim being made but that the second a teenager stops taking them everything just goes back to to normal and and they can carry forth with puberty as intended um it turns out that there have been three studies in recent years on how many kids who get puberty blockers go on to cross-ex hormones and virtually all of them do um which leads any kind of you know thoughtful Observer to say um this is pretty strong evidence of ayatrogenesis which means uh an illness that is the cause of a medical intervention itself um because the only other explanation is that clinicians are remarkably efficient at avoiding false positives right at picking out the exact kids who are good candidates and leaving out those who are not good candidates and there just is zero evidence for that being the case and it also I think is very it offends common sense to believe that um so in any case it's you know puberty blockers there have been no randomized control trials they are not FDA approved for this purpose um um and I'm recognizing these points the health authority of Finland now considers them a medical experimentation which they are prospects hormones and surgeries also have their risks both known and unknown sterility heightened risk of cancer and heart disease anxiety and depression medical leash means that once you start taking them especially if it's in conjunction with other procedures you're on them for life even if you come to regret it surgeries of course are irreversible and they have very high rates of complication um not to get too graphic but these things are important but for boys who go through puberty blockers because they go through they use puberty blockers their their penis is not allowed to develop and because the creation of a neo-vagina later on requires the in the surgical inversion of the penis to create an orifice and it's not big enough they have to borrow from the colon in order to create a neo-vagina and that opens up a lots of lots of health risks and complications um and actually the the TV star Jazz Jennings that's exactly the story behind um Jazz's uh uh um health health complications right now um and we have no long-term follow-up data on any of these medical interventions for minors puberty blockers cross-ex hormones or surgeries there just is no data um let me say a few words on social transition because this is highly relevant for schools for the educational context and that this is going to be a major political Battleground um uh going into the midterms and I think the 2024 presidency um because uh the the whole problem of gender instruction gender ideology in schools is becoming a major flash point um when schools agree to use a child's pronouns and names what they are effectively doing is socially transitioning that child right the ACLU has said so explicitly in its Title IX lawsuits um and um it's important to recognize and one of the things that I've been trying to bring to the awareness of policy makers is that social transition is a medical intervention it's not just some neutral act of kindness by teachers um and the evidence backs this up um and I should point out the schools are now doing it increasingly without the consent of parents and sometimes without even notifying the parents um so um as I said there's no evidence of an innate in fixed gender identity and 12 studies on the rates of desistence and persistence among youth with gender dysphoria um show that um it's that it's an iatrogenic intervention why because 11 of these studies show as I mentioned earlier that the vast majority of these kids will desist by puberty they will no longer reject their sex most of them will come out as gay or lesbian the only study that showed otherwise came out earlier this year and it showed that 97.5 of the kids who were socially trained in the study did not desist meaning they did not come to terms with their body the only difference between this study and the previous 11 studies is that the kids in the 2020 study were all socially transitioned so if that's not a good evidence of ayatrogenesis I don't know what is it's as if we were to take toddlers who play with building blocks um put all of them in vocational schools encourage them to identify themselves as construction workers and then later when 98 of them say I'm a cons want to be construction workers we've pride ourselves on being remarkably effective at predicting adult vocational preferences in toddlerhood um so in any case social transition Is Not Innocent gender exploration it greatly increases the chance of medicalization and that's why what schools are doing right now is um just extremely irresponsible and the UK has recently advised caution on social transition um the cast report said it's not a neutral act it constitutes an active psychosocial intervention two weeks ago the NHS issued new draft guidance basically saying don't socially transition kids and if you're going to socially transition teenagers um you should only do so if they have a diagnosis of gender dysphoria and on the basis of informed consent um and yet the American Academy of Pediatrics continues to maintain that all kids should be automatically affirmed meaning socially transitioned no questions asked and if parents have a problem with that this appears in the AAP article the parents are the ones who need to get psychological counseling um I'm not going to go through the whole you know the two most common arguments in favor of gender affirm and Care is that kids are going to kill themselves if they're not allowed to do it I'm happy to get back to this in the Q a suffice to say that that the evidence for that claim is extremely weak and actually the claim is very likely to do more damage than um than more harm than good um the claims about regret rates being extremely low um are based on studies done on adults we have no way of knowing what the actual regret rate is going to be for for the current cohort of miners transitioned under the gender affirming protocol um and then finally before I end I'll just kind of get into some of the regulatory actions undertaken um in recent years um right now there are four states that have tried to prohibit gender affirming care um Alabama tried it got blocked in a federal court uh in a preliminary injunction hearing um by a judge Who was appointed by Donald Trump and has sympathies with the Federalist Society um he basically only allowed the block the prohibition of surgeries to go through um but he blocked the two Provisions um Banning hormones um Arizona has a law like this it's set to go in into effect next year Arkansas is currently under litigation um I think the trial ended a few days ago but don't quote me on that um and then Tennessee technically has a law in the books but it's a very odd law because it basically says no cross-sex hormones to Children before puberty but that's never really been part of the protocol anyway um 19 additional states have proposed similar bills but these have either died or are still kind of wending their way through the legislature um and then on the blue side you have States like California that have taken aggressive measures to try to make gender affirming care as readily available as possible so earlier this year California passed sv-107 which basically creates uh sets up California as a sanctuary state for gender affirming care and what it does in practice is it says to um authorities in in the state of California if there is ever a um you know if if a minor shows up in the state and wants to go and wants to have puberty blockers but there's let's say a court order from another state preventing him from doing so let's say because the parents don't agree um then that minor is eligible to get uh puberty blockers and cross-ex hormones regardless of the court order regardless of any action of another state so here's the big question why are we an outlier and let me suggest a few things and then and then I'll shut up um number one I think uh the fact that we have a decentralized political system is highly relevant here um and that of course coincides with a managed Market Health Care System um in Finland all procedures are covered by public insurance right they have nationalized health care insurance and that means that um anything that's going to be paid for has to be approved by what's known as the council for choices in health care or cohere that's the governmental body that does reviews does systematic reviews of evidence behind certain procedures decides whether there's good evidence for them or not and on that basis decides what what to fund that's not how we do things um in the United States um there is there's a high degree of decentralization um just to give you one example um Medicaid which is used in 25 States plus the District of Columbia um to prohibit discrimination against gender identity medicine meaning kids are eligible in these states for Medicaid covered transition um the Obama administration's Obamacare excuse me Obamacare has a provision in it 1557 that says you cannot discriminate on the basis of Sex and the Obama administration's um Health and Human Services I was going to say health and human sacrifices Health and Human Services interpreted provision 1557 to mean gender identity meaning if any health care provider um uh discriminates on the basis of gender identity with gender affirming care um then then they're in violation of civil rights law so we have a highly decentralized system that makes unified policy on this issue very difficult um we also have a public interest politics right where groups like the ACLU um that has been at the Forefront of litigating these cases Human Rights Campaign all these group organizations um have a lot of entry into the political system right as uh um as as I learned uh from from you Shep every veto point in the American political system is simultaneously an opportunity point and public interest organizations are extremely efficient in identifying what those points are and getting their policy preferences Advanced with no accountability nobody votes for the ACLU nobody can vote them out so unlike uh you know the the government in Finland or Sweden if they uh if they make unpopular moves on in this area of Regulation their governments there can be voted out that's not true of the ACLU and federal courts trans activists have been very effective at tapping into our civil rights Traditions attorney general Loretta Lynch famously compared the bathroom question uh in the trans issue to the bathroom to bathroom segregation under Jim Crow partisan polarization is highly relevant here when Texas came out with its um policy through executive action to investigate parents who transition their kids California responded with SB 107 by making California a sanctuary state right so this logic of spiraling polarization but we also have an individualistic and entrepreneurial political culture which helps to explain I think why um doctors here are more willing to be Risk Takers um more willing to stick their neck out and say gender affirming care is life-saving and medically necessary even when there's no good evidence for it um I had a conversation with Rita kirtu kaltiala who's the head of finland's biggest gender clinic and she said you know now doctors are not allowed to perform these procedures um and I asked there is there I asked her is there a law criminalizing doctors who do and she said no so I said how are you how are you so confident that doctors are not just going it alone just doing whatever they want taking risks and her response was because we're not like you Americans here doctors follow rules Finnish people like rules and we follow them um and I think that that goes quite quite a long way towards explaining why we have so many doctors willing to engage in Risky medical practices um and then the final two aspects are the capture of our knowledge gatekeeping institutions this took off especially after the George Floyd events we have peer-reviewed Publications now publishing articles that are just demonstrably false easily refuted um they they wouldn't even pass musters an undergraduate paper and yet they they get through the peer-reviewed process which is quite shocking and then finally the failure of investigative journalism um uh anything left of center until very recently has been unwilling to raise any critical questions rarely ever even asking why other countries have changed Force um there's they're now starting to be some cracks in the dam um but it's too little too late and we're not seeing enough momentum on that so with that I'll shut up um uh and I welcome your questions foreign thank you very much Leo godford a powerful presentation right right but now I'm sure we have questions what do you want us to do if we want to ask a question just raise our hand yeah you can since you barged and you can start and then Jerry is next but keep yourself muted and um raise your hand or call me in chat okay um so you've created a new villain in in my uh Pantheon called the American Academy of Pediatrics I mean this they should be right the most uh the seminal kind of legitimating organization um from your and I know you're there they consider you their enemy but what have you learned about them why are they so uh professionally irresponsible that's a great question it's a question I get a lot why is the AAP captured on this issue um I think there's a number of explanations one is I think we're seeing with the AAP what we're seeing in of a wide variety of other institutions um on this you know kind of ideological infiltration or I should say exfiltration out of the academy and into other institutions including corporations media editorial boards and it's basically a story of a small number of very well-connected well-organized ideologically motivated activists in the profession um uh and a large majority of you know pediatricians who either don't have expertise in this area of medicine so they don't they don't want to risk their professional reputations thinking that maybe there's something they're missing or who are afraid to speak out I've spoken to many pediatricians or at least a handful of them who have told me um I I can't say anything about this because I'm going to lose my job um so that's one thing right this kind of collective action problem a silent majority small organized minority um what I've also come to to learn is that these professions are um very heavily female dominated um so AAP and American Psychological Association are two-thirds to three-quarter female School teachers are roughly the same um and you know women uh to much to their advantage I think have a capacity for for empathy in ways that many men don't but that empathy can also be weaponized um and I think that that a lot of what we're seeing is weaponized empathy um and you know you can see this too on if you just start to survey the forces on the ground of who's promoting this stuff you see many many many more women than men um although you also see women at the Forefront of pushing back against it which is also interesting um but regardless I think those are those two features are probably what what explain why the AAP uh and the American Psychological Association Association has been captured on those issue thanks leor and you've added a word to my two words to my vocabulary weaponized empathy oh my word thank you Jerry please and please keep it short because we will go over time but I bet I'm sure there are going to be a million questions all right Shalom and uh I want to clarify what your major point is are you merely saying that you oppose medical intervention with transgenderism you oppose puberty blockers and surgery but sometimes you speak as if you're making a stronger claim that you think that transgenderism is merely social contagion and you compared it to Witchcraft and you compare it to other kinds of hysterical phenomena like recovered memories there are no witches is there such a thing as transgenderism and I just want to add my own experience I treat a transgender males in the 70s before this flip when it was very rare and my experience is that is that there is something as transgenderism especially the early onset yeah that's a great question um no I don't I I don't want to say that yeah well let me put it this way if you're asking me whether there is a form of gender dysphoria a kind of a profound and Lasting discontent with one sex that brings with it a lot of distress um uh over one's lifetime that results in impairment of social function um yes I think that that does appear to be the case you would know that better than I would but I see no evidence why that isn't the case if you're also asking whether this type of dysphoria can start to appear in childhood um I think the jury is out on that question I I'm not sure we can know that um I don't think we can know that until the the kind of the the identity of of these people has been until once they've passed through puberty and possibly into mid adulthood when you know because the brain develops roughly until age 25. um so you know there's two kind of schools of thought among those of us who are objecting to what's going on now in the medical field one is the whole kind of no child is born in the wrong body nobody's born in the wrong body meaning there's no such thing as transgenderism men or men women are women um uh you know we can entertain these delusions for some reason but but we shouldn't the other school of thought is if it were possible to know who among kids has life is going to have lifelong dysphoria then you know we could potentially in an ethical and responsible manner we can have these uh medical interventions for those particular kids but we have no way of knowing and we probably will know know never have a reliable way of knowing and so we just shouldn't do it right because the harm we'd cause far outweighs any benefits um I'm not sure in order to push back against what's going on in the America American Medical establishment today I'm not sure you have to decide between those two positions either one of them is going to get you to the same conclusion but if you're asking me whether I think that um that that uh that had that gender identity exists in that it is the determining factor in being a man or a woman my answer is no I don't think so but does that mean that we should never make exceptions we should never treat people who have dysphoria as if they are the opposite sex in certain contexts subject to certain reasonable limitations yeah I'm willing to do that why not thank you yeah Gene please and then Joanne okay uh thank you very much for your presentation and also for the essay that you wrote that I read in June the day that I was slated to give a talk about what's going on in the Maine public schools so I was especially interested in your hypothesis that perhaps uh it was the shutdown of the schools that accelerated this um uh unhappy situation but I wonder if that's really true um let me suggest something else and I really I'm not I'm not a social science researcher in any way um but it if kids have dropped out while they're while they're going to school online I can see that they're alienated they're bored they're detached from school but I don't know that those are the conditions that we really prompt somebody to rethink their sexual identity of gender identity but when they go back to school and I'm what I was focusing on in Maine was something called Esser the elementary and secondary school Relief act and part of that was a huge chunk of money for social and emotional learning and although that was set out described in what most people understood that to mean is you've got to make your kids safe as they will wear masks when will they not wear masks how will they re-enter into the schools but it was also used to push the gender ideology stuff and so it seems that you might have kids who are tuned out I certainly see it with my students at Bowdoin and this is several years ago go I mean they're still carrying that burden of alienation and remoteness and they are struggling so when these kids go back to school it seems to me that they're much more ripe for this kind of uh you could say almost turning them into victims uh you know they have other problems and I think your essay was very helpful in terms of identifying especially girls from troubled backgrounds who think that they will suddenly catapult themselves to heroic status in the schools but and that's another reason why I don't think it really worked as well during the period of remote learning so I just wonder if you have any reaction to that thank you yeah great question thanks for that um let me say two things number one um The Missing Link here of course is social media um Tick Tock has been an extremely important platform for um and Reddit I should say but Tick Tock especially has been extremely influential platform for these mostly young girls to be exposed to kind of these heroic stories of other girls who went through this transformation and now they um they've come out the other side as their authentic selves and so on and so forth right so and we know that there's a lot of trans influencers in these social media platforms um some of them are adults some of them are older teenagers um who who really counsel these young young people especially young girls through the process you know instruct them what what to say um you know kind of give them the whole social justice feel about how the worst thing you can be is a CIS person and um and and it's all rooted in a system of Oppression and this ties into a lot of what they especially if they come from a state like California a lot of what they've been told because of California's new um social justice curriculum which basically mandates the teaching of critical race Theory um in in many of its components so social media is uh hugely influential and of course during the pandemic um uh well I shouldn't say of course it seems to be the case that during the pandemic these teenagers were exposed to social media much much more than when they were in the classroom where there was at least some supervision and monitoring of their activities but what you are what you're saying is actually true that the school environment itself can serve as a catalyst here and what ends up happening and I know this just based on conversations I've had with parents and with detransitioners meaning young women who have gone through this process and regretted it um is that what happens is that they get exposed to all the stuff and primed for it online and then they but then they need to be actually go through the social transition itself right they need to show they need to put their money where their mouth is um and they end up going back to school and then a few things happen one is that they get what's known as love bombing um that's when they declare themselves trans and the the local GSA Club the gender sexuality Alliance Club immediately kind of envelops them and says you're authentic and courageous and amazing um there's going to be a a number of teachers and school counselors who immediately come to their to this child's Aid and says you're courageous and authentic and I love you nowadays the language the preferred language that they use is we are your real family now we're your family they use they use that language um and so the presence of so to speak affirming adults is made possible by the return of these young girls to school whereas if they had stayed home they probably their parents bought probably would be at the very least suspicious um uh whereas in school partly because of the incentives the civil rights laws that they face but partly because of school culture and who the teaching profession tends to attract they're much more likely to encounter an immediate and uncritical affirmative environment two and please um Leo I've learned so much from you as and you were very affirming of me when I was a uh you know several years ago a struggling clinician trying to make sense of all this um is one aspect of what you said that I question and that that has to do with the um issue of confidentiality between kids and parents um I I haven't read a lot of the uh research about this but because I don't have many of these kids in my particular practice but a couple and so when that happens I'm sort of uh all of a sudden intensely trying to find out more find out more and listen closely and one of the um helpful articles from the American Pediatric Association showed there was a very uh troublingly a troubling uh number of kids who identify as trans who also report experiencing physical and sexual abuse in their homes and so when you think about talking to a young teenager who's in a home where in a particular instance I'm thinking of where I began to wonder about the question of abuse on the parents side um the the assumption that you're going to have wise compassionate parents who are going to respond well to a child saying something that's troubling controversial um maybe even doing so reactive to feelings about their body that have come up through a terrible history um I think the assumption that school Authority school counselors psychologists should out of some ethical responsibility always inform parents has risks that's a great Point um so let me say a few things about this um I'm not aware of kind of the the the research that gets into um the the family environment of these kids and what exactly it is and and I think no less important to history um of that uh of those interactions because one thing that it will be very useful to know is you know when when so to speak trans kids report high levels of sexual abuse or uh or physical abuse at home one immediate question to ask is what's the causal link here is the abuse because they came out as trans or is they're coming out of trans somehow linked to pre-existing physical and sexual abuse we don't know that um I I don't know any research on that question um posed in that way but there may be there may be research on that so that's one just one thing to keep in mind I mean you're certainly right that um that it would be hard for for a parent to immediately kind of Express uh you know to affirm their child and their new gender and what have you but based on I think both the research and the common sense um it's it it's not good for parents to do that that's that's irresponsible I think um partly because we know that the vast majority of kids of these kids will desist and come to terms with their sex um and partly because I think it's the you know the role of the parent is to is to be proceed with Extreme Caution here is to say you know I love you and support you no matter what but you know let's let's think about what's go what's what's going on in your life and maybe there's things that we're not seeing here I mean um so it all I guess it all depends on what you would Define as a supportive family environment and this becomes a very um important concept because you see this in a lot of research articles and a lot of political a lot of policy activism where activists will say things like um these kids come from a non-supportive home so um their school districts across the country that now have explicit policies that say teachers should only report on a gender transformation to the student's parents if the teachers believe that the student comes from a sub if the teacher has reason to believe that the student's parents are going to be supportive what does that mean um does that mean agree uncritically with the child's new gender or does that mean say something like um you know you might be going through a phase um I'm not going to use your your new name and pronouns but I love you no matter what and I'm here for you and I'll support you according to activists that's an unsupportive parent um which leads to the final thing that you said um which is you know what are teachers supposed to do in this kind of situation right if they do think that there's actual abuse going on you know my answer to that is increasingly becoming called Child Protective Services that's not the role of a school um teachers are not the ones who are supposed to decide whether whether a student's parents are supportive and in what way they're supportive if a teacher actually has grounds to believe that there's physical or sexual abuse going on in this in the home call Child Protective Services it's not your role um but if if no call to Child Protective Services is made I'm I'm inclined to think that it's probably because the teacher doesn't think that there's actual abuse going on but merely a lack of support for the new declared gender and again that lack of support given what we know from the research is good thank you Army please a comment and two questions first I was struck by what you said earlier that uh some of these girls would look at Social Justice and they dislike the white supremacist movement all that and I found it sort of incongruous that they would then want to become white males which usually the target of uh of of all this objection yeah this the second the question is uh we frequently have to draw lines in the gray we decide 18 you can vote below that you can't 21 you can drink below that you can't we we do that because things are are it's hard to come up with definitive lines would an appropriate policy be to say you're a child and you may have all sorts of thoughts that may or may not hold to adulthood but a decision like this you cannot Implement until you learn adult we can pick 18 or 21 whatever it is but make that the policy because we have to decide something to resolve what seems to be really a mess and the second question is are there others like you who are pushing back is there is there any kind of beginning of an an intellectual movement among researchers and Scholars who are beginning to raise the questions that you're raising and producing scholarly papers in support of that okay um regarding your first comment yeah you would think that opting into being a white male is exactly is is wrong-headed from their perspective um but there's a there's a kink here which is that uh they're opting into being a trans male they're opting into the trans category which you know in and of itself puts them very high on the on the victim um totem pole um so so that's that's fairly easy to dispense with you know there's obviously a contradiction there right because if they're trans male then they're not really a male and if they're really a male then they haven't opted out of of being an oppressor right so uh um but these are don't forget these are 14 year old girls we're talking about they're not professors of philosophy um okay so why not delay decisions uh why not have an arbitrary cutoff line I mean that is essentially the position that many people take um it's not very arbitrary either um you know we can say 18 is the age of adulthood for a lot of other important decisions credit cards things like that why not with this one um some people go even farther and say look um you know we know that cognitive development happens until age 25 and so these decisions should be delayed until after age 25. um not 18. um what I will say is that maybe let me just kind of give a very short um uh background in terms of the the original rationale for Pediatric transition as articulated by the Dutch Dutch researchers at the University of Amsterdam in the 1990s um was this the lifelong distress that these people uh transsexuals as they were called at the time uh are likely to suffer that distress is not because of how Society views them necessarily rather it's distress because of their physical bodies their physical bodies cause them to stress and specifically their secondary sex characteristics so if we're talking about male to female transitioners the fact that they have big hands a lot of muscle and Adam's Apple a deep voice um high cheekbones right all these all these secondary sex characteristics make them feel um dysphoric um and severely so so the thinking among the Dutch clinicians was look we need a way to prevent these features from coming into the into existence in the first place that's going to be the most effective it's almost like a preventative type of medicine right that's going to prevent them not only from feeling distressed in the future but it's actually going to reduce the likelihood of them ever needing these complicated expensive and very risky surgeries um so you know if we can nip it in the bud if we can get them early on um we can think of it as a type of preventative medicine so there is a kind of a rationale for these procedures but of course then that gets into the whole question of can children meaningfully understand what what they're sacrificing here and especially considering that the costs the sacrifices are almost never articulated to these kids in a way that's clear and honest I think it's it's it's really troubling um so you know the final question is there a coalition opposing this stuff yeah um it's just that you know you don't hear about uh these people very often in the left of center Media or if you do it's it's uh it's because we have been demonized um in the right of Center media there's quite a bit of coverage uh of of people uh acting in this area um journalists researchers organizations um it's becoming quite robust to be honest um so there is opposition but you know the obstacles are formidable because um you know you're talking about um a lot of these Elite institutions um AAP Academia peer-reviewed journals uh Democratic Party The New York Times editorial board it's very very difficult to get them to even consider that there's another perspective let alone to kind of give that perspective um it's it's charitable due so yes there's movement underway but it's uh and and we have made some progress over the past few months but it's going to take a lot more I have two questions I'm using my privilege here and what was the argument of the Trump appointed federal judge that as Federal Society judge I'm curious about that my my second question is more normative and personal um are there people who have a very strict sense of men or men women are women there is no third thing who will not refer to trans men as she I I don't know what to do about this anymore I you know out of kindness out of not it was fine to say deodor mykoski she no skin off my back I'm becoming increasingly hostile to have to do this I don't want to do this anymore because I see where this leads but it's almost impossible when there's name changes when there's you see this everywhere so what's the Practical what's a practical way to navigate this difficulty um okay good questions um regarding the uh Agnes Tucker lawsuit that was the a lawsuit out of um Alabama um the judge there's judge Lyles Burke um Trump appointee and you know his his temporary injunction basically was based on two arguments one is an argument about parental rights um that this really infringes this this prohibition infringes on the right of parents to direct the medical uh medical care of their children and in a way that to the extent that this becomes a precedent and it might I think that that's actually quite useful um because I I would imagine just based on my understanding of the field for every one parent who wants to transition um his or her kid there's 10 parents who want to put on the brakes or stop it so if we could get kind of a robust judicial doctrine of parental rights on this issue and there there's an organization a couple organizations legal advocacy organizations already working on this um there are a few lawsuits underway in a number of states on this question um that's not necessarily A Bad Thing um the reason though that he struck down the prohibition on puberty blockers and cross-sex hormones is basically that um it was against the considered Judgment of um 22 major medical organizations that filed an amicus brief on behalf of the ACLU um and judge Burke basically said look I'm not an expert right judges are are generalists they don't have a lot of time on their schedules they can't familiarize with themselves with the clinical literature um but by virtue of their institutional incentives and position they're almost guaranteed to defer to uh uh experts especially when all of the major professional organizations line up on one side and a a few smaller outliers line up on the other side so that's not that's not terribly surprising um on your question of pronoun etiquette I wrestle with this myself um yes there are some people who just will not use pronouns that don't uh coincide with biological reality um I'm not one of those people um if I'm interacting directly with a transgender woman I'm gonna use she and um yeah in her in her presence right because we don't use these pronouns when directly addressing someone that's in their presence um I won't use they I don't do that because that already gets into kind of a queer Theory ideology that I think is just too it's too jarring um so I don't do Neo pronouns um I'll just refer to a person with their name over and over and over again even though that's awkward too um so you know anytime somebody asked me this question my advice is if you're in a one-to-one setting with a person who is civil with you um there's no reason to be um you know not pleasant uncivil about it but at the same time it's important to recognize that we don't want to um we don't want to normalize and we don't want to create the impression that there's nothing um nothing wrong here that that that being male or female really is just a matter of an internal feeling because that again it bleeds out from popular culture into adolescent culture and it informs how teenagers are thinking about these these um uh what they're going through when they go through puberty and what their options are and we have to be very very careful because they hear that message exactly and I increasingly think that trying to split the difference as in so many of these issues is just not going to work and you have to fight the bullet but okay um Keith and then Tom thanks so much and thank you for the very informative presentation um I have a bite the bullet kind of question stepping back from policy here and you've referred kind of or alluded more to the Precedence of the homosexual rights movement to this to the trans movement and also maybe to I think you've alluded to and you've written about also some tension between homosexual rights and trans rights and so I guess I'm wondering if in your study of this has um has your work caused you to question uh the application of Rights language uh also to homosexuality and the consequences that follow from that in terms of legislation education social practice and convention at all or do you draw a very hard line based upon facts of either nature or convention between the trans movement and how it should be treated and the homosexual movement yeah uh it's a it's a it's a big question um you know uh I think one thing maybe to observe is just that uh well two things one is that the gay rights movement especially after kind of the late 70s and early 80s it it congealed more or less into a Libertarian uh movement with a strong libertarian streak which is not to say that they didn't want some kind of cultural transformation but it was mostly about you know leave us alone so you know get rid of all these State prohibitions on same-sex sexual acts get out of our bedroom um um you know and then the two major issues after that became employment non-discrimination so don't refuse to hire or don't fire us or don't not promote us just because we're gay um which I think is a perfectly sensible and reasonable position I agree with it um uh with of course some exceptions for religion and things like that as necessary and of course the marriage question on the marriage question you know my position was always that this is a policy question it's not just this abstract question of Rights there's costs and benefits to legalizing um same-sex marriage and my objection at the time when when the Supreme Court came out with its decision in 2015 was was not to the policy decision itself but to the way in which it was framed as there could be no legitimate objection to this right that there's going to be no Associated costs um no unintended consequences anybody who raises any objections is um is a bigot um so that that's a position I never found very compelling um but again you know the the gay rights movement for at least for the last 30 40 years has had a pretty strong Live and Let Live streak and the other I think it very in a way that the trans movement clearly does not and that um ties into the second really important difference which is that um you know if you if you're uh if you're if you have a religious Faith convictions on this issue you know you might think that that a homosexual style lifestyle is very damaging to the soul and things like that um you know fine um I don't believe that but but it but but some people do and I don't I don't begrudge them that belief I don't think the same can be said here um to undergo medical transition is by definition to impose on yourself a whole host of medical risks and a psychological risks and and to have to live with the consequences for the rest of your life and if you're adult you know you can make that calculus for yourself but if you're a child you can't possibly what 14 year old girl can say I know I don't want to have kids when I'm in my 20s and I know I never want to have kids in life you you know your mind is likely to change um so in that in that regard there's an obvious and huge difference between these two movements thank you thank you Tom uh Keith and I were going down the same path um the the gay marriage support in this country was very fast swept along very fast after Margaret Marshall and the SJC led the way in Massachusetts but it seems to me the transgender transgender support has a great big obstacle in supporting um transgender people and um saying that they're women in sports that's not religious it's a fairness issue seems to me there's a lot of sort of progressive and well people who've taken well say our side on this one I just wondered whether you think that's uh sort of a big obstacle to the the wide acceptance of transgender genderism and medical treatment for it in fact yeah uh it's a good question I think the sports is really kind of a um is one of the Achilles heel of the trans movement and uh I think we saw that especi in the events surrounding Leah Thomas which I've written about on a number of occasions I'm actually supposed to go to UPenn a few weeks and give a talk there um they want I think they want me to talk about Leah Thomas but I think that's in bad taste um look it's interesting that when you look at trans rights organizations like the ACLU and glsen a Human Rights Campaign I believe has also come out with statements to this effect it's very interesting that in almost every other aspect of public policy and public life they will say gender identity determines whether a person is male or female there's no such thing as biological sex anybody who thinks there is is an ignorant bigot case closed but not when it comes to sports when it comes to sports their position is total prohibition on when trans women participating in female sports is unconstitutionally Broad that's it that's their position meaning according to their logic it's acceptable and maybe even necessary in the interest of fairness and safety to exclude at least some individuals who have a female gender identity from the female category of sports so clearly they have two separate philosophical anthropologies one for sports and one for every other domain of public life and public policy um I've called out this contradiction a number of times I've I've never seen it addressed anywhere by by activists on the other side they just they're perfectly happy to let it um persist um but you are certainly right that the sports issue is where the rubber meets the road and I should say one one more thing as a student of chefs um it's been really surprising and Chef maybe you can uh chime in here too it's been really surprising to see conservatives line up behind women's sports over the last few years in the wake of the trans issue and I don't just mean kind of you know quietly agree that Title IX should protect women's sports against trans identity against female identified males I mean conservatives making positive arguments on behalf of the benefits of women's sports which I think is is is not a good idea um I I think Title IX sports have corrupted the university I don't think it's good that conservatives are are now lining up behind it as if it's you know our Saving Grace here um but it does hold activist feet to the fire and force them either to have a consistent position on what it is that makes a person female um or to concede and this is I think what what you can see in some of the court cases on Athletics on this issue um to concede that if gender identity is not the only thing that determines whether someone is male or female the reason for that is because it depends and it depends on what the trade-offs are but if it depends on what the trade-offs are then that is also true of other areas of policy like bathrooms and prisons and and all these other areas that are being litigated and and then it's no longer just a question of Rights it's a question of policy of trade-offs um but of course the other side is not willing to frame it that way they can they insist that it's a simple straightforward question of Rights so I I think keeping open the sports issue is extremely valuable for those of us pushing back against gender identity policies because it forces the other side to recognize that there are in fact trade-offs and therefore that we cannot resolve these issues by abstract right stock now we can take a few more questions because we can go over time a little bit more but um if there are none I do have a prison because since you brought it up is there any legal recourse for women um who had have had to deal with a male in their midst um and have been assaulted or raped or I don't know whatever um are there area are there paths open for women to uh to sow I know so I actually this is one area of policy that I'm not very familiar with um I I know that there have been some laws and some court cases on this question in the last year or so um uh I I I don't know to be honest I don't know there's a question uh they are what about pronouns uh you mentioned them several times but um is it is it would seem from what you say that it's not harmless for universities to require people to State their pronouns it makes it seem that you have the right to choose your sex right um so I was expect I was focusing that argument especially on K-12 education because that's where you know uh kind of vulnerable um um teenagers especially female teenagers can uh where the social transition can um lead them to want to medicalize um I think in the context of colleges it's slightly different not maybe there are there's some overlap but slightly different though um but yes I you know I think there is a kind of a school to Clinic pipeline argument to be made for universities as well um of course they're you know complicating factors that they're adults that there's no parental notification requirements um um but yeah that that's what I would say that that the the school to Clinic pipeline concern does I think should come up in the context of universities but not nearly as much as um in K-12 schools thanks very much okay I'll be very short uh you are uh inviting me to say a word about Athletics but um the Assumption behind Athletics is that because there are biological differences between men and women we shouldn't be on the same team um so it really makes a difference if we're talking about policy about areas where we're segregating by sex or Not segregating by sex so most Bostock decision says you can't discriminate on basis of uh uh transgender status for if people have equal ability to do a job and to me I'm quite happy to say that but the big question is um when you are obliged to segregate by sex what do you mean by that and the reason that Athletics is such a big problem is because the reason that we segregate is because we recognize there's this big biological difference so if you say biology doesn't matter that that's that's uh the response to that is we shouldn't have two different sets of teams and I'll just say one more thing you're talking about the corruption of uh Athletics and colleges by college sports related to Title IX I would I think the biggest corrupting influence is the NCAA which has really bought into we're going to be the promoter of women's sports and we're going to do it on the male model which I think is a fundamental mistake yeah no I mean those are good points um you know I I think pretty much all policy controversies on the trans issue um schools prisons medicine um they all revolve essentially around the question of you know there's a few areas in life where sex actually matters nowadays um and so what should be the definition of sex meaning of male and female um should it be a matter of anatomy chromosomes functions all these kinds of um traits or should it be a matter of um sincere self-assertion authenticity or whatever you want to call it um and again as I explained when I went over kind of the philosophical assumptions of gender affirm and care it really is crucial to that medical protocol um the belief that um sex is a social construct but gender identity is an innate quality of course they're never going to use the word soul but they do think of gendered souls um in sexed bodies um and and that um and that it matters um whether you're male or female so right so contrary to queer Theory and then it matters that others recognize you as being male or female and that's why they recommend um medic medical and surgical procedures so that you appear in the typical in the body typical of members of of the sex that you claim to be so um you're right there's very few areas of life that where sex actually matters and and sports um is an obvious example of them and you know I don't think you're ever going to get a trans rights organization agree um that biology matters in sports but at the same time in their arguments they imply exactly that Leo thank you on this talk and How Deeply irrational animals we are thank you say the last word all right all right thank you thank you a very powerful argument and a lovely combination of philosophy and policy thank you thank you Harvey

Channel: Program on Constitutional Government at Harvard

Views: 6,413

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Id: LwbCDYZlAXw

Length: 101min 23sec (6083 seconds)

Published: Thu Jan 12 2023