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False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used to legislatively restrict transgender people's healthcare.[1][2] The claims have primarily relied on manufactured uncertainty generated by various conservative religious organizations, pseudoscientific or discredited researchers, and anti-trans activists.[3]

Common false claims include that most people who transition regret it, that most pre-pubertal transgender children "desist" and cease desiring transition after puberty, that gender dysphoria can be socially contagious and rapid-onset or caused by mental illness, that medical organizations are pushing youth to transition, and that transgender youth require conversion therapies such as gender exploratory therapy.[4][5][6]

Misinformation has affected the decision of the United Kingdom to reduce use of puberty blockers for transgender individuals.[1] Elected officials in Central and South America have called for legislative bans on trans healthcare based on false claims. Misinformation has been platformed and amplified by mainstream media outlets.[7] Medical organizations such as the Endocrine Society and American Psychological Association, among others, have released statements opposing such bans and the misinformation behind them.

Origins

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Transgender healthcare misinformation primarily relies on manufactured uncertainty from a network of conservative legal and advocacy organizations.[8][3] These organizations have relied on similar techniques to those used in climate change denialism, generating exaggerated uncertainty around reproductive health care, conversion therapy, and gender-affirming care.[3]

According to the Southern Poverty Law Center (SPLC), the hub of the pseudoscience movement is the Society for Evidence-Based Gender Medicine, which was closely related to Genspect and Therapy First.[6] A Yale School of Medicine report described them as spreading "biased and unscientific content" and "without apparent ties to mainstream scientific or professional organizations".[3]

Other notable producers of anti-LGBTQ misinformation and disinformation include the evangelical organizations the Alliance Defending Freedom, American College of Pediatricians, and Family Research Council.[6][3] These efforts have been aided by scientists who were once dominant in transgender care but are now fringe such as Ray Blanchard, Stephen B. Levine, and Kenneth Zucker.[9][3] Misinformation and disinformation about transgender health care sometimes relies on biased journalism in popular media.[4]

Common misinformation

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Detransition and transition regret

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Main article: Detransition

"Detransition" refers to the cessation of gender-affirming care and does not necessarily require a reversal of transgender identity or regret for past transition. Data suggests that regret and detransitioning are rare, with detransition often caused by factors such as societal or familiar pressure, community stigma or financial difficulties.[4][3]

In the United States and United Kingdom, conservative media outlets and the Alliance Defending Freedom have promoted high-profile detransitioners and advocacy groups who argue that detransition and transition regret are prevalent.[3] The global anti-gender movement has also relied on these inflated statistics.[10] States in the United States have primarily relied on anecdotes to argue detransition is cause for bans on gender affirming care.[4] Detransitioner Chloe Cole has supported several such state bans as a member of the advocacy group Do No Harm.[4][11] Former detransitioners Ky Schevers and Elisa Rae Shupe have detailed how they were recruited by organizations and activists who used their stories to limit transgender rights before they retransitioned and started working against them.[11][12][13]

Desistance myth

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See also: Gender dysphoria in children § Persistence

The desistance myth[14] is the theory that majority of pre-pubertal youth diagnosed with gender dysphoria will "desist" and stop desiring to transition by adulthood without intervention. It relied on studies that had serious methodological flaws such as low sample sizes, outdated diagnostic frameworks that conflated gender non-conformity with transgender identity, usage of conversion therapy on the sample population, and poor definitions of desistance.[4][8][15] Most youth sampled in them never identified as transgender nor desired to transition, but were counted as desisting.[8]

The claim has often been used to support the criminalization of gender-affirming care.[16] The term "desistance" was first used for trans children by Kenneth Zucker in 2003, who borrowed the term from its usage in Oppositional Defiance Disorder which stemmed from its usage in criminology, where in both cases it is regarded as a positive outcome.[17] The myth was primarily popularized in a commentary by James Cantor in 2020, who argued based on the outdated studies that most children diagnosed with gender dysphoria will grow up to be gay and lesbian adults if denied such care.[4][8] Recent work has found the vast majority of pre-pubertal children who express transgender identities and socially transition with parental support continue to do so in adolescence.[4][15]

A systematic review of research relating to the topic in 2022 found it was poorly defined: studies sometimes did not define it or equally defined it as desistance of transgender identity or desistance of gender dysphoria. They also found none of the definitions allowed for dynamic or nonbinary gender identities and the majority of articles published were editorial pieces. In total, thirty definitions for desistance were found from 35 pieces of literature. This included 5 quantitative studies that cumulatively found 83% of 251 people desisting, but the review described these quantitative studies as "all poor quality", with none of them having "explicitly defined desistance". The review concluded that desistance was based on biased research from the 1960-80s and poor quality research in the 2000s. They concluded there was a "dearth of high-quality hypothesis-driven research that currently exists" on the subject, and suggested that desistance should "be removed from clinical and research discourse to focus instead on supporting [transgender and gender-expansive] youth rather than attempting to predict their future gender identity."[17]

Transgender identity as a mental health condition

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Legislative efforts to ban gender affirming care in the United States have relied on the unfounded narrative gender dysphoria is caused by underlying mental illness, trauma, or neurodivergence, such as autism and ADHD.[4][15][2] Though transgender people have higher rates of mental illness, there is no evidence these cause gender dysphoria and evidence suggests this is due to minority stress and discrimination experienced by transgender people.[4][15] The American Psychological Association stated "misleading and unfounded narratives" such as "mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence" have created a hostile perception for trans youth.[2]

Social contagion and rapid onset gender dysphoria

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Main article: Rapid-onset gender dysphoria controversy
An illustration by Catherine Lockmiller of the cyclical pipeline between transgender healthcare misinformation and anti-trans legislation featuring ROGD as a case study
An illustration by Catherine Lockmiller of the cyclical pipeline between transgender healthcare misinformation and anti-trans legislation featuring ROGD as a case study

In 2018, Lisa Littman authored a study that has since been heavily corrected, arguing modern youth are experiencing a new type of gender dysphoria, "rapid onset gender dysphoria" (ROGD), which is spread through social contagion and peer groups.[4][15][9][18] The study relied on anonymous parental reports on transgender children collected from websites known for anti-trans misinformation and gender-critical politics who were informed of the study's hypothesis.[4][15][9][18]

While there is no empirical evidence to support the hypothesis, it has been heavily referenced in discourse about transgender youth.[18][4][19] In 2021, a coalition of psychological professional bodies issued a position statement on ROGD that supported eliminating the use of ROGD, clinically and diagnostically, "given the lack of rigorous empirical support for its existence". It stated that "there is no evidence that ROGD aligns with the lived experiences of transgender children and adolescents" and "the proliferation of misinformation regarding ROGD" led to "over 100 bills under consideration in legislative bodies across the country that seek to limit the rights of transgender adolescents" predicated on its "unsupported claims".[19]

Psychotherapy and conversion therapy

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See also: Conversion therapy § Gender identity change efforts (GICE)

Proponents of bans on gender-affirming care in the United States have argued that youth should receive psychotherapy including gender exploratory therapy (GET), a form of conversion therapy, instead of medical treatments.[15][20] Practitioners of GET frame medical transition as a last resort and argue their patient's gender dysphoria is caused by factors such as homophobia, social contagion, sexual trauma, and autism.[21][22] Some practitioners avoid using their patients' chosen names and pronouns while questioning their identification.[23]

There are no known empirical studies examining psychosocial or medical outcomes following GET.[23][24] Concerns have been raised that by not providing an estimated length of time for the therapy, the delays in medical interventions may compound mental suffering in trans youth,[21][23] while gender-affirming model of care already promotes individualized care and gender identity exploration without favoring any particular identity.[23] Commenting on gender exploratory therapy in 2022, bioethicist Florence Ashley argued that its framing as an undirected exploration of underlying psychological issues bore similarities to gay conversion practices such as "reparative" therapy.[25]

Multiple groups exist worldwide to promote GET and have been successful in influencing legal discussions and clinical guidance in some regions.[26] Therapy First (TF), previously named the Gender Exploratory Therapy Association (GETA), asserts that "psychological approaches should be the first-line treatment for all cases of gender dysphoria", that medical interventions for transgender youth are "experimental and should be avoided if possible", and that social transition is "risky".[20][27] All of TF's leaders are members of Genspect and many are members of the Society for Evidence-Based Gender Medicine (SEGM), which both promote GET and argue that gender-affirming care should not be available to those under 25.[27][6]

Blanchard's transsexualism typology

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Main article: Blanchard's transsexualism typology

In the 1980s and 1990s, Ray Blanchard developed a theory and typology of transfeminine people, classifying them all as either "homosexual transsexuals" – straight transgender women who are alleged to be homosexual men who transitioned to seduce straight men – or "autogynephilic transsexuals", who medically transition due to an alleged sexual fantasy or fetish of being a woman.[28][29] It was popularized in 2003 by J. Michael Bailey in his book The Man Who Would Be Queen and heavily promoted by the far-right Human Biodiversity Institute of which Blanchard is a member.[30][31] There is little to no evidence for the theory and it has been criticized on numerous grounds.[29][28]

He did not empirically derive the subtypes but created them by grouping trans women based on sexual orientation, disregarded their lived experiences, ignored that cisgender women also report autogynephilia, and sexually objectified trans women. He also assumed causality, that transgender women have gender dysphoria and desire to transition due to their fantasies, rather than their fantasies being due to their identity.[28] Studies have criticized the conceptual flaws and empirical errors in the theory. Transfeminist Julia Serano has summarized the debate in this way: "If proponents of autogynephilia insist that every exception to the model is due to misreporting, then autogynephilia theory must be rejected on the grounds that it is unfalsifiable and therefore unscientific. If, on the other hand, we accept that these exceptions are legitimate, then it is clear that autogynephilia theory's two-subtype taxonomy does not hold true."[28]

Untrustworthiness of medical organizations

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Though every major medical organization endorses gender-affirming care, proponents of gender-affirming care bans in the United States argue the mainstream medical community is untrustworthy, ignores the evidence, and that doctors are pushing transgender youth into transition due to political ideology and disregard for their well-being.[15][4] This extends to claims that standards of care and guidelines from reputable medical organizations do not reflect clinical consensus.[4]

Children are transitioned too quickly

[edit]

Opponents of trans rights and trans healthcare have argued that gender-nonconforming youth are being pressured into transitioning. However, few providers offer such care and it requires parental consent, health insurance approval, social transition, and psychiatric assessment.[5] This has included arguments transgender youth are incapable of providing informed consent to medical transition though scientific literature demonstrates that transgender youth, including those with mental health conditions, can competently participate in decision-making.[15][4] This also extends to arguments that minors are being given gender-affirming genital surgeries routinely. However, records of minors such surgeries are very rare, and most of the recorded minors have been 17 years old with full parental support.[32] Prior to the onset of puberty, children are only eligible for social transition, with puberty blockers not given until puberty's onset.[33]

In a June 2023 statement, the Endocrine Society released a statement emphasizing "pediatric gender-affirming care is designed to take a conservative approach". It explained that younger children are supported in exploring their gender identity as needed, while medical interventions are reserved for older adolescents and adults and tailored individually "to maximize the time teenagers and their families have to make decisions about their transitions". They concluded that major medical organizations agree on waiting until individuals are their country's age of majority for genital surgery.[34]

Schools are medically transitioning children

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In 2024, former United States president Donald Trump attended a Moms for Liberty rally and stated children were being given gender-affirming surgery at school, and continued to repeat the claim. As of September 2024, there was no evidence that any school in the United States had provided gender-affirming surgery to a student.[35][36]

Impact

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Legislative impacts

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Australia

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Australian legislators and media have increasingly spread misinformation and disinformation about detransition rates since 2022, relying on the efforts of apparently astro-turfed organizations such as Genspect and the Society for Evidence-Based Gender Medicine and local groups such as Binary Australia and the Australian Christian Lobby.[37]

Europe

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According to Transgender Europe, as of 2024, member states of the European Union were broadly not moving towards bans and there was "significant disinformation around the real state of affairs" of trans-specific care in Europe, though transgender people were still often pathologized and mandated to undergo psychiatric diagnosis.[38]

Norway
[edit]

In 2024, a false claim that Norway had banned gender-affirming care for minors was widely circulated on social media. An independent non-governmental Norwegian healthcare board proposed increased restrictions on such care but not an outright ban. It did not have the power to implement these policies, and the governmental body for medicine, the Norwegian Directorate of Health, did not implement any bans and was only considering the recommendations.[39]

United Kingdom
[edit]
See also: 21st-century anti-trans movement in the United Kingdom

The Cass Review—a non-peer-reviewed independent evaluation of trans healthcare within NHS England—said that there was a lack of evidence to support trans healthcare for children.[40] The Cass review was widely welcomed by the UK's medical establishment[41] though professional organizations, transgender health providers, and LGBTQ rights groups criticized the review's finding internationally.[42][43][44][45][46][47] It was criticized for lack of transparency and exclusion of transgender expertise.[42][48][49][50] Disputed aspects of the report include allegedly pathologizing language,[43][48] claims that a majority of transgender youth desist,[48][51][52] endorsing gender exploratory therapy[48][46][51], and implying poor mental health causes children to be transgender.[52][48][53] UK charity Mermaids said that the Cass Review had been both misrepresented in the press as supporting a ban on transition.[54] Amnesty International criticised "sensationalised coverage" of the review, stating it was "being weaponised by people who revel in spreading disinformation and myths about healthcare for trans young people".[55]In March 2024, NHS England instated restrictions on use of puberty blockers for the treatment of gender dysphoria in adolescents, only allowing them within clinical trials.[56] In May 2024 the UK government enacted a ban on puberty blockers based on the report.[56][57]

Latin America

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As of February 2024, Mexican federal deputy Teresa Castell [es] of the conservative National Action Party had repeatedly claimed that gender dysphoria resulted from mental illness or perversion and required psychological treatment.[58] One party deputee pushed an initiative to ban transgender healthcare for minors and criminalize pressure from "an adult for the determination of sexual identity ... contrary to their biological identity" arguing that minors are incapable of knowing their gender identity.[59]

In late September 2024 in Colombia, far-right groups and organizers who successfully lobbied against a national ban on conversion therapy spread a hoax that the Superintendent of Health had promoted genital surgeries for three year olds. Despite fact checking from independent reporters, the President (Gustavo Petro), and the Superintendent of Health (Luis Carlos Leal) the hoax has continued to be popular.[60]

In Brazil in November 2024, many politicians and political candidates relied on anti-trans rhetoric and misinformation during their elections, including claims that transgender children don't exist or are being co-opted into being trans by advocacy organizations.[61][62]

United States

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See also: 2020s anti-LGBTQ movement in the United States
States with laws limiting youth access to gender affirming care as of 2024
States with laws limiting youth access to gender affirming care as of 2024

Misinformation and disinformation have led to proposed and successful legislative restrictions on gender-affirming care across the United States.[1][36] As of November 1, 2024, 26 states in the United States have passed bans on gender-affirming care for minors and 16 have passed shield laws and executive access protecting such care.[63] In December, the Supreme Court of the United States considered United States v. Skrmetti, a case on the constitutionality of Tennessee's on gender-affirming care for minors. Multiple doctors known for peddling misinformation about transgender healthcare such as Stephen B. Levine and James Cantor in addition to various SPLC-designated anti-LGBTQ groups testified in support of the ban.[64][65][66]

Media impact

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Mainstream media outlets such as The Atlantic, Washington Post, and New York Times have platformed and amplified misinformation, with the New York Times' coverage of transgender healthcare particularly criticized.[7] In November 2022, WPATH released a public statement criticizing misinformation in a commentary from the New York Times.[67] In February 2023, over 1000 NYT contributors signed an open letter criticizing the paper's coverage, which was signed by an additional 30,000 supporters within a week. They argued the paper "treated gender diversity with an eerily familiar mix of pseudoscience and euphemistic, charged language, while publishing reporting on trans children that omits relevant information about its sources" and noted how its articles had been used to support anti-trans healthcare bans.[68][69] A second letter by GLAAD signed by over 100 LGBTQ and civil rights groups including the Human Rights Campaign and PFLAG was released the same day arguing that the New York Times platformed "fringe theories" and "dangerous inaccuracies".[70]

Bomb threats against Boston Children's Hospital

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Entrance to the Boston Children's Hospital
Boston Children's Hospital was subject to bomb threats following disinformation about the hospital's gender-affirming care.

In August 2022, Chaya Raichik, owner of the far-right social media account Libs of TikTok, claimed that Boston Children's Hospital (BCH)[71] and Children's National Hospital (CNH) were providing gender-affirming bottom surgeries to minors.[72] With the BCH-related content, Raichik included a BCH video that featured one of the hospital's gynecologists explaining the procedure.[71] While USA Today,[73] NPR,[72] and PolitiFact[74] concluded that BCH claim was false, several conservative outlets—including The Daily Caller and The Post Millennial—republished the claims.[75][76][73][77] After the Libs of TikTok posts, each hospital's employees were subject to harassment,[78] and both BCH and CNH were subject to bomb threats,[84] though it was unclear whether each of the threats were related to the harassment.[80] NBC News described Libs of TikTok as "one of the primary drivers of the harassment campaign" against BCH.[85]

Responses from medical organizations

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In June 2023, The Endocrine Society released a press release stating "widespread misinformation about medical care for transgender and gender-diverse teens" had resulted in 18 US states banning such care, including for adults. They stated "these policies do not reflect the research landscape. More than 2,000 scientific studies have examined aspects of gender-affirming care since 1975, including more than 260 studies cited in the Endocrine Society's Clinical Practice Guideline."[34]

The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Urological Association, the American Society for Reproductive Medicine, the American College of Physicians, the American Association of Clinical Endocrinology, GLMA: Health Professionals Advancing LGBTQ+ Equality, the American Medical Association (AMA), AMA's Medical Student Section cosponsored an Endocrine Society resolution "opposing any criminal and legal penalties against patients seeking gender-affirming care, family members or guardians who support them in seeking medical care, and health care facilities and clinicians who provide gender-affirming care."[34]

In February 2024, the American Psychological Association released a policy statement which included:

[T]he spread of misleading and unfounded narratives that mischaracterize gender dysphoria and affirming care, likely resulting in further stigmatization, marginalization, and lack of access to psychological and medical supports for transgender, gender diverse, and nonbinary individuals [...] [T]he APA opposes state bans on gender-affirming care, which are contrary to the principles of evidence-based healthcare, human rights, and social justice, and which should be reconsidered in favor of policies that prioritize the well-being and autonomy of transgender, gender-diverse, and nonbinary individuals

In the same statement, the APA urged that the spread of disinformation be curbed via greater and more easily accessible scientific research, describing it as essential for protecting access to gender-affirming healthcare.[2]

See also

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References

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  1. ^ a b c Kim, Hyun-Hee; Thayer, Nova; Bernstein, Caryn; Cruz, Roxana; Roby, Christopher; Keuroghlian, Alex S. (2024). "On the Frontlines: Protecting and Advancing Gender-Affirming Care in a Hostile Sociopolitical Environment". Journal of General Internal Medicine. doi:10.1007/s11606-024-09080-3. ISSN 1525-1497. PMID 39384688.
  2. ^ a b c d "APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science" (PDF). American Psychological Association. February 2024. Retrieved 2024-12-03.
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  4. ^ a b c d e f g h i j k l m n o p McNamara, Meredithe; McLamore, Quinnehtukqut; Meade, Nicolas; Olgun, Melisa; Robinson, Henry; Alstott, Anne (2024). "A thematic analysis of disinformation in gender-affirming healthcare bans in the United States". Social Science & Medicine. 351: 116943. doi:10.1016/j.socscimed.2024.116943. ISSN 0277-9536. PMID 38759383.
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  7. ^ a b Romano, Aja (2023-03-31). "Trans rights are human rights. Journalists are failing both". Vox Media. Retrieved 2024-12-28.
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  15. ^ a b c d e f g h i Alstott, Anne; Olgun, Melisa; Robinson, Henry; McNamara, Meredithe (2024). ""Demons and Imps": Misinformation and Religious Pseudoscience in State Anti-Transgender Laws" (PDF). Yale Journal of Law and Feminism.
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  26. ^ Amery, Fran (2023). "Protecting Children in 'Gender Critical' Rhetoric and Strategy: Regulating Childhood for Cisgender Outcomes". DiGeSt – Journal of Diversity and Gender Studies. 10 (2). doi:10.21825/digest.85309. ISSN 2593-0281. Archived from the original on 24 September 2024. Retrieved 1 January 2024.
  27. ^ a b Santoro, Helen (2023-05-02). "How Therapists Are Trying to Convince Children That They're Not Actually Trans". Slate. ISSN 1091-2339. Archived from the original on 21 January 2024. Retrieved 2024-01-01.
  28. ^ a b c d Rider, G. Nic; Tebbe, Elliot A. (2021). "Anti-Trans Theories". In Goldberg, Abbie E.; Beemyn, Genny (eds.). The SAGE Encyclopedia of Trans Studies. Vol. 1 (1st ed.). SAGE Publications, Inc. pp. 41–42. ISBN 978-1544393810.
  29. ^ a b Pfeffer, Carla A. (2016). "Transgender Sexualities". In Goldberg, Abbie E. (ed.). The SAGE Encyclopedia of LGBTQ Studies, Volume 3. Thousand Oaks, CA: SAGE Publications. pp. 1249–1250. doi:10.4135/9781483371283.n439. ISBN 978-1-4833-7129-0. The term autogynephilia was first used in 1989 by Ray Blanchard, a sexologist, to describe a purported class of transgender women. Classifications of transgender women prior to this time tended to divide this group into those who were sexually and romantically interested in men as 'homosexual transsexuals,' and those who were sexually and romantically interested in women were classified as 'heterosexual fetishistic transvestites.'
  30. ^ Bancroft, John (2009). "Transgender, gender nonconformity and transvestism". Human Sexuality and its Problems (3rd ed.). Elsevier. pp. 290–291. ISBN 978-0-443-05161-6. Controversy over [Blanchard's] division into two types peaked with Bailey's publication of his book The Man who would be Queen: the Science of Gender Bending and Transsexualism (2003), which caused anger and outrage in the transgender community and disapproval among some clinicians working in this field.
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Further reading

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