Part 5: Reversing the Damage of “Irreversible Damage: The Transgender Craze Seducing Our Daughters”. Misrepresenting Data and Experience.
Chapter Eight
Chapter Eight touches on a lot of separate issues. The primary thesis seems to be that trans people have been promoted on a societal level, with Caitlyn Jenner’s coming out being a turning point. Shrier (2020) compares her to others like Bill Cosby and Lance Armstrong, who were both admired until their careers took a downfall (albeit for very different reasons). It’s unclear exactly how all this is related, but I believe the correlation she’s trying to make is that several other celebrities have done bad things (or at least were perceived as having done so), making Caitlyn Jenner being trans not something worth being upset about. Even if true, however, it doesn’t justify the claims she made about trans-identified individuals being “promoted” while the others are “demoted” (Shrier, 2020). Recognition and acceptance for one group does not imply that another group is now less recognized or accepted than before.
The varied topics presented in this chapter are divided into subheadings below.
Language Problems
Shrier (2020) talks about the way female anatomy is discussed in public discourse, calling it grotesque. She refers to using the terminology “people who menstruate” and “pregnant people” as whitewashing anatomy that makes girls less eager to become women. She also displays a lack of understanding about anatomical terms commonly used in the trans-masculine community, acting as if there are activists pushing to replace the word “vagina” with “front hole”. This isn’t the case at all, as the latter term is often used by choice to refer to one’s own genitalia (or to refer to the anatomy of others who have requested such specific terminology). There is no movement to replace the word vagina.
The hypocrisy is evident as she takes issue with the notion of calling people who menstruate “bleeders” (also not something that’s actually being adopted) and the “grotesque” nature of it all. Meanwhile, on the first page of the chapter, she referred to the breasts of a transwoman (she didn’t even see this person with her own eyes) as “two breasts grafted onto a muscular torso like add-ons” (Shrier, 2020, p. 195). As mentioned in discussion of previous chapters, many similar comments are made about transmasculine bodies, even at times referring to specific people. So once again, this seems like a bad faith attempt at describing the social contagion she believes to exist. It also implies that it’s okay to talk about trans bodies in ways that are graphic and hold negative connotations but not non-trans bodies (AKA dehumanization).
No Motivation for Womanhood
Shrier (2020) says men are invading women’s spaces, and it’s no longer desirable to become a woman. She cites sources that show transwomen have taken over sports, except they don’t show that. In fact, the source for swimming says that the transwoman would be competing in the men’s division and wanted to compete in the women’s in the future (but wasn’t at the time). Once again there’s either deliberate presentation of incorrect information or the author didn’t read the cited sources/double check them prior to the book’s publication.
The sports debate is beyond the scope of this article, but the argument she presented doesn’t hold as the sources don’t support her claims; she had two examples of trans-identified women setting records/winning. A sample of two isn’t sufficient to make any definitive claims about anything.
She then literally says girls don’t have romantic comedies anymore to provide them with “fantasy on which to hang their girlish hopes” (Shrier, 2020, p. 209). This is presented as another reason why being a girl isn’t enjoyable anymore. While there was a drop-off in romantic comedies, they had a resurgence starting in 2018, or two years prior to the publication of this book [1]. Moreover, romantic comedies weren’t thrown out to deprive girls of fantasy; it was motivated by pure capitalism [2].
Obviously it’s absurd to use the prevalence of romantic comedies as evidence for the argument that girls don’t want to be girls, but it was presented and thus seemed relevant to refute.
On Pornography
Shrier (2020) discusses that porn is often disturbing to young girls and indicates that there’s been an increase in choking (men choking women) in online porn. Additional research reveals teenage girls reporting having been choked during sex and women stating they had been scared during sex.
The disconnect between porn and actual sexual encounters is definitely something worth exploring. If men are engaging in non-consensual choking that needs to be addressed. Ideally it would be done prior to an intimate encounter by simply talking to the other person about what they’re comfortable with.
However, Shrier (2020) doesn’t talk about the ways we might mitigate the influence of unrealistic pornography or encourage consent, such as with better sexual education. Instead, she uses this as another reason why girls don’t want to be girls. One of the gender therapists she interviewed told her that a major factor in the dysphoria many of her clients is a negative response to pornography.
It’s not unreasonable to consider that in light of these issues, a girl might decide she’d rather not be intimate with a guy or even wish she didn’t have a female body that could be desired by predatory men. However, it does not follow that these feelings cause gender dysphoria, and as acknowledged in a previous article, the gender affirmation model encourages evaluating the whole patient, which would include concerns about sexuality/sexual experiences. It seems Shrier is confusing discomfort with one’s body and/or a fearful/anxious response after exposure to graphic and possibly even violent porn with the experience of gender dysphoria.
Disclaimer: This isn’t to suggest that gender issues can’t emerge from sexual problems and/or abuses. The point is that the gender affirmation model doesn’t (and shouldn’t) require professionals to immediately recommend medical transition to patients who present with symptoms indicative of gender dysphoria. Not only is there the therapy aspect which aims to help the patient explore themselves, but there are so many conservative (non-surgical, non-invasive) ways to socially transition that can help the patient to hopefully better understand their own identities/comfort/preferences with gender expression.
Chapter Nine
This chapter is titled “The Transformation” and primarily focuses on hormones, surgery, and physiology (Shrier, 2020). The various sub-sections are discussed below.
Bones
Shrier (2020) discusses the sexual dimorphism of human bones and how forensic anthropologists can often determine the sex of skeletal remains. Anecdotally, I’ve seen a lot of anti-trans “memes” and discussions that point out something along the lines of: “Well in 1,000 years, someone will dig up your skeleton and say oh this was a female”. This is a non sequitur. The entire reasoning behind medical transition is to align one’s body with the desired sex. If there was a general delusion that one’s body is actually male when it’s female, then there wouldn’t be gender dysphoria.
Additionally, it’s unclear how skeletal remains might be classified in the future, as hormone replacement therapy (HRT) has been shown to alter bone structure in trans-masculine individuals when compared to female controls [3]. Even though Shrier’s point isn’t relevant, it might even be the case that sex designation of remains (that are hypothetically going to be discovered in the future) could be more difficult than she asserts. In fact, one of the easiest bones to differentiate by sex is the pelvis, and pelvic anatomy in female-to-male individuals (after HRT) has been found to show a masculinized structure [4].
Puberty Suppression
Next Shrier (2020) discusses puberty blockers, with sparse references and a lot of bold claims about how it works. For example, she says that “gender doctors” call puberty blockers a neutral intervention. Of course it isn’t a neutral intervention! It’s a medication given to halt a physiological process and it shouldn’t be taken lightly by adolescents or their parents. Calling it neutral, as if medical professionals are casually advocating for puberty blockers, is disingenuous.
In good news (albeit not acknowledged by Shrier), puberty blockers aren’t taken lightly. Guidelines require an adolescent to meet several criteria to be eligible for pubertal suppression, and this includes being free of any potentially conflicting psychological, medical or social issues [5]. This doesn’t mean, for example, an adolescent has to be “cured” of concurrent depression, but they have to be psychologically and medically stable enough to consent to treatment.
Moreover, adolescents under the age of majority can’t independently consent to puberty blockers; parental consent is required [5]. Potential side effects are widely available online and aren’t hidden from the public view to make it seem like these medications are neutral. While much research is still needed to fully understand how pubertal suppression influences development, our current knowledge doesn’t align with Shrier’s claims.
For instance, she points out loss of bone density and increased risk of osteoporosis as a possible outcome of using puberty blockers (Shrier, 2020). While bone density does usually decrease with pubertal suppression, it’s shown to increase to normal levels with HRT (and thus puberty). Similar findings have also been reported for children treated with blockers for precocious puberty [5]. Granted, with the relative dearth of studies and difficulty in obtaining large sample sizes, it would be unfair to assert we know all we need to know regarding bone health in adolescents with gender dysphoria treated via puberty blockers. The point is that initial findings have been replicated and are promising for the resurgence of bone mineral density with puberty onset.
So overall, puberty blockers are supposed to be taken seriously and adolescents have to be considered mentally, physically, and socially capable of undergoing treatment. Shrier (2020) focuses on all the potential downsides without discussion of possible benefits. It’s certainly crucial to acknowledge any side effects (or even definite negative outcomes) of any medical treatment. This is part of ensuring full informed consent from the patient. What she misses are the positive psychosocial outcomes for gender dysphoric adolescents treated with puberty blockers. While correlational, some research suggests that much of the negative emotional experiences teens with gender dysphoria experience is not due to the dysphoria insomuch as being treated unfairly by others, bullied, etc. Puberty blockers actually help circumvent this issue by allowing the person to present as the desired gender without unwanted secondary sex characteristics complicating the process [5].
Testosterone
She blames transmen on social media for praising testosterone’s effects yet does the exact same thing when she says “makes young women bold and unafraid. For the socially inhibited, the freedom it offers can feel like nothing short of a miracle” (Shrier, 2020, p. 224). Not only is this not a true representation of how testosterone therapy works, but she seems to be implying that women would naturally love to be on testosterone as it makes your fears and social anxieties disappear.
Sure, HRT can lead to a reduction in social anxiety if it leads to greater gender congruence and thus higher self-confidence. That requires the therapy to be affirming though, which wouldn’t be the case for a woman who wants to be a woman/feels aligned with being female.
And yet again: She references a study that doesn’t say what she claims it does. She’s discussing how it isn’t true that HRT only increases the risk of cardiovascular disease to that of male levels, but actually exceeds it (Shrier, 2020). Two studies are used for this point, one of which states that the data were insufficient to make any conclusions about trans-masculine individuals [6]. Granted, the second study did show the 2-fold increase in risk of myocardial infarction (heart attack) in transmen when compared to cisgender men that she claimed [7]. The issue is that the data are inconclusive and even contradictory [8].
Simply put, we don’t know enough about cardiovascular health outcomes in trans populations to make a definitive statement either way. Further research will hopefully shed light on this issue; if risk for cardiovascular diseases or events is increased with testosterone therapy, management protocols can be designed to help mitigate these risks.
Surgery
Phalloplasty was discussed in the first article and won’t be repeated here. She also talks about top surgery, or mastectomy, once again sliding in odd comments. Under the list of risks, she includes “nipples that resemble cooked hamburger meat” (Shrier, 2020, p. 235). This seems like an attempt to be hateful, especially when it’s included in a list of actual complications. Of course, aesthetics is an important part of top surgery, and it’s possible that nipple appearance might not live up to expectations (and loss of the nipple and/or areola are possible complications). When using medical terms/descriptions like seroma and bleeding, it’s clearly meant to be provocative by describing nipple appearance as akin to hamburger meat. Otherwise she would have just said “dissatisfying nipple appearance” or “unfavorable aesthetic outcomes”, in keeping with the tone of the preceding potential complications.
Conclusions
Shrier (2020) concludes this chapter with the wild and unverified assertions that doctors no longer attempt to cure patients but simply encourage them, handing out medications without oversight. As mentioned above, this isn’t true. Medical transition isn’t the first step, and it’s not a step that’s actively encouraged on day one. If a provider does suggest immediate medical and/or surgical intervention upon first impressions without the presence of a life-threatening emergency, it’s advisable to get a second opinion.
The next and final article will cover the last two chapters of the book.
Non-hyperlinked References:
Shrier, A. (2020). Irreversible damage: The transgender craze seducing our daughters. Regnery Publishing, a division of Salem Media Group.
