Detransition research is valuable, but it won’t validate your moral panic about transgender people

This came up with I did a GIS for “methodology.”

I have a lot of problems with the article published in the Daily Mail on James Caspian and his attempt to study detransitioned people. I am especially concerned with the idea that medical transition is a dangerous epidemic, because it is not based in evidence. In fact, the study that Caspian proposed could not actually have tested any relationship between standards of care and rates of detransition. I worry that articles like these take the experiences of detransitioned people and weaponize them in a culture war against transgender people, but I also worry that the backlash against studies like these harm detransitioned people, too. By trying to unpack some of rhetorical strategies of this article and contrasting them with the methodological issues of studying detransition, my hope is to illuminate what is really at stake here.

This line early in the piece captures one of my problems with it: “The nature of his research? To ask questions about the increasing numbers of people who were changing gender and subsequently regretting it.” In one sense, this is a straightforward description of Caspian’s research methodology: he wanted to study the experiences of detransitioned people (especially detransitioned women). And it is certainly true that the absolute number of detransitioned people has increased over time, because the number of people who have transitioned has increased over time.

That word “increasing” does a lot of rhetorical work throughout this article, though. Because while the number of detransitioned people may be increasing, there is no empirical evidence regarding whether the percentage of people who detransition has increased over time. The only statistic that Caspian cites to support this claim is an increased number of surgical reversals performed by one surgeon he talked to, but there are many potential explanations for this outcome. It could be that surgical reversal techniques have improved; it could be that there has been more communication among detransitioned men regarding the efficacy and outcome of these techniques generally; it could be that one detransitioned man informed others that this surgeon was especially adept at the technique. Considering that the majority of people in the detransition community are women who typically don’t undergo surgical reversals of any kind, it’s very hard to know what this statistic means.

Importantly, Caspian’s methodological approach is unable to answer the question of whether the rate of people detransition as a function of the number of people who transition has increased over time. That would likely require a longitudinal design, tracking large samples of people who are medically transitioning over a long period of time to determine what percentage of them detransition and whether that percentage has changed over time. This would be a very difficult study to do for many reasons, including the fact that detransitioned people often disengage from the medical system. Any participant that dropped out of the study or could not be found during follow-up might be someone who detransitioned. Additionally, because the rate of people who detransition is low according to older studies, you would need very large samples to reliably detect changes in the base rate of detransition.

Interviewing detransitioned people about their experiences is valuable, however. I believe detransitioned people should be able to receive care tailored specifically to their needs, and that detransition should not be negatively stigmatized. Many detransitioned people report incredible difficulties with both the medical and legal aspects of detransition, as well as feelings of shame and stigma. In this regard, I think Caspian’s methodological approach is valuable: it can provide insight regarding the experiences of detransitioned people and spread awareness about their specific needs.

At the same time, the arguments that detransitioned people make regarding how they believe the standards of practice should be changed have to evaluated in context. The experiences of detransitioned people can’t definitely tell you how whether the current system makes it too easy to transition, or whether and how it should be changed to reduce the rate of detransition. They provide a valuable perspective, but it’s a big step from providing specific care for people detransitioning to changing the care received by all transgender people. The burden of proof is much greater because a wider range of people are affected. Their opinions regarding the problems with standards of care today should not be dismissed outright or embraced immediately, but considered in a thoughtful and evidence-based way.

I think Bath Spa University made a mistake in refusing to allow James Caspian to carry out his study. It makes no sense for the university to approve his first proposal and reject his second one, which expanded the participants of his study beyond those who undergo surgical reversals. And the rationale they presented is terrible. If they believed his research was fundamentally unethical in some way, they should have made that argument. Refusing to approve his research because of the hypothetical attacks from activists is wrong because it simply passes the buck. Bath Spa University should take responsibility for its own decision.

I believe Caspian’s research is valuable not because of an abstract commitment to free speech but because I believe detransitioned people, especially detransitioned women, have unique struggles and viewpoints that deserve to be heard and represented in the scientific literature. That doesn’t mean I will agree with everything they have to say; but suppressing their experiences only compounds their suffering and does unnecessary harm.

One final note: there is a discussion in this article about the UK Council for Psychotherapy’s updated “Memorandum of Understanding” addressing conversion therapy and transgender people (the 2015 version does not discuss transgender people at all). To my knowledge, this document has not actually been published yet (this press release is the closest we have at the moment, and it’s quite vague). I am troubled by what Caspian claims is in the new or updated MoU, but I will reserve my judgment about its merits until I actually see the document itself.

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