N.B.: I am a cisgender male. As such, I would never pretend to speak for transgender people or claim personal knowledge of anything other than my own cisgender experience.

My sole claim to any expertise on this subject (if any claim can be made) is that I have been writing a novel in which a young transgender girl plays an important role. In an attempt to present this character as authentically as I can, I have conducted a couple of years of entirely autodidactic study on the subject.

It is easy to find virulent anti-transgender rants online. It is equally easy (and probably healthy) to dismiss the authors of these rants as bigots. For most thoughtful, open, curious people, arguments arising from unalloyed bigotry are not worth the time to read or watch.

However, there is another strand of anti-trans thought which I call “trans pseudo-skeptical.” Trans pseudo-skeptical arguments are often delivered in a clear, calm, erudite voice by an author with (sometimes dubious) professional credentials. The trans pseudo-skeptical authors present as skeptical, yes, but in a healthy way; the way we are taught to be skeptical of fad diets and used-car salesmen. They want us to believe they are just asking difficult questions in search of deeper understanding.

But the bigots and the trans pseudo-skeptics always reach the same conclusions even if by different routes: deny transgender people (especially children) their self-expression, dismiss gender dysphoria as a mental illness, and claim that the standard approach to treating gender dysphoria is not only ineffective but dangerous.

It happens that we have recently been presented with a nearly perfect example of the trans pseudo-skeptical argument in an essay by Dr. Michael K. Laidlaw. The essay appears on a website edited by a more famous trans pseudo-skeptic, Ryan T. Anderson, whose recent book When Harry Became Sally has gained popularity among the anti-trans cohort.

According to the website, Laidlaw is a “board-certified physician in Rocklin, California specializing in Endocrinology, Diabetes, and Metabolism.” If “Rocklin, California,” rings a bell, it may be that you heard about a controversy last year caused by the parents of some students at Rocklin Academy, a local charter school, when kindergartners were read books about transgender kids and one of the students came out as a trans girl in class.

It does not appear that Laidlaw has any education or experience dealing specifically with transgender children. He tells us that he was asked by some concerned parents to make a medical evaluation of the popular book I Am Jazz and determine whether the book “is suitable for children to read.” I Am Jazz was one of the books read in the Rocklin Academy kindergarten class.

I Am Jazz, published in 2014, was written by trans girl, television and YouTube star, and trans activist Jazz Jennings, along with co-author Jessica Herthel. Jennings and her family also appear in a reality television show about their lives also called I Am Jazz. You can watch the teenage Jazz read the book on YouTube.

Laidlaw begins his essay with the obligatory throat clearing about treating trans kids with “compassion…dignity and kindness.” Obviously, no bigots here, just concerned skeptics. But then Laidlaw destroys his carefully constructed cover in the next paragraph by using the term “transgenderism.”

The history of the word “transgender” is somewhat clouded but is generally understood to have been embraced in the 1970s by trans activists in the U.K. The word “transsexual” had long been used to describe people with gender incongruence, but activists wanted a broader term that included people who were transgender but had no desire to change their bodies. These activists also wanted to clearly separate the concepts of sex and gender (an important distinction).

In today’s usage, the term is only properly used as an adjective: “transgender (or trans) girl,” “transgender man,” “transgender youth,” etc. Transmuting the word into a noun (“transgenderism”) or a verb (“transgendered”) has important implications.

First, and perhaps most importantly, changing the word transgender into something else labels the very people we are talking about with a word they did not choose and specifically object to. This is insulting and unnecessary.

Second, by making transgender just another “ism” we are encouraged to dismiss it like any other political, social, or religious belief: liberalism, conservatism, socialism, communism, Catholicism. In this formulation, transgender becomes a description not of who a person is but of what they believe. It’s like telling someone from Japan that they are not actually Japanese (adjective) and their ethnicity is only a belief that they are Japanese, perhaps a mistaken belief. Might we call this “Japanese-ism?”

It doesn’t take long for Laidlaw to go all the way and misgender Jazz: “Throughout this essay, for the sake of clarity, I use the pronouns of Jazz’s biological sex.”

Like using the proper word form to describe transgender people, pronouns are important when referring to transgender individuals. Deliberately using the wrong pronoun to refer to a transgender girl is a direct and deliberate insult. There is no need for “clarity” here. There is nothing complicated about referring to Jazz as “she,” just like there is nothing difficult in using the term “transgender” properly.

If you are still wondering why mere words are so important, let me posit this: If we begin by treating trans people with “compassion…dignity and kindness,” as Laidlaw claims, then should we not use the words trans folks use to refer to themselves? Why is this so hard?

The answer is that Laidlaw, like all trans pseudo-skeptics, must walk a very fine line. Laidlaw must not appear bigoted lest his trans pseudo-skeptical facade be exposed for what it is. But he cannot bring himself to refer to Jazz as “she” because that would be confirming Jazz’s sense of herself, and his entire essay is an attempt to deny Jazz and all trans people that very sense of self.

We should be deeply skeptical as to Laidlaw’s motivations and opinions. His essay consists of a series of “inaccuracies” he claims to have discovered in I Am Jazz, followed by a series of “omissions,” issues he feels the book does not address.

Let’s first consider Laidlaw’s inaccuracies and his supposed facts rebutting those inaccuracies.

Inaccuracy #1: About a quarter of the way through I Am Jazz, the author states: ‘I have a girl brain in a boy body.’ Jazz later goes to the doctor and relates: ‘Afterwards, the doctor spoke to my parents and I heard the word “transgender” for the very first time.’
The Facts: The book is written in a way to make you believe that Jazz was diagnosed as transgender. But this is not a diagnosis. The medical diagnosis is gender dysphoria…Gender dysphoria is never mentioned in the book.

This is disingenuous. Assuming Jazz’s therapist is professional and knowledgeable, it is unlikely that Jazz was diagnosed as anything (transgender or gender dysphoric) in her first visit. Such diagnoses require lengthy therapy and testing. Trans pseudo-skeptics often imply that a firm diagnosis (and even treatment such as hormones and surgery) is immediately and unquestioningly applied the very second a 5-year-old child puts on a dress or wants his hair cut short like the other boys. This is not and never has been considered appropriate therapy.

Jazz was clearly gender nonconforming at this point, as she herself relates in the book: Her favorite color is pink, she likes to wear dresses, and she wants to grow up to be a “beauuuutiful lady.”

It is also important to understand that I Am Jazz was written for children between the ages of perhaps 4 to 7 years. I suggest that kids that age are not going to relate well to medical terms like “gender dysphoria,” and that alone would be a valid reason that the term is not used in the book.

Jazz does make clear the effects of her dysphoria in an age-appropriate way. Quoting now from I Am Jazz:

When I was very little, and my mom would say, ‘You’re such a good boy,’ I would say, ‘No, Mama. Good GIRL!’
Sometimes my parents let me wear my sister’s dresses around the house. But whenever we went out, I had to put on my boy clothes again. This made me mad!
Still, I never gave up trying to convince them. Pretending I was a boy felt like telling a lie.

Laidlaw continues:

As a younger child, when Jazz went to see this doctor, he (sic) actually had the condition of gender dysphoria. He (sic) was not transgender at that point in time. In fact, most children who suffer from gender dysphoria will no longer experience it by the time they become adults. In other words, about 90 percent of biologically male children who believe they are female as young children, when allowed to go through normal puberty and enter adulthood as men, will identify as biological males.

Unlike many trans pseudo-skeptics, Laidlaw does not link to any of the now debunked studies that have led to outrageous claims of 80 or 90 percent “desistance” among trans adults. To Laidlaw’s credit, it does not appear that his “90 percent” number has such dubious origins. Instead, Laidlaw provides a link which oddly (and one assumes, unintentionally) undermines everything he has claimed thus far and even his later claims about the dangers and ineffectiveness of treatment. The link goes to a PDF of Endocrine News from November 2017. After paging through the magazine, looking for what exactly Laidlaw was trying to link to, I found an article titled “Changing Course: Treating Gender Dysphoria.” (It’s on Page 29 of the PDF.) The article summarizes the (then) new guideline from the Endocrine Society for treating gender dysphoria.

I am doing a bit of spelunking here, but I believe Laidlaw’s “90 percent” may come from the following passage, quoting Dr. Wylie C. Hembree, chair of the task force that wrote the guideline:

Hembree notes that “most children who have gender dysphoria actually lose it. There may be only 10% to 15% whose dysphoria continues throughout childhood and into puberty.” For this reason, the guideline recommends holding off on any treatment until a child has entered puberty.

This is a perfect example of how throwing out a number like “90 percent” can be entirely misleading. If Hembree’s numbers are correct — I see no reason to doubt him — most dysphoric (including trans and gender nonconforming) children will grow out of the condition some time before puberty. This is neither a good thing nor a bad thing, nor is it very surprising; it’s just the way kids are. Many, perhaps most, children’s gender identity (how they understand themselves) is very fluid when they are young.

But Laidlaw moves the goalposts. Hembree clearly states his 10 to 15 percent applies to children “whose dysphoria continues throughout childhood and into puberty.” Laidlaw takes those figures and applies them to people who are “allowed to go through normal puberty and enter adulthood as men.” In effect, Laidlaw is lifting Hembree’s numbers and applying them to a different group.

The real problem, of course, is that puberty alters the body in ways that cannot easily be reversed. Forcing transgender children to go through their natal puberty is forcing them into a body they do not want. Also, we know that untreated gender dysphoria often leads to self-harm and suicide, so an unknown but significant number of these untreated kids are going to die before they even become adults.

Are we to understand then that Laidlaw’s prescription is to withhold the only known effective treatment for gender dysphoria until a trans person is an adult, even though we know that for a large number of these people, their dysphoria will not magically disappear but will become so acute, so distressing, before adulthood that they will attempt to or succeed in ending their own lives? This seems to me to be the only way to interpret his logic.

Inaccuracy #2: According to Jazz, ‘I have a girl brain but a boy body. This is called transgender. I was born this way!’
The Facts: The ‘born this way’ narrative contradicts known medical facts involving twin studies…Furthermore, no genetic studies have ever identified a transgender gene or genes.

This is a common and rather lazy straw-man argument. No one that I am aware of in the medical, psychological, or transgender community claims that genetics are the sole reason someone is transgender. Genes may be involved but there are no clear indications to what extent — yet. Genetic studies and studies of the prenatal and postnatal brain are underway.

Inaccuracy #3: Jazz says: ‘I have a girl brain.’
The Facts: As to Jazz having a ‘girl brain,’ consider, what does the brain comprise?…females have two X chromosomes, and males have one X and one Y chromosome. These sex chromosomes are present in every cell in the body. They remain in the cells from conception until death and do not change.

As inaccuracy #2 above, another straw man. No one claims that being transgender has anything to do with chromosomes. In fact, trans people claim just the opposite, which is what Jazz is saying in her 5-year-old voice. Her brain in this context is not the physical organ filled with chromosomes but instead her sense of herself as a girl, in spite of the chromosomes.

Laidlaw also includes a couple of links that reveal a great deal about the trans pseudo-skeptical arguments and where they come from.

The first is to what Laidlaw calls a “left-leaning, open-minded, and pro-gay rights” group with the rather clumsy name of “youthtranscriticalprofessionals.org.” The link goes to a private Wordpress site, but the Internet Archive has crawled the site in the past.

An admittedly cursory review tells me I have seen all of this before. The views are unadulterated trans pseudo-skeptical and far from “open-minded.” I couldn’t find any indication of the site being “pro-gay rights.” There is much discussion of the chromosomes straw man, which I assume is why Laidlaw tried to link to the site. There is also fevered discussion of sterility, even invoking Aldous Huxley’s Brave New World. I have yet to discern why sterility, among a very long list of horribles, excites such concern with trans pseudo-skeptics but it often features prominently.

Laidlaw’s second link is to the “right leaning American College of Pediatricians.” This is not an organization of medical professionals, as the anodyne name would suggest, but an anti-LGBT group founded to fight against gay couples’ right to adopt children. The organization has also been labeled a hate group by the Southern Poverty Law Center. It has gleefully waded into the transgender debate because, well, why not?

The organization has also been labeled a hate group by the Southern Poverty Law Center. Whatever you may think about the SPLC and its practice of labeling groups, the American College of Pediatricians is far beyond what Laidlaw describes as “right leaning.”

The point here is that it can be difficult to figure out among the trans pseudo-skeptics exactly who is speaking (such as in anonymous interviews) and what the motivations and prejudices may be. The American College of Pediatricians, a hate group with a few hundred members, is trying to put itself on a par with the American Academy of Pediatrics, a real medical association with hundreds of thousands of members. The obfuscation is so cleverly done, one has to almost admire it.

Returning to Laidlaw and the “omissions” he found in I Am Jazz, it is important to consider a few things.

First, I Am Jazz is a book for very young children. As such, it is necessarily incomplete as to all the details of gender dysphoria and being transgender. It was not written to inform adults making policy decisions about how to deal with trans people. It simply and elegantly presents the basic concept that there is such a thing as a transgender girl or boy.

Also, Laidlaw begins to mix in references and events not in the book but from the reality television show, which takes place much later in Jazz’s life. This is unfair to the book, which is certainly appropriate for 4-year-olds, while I doubt anyone would claim that the TV show is.

Omission #1: The authors fail to mention that Jazz suffers from depression.
At least 70 percent of people with gender dysphoria suffer from mental illness currently or in their lifetime. The most common comorbid mental illnesses include depression, anxiety, bipolar disorder, and dissociative disorder. Jazz has depression, as he (sic) has discussed on the TLC program I Am Jazz.

The only question here is simply put, although neither I nor Laidlaw know the answer: Is Jazz’s teenage depression — discussed in the TV show but not the book — caused by her dysphoria or is it the cause of her dysphoria?

It might be good to know this since the difference might alter her treatment. But in any case, both the depression and the dysphoria clearly exist and both must be treated. Treating one and ignoring the other would be malpractice. More on mental illness below.

Omission #2: The suicide rate of transgender individuals is alarmingly high.

This is also true. But what is the cause? Does being transgender and being treated for gender dysphoria cause people to commit suicide? Or does the way society (and people like Laidlaw) treat trans people lead them to be suicidal? As a cisgender person, I can only try to imagine what it would be like to constantly be told that I am not who I know I really am. Is it such a surprise that this leads some people to seek an end to this suffering, especially if their dysphoria is untreated or treated incorrectly?

And how does not treating gender dysphoria, as Laidlaw advocates, solve the problem of suicide?

Omission #3: Jazz is currently being given hormone blockers to stop him (sic) from going through normal pubertal development.…Jazz is now a teenager who has not been allowed to go through puberty.

This is simply not true. Jazz is on hormone blockers and cross-sex hormones. She is going through puberty as a girl. The cross-sex hormones cannot replace male organs with female organs but in every other way, Jazz has gone through normal puberty.

Also why would this be an unacceptable omission from a book for young children? Laidlaw seems to have wandered into a bit of a conundrum. On one hand, he seems to find the book inappropriate for young children because it discusses things he thinks they are too young to understand, but on the other hand, he faults the book for not thoroughly discussing hormones and puberty? Which is it?

Omission #4: Jazz will need to have his (sic) child-sized penis surgically destroyed to create a false vagina.

Jazz might say the penis is the part that is false, but I digress.

It is fairly common for trans pseudo-skeptics to go into great detail about gender affirmation surgery. This is intended, one supposes, to shock the reader. Yes, turning penises into vaginas is an option for trans women. A phallus is an option for trans men. You can find videos on YouTube of the actual operations. I found them fascinating.

In his description, Laidlaw refers to such surgery as “dangerous.” In fact, it is not particularly dangerous, as surgeries go, and has become quite commonplace. It seems, for perhaps obvious reasons, that constructing a penis is more difficult than constructing a vagina. But a pioneer in the medical treatment of gender dysphoria recently said that vaginoplasty can now create a vagina which would “fool a gynecologist,” so one may hope and expect that plastic surgeons will continue to make advances on this front.

Omission #5: Jazz currently suffers from sexual dysfunction and will likely have permanent damage.

Here Laidlaw is diagnosing Jazz having never met her (and working far outside his area of expertise) and confidently predicting an unknowable future. No responsible doctor would do this.

Omission #6: Jazz will very likely be rendered permanently infertile.

This is true. I can only say that I have been capable of fathering a child for over 40 years and never chosen to do so. Perhaps Jazz, like me, has other priorities or perhaps this is an unfortunate trade-off that she chooses to make. In any case, it is none of my business nor Laidlaw’s.

Another trans pseudo-skeptical point arises here. Laidlaw says: “Is this a decision that any adolescent child has the maturity and insight to make? I do not believe so.” By Laidlaw’s logic, kids are always too young; at 5 years, too young to understand gender or even hear about the existence of their trans peers; as teens, too young to make informed decisions about their future fertility.

Kids are always too young until it is too late, a convenient metric for people like Laidlaw to deny children any advocacy of their own. Jazz is not making this decision in a vacuum or alone. I would suggest that Jazz, her parents, her doctors, and her therapist might have a better understanding of the consequences of her therapy than anyone else, including Laidlaw.

Omission #7: There is a high level of substance abuse among people who identify as transgender.

Laidlaw is again confusing correlation with causation. Does being trans lead to substance abuse? If this is true, might we want to discover why?

Laidlaw presents an easy answer that reveals much: transgender equals mental illness equals drug abuse. It is absolutely critical to the pseudo-skeptics that trans people be considered mentally ill. See Laidlaw’s claims about suicide above.

This is understandable. If being trans is an illness, then a trans person’s understanding of themselves can be summarily dismissed (they are crazy, after all), and all the standard treatments — affirmation, blockers to delay puberty, perhaps hormones and surgery — are treating the symptoms of the illness while not addressing the underlying cause. Worse, by participating in the standard treatments, we — therapists, doctors, parents, teachers, siblings, peers, allies, society at large — are all encouraging a mentally ill person to remain ill.

If, however, being trans is an admittedly rare but entirely normal human condition, the trans pseudo-skeptics’ arguments — their entire worldview — collapses.

Omission #8: There are a number of serious health risks associated with taking cross-sex hormones.

Here we can return to the guideline published by the Endocrine Society:

Gender-dysphoric/gender-incongruent persons should receive a safe and effective hormone regimen that will suppress the body’s sex hormone secretion, determined at birth and manifested at puberty, and maintain levels of sex steroids within the normal range for the person’s affirmed gender.

Laidlaw is entirely at odds with the preeminent organization in his specialty.

Omission #9: The mortality rate of those who identify as transgender is three times higher than that of the general population.

See my response to omissions #1, #2, and #7 above. It’s “trans equals mental illness” all the way down.

It is undeniable that we don’t know everything about why people are transgender. What role do genes play? Are there other, non-genetic, prenatal conditions at work? What of postnatal nurture versus nature?

We don’t know every possible outcome of the currently accepted treatment for transgender people with gender dysphoria. Studies have been sporadic and often conducted poorly in the past. New studies take time because a large cohort of people must be followed from childhood through adulthood.

But we do know what happens when gender dysphoria is left untreated. Transgender kids grow up in terrible circumstances. They are bullied. Many of them end up homeless. Many of them try kill themselves, and too many of them succeed.

And yet, trans pseudo-skeptics like Laidlaw are insidiously trying to undermine the best-known treatment to prevent those terrible outcomes.

Laidlaw’s conclusion is revealing:

It is possible that with proper therapy the child’s gender dysphoria could be alleviated. He (sic) could then be allowed to regain his (sic) masculine identity and therefore not suffer the very troubling life of transgenderism, with all its risks of increased mortality, suicide, mental illness, substance abuse, infertility, and other grave conditions detailed above.

Jazz has already received the proper therapy. Jazz never in her entire life had a “masculine identity.” Laidlaw is suggesting she should go through “reparative” or “conversion” therapy to convince her that she is not a girl. This practice has been condemned by the American Psychiatric Association and other groups. It is illegal (at least for children) in several states and many countries.

Trans pseudo-skeptics may not be bigots. They don’t tend to rave at you on YouTube. They have letters after their names, even if the letters often have little to do with the specifics of treating transgender people. People like Laidlaw seem so calm and reasonable and logical until you pierce their pseudo-skepticism with a little real skepticism of your own.

In the end, I don’t believe we need be overly concerned about the bigots, as revolting as their views may be. They are just talking to fellow bigots in an endless loop of bile upon more bile. I believe the trans pseudo-skeptics are the real problem. They are causing more harm than the raving bigots could ever hope to.