(2021-07-12) Abigail Shrier's Irreversible Damage A Wealth Of Irreversible Misinformation

Rose Lovell on Abigail Shrier’s Irreversible Damage: A Wealth of Irreversible Misinformation. Controversy erupted here on Science-Based Medicine with a recent publication of a review of Irreversible Damage: The Transgender Craze Seducing Our Daughters by Abigail Shrier. As a family physician who provides affirmative care to transgender adults and youth, I’d like to offer my perspective on the topic. (2018-09-18) Hall Rapid onset Gender Dysphoria And Squelching Controversial Evidence

There are two aspects of those claims most relevant to the medical care I provide for transgender people which I would first like to address.

Claim #1: Gender dysphoria is normally vanishingly rare and its increase is because it is a social phenomenon being spread by social contagion, with particularly massive increases in the numbers of transgender people who were assigned female at birth.

Calculating the prevalence of gender dysphoria is an immensely difficult proposition even now. The US census does not collect data on who is transgender.

The best modern estimate of prevalence is from the Behavioral Risk Factor Surveillance System (BRFSS), a yearly telephone survey administered to a random sample of adults in the United States in English and Spanish using the two step approach. This results in an estimate of 0.6%.

Modern attempts to characterize the population into a simple sex ratio results in an overall estimate of 1:1, as is seen in the US Trans Survey

This is radically different from the old estimate of prevalence in the 1990s which was roughly 1:10,000 to 1:30,000 with a sex ratio of 3:1 of transgender women to transgender men in the United States and Europe. However, these old numbers came from the Netherlands and only included individuals who had received hormone therapy and surgery, not all people with gender dysphoria.

As for the idea that more young people are seeking services and that more of them were assigned female at birth, that turns out to have some possible basis in data.

Claim #2: Treating gender dysphoria with affirmation and puberty blockers is premature and causes harm because some children will change their mind.

The concern about patients who may change their mind is very old and largely unfounded. One meta-analysis of transgender adults found, at most, a 1% regret rate amongst those who had undergone surgery

The oft-cited “80% of children will change their mind” statistic comes largely from four observational studies from 2008 to 2013 in Canadian clinics. In general, these studies started before the age of 12 and followed up in later adolescence/adulthood (anywhere from after age 15 to after age 17). These studies have some significant flaws.

The studies themselves are behind paywalls, but many criticisms are publicly available. Research on the social-cognitive development of transgender children continues.

Lastly, as clearly noted in the American Academy of Pediatrics statement, complete with many citations of their own, we use affirmation, pubertal suppression, and hormone therapy in youth because it leads to improved psychological outcomes. The literature is abundant and clear on this topic. Blocking puberty with GnRH agonists is, unlike what Shrier claims, safe and reversible in the pediatric population. Were it not, these medications would not have been in use for decades for precocious puberty.

For those interested in reading other critiques of Shrier’s book, I recommend these two:

• Dr Jack Turban
• Sarah Fonseca