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Don’t Doubt the Trans Dogma

A recent town hall on transgender healthcare showed activist doctors' religious belief in the current trans dogma.

“White gay men are the worst.”

Thus spoke Dr. Robert Garofalo. A division chief at the Lurie Children’s Hospital in Chicago, and a gay man himself, Garofalo voiced his frustration with his own demographic’s growing skepticism of unconditional “gender-affirming care.”

“Even in my circles—in my own social circles—I hear the whispers sometimes. ‘Aren’t they a little too young?’ ‘Should she really be competing as a girl?’ Sit down,” he said forcefully. “If you can’t educate yourself and get better informed, at least sit down, because there are lives at stake.”

This sort of animus, explicitly directed at identity groups, cropped up again and again during the “Black Queer Town Hall in STEM and Healthcare,” a two-day seminar hosted by Peppermint, a trans activist and participant in Ru Paul’s Drag Race, in collaboration with the University of Iowa and the University of Pennsylvania.

“We see the straight black men holding tightly to patriarchy—people joke that they’re the white people of black people,” said Oni Blackstock, a physician and founder of a healthcare diversity consultancy. Elle Lett, an epidemiologist, medical trainee, self-identified transwoman, and key promoter of the event, also chimed in: “White people are comfortable studying [HIV] because it stigmatizes us.”

Panelists threw out these sweeping claims without consternation, strengthening the case of those who describe social justice as its own sort of religion, replete with its own dogmas. What sounds brazen from the outside might be banal and uncontroversial from the inside of the faith. As prominent detransitioner Helena Kerschner has pointed out, the dogma lives loudly with the adherents of gender ideology. The Black Queer Town Hall, then, illustrates a predictable new subgenre of equity programming, one which will likely grow in prominence as the national debate heats up: trans apologetics.

In the session titled “Combatting the Misinformation and Pseudoscience of the Anti-Transgender Movement,” the moderator, Elle Lett, asked questions that built toward a systematic response to critics: Do all “trans kids” seek surgery? Are they too young to know their own gender? How do you respond to the idea that “gender affirming surgery is mutilation”? Or to the idea that puberty blockers are irreversible? Or the detransitioners being “weaponized against trans folks”? Each question received a pre-packaged response, often backed by a few quick citations.

Lett asked about “rapid onset gender dysphoria,” the theory that some teens, especially teen girls, are coming out as trans in unusual patterns, often as a part of groups, in a way that resembles a social contagion. Lett describes the hypothesis as a “particularly egregious example of pseudoscience,” and dismisses it as “coined on the basis of a scientifically invalid study.”

Dr. Garofalo quickly added that this study, authored by Lisa Littman, exhibits “so much inherent bias that I don’t know why we’re giving the paper credence.” Lett asked Garofalo to explain further why Littman’s study was so unreliable. Despite the adamant denunciation, Garofalo could not. “I don’t have the details in front of me because I’ve blocked it from my permanent memory because I’m tired of hearing about it.”

On the question of puberty blockers, the panel was similarly adamant. Garofalo quickly asserted that blockers have been used safely (though not for gender dysphoria) for “hundreds of years,” before catching himself and amending to “a very long time.” Christi Butler, a “gender-affirming” urological surgeon, argued that the opposition to blockers “speaks to the ineptitude of not understanding the science,” adding “again, emphasis on, these are reversible.” Lett followed up by noting that, according to studies, puberty blockers decrease the odds of suicidality by 70 percent.

“I can’t remember another time when every medical society, mainstream, and respected societies, all agreed on the same thing,” Garofalo concluded. “I mean, we never all agree.”

Lett also brought up detransitioners, a topic that gender-affirming advocates have been forced to acknowledge, albeit preferring such terms as “identity evolution,” “gender journey,” or “retransitioning.” Lett cited a study in the journal Plastic and Reconstructive Surgery, which found very low levels of regret after gender reassignment, most of which was due to surgical errors. Butler, the panel’s reconstructive surgeon, agreed: “The concern for regret is extremely low.”

The panelists responded to each objection with what appeared to be sincere confidence, even exasperation that anyone would disagree. These responses relied on data and the interpretation of that data. In each case, the data doesn’t exactly support what the Black Queer Town Hall panelists asserted.

Dr. Garofalo’s assertion that all medical societies agree on puberty blockers, and that there is no serious debate within the medical community over their benefits, is simply false. A growing number of European medical authorities have pulled back on puberty blockers and cross-sex hormones, expressing skepticism over the benefits and concern over the harms. So far, trans activists in the U.S. have mostly ignored this development.

The study that Lett cited on transition regret does indeed show low levels, but it relies on old data that looks at a very different population of patients than today’s cohort seeking “gender-affirming healthcare.” Meanwhile, Littman’s paper is modest in its scope, was accepted for peer review, and explains its methodology; it’s not the final word on rapid onset gender dysphoria, but a perfectly reasonable first word, hardly deserving adamant denunciation.

But for the purposes of providing a quick, pithy, and seemingly formidable apologetic response, a few citations are enough, regardless of their quality. More of this evidence, politically useful but low quality, is on its way, as medical schools increasingly push for research aimed at “health equity.”

The town hall’s first keynote address gave a good example of such “health equity” research. Tonia Poteat, a professor of social medicine at the University of North Carolina School of Medicine, gave an overview of a study she conducted. One of its main conclusions: Trans-led organizations made trans people feel more connected during the pandemic. Poteat noted that her next step after concluding the study was to write a research grant with the Black Trans Advocacy Coalition, an organization that lobbies for the Equality Act.

Taken as a whole, this “health equity” research has major consequences. Once it becomes a “established” that, for example, “trans kids” are at an enormous risk of suicide without instant and unconditional “affirmation,” any procedure can be justified. Hence the popular refrain, “I’d rather have a living daughter than a dead son.” Terminal illnesses call for desperate measures.

Late in the session, in a moment of seeming moderation, the panelists admit that cross-sex hormones can indeed damage fertility. “There are some ethical considerations around, like, is it ethical to even ask a young person to make these decisions at 14, 15, and 16,” notes Garofalo, “and I think we don’t talk about that enough. They’re just realities, right? Decisions have to be made.”

Lett agrees: “Can a child ethically consent? Can a 15-to-18-year-old consent to a decreased chance of fertility?…I don’t know if that’s true.” The conclusion, however, remains unchanged. “I also just want to say,” Lett adds, “that a live child who makes an uninformed choice about fertility is better than one who’s not with us.”

John D. Sailer is a research associate at the National Association of Scholars.