Is this really science?  When reading Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences published in the Fall 2016 edition of New Atlantis, one must be careful to consider whether this is an actual scientific paper or not.  After all, there’s a difference between a scientific study and a study by a scientist.  There’s also a difference between scientific research and philosophy.  In this Special Report we find a critical review by a couple of heavyweight psychiatrists, not scientific findings per sé.  While the report is about science, it only criticizes research offered by others.

A scientific paper needs actual case study.  While this report does cite case studies, no actual case research by either writer has been cited for comparison anywhere in the report.  What it does instead is examine the limitations of a select group of other studies, using those limitations to either skew their purport or to attempt an invalidation of their conclusions altogether.  If no case studies have been done by either doctor then we’re left with ideological and methodological foundations upon which to evaluate other studies. Where that happens the report shifts from actual science to philosophy.  The material in the New Atlantis article, instead of being a scientific paper is actually a polemic and its contributions need to be taken on philosophical grounds.

Paul McHugh, MD, the former Chief of Psychiatry at Johns Hopkins Hospital, has been an anti-transgender activist for many years now, pushing for psychiatric treatment of transgender people excluding transition, dismissing all transpeople as afflicted with a “disorder of assumption.”1 He would not have been able to write this type of critique on his own, though many of the views represented in this paper are his own.

Lawrence S. Mayer, M.B., M.S., Ph.D., being Scholar in Residence at Johns Hopkins, took over the paper; rewriting, reorganizing, and expanding the work that Dr. McHugh began based upon his expertise in statistics and epidemiology.2 His work also served to moderate what has at times been perceived as inflammatory rhetoric on the part of Dr. McHugh.  Scholars like Dr. Mayer rely on facts and manifest at least an appearance of humility and this moderates the work very well.

What also comes into play is the publisher itself, for a publisher will only accept work agreeable to its mission. The publisher, Ethics & Public Policy Center (EPPC), founded in 1976 by Ernest W. Lefever, describes its mission as “applying the Judeo-Christian moral tradition to critical issues of public policy.”3 Such a mission automatically demands an Augustinian approach to science and faith.  Faith comes before science in such an approach, and that a primarily Roman Catholic perspective, virtually disallowing the objectivity required in true scientific research.

Dr. Meyer admits this in the preface of the report:

“We readily acknowledge that this report is neither an exhaustive analysis of the subjects it addresses nor the last word on them. Science is by no means the only avenue for understanding these astoundingly complex, multifaceted topics; there are other sources of wisdom and knowledge — including art, religion, philosophy, and lived human experience. And much of our scientific knowledge in this area remains unsettled.” 4

It behooves any reader to take this issue into account when reading this report.  It also demands fairness in recognizing that the fact of report being a polemic review of scientific literature does not automatically invalidate all arguments.  Neither does its association with EPPC or Dr. McHugh automatically invalidate all arguments.  In fact the reader will find more correct than incorrect throughout this report.

It’s true that science remains quite unsettled concerning the trans experience.  It is, after all, still in its infancy.  Since modern sex-reassignment surgeries first developed under Magnus Hirschfeld, MD in the 1920’s, no such surgery has produced a fully functioning female or male.  Uterine transplant may have been attempted early, in fact, organ rejection after such a transplant very likely killed Lili Elbe in 1931.5 But this doesn’t mean that success at this can never be known, especially given the recent successes in transplanting a uterus in typical females.6  To date no attempt at transplantation has been made in the case of female to male transsexuals since these recent successes.  But we can anticipate how that may also eventually change.

These limitations have caused some to simply denounce all such attempts as a sham, that no sex changes had ever really occurred, and as a result transsexuals don’t really exist.  The logical conclusion of such sentiment would be to condemn all such surgeries as “mutilation” and so seek to outlaw such therapies altogether.  Perhaps we need to posit other questions and studies like what has been offered in this paper should compel us to seek them, not to simply dismiss all attempts at new therapies in favor of others that have failed to reverse what has been declared as “serious and irreversible”7 by the Vatican to whom Dr. McHugh has served as an advisor.8

The scope of the New Atlantis report is too broad to be appropriate for a blog article of this nature, but to restrict the section on gender identity per sé, the report posits the following:

 

  1. Gender identity as an innate, fixed property of human beings independent of biological sex is “not supported by scientific evidence.”
  2. 6 tenths of 1 percent of adults in the United States identify as a gender not corresponding to biological sex.
  3. Brain studies of trans and non-trans individuals have demonstrated correlations too weak to be cited as evidence.
  4. Post-operative transsexuals continue to have higher risk of poor mental health outcomes: 5 times more likely to attempt suicide and 19 times more likely to die by suicide.
  5. Only a minority of children experiencing cross-gender identification continue to do so into adolescence and beyond.
  6. Too little scientific evidence exists for the therapeutic value of delaying puberty in trans children or to modify secondary sex characteristics of adolescents, though some may have improved psychological well being if encouraged and supported therein.
  7. (Merged with the sixth bullet in the report) No evidence that all children expressing gender –atypical thoughts or behavior should be encouraged to “become transgender.”9

 

Most trans activists have no quarrel with most of these statements.  Statement number 2 is entirely correct as far as has been estimated to date.  The continuance of higher risk of poor mental health outcomes has been asserted by us many times though we do object to the numbers being taken out of the context the researchers intended.10 A minority of children experiencing cross-gender identification persist and persistence is one of the criteria for candidacy for transition.  Yes, scientific evidence regarding the delay of puberty is in its infancy, but we caution that because it’s so young we’re neither at liberty to simply dismiss it nor prevent further research in this area.  No we don’t suggest to anyone that all children expressing gender-atypical thoughts or behavior should transition and in fact we typically try to dissuade those considering transition from doing so because we know just how harsh life as a transsexual can be.

So is gender innate and fixed?  Could gender identity exist independent of assigned birth sex based upon biological presumptions at birth?

Dr. Mayer cites the sad case of David Reimer, a patient of Dr. John Money at Johns Hopkins.  After having been genitally mutilated by a surgeon as an infant, Money believed that the gender of children is fluid and so followed his patient’s upbringing as a girl.  However, his patient rejected the imposition of that role and was in the process of detransition when he died a suicide.11

This story has been regarded by trans activists for years as evidence that gender identity is in fact innate and fixed.  But Dr. Mayer goes further than that.  His approach is that if David was really male from birth, his case cannot be used as evidence that such can happen independent of birth sex.

He further refers to a very narrow group of 16 “males” afflicted with cloacal extrophy studied by William G. Reiner and John P. Gearhart.   Of the 16, infant surgeries had been conducted on 14 to fashion them with external female anatomy.  Out of the 14, 6 rejected their female roles, 5 continued to live as females, and 1 refused to discuss gender identity when told of being born “male”.  If all had accepted their female roles then the evidence would have supported Dr. Money.  But instead we find a condition consistent with what intersex societies have urged from the beginning:  that infant surgeries on intersex patients must not be permitted and that any genital reconstruction must wait till the patients can decide whether such procedures are in fact appropriate.12

Instead of providing this recognition the report makes the following statement:

“This lack of persistence is some evidence that the assignment of sex through genital construction at birth with immersion into a “gender-appropriate” environment is not likely to be a successful option for managing the rare problem of genital ambiguity from birth defects. It is important to note that the ages of these individuals at last follow-up ranged from 9 to 19, so it is possible that some of them may have subsequently changed their gender identities.”13

We’re not at liberty to determine from this if any had “changed their gender identities,” or to presume upon them that gender identity is in fact a choice.  In the intersex world gender appears to be more fluid than the world typified by a gender binary.  Had all such patients rejected their female roles then Dr. McHugh would have been correct in that gender must be consistent with biological sex and no exceptions may be entertained.  But the 5 of the 19 cannot be dismissed outright with the statement, “Gender identity as an innate, fixed property of human beings independent of biological sex is not supported by scientific evidence.”  The 5 are in fact evidence.  Even if all of 14 rejected their female roles, 14 is too small a sample to statistically apply to an entire population of intersex people let alone all humans.  While the evidence remains anecdotal, scientific evidence has not refuted the idea of gender identity being fixed, innate, and possibly independent of biological sex either.

This is something the reader of the New Atlantis report needs to keep in mind when reading the numerous other studies cited concerning research on transgender people including brain studies.  “No scientific evidence” in these studies has been repeatedly applied to those studies, and that based upon any limitations within those studies. Of course, all scientific research has limitations and those limitations will always be explored by any credible researcher.  What this report consistently does is dismiss the research on the basis of those inevitable limitations, declare them not to be “scientific evidence,” and therefore lead to the reader to believe that the whole matter is refuted.

If the writers wish to refute this research they must provide actual evidence of their own to do so, not simply dismiss the work of others on the basis of limitations.  The New Atlantis report cites no such research.  The closest thing offered is this statement from Dr. McHugh:

“We in the Johns Hopkins Psychiatry Department eventually concluded that human sexual identity is mostly built into our constitution by the genes we inherit and the embryogenesis we undergo. Male hormones sexualize the brain and the mind. Sexual dysphoria — a sense of disquiet in one’s sexual role — naturally occurs amongst those rare males who are raised as females in an effort to correct an infantile genital structural problem.”14

Those of us who have been involved in trans and intersex activism have little in this statement with which to object.  However, environmental assaults upon fetal development remain the best consensus any of us have had to account for the fact that some people are transgender, a factor Dr. McHugh does not address in his comment and scarcely  has been mentioned in the report at all.  But this factor of fetal development (not embryogenesis) suggests that some of us really may have been “born this way” after all.

Do you see what’s happening here?  By dismissing evidences as non-evidence or non-scientific, and without providing actual research refuting the idea that transsexualism exists, the New Atlantis report becomes a grandiose exercise in card-stacking.  Card-stacking is a popular approach in religiously based publications like The New Atlantis.

To get an idea of what card-stacking is, picture the high school exercise you might have done in an English class prior to writing a term paper.  You were probably directed to research as many facts about a subject and to write those individual facts upon index cards.  When it comes time to write a term paper based upon what may be hundreds of index cards, you must organize those cards according to the thesis, or main idea of your article.  You choose and order the cards that help your position, discarding those that do not support your thesis, and neatly organizing the others.  It’s a practice that helps students organize thoughts into cogent compositions.  But another serious problem may arise in terms of bias. Certain facts may be given improper import.  Others that deserve consideration don’t get that consideration due to their being played down or eliminated.  While a paper may be cogent, the bias revealed in card-stacking can delegate a composition to the role of propaganda.

But issues in the New Atlantis report extend even beyond this.  Consider the citation of the definition of gender from the American Psychological Association:

“Sex is assigned at birth, refers to one’s biological status as either male or female, and is associated primarily with physical attributes such as chromosomes, hormone prevalence, and external and internal anatomy.

“Gender refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for boys and men or girls and women. These influence the ways that people act, interact, and feel about themselves. While aspects of biological sex are similar across different cultures, aspects of gender may differ.”15

On the basis of this definition Dr. Meyer attacks the idea that gender can exist apart from sex.  The verbiage does appear to assert that (to use his words) “gender and thus gender identity are fluid and plastic, and not necessarily binary.”  He spends some time following this citation on this attacking feminist positions regarding gender before turning his attention to the aforementioned studies.  This behaviorist definition of gender will very likely go through several modifications in the near future.  There’s nothing canonical about this definition.

Gender identity is really an internal construction of gender within the individual.  Do sociological factors apply?  Of course they do.  Typical male and female cultural roles in Arizona may vary remarkably from what those cultural roles may be in Uttar Pradesh.  But when considering candidates for transition, the following issues get scrutiny in advance:

 

  1. What are the beliefs of the patient regarding construction of the self in terms of gender?
  2. What gender do others perceive the patient to be?
  3. How does the patient conduct himself or herself?
  4. How does the patient present himself or herself?
  5. Will transition be likely to be successful?

 

You see, a subjective feeling isn’t enough to recommend anyone for transition.  One’s gender identity may be opposite to biological sex and yet conditions may exist by which transition is simply not a possibility.  One’s own appearance may not be at all consistent with gender identity and may require extensive plastic surgery.  Not all can do this.  But the most common candidate for transition is the one who has suffered because of other people’s incongruent perceptions of that person’s gender.  That’s an issue of socialization.

The issues of socialization carry a lot of weight in the New Atlantis report, and their psychological impacts direct Drs. Mayer and McHugh to favor a different course of treatment that what involves anything surgical.  Those arguments extend beyond the initial nature vs. nurture argument entertained in the report.

But let the reader take in the report for himself.  Let him watch for the literary devices involved and see where those biases exist.  What may appear initially convincing and compelling will reveal itself as less compelling when one questions the converse of “no scientific evidence to support” this or that, for we cannot be satisfied without scientific evidence refuting it.

(to be continued)

________________________

REFERENCES:

  1. McHugh, Paul. Transgenderism: A Pathogenic Meme (June 10, 2015) Web: The Witherspoon Institute. http://www.thepublicdiscourse.com/2015/06/15145/. Retrieved September 7, 2016.
  2. Mayer, Lawrence S. M.B., M.S., Ph.D., and McHugh, Paul, MD Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences (Fall 2016) Web: New Atlantis 50. www.TheNewAtlantis.com20160819_TNA50SexualityandGender.pdf, p. 4. Retrieved August 26, 2016.
  3. (n.a.) About (n.d.) Web: Ethics and Public Policy Center. https://eppc.org/about/. Retrieved September 7, 2016.
  4. Op Cit. p. 12.
  5. Arundel, Nikki. Magnus Hirschfeld (1868–1935) (n.d.) Web: GenderShift http://www.gendernetwork.com/Magnus-Hirschfeld.html#.V9CbMvkrLcs . Retrieved September 7, 2016.
  6. Chappell, Bill. A First: Uterus Transplant Gives Parents a Healthy Baby (October 4, 2014) Web: NPR. http://www.npr.org/sections/thetwo-way/2014/10/04/353691555/a-first-uterus-transplant-gives-parents-a-healthy-baby. Retrieved September 8, 2016; and Kennedy, Merrit. Cleveland Clinic Performs First Successful Uterus Transplant In the U.S. (February 26, 2016) Web:  http://www.npr.org/sections/thetwo-way/2016/02/26/468283774/cleveland-clinic-performs-first-successful-uterus-transplant-in-the-u-s. Retrieved September 8, 2016.
  7. Winfield, Nicole. Vatican Denounces Transsexuals(January 31, 2003) Associated Press, Web:  Free Republic. http://www.freerepublic.com/focus/f-religion/833752/posts. Retrieved August 9, 2016.
  8. Goldstein, Laurie. Bishops Select Lay Board On Sexual Abuse Review (July25, 2002) Web: New York Times. http://www.nytimes.com/2002/07/25/us/bishops-select-lay-board-on-sexual-abuse-review.html. Retrieved August 10, 2016.
  9. Mayer and McHugh, p. 8,9.
  10. Stuart, Lynnea Urania. A Presumption of Evil (June 24, 2016) Web:  https://lynneauraniastuart.wordpress.com/2016/06/24/a-presumption-of-evil/  Retrieved September 8, 2016.
  11. Op cit, p. 91,92.
  12. Dreger, Alice Domurat. “Ambiguous Sex” – or Ambiguous Medicine? (June 1988) The Hastings Center Report, Vol. 28, Issue 3, pp. 24-35, republished (n.d.) on Web:  Intersex Society of North America. http://www.isna.org/articles/ambivalent_medicine. Retrieved September 8, 2016.
  13. Op cit, p. 92.
  14. Ibid, p. 93.
  15. Ibid, p. 87.
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