Ryan Anderson’s Book is Harmful Pseudo-Science

(Note: Page numbers in this review refer to the advanced reader copy of the book that I acquired.)

I have written elsewhere on how to detect and debunk anti-transgender propaganda in science and the media previously.  I described fifteen tests, and Anderson’s book fails at every level.  I cannot address all of the issues in this book, but fundamentally it is deliberately misleading and  designed to push transgender people into the closet.

This book was not science. It is apologetics to support a religious viewpoint and a set of policies that would cause great harm to a vulnerable minority community already suffering from significant stigma and economic disparities.

So, how does this book look when you ask the 15 questions I wrote about in the link above?

1. Who wrote it?

Ryan Anderson works for the Heritage Foundation, and is a conservative Catholic. Anywhere that science conflicts with his Catholic faith, he defaults to the position of the Catholic Church, and interprets the science in such a way that it conforms with his religious beliefs. At other times, he ignores scientific evidence that is contrary to his (and the Church’s) religious beliefs.

Fundamentally, this is not science. This is religious apologetics.

2. Who does the author hang out with?

Ryan Anderson works for the Heritage Foundation, and has strong ties with the Family Research Council, which is designated as an anti-LGBT hate group by the Southern Poverty Law Center for making “claim(s) that LGBT people are threats to home and society. Others in these hate groups disseminate disparaging “facts” about LGBT people that are simply untrue — an approach no different to how white supremacists and nativist extremists propagate lies about black people and immigrants to make these communities seem like a danger to society.”

3. Where is it published?

The book is published by Encounter Books, which is a publisher of conservative religious tracts. This affects the quality and objectivity of the book with a rather slipshod editing process. For example, on page 21 Anderson asserts that no one on the left has been able to specify any errors or flaws in an article written by Mayer and McHugh.  This is patently untrue, as  can be found in the enclosed links, including an article by McHugh’s colleagues at Johns Hopkins University.

On page 19, Anderson claims that the decision to reopen the Johns Hopkins gender clinic “was not a consequence of any new scientific evidence” since the study commissioned by McHugh in 1977. Again, this is patently untrue: there have literally been hundreds of studies on transgender health care since 1977, and over the past 20 years the wide majority of them have shown improvements in quality of life for transgender people.

A competent, unbiased editor would have challenged these rather sweeping assertions, but did not.

4. Does it blatantly misuse (or cherry pick) real research?

One of the quickest ways to spot biased and unreliable articles about transgender people is when they misuse actual research.  Most commonly this occurs when they cite a 2011 study by Dr. Cecillia Dhejne to argue that medical care for transgender people is ineffective, or that it makes them suicidal.  The problem is, the research actually says no such thing, and Dhejne has gone on the record saying that attempts to use it to make these points are both wrong and unethical.

As such, articles which deliberately misrepresent (lie) about the findings of actual academic work to support anti-transgender positions aren’t just wrong, they are unethical from the get go. I’ve met Dr. Dhejne, and she finds the use of her work to these ends disgusting.

Anderson’s book does just this, repeatedly.

Anderson misuses her research by saying that it shows that health care may not improve outcomes, when the study explicitly says you cannot use it this way because there was no transgender control group which received no treatment, so one cannot make any inferences as to the efficacy of treatment.

He also omits the crucial part of Dhejne’s research that found that after 1989, the suicide rate for transgender people was mathematically similar to the general population. Dhejne looked at this data, and posited that as society became more accepting, mental health outcomes for transgender people improved.

5. Does it blatantly misrepresent the actual positions of people?

I have already discussed how Anderson misrepresents Dr. Dhejne’s positions and research above. But let’s discuss Dr. Kenneth Zucker.

Dr. Kenneth Zucker is a problematic figure. He has been the biggest proponent of the 80% Desistance Myth, and been completely opposed to supporting pre-pubescent kids in any gender variant behavior whatsoever, even if the kids are otherwise emotionally healthy and happy.  This is why he is frequently cited by people and organizations opposed to letting transgender and gender variant kids be themselves.

However, what Anderson never acknowledges is that even Zucker supports the use of puberty blockers for adolescents (i.e. those who have started puberty) who are gender dysphoric, because in an interview with a conservative outlet he conceded that, “By age 11 or 12, trans kids are typically “locked in” to their gender identity” and for them, “I very much support that pathway, because I think that is going to help them have a better quality of life.”  (i.e. even Dr. Zucker thinks that kids older than 11 or 12 are unlikely to desist)

Indeed, Zucker wrote a considerable portion of the DMS 5, and the WPATH Standards of Care for Transgender Adolescents.  While Anderson is happy to hold Zucker up as someone who agrees with him on one thing, he ignores all the other areas where he doesn’t.

6. Does it misrepresent the positions of mainstream organizations?

This book does not so much misrepresent mainstream organizations as ignore them altogether.  He spends almost no time exploring the positions of the American Psychological Association, American Psychiatric Association, American Medical Association, and other major professional organizations.  He spends no time exploring how these organizations arrived at their conclusions on transgender care, or the research they examined. He doesn’t look at the evidence they examined to arrive at their conclusions.

He simply dismisses them as wrong, and defaults to the viewpoints of people with similar religious views, such as Michelle Cretella and Paul McHugh.  Neither has produced clinical research on transgender people (McHugh commissioned someone else to do the study at Jon’s Hopkins in the 1970’s)

You can read actual position statements at the following links, and read the reports of the task forces that looked at transgender health care as well. These position statement provide copious peer reviewed references to why they support health care for transgender people.

7. What organizations does the author represent?

As discussed above, Mr. Anderson is an employee of the Heritage Foundation and a conservative Catholic. His views must represent the political and religious views of the organizations he represents, and cannot represent anything close to an impartial, scientific review.

Within the book itself, he includes the views of many people with strongly anti-LGBT views, such as Michelle Cretella of ACPeds (a fake medical organization and SPLC certified hate group for deliberately spreading falsehoods and misinformation about LGBT people), Leon Kass (who was a conservative opponent of same sex marriage),

Ask what organizations the writer belongs to, or is representing.  Do they belong to a hate group, as defined by the Southern Poverty Law Center?[1]  Or speak for fake medical organizations that are routinely produce recommendations driven by religious beliefs rather than peer-reviewed science and medical consensus?[2] If they do, they cannot credibly claim to be unbiased, or acting in the best interests of transgender people.

(Seriously, if someone is a spokesperson for the Klan, you can’t take their claims that they’re acting on behalf of the best interests of black people. Why should we think about it differently when the group being targeted is transgender people?)

 

8. Who does the article cite?

Many of the primary people used to support Anderson’s assertions have long histories of anti-LGBT animus,  such as Michelle Cretella of ACPeds (a fake medical organization and SPLC certified hate group for deliberately spreading falsehoods and misinformation about LGBT people), Leon Kass (who was a conservative opponent of same sex marriage),  Ray Blanchard and Michael Bailey (who routinely post at anti-transgender websites and push theories designed to denigrate the identities and dignity of transgender people), Paul McHugh (long history of anti-LGBT nastiness and defender of pedophile priests)

 

9. Does the article go against the scientific consensus?

There is currently an overwhelming consensus by professional organizations for mental and medical care providers on the necessity and efficacy of health care for transgender individuals.  These organizations include the American Medical Association, the American Psychological Association, and the American Psychiatric Association.  These organizations studied the matter in detail before taking these positions.

Ryan attempts to contradict all of these organizations, while relying primarily on a pair of non-peer reviewed articles in a religious publication written by people with a long history of religious based hostility towards LGBT people to support his assertions that everyone else got it wrong.

Mr. Anderson must adequately explain why he’s more qualified or smarter than the vast majority of experts who have studied the issue based on peer-reviewed evidence. Alternately, he must explain why all the peer-reviewed evidence is wrong in a way that would survive peer review.

Ryan Anderson does neither, meaning that this book is much more of an opinion piece than a work based on science.

10. Does it substitute anecdotes for research?

The entire chapter on detransitioners chooses anecdote over research. The actual peer reviewed evidence shows that regret rates tend to be very low (1-2%), and regrets are frequently over being treated poorly after transition by others, and not about being transgender.

Worse, Anderson did not even interview at least 4 out of the 6 people he cites, and they were not happy about how their stories were being used.

Another example of anecdote over research in this book is the claim that public accommodations laws endanger women based on a small number of anecdotes and people who fear (and sometimes hate) transgender people, when there is no peer-reviewed quantitative evidence to support this assertion.

11. Are crucial details deliberately left out or ignored?

This occurs frequently in Anderson’s book, and is deliberately done to mislead the reader. For example:
* On page 191-192 Anderson leaves out the crucial fact that the transgender boy (Mack) wrestling in the girls’ division in Texas tried to wrestle with the boys, but was not allowed to because Texas law required him to use his birth certificate to determine which division he should be in. In Texas, it is almost impossible to change your birth certificate. As such, Mack was left only two options: quit the sport or wrestle in the girls division.  He tried to do the right thing, but people with positions like Anderson’s prevented him from doing so.

* Leaves out all of the current research showing positive psychological outcomes for transgender youth with supportive environments

* Leaves out all of the studies showing that transgender youth in unsupportive environments (like the ones proposed by Anderson) have worse mental health outcomes

* Leaves out all of the previous research showing that attempts to change the gender identity of adults have failed, just as they did when trying to make gay people straight

* Omits discussion of epigenetics and other biological factors in human development.  For example, studies of identical twins show that while autism, sexual orientation, and gender identity are correlated (i.e. if your twin is autistic/gay/transgender, you’re more likely to be as well). However, it’s not a 100% correlation (if your twin is autistic/gay/transgender, you might not be).

* Omits the fact that transgender people exist across cultures throughout human history, and it didn’t cause cultural collapse or people to forget how to procreate or have families. Indeed, the Hijra of India have been around for 2500 years, and there are 1.3 billion people in the country.

* Fails to note that transgender unemployment runs at twice the national rate due to discrimination, similar to the figure for African-Americans.

* The book did not discuss the fact that transgender people can be, and often are, happy and successful in their daily lives and careers

* Omits the entirety of the research into biological origins of gender identity.  You can read some of it at these links; there’s actually quite a bit.

Anderson fails to explore any of these, and a lot more, in order to present the reader with a distorted picture of the state of the research.

12. Does it make unsupportable assumptions?

A prime example of an unsupportable assumption is that transgender people can (and should) just stop being transgender because of higher health risks, as if it was like quitting smoking or eating carb-loaded snacks before bedtime.  This assumption first ignores that the medical and mental health care communities regard efforts to change sexual orientation and gender identity as ineffectual and unethical. It also ignores the fact that the only people promising to “fix” someone’s gender identity are the same people who failed so miserably at “curing” gay people while using the same “embrace your God-given masculinity” snake oil.

Anderson’s book implies that “clinicians need to be trained in these methods.” (p. 211) The problem is, Anderson doesn’t actually acknowledge that there are NO clinically tested, peer reviewed treatment methods to change a persons’ gender identity.  They tried all the same things they did on gay men (praying, electric shocks, aversion therapy using castor oil and chemical tear agents, cognitive behavioral therapy, anti-psychotics, anti-depressants, psychic driving, hypnosis, Jungian theory, you name it) without success.

In short, Anderson assumes that there is a method that works (there isn’t), and that the reader won’t question whether there is (you should). Anderson makes the unsupportable (and no, 14 people in Europe does not constitute a need for a nationwide network of doctors) assumption that there are lots and lots of transgender people out there who cannot wait to have their surgeries reversed, if only activists would let them.

Or, conversely, it’s a lot easier to reasonably assume based on the peer reviewed evidence that if transgender people weren’t ostracized, abused, and legally marginalized they’d have better mental health outcomes.  This has been borne out in numerous studies (i.e. transgender people have much better mental health outcomes when they’re not abused, ostracized, and discriminated against)

Go figure.

13. Does it make unsupportable conclusions? (And ignore the supported ones?)

Examples of unsupportable conclusions in this book are myriad.

Many of the anecdotes about detransitioners essentially conclude that no one should ever be allowed to transition (which ignores the peer reviewed evidence showing the vast majority of transgender people report improvement in quality of life after transition). A far more logical conclusion would be that people should have better (more) access to competent mental health care providers, which is something the APA is recommending anyway.  A common thread among the people Anderson cited was that they either had limited access to mental health care providers, or in the case of Walt Heyer, deliberately deceived them.

It essentially concludes that stigmatizing and abusing transgender people until they go back into the closet is good for transgender people.

It concludes that the best thing for transgender people is to undergo some sort of unspecified reparative therapy, when no such therapy has ever been demonstrated to be effective (but there is plenty evidence of harm.)

It concludes that all transgender people are, by definition, mentally ill, even if they are happy, well adjusted, successful, and highly successful in their careers. In other words, in order to conclude that transgender people are mentally ill, Mr. Anderson has taken upon himself to re-write the very definition of mental illness as defined by psychiatrists and psychologist (which he is not).

It concludes that transgender people should be banned from bathrooms because someone might pretend to be transgender and do bad things.  Sort of like banning Sikhs from entering the US because most people don’t know the difference between Muslims and Sikhs anyway.

14. Does the article make wild accusations and predict ludicrous outcomes?

Strange ideas and accusations in this book include:

* Accepting transgender people will destroy our entire cultural concept of gender and sex,
* Transgender people destroy women’s rights
* Transgender people are somehow contributing to the decline of family / marriage in the US
* Transgender people cause people to forget how to procreate
* Support for transgender health care is part of a conspiracy by “politically correct” medical and mental health organizations
* Transgender activists are stealing kids and forcing them to transition with therapists who railroad them.

When your positions require a conspiracy theory where thousands of medical professionals are in on it in order to be true, the positions are on pretty weak ground.

15. Does the article imply religion is a cure for gender dysphoria?

While Anderson does not explicitly state what the “cure” for gender dysphoria should be, he does not rule out the religious based programs recommended by the Family Research Council (with which he is affiliated and cites).  Indeed, every one of the “ex-trans” programs recommended by the FRC is religious based.  Since Anderson cannot cite a secular methodology for curing gender dysphoria, all that remains are religious ones.

And using religion to establish public health policy is not scientific.

 

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While Anderson claims “we must not be careful to stigmatize those who are suffering”, the book alleges the following about transgender people:

• Transgender people are all mentally ill
• Transgender women are gay men who want to trick straight men into sleeping with them OR
• Transgender women are straight men who are all sexual perverts
• Transgender activists are stealing children and conducting medical experiments on them
• Acceptance and inclusion of transgender people is unacceptable because of bathrooms
• Transgender people are destroying the American family (somehow)

The goal of convincing readers transgender people are deranged perverts who steal children while destroying America is to get them to discriminate against transgender people.  Anderson then advocates for eliminating all civil rights protections for transgender people to ensure that people are able to do just that.

On page 27, Ryan makes it clear that this book isn’t really about what’s best for transgender people, it’s what he sees as best for everyone else. “The topic at issue that day was not whether people who identify as transgender have a right to their lives; it was what sort of policies best respect the lives of students who identify as transgender and the lives of all the other students,” where he italicizes “all the other students,” for emphasis on who really matters.

This book was not science. It was propaganda to support a religious viewpoint and a set of policies that would cause great harm to a vulnerable minority community already suffering from significant stigma and economic disparities.