Conservatives Are Lying About What My Atlantic Article On Gender Dysphoria Says

I guess it was their turn

(PSA: Your Ask Me Anything questions have been answered.)

On May 3rd, a “Reply Brief In Support Of State Plaintiffs’ Renewed Motion For Summary Judgement” was filed in the ongoing litigation surrounding the reach of the Affordable Care Act. The legal wranglings are complicated, but the short version is that the plaintiffs — Franciscan Alliance, Inc. which is a healthcare system in Indiana and Illinois, Specialty Physicians of Illinois, Inc., and the Christian Medical & Dental Associations, alongside the states of Texas, Nebraska, Kentucky, Kansas, Louisiana, Arizona, and Mississippi — have been attempting to get an Obama administration rule guiding ACA enforcement tossed out for good.

Politico has good background from late April on the Trump administration’s parallel efforts to overwrite that rule with their own rules, and how those efforts intersect with this lawsuit:

One rule [the Trumpistas are considering] would replace an Obama administration policy extending nondiscrimination protections to transgender patients, which have been blocked in court. A second rule would finalize broad protections for health workers who cite religious or moral objections to providing services such as abortion or contraception, a priority for Christian conservative groups allied with the administration.

The Obama administration issued transgender patient protections as part of a rule enforcing Obamacare’s Section 1557 provision banning discrimination in health care based on sex, but they were halted in 2016 by a Texas federal judge who found Congress didn’t intend to protect gender identity. The Justice Department this month told the judge it agreed with the ruling and signaled that the administration would soon issue a replacement rule.

Indeed, as the introduction to the latest brief reads: “The federal government agrees with Plaintiffs that the Rule is unlawful under the Administrative Procedure Act (‘APA’) because it redefines sex discrimination under section 1557 of the Affordable Care Act (‘ACA’) to include gender identity and termination of pregnancy discrimination.”

In the latest brief, my long story in The Atlantic about gender dysphoria is used as a political football by the conservative plaintiffs in an attempt to fuzz up the science of gender dysphoria. There is obviously much more at stake here than a disingenuous reading of my article, but I don’t like the idea of my work being used in this manner, so I want to quickly and forcefully set the record straight.

Here’s the passage in question:

The bathroom example highlights the fundamental point that putative intervenors miss. The basis of sex discrimination law, as it currently exists, is biological sex. By contrast, there is no broad consensus—much less federal law—on the proper approach to treating individuals with gender dysphoria, the clinical term for the feeling of disconnect between one’s gender identity and sex at birth. See, e.g., Jesse Singal, When Children Say They’re Trans, THE ATLANTIC, July/Aug., 2018 (describing the “growing number of people” who regret transitioning to a different sex and later detransition); Katherine Cave, The Medical Scandal that the Mainstream Media Ignores, PUBLIC DISCOURSE, Apr. 8, 2019 (“I am liberally-minded in my political beliefs. [When my daughter announced she was transgender], I was pressured to consent to puberty-blocking drugs, with assurances that they were safe and well-studied. My research later confirmed that this was not true.”). The role of federal agencies is to implement and execute the law—not to conduct social experiments without Congressional authorization. The Rule cannot redefine sex discrimination. [emphasis mine]

Unless I am missing something, the bolded part is very muddled. The plaintiffs appear to be mixing up two entirely unrelated questions: how sex should be defined under federal law, and what the medical consensus on treatment for gender dysphoria is.

Anyway, to use my article as evidence for the claim that there’s no consensus on how to treat gender dysphoria is a complete, profound misreading, as well as a very disingenuous harvesting of the “growing number of people” quote. Let’s start with the latter, which deals with Max Robinson, a detransitioner I interviewed in Oregon:

Max is one of what appears to be a growing number of people who believe they were failed by the therapists and physicians they went to for help with their gender dysphoria. While their individual stories differ, they tend to touch on similar themes. Most began transitioning during adolescence or early adulthood. Many were on hormones for extended periods of time, causing permanent changes to their voice, appearance, or both. Some, like Max, also had surgery.

Many detransitioners feel that during the process leading up to their transition, well-meaning clinicians left unexplored their overlapping mental-health troubles or past traumas. Though Max’s therapist had tried to work on other issues with her, Max now believes she was encouraged to rush into physical transition by clinicians operating within a framework that saw it as the only way someone like her could experience relief. Despite the fact that she was a minor for much of the process, she says, her doctors more or less did as she told them.

Here and elsewhere in my article, it’s clear that the issue is with diagnosis and assessment, not the question of whether transition helps people who are properly assessed and subsequently diagnosed with gender dysphoria. The article couldn’t be clearer on the question of whether physical transition helps people with severe, long-term gender dysphoria:

For gender-dysphoric people, physical transition can be life enhancing, even lifesaving. While representative long-term data on the well-being of trans adults have yet to emerge, the evidence that does exist—as well as the sheer heft of personal accounts from trans people and from the clinicians who help them transition—is overwhelming. For many if not most unwaveringly gender-dysphoric people, hormones work. Surgery works. That’s reflected in studies that consistently show low regret rates for the least-reversible physical procedures to address gender dysphoria. One 2012 review of past studies, for example, found that sex-reassignment surgery “is an effective treatment for [gender dysphoria] and the only treatment that has been evaluated empirically with large clinical case series.” A study on “bottom surgery,” or surgery designed to construct a penis or vagina, found that from 1972 to 2015, “only 0.6 percent of transwomen and 0.3 percent of transmen who underwent [these procedures] were identified as experiencing regret.”

Those of us who have never suffered from gender dysphoria can have a hard time appreciating what’s at stake. Rebecca Kling, an educator at the National Center for Transgender Equality, in Washington, D.C., told me that before she transitioned she felt as if she were constantly carrying around a backpack full of rocks. “That is going to make everything in my life harder, and in many cases is going to make things impossible,” she said. “Of course being able to remove that heavy burden has added comfort and stability in my sense of myself and my body.” Other trans people have offered similar descriptions of gender dysphoria—a weight, a buzzing, an unavoidable source of rumination and worry. Hormones and surgery grant transgender people profound relief.

No honest person could read this passage and come away believing my article supports the view that there is “no broad consensus… on the proper approach to treating individuals with gender dysphoria.”

This Atlantic article is the most misread thing I have ever written. Not even close. Oftentimes, as is the case here, the misreadings take a specific claim from the article, X, and confidently assert that the article argues against X. In this case: The article states that physical transition is the best and most evidence-based treatment available for gender dysphoria. Then the article gets summed up, in the legal brief, as supporting the view that there’s no real medical consensus on treatment for gender dysphoria.

Since the article came out, these egregious misreadings have come predominantly from the left — as represented by this correction in Slate; this 180’ing of my opinion on informed consent in Jezebel (I’ve reached out repeatedly to ask them to fix it and never heard back); this dishonest cherrypicking of a quote and similar complete 180’ing of my opinion on informed consent in The New York Times that the Times at least let me respond to; basically an entire article in ThinkProgress that included at least one outright fabricated claim about my own article’s content (the one about the 80% figure); and on and on and on.

So I guess it was just the right’s turn, or something. It is frustrating, but there isn’t much I can do about it — the article says what it says, and people are either going to read it closely and honestly, or not. And many people aren’t. In conclusion: sigh.

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Questions? Comments? Dishonest misreadings of this very post? I’m at singalminded@gmail.com or on Twitter at @jessesingal.