We All Deserve Better Data — And Data Analysis — On Trans And Gender-Questioning Youth

Better than what the CDC is providing, at least

On October 10, the Centers for Disease Control and Prevention published important new survey data on transgender and gender-questioning youth. The data “come from the agency’s Youth Risk Behavior Surveillance System, a survey of more than 20,000 high school students conducted in public and private schools across the country every two years,” writes Azeen Ghorayshi in The New York Times. “The 2023 survey was the first to ask teenagers in all schools whether they identified as transgender.”

Kathleen Ethier, the director of the CDC’s adolescent and school health division, painted a dire picture of the results to Ghorayshi. “We have 5 percent of young people in the country who, because of the way they identify around their gender, are stigmatized, bullied, made to feel unsafe, feel disconnected at school and consequently have poorer mental health and higher risk for suicide than their cisgender peers,” she said. “That’s just heartbreaking.”

Ethier is making a very specific causal argument about the correlations uncovered by this survey. But if you look closer, there are reasons to be skeptical. And there are huge, underappreciated problems with survey data on youth gender issues that make it genuinely hard to know how to interpret the scraps that have been published.

Let’s start with how the terms in question are defined, and how the question was posed to respondents. The very start of the CDC article, co-authored by 10 public-health experts within the agency, explains:

Gender refers to the socially constructed norms and expectations imposed on persons according to their designation as male or female sex at birth. Gender identity refers to a person’s sense of self and personal experience of gender. Transgender persons are those persons whose gender identity differs from their sex assigned at birth, whereas cisgender describes persons who identify with the gender aligned with their sex assigned at birth (https://www.who.int/health-topics/gender).

I’m far from the first person to have pointed out that the way many people talk about gender identity is circular and/or incoherent and/or steeped in stereotypes that (we are simultaneously told) are not the basis of transgender identities. But we don’t need to get deeply philosophical to see that the CDC is capturing a very broad subset of experiences here. 

Here’s the CDC’s chosen definition of “transgender” again, but with the terms gender identity and gender replaced with their own definitions from elsewhere in the paragraph (I’ll put brackets around those definitions to make things a bit clearer):

Transgender persons are those persons whose [sense of self and personal experience of {the socially constructed norms and expectations imposed on persons according to their designation as male or female sex at birth} differs from their sex assigned at birth], whereas cisgender describes persons who identify with [the socially constructed norms and expectations imposed on persons according to their designation as male or female sex aligned with their sex assigned at birth].

That’s not a very good or coherent definition. And it would be an arguably silly or pedantic exercise for me to point this out if I were quoting from some Tumblr resource or an LGBTQ+ club at a high school. But I’m quoting from the CDC — a government agency. And by this definition — the definition used to determine the approximate number of trans and gender-questioning youth in the U.S., and to measure their outcomes — it turns out I’m trans: After all, my sense of self and personal experience of the socially constructed norms and expectations imposed on me according to my designation as male differs from my sex assigned at birth” (to the extent that makes any sense). Or, stated more frankly, it’s definitely not the case that I “identify with the socially constructed norms and expectations imposed on” me by dint of having been born male, i.e., I’m not “cisgender.”

Back to this in a minute. Let’s jump down to how the questions were actually asked in the survey:

A single item assessing transgender identity was developed by CDC survey methodologists and external researchers. In 2018, the item was cognitively tested with high school students and found to be understood as written. The question reads, “Some people describe themselves as transgender when their sex at birth does not match the way they think or feel about their gender. Are you transgender?” Students who responded, “Yes, I am transgender,” were categorized as transgender, and students who responded, “I am not sure if I am transgender,” were categorized as transgender or questioning. Students who responded, “No, I am not transgender,” were assumed to be cisgender. Students who responded, “I do not know what this question is asking,” and students who skipped the question were excluded from analyses.

This isn’t quite as bad as the definitions provided to readers of the subsequently published findings, but it’s still extremely broad. I’m not sure how the kids could have understood the question “as written” given how confusing it is to even an educated adult. Not to belabor the point, but I really don’t think my sex at birth “matches the way I think or feel about my gender — again, to the extent I can even parse exactly what this means.

On the one hand, this isn’t really the CDC’s fault — that’s just how the term is defined these days. Most mainstream LGBT communities have evolved with an eye toward inclusion: Basically anyone can identify as transgender, and it’s bad to “gatekeep” this identity because it isn’t inherently about wanting to change your body (though some people do), or feeling strongly that you are (fe)male despite having been born the other sex (ditto). Rather, especially among young people, all it takes is for your “sex at birth [to] not match the way [you] think or feel about [your] gender,” and this can mean just about anything. 

What this leaves us with is a category that is undeniably going to sweep in a lot of kids. And, sure enough, the survey yielded eye-popping percentages: As Ghorayshi notes, “About 3.3 percent of high school students identify as transgender and another 2.2 percent are questioning their gender identity.” If, as the U.S. Census believes, there are about 17.3 million high schoolers in the U.S., that means almost a million of them are trans or gender questioning. 

That doesn’t mean that a million American high schoolers are considering blockers or hormones, or present in a gender-nonconforming way, or are in any manner affected by laws concerning gender identity or dysphoria. It’s hard to know exactly what it does mean, other than that there is a tremendous amount of gender talk in the air, and it’s a very important subject to a lot of young people.

Just about everyone who is a serious commentator or researcher on this subject is aware of the wide gamut of trans and gender-questioning youth these days. There are kids who have old-school, “traditional” gender dysphoria. There are kids who identify as trans but are more or less gender conforming. There are, undoubtedly — I have spoken to both parents of youth who have experienced this as well as detransitioners who fit this bill — kids who arrive at their new understanding of their gender identity following a period of profound trauma or distress, and for whom it ends up being a passing phase. This does not appear to be a rare occurrence, in fact.

To define the categories of “transgender and gender-questioning” so loosely as to lump all these kids into one bucket makes it extremely difficult to collect and analyze data on them, and to help the ones who need help.

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The CDC authors do show in the survey that trans and gender-questioning youth experienced all sorts of negative outcomes at a higher rate than their cisgender peers: