Transition as Treatment: The Best Studies Show the Worst Outcomes

Jan 11, 2019 – Paul Dirks

The treatment for this particular disorder is severe; lifelong experimental medicalization, sterilization, and complete removal of healthy body parts—a treatment Dr. Ray Blanchard, one of the world’s foremost sexologists, calls “palliative”. In spite of its severity, however, medical transition is no longer a rarity. It is the recommended treatment for gender dysphoria, a diagnosable disorder of incongruence between a felt “gender” and one’s natal sex that is undergoing a tremendous increase in prevalence throughout the world. More and more children and adolescents are being diagnosed and are undergoing medical treatment prior even to completing puberty.

For those who express caution or concern there is a familiar retort— “trust the experts”.

This argument, however, makes mockery of the fact that three of the most influential sex researchers of the last couple decades—Ray BlanchardMichael Bailey, and the recently vindicated Ken Zucker, all have problems with the affirmation-only transition narrative currently being promoted. You could add to this list names like James CantorEric VilainStephen LevineDebra Soh and Lisa Littman.

I want to invite you to look at the data these and other researchers draw from. What does the peer-reviewed research itself say about the effectiveness of medical transition for those who have gender dysphoria? Do puberty blockers, cross-sex hormones, mastectomies, vaginoplasties, and phalloplasties successfully alleviate the mental and emotional distress gender dysphoric persons face? Findings are varied, as are the political and philosophical perspectives of the researchers, but a careful reading of the literature demonstrates that the best studies show the worst outcomes.

Part of the problem, admittedly, is the studies themselves. It is often represented in the mainstream narrative that medical transition is well-studied and that there is academic consensus around its effectiveness. In reality, the literature is fraught with study design problems including convenience sampling, lack of controls, cross-sectional design, low sample sizes, short study lengths, and enormously high drop-out rates. Very few studies on transition evade these issues. For example, in Nobili’s 2018 systematic review of quality of life studies of transitioned adults, she rates only 2 of 29 studies as high quality.

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