CW: transphobia, misgendering, discussion of gender-affirming surgeries
For the last five years, I have devoured each edition of Private Eye from cover-to-cover. A sixty-year-old magazine currently edited by Ian Hislop, about 80% of Private Eye is investigative journalism, and about 20% is satire. What I like most about it is that almost all of its stories aren’t in the mainstream news, but many ought to be. It champions those who have been short-changed, treated unjustly, or ignored by the establishment. It also loves to puncture movements or ideas that have become hegemonic or commonly accepted in society. (Its reporting of the Post Office IT scandal was excellent, and it’s also really sharp at covering the ongoing incompetence of ACOBA).
I recently learnt that this “sticking up for the little guy” mission includes people who are “gender critical”, or as you and I might know them, TERFs. To be clear, I am a cisgender woman and I consider myself a trans ally. I wanted to use my voice to speak up against what I read. As they didn’t publish anything I sent them, I wanted to keep a record of that exchange.
Strap in.
The Article: Irreversible Damage by Abigail Shrier
As someone who works in publishing, I always skip to the Books pages. They often have quietly critical reviews of the Big Books of the Moment — a nice antidote to the fawning praise most other outlets employ. However, they didn’t really criticise this book at all: and actually extended its points to the UK healthcare system. I can’t post the entire article here for plagiarising reasons (i.e. I don’t want to plagiarise), so the key points are below.
- Puberty blockers have not yet been thoroughly tested. Giving them to children is like giving thalidomide to pregnant women, or lobotomies to the mentally ill or epileptic.
- Irreversible Damage by Abigail Shrier, a book critical of the recent rise in allowing young trans men to transition, has been “exposed to the liberal version of a fatwa”, with calls to burn it (from whom, it does not say), and a lack of a review from the New York Times or the Guardian.
- Young teens are “isolated, stressed, and straitlaced”, and Shrier argues that this leads them to come out as trans, evidenced by the rise in transmasc young people seeking medical gender services in recent years.
- The idea of having a “gender identity” is a new phenomenon, co-opted by the medical establishment and the “liberal left”. Gender is “now nothing to do with sex, and everything to do with living your truth.”
- Transmasc teens (whom she misgenders) come out as trans because they are sufferers of Rapid Onset Gender Dysphoria, and not because they are “really” transgender. Part of the reason they do so is that they “don’t want to be degraded like teen sluts on PornHub, and can’t imagine being as flawlessly feminine as an Instagram influencer.”
- In the UK, it is becoming harder for teens to transition. There is insufficient evidence that puberty blockers save lives, as the only under-18 gender identity clinic, the Tavistock, has failed to publish any studies. (Coincidentally they now have published one: here).
- As a nice closing sentence, they compare giving trans teens medical treatment for gender dysphoria “an icepick to the eye socket.”
When I read this, I was absolutely furious. Pacing-around-the-room, ranting-about-how-wrong-it-was furious. Comparing gender affirming hormonal treatments to getting an icepick to the face? Making out that the normal angst of being a teenager is being misinterpreted as gender dysphoria? Not proposing any sort of criticism of the book, but instead parroting its main arguments without criticising them or providing evidence for its arguments?
My first email
Dear sir,
I hope to be the 94th person to get in touch following your review of the book ‘Irreversible Damage’ by Abigail Shrier. I was astonished to read your ignorant and alarmist discussion of the book’s hateful contents.
To compare hormone therapy for trans or gender non-conforming (GNC) children to thalidomide or lobotomies is to give the impression that transgender treatment and surgery is somehow imposed on people without their consent. With the average waiting list for child transgender services currently at 33 months, there is ample time for children to change their minds – and the overall average detransition rate is under 1% (Davies, McIntyre and Rypma, 2019).
[This is a big, long-term, study with a pretty big sample size].
You mention approvingly that UK children have been banned from accessing hormone blockers, saying “these drugs almost always lead to cross-sex hormones (and therefore infertility and impaired sexual function)”. This is false: hormone blockers are safe and reversible (Rafferty 2018). And they “almost always lead” to cross-sex hormones because the patients taking the blockers then decide that they want to start the hormone therapy. No one forces the medication down their throat.
[This person says it better than me:]
Most egregiously, you say that youth with ‘rapid onset gender dysphoria’ (ROGD) are a distinct group’ [compared with ‘genuinely’ trans people]. A cursory Google search will inform you that ROGD is not a valid psychological diagnosis distinct from gender dysphoria, and is based on discredited research. The incidence of left-handedness soared through the 20th century because being left-handed was no longer taboo. It was not due to left-handed propaganda or peer groups saying it was cool. And any teenager will tell you finding people with whom they share things in common is very easy on the Internet.
[Any millennial will tell you that too. Pretty much anyone who’s used the internet for socialising will tell you that.]
A better review of the book might mention that Shrier’s primary research was with parents of trans youth, whom she found on an anti-trans website for parents: hardly a reliable or objective source.
[I want to scream]
I recommend YouTuber Ty Turner’s video ‘Transphobic Book Targets Me & Other Trans Creators, LGBT YouTubers Promote It’ for a discussion of what a real transgender person thinks about the dangerous lies being peddled in this book.
Yours sincerely
Jess Harris
London
Private Eye’s response
I received an email from Ian Hislop’s assistant: Ian himself greeted me and signed off. He was the middle man for a response from the author themselves, who wrote me an extensive response that I will quote in full below.
Dear Jess Harris,
Thankyou for your letter. Our reviewer, who is neither ignorant nor alarmist, replies as follows:
The average wait to be seen at the Tavistock is indeed too long – and this undoubtedly contributed to its “inadequate” rating by the Care Quality Commission last week. However, so did its lack of record-keeping and follow-up care. Also, there is a difference between a long wait to be seen, and the speed of being placed on a medicalisation pathway once seen; in fact, the two might be related. Whistleblowers have suggested that overstretching at the Tavistock means that children under its care are given inadequate time and space to explore other issues which might be related to their gender distress (eg abuse, anxiety, depression, autism).
Honestly, I don’t think we have useful statistics on detransition rates, because the spike in teenage cases is so recent, and follow-up studies have focused on those who stay in contact with services (and are therefore likely to be those who continue to be happy with their care). It’s an inherently distorted sample. Again, this is information that might have been obtained had the Tavistock kept better records, so it’s a shame that the clinic has been so poor in this respect.
I’m surprised that this correspondent has missed the NHS’s reversal of its position on puberty blockers being “safe and reversible” in the last year: this phrasing has now disappeared from the NHS website. It was also made clear by the Bell judgement that the judges did not believe PBs were safe and reversible: instead they ruled that they were an “experimental treatment” and that they proceeded in almost every case to cross-sex hormones, which are associated with infertility and inability to orgasm. The Tavistock claimed at the hearing not to have statistics on this, and then published a study the next day confirming it. (A study, incidentally, which showed no mental health benefits to PBs.) See the TV show I Am Jazz for a frank discussion of the problems of not going through natal puberty with regard to a trans girl’s future sexual development, or Susie Green of Mermaids joking about how her daughter Jackie’s penis was so small as a result of puberty blockers that the surgeons who carried out SRS on her 16th birthday didn’t have much to work with:
“The majority of surgeons around the world do something called penile inversion where they basically use the skin from the penis to create the vagina. And she hadn’t developed through full puberty so to not put too fine a point on it there wasn’t much there to work with”
The idea of PBs as “safe and reversible” came from their short-term use on, say, 9-year-olds with precocious puberty, who then proceeded to puberty in their natal sex. There has been little long-term research on the outcome of using them in transgender children, and there are concerns that doing so in biological females might have longterm implications for bone mineral density. This is a live debate in the pages of the BMJ currently.
Impressed though I am by the concept of making up one’s mind on the basis of a “cursory Google search”, it is a fact that Lisa Littman’s paper on ROGD was reinstated (after an over-reaction to activist pressure). It was only ever an observational paper, not a longitudinal research study, and I agree that the subject needs more research. It is an unfortunate activist tic to describe research which comes to controversial conclusions as “debunked” when what is really meant is “challenged”, which is part of the normal scientific method. Only holy writ goes unchallenged. And given that “gender dysphoria” is an incredibly recent diagnostic standard – it was only changed from “gender identity disorder” in the latest issue of the DSM, it’s not surprising that there is more work to be done on whether ROGD is a useful term.
As for the incidence of left-handedness soaring over a century, I would say that a century is a very different timescale to a decade. Perhaps the better comparison with the recent sharp rise in females at gender clinics is the 19th century spike in right-handedness when teachers forced pupils to write that way. Undoubtedly, the rise in numbers of “out” trans people generally reflects a welcome shift in social acceptance, but it would not explain why the sex ratio in teenagers seeking medical transition had changed so suddenly and precipitously.
I agree that Shrier selected examples to make her point: it’s a polemic book, albeit written in a folksy way. She is overt in positioning herself on the side of the parents in this debate. But that’s not a reason not to publish it, unless you also want to ban, say, ITV’s Butterfly, which takes an uncritically positive view of childhood transition.
As the review states, there might well be children for whom puberty blockers are appropriate — and I must correct your correspondent here, because they have not been “banned”, but instead clinics are recommended to seek a court order — but the onus is on the Tavistock to prove that hypothesis. If the benefits are as obvious as your correspondent seems to think, that should be easy. Instead whistleblowers and a court judgement have painted a picture of well-meaning people trying to help distressed children, and seeing any (normal, expected) interrogation of their methods as inevitably destructive and motivated by bigotry. This is the intellectual climate in which medical scandals often happen: how dare you question people who are just trying to help?
As for further reading, I would recommend Galileo’s Middle Finger, by Alice Dreger, for more on the birth of the modern trans activist movement, and the harassment of researchers involved.
I hope this helps.
Best wishes
Ian Hislop
Editor
Ian, it did not help.
My reply
I did not expect to get a response at all, let alone such a long one, so my response took a few days to write, meaning that it missed the deadline to be included in the following edition of the magazine. I got most of the best arguments from a transfeminine friend: I did not have such good arguments off the top of my head.
Hi,
Thank you for your careful and reasoned email: I appreciate you taking the time to respond to my points. I don’t have the expertise or time to engage in a long email debate, but I wanted to send a further response to your message.
Your review concerned a book written by an American author about American children. You say that the Tavistock GIC has inadequate record-keeping and is too quick to prescribe medical treatment to those experiencing gender distress. It seems curious to me that you are using the fact that there are flaws with the care at one specific GIC — admittedly the only one in the UK — to suggest that we should not allow GNC children to transition at all.
What is the correct amount of time that GNC children should wait to be given treatment, beyond the excruciatingly long wait for their first appointment? This idea that they should wait an unspecified amount of time and receive careful and extensive therapy suggests a hope that these children will change their minds and turn out to be cis. That idea is built on the premise that being trans is bad and should be avoided if at all possible: that it’s better to allow dozens of GNC children to suffer on long waiting lists or by going through the incorrect puberty than to let one person transition when they shouldn’t have: that nothing is worse than having a transitioned body.
It also, more fundamentally, deprives these children of autonomy about their own bodies. If there are insufficient counselling services then that is a problem, but the idea that they should be compulsory seems patronising at best and controlling at worst. It is ludicrous and inconsistent that sixteen-year-olds are able to have abortions, plastic surgery, and other drastic and permanent medical care, but when it comes to transitioning, they should face as difficult a journey as possible in the hope that they will change their minds.
You also state that we have inadequate data about detransitioning. It’s interesting to me that you say that peer-reviewed studies around detransitioning are insufficient, but the discredited study around ROGD is somehow more reliable. You are correct that detransition studies tend to over-represent those who stay in contact with services and are therefore happy with their care, but this goes both ways: they also under-represent people who have transitioned and are no longer in touch with those services. Okay, the Tavistock keeps poor records, but that is not the same as the peer-reviewed study on detransitioning that I mentioned in my initial email (Davies, McIntyre, Rypma 2019).
It is interesting to consider the difference of narrative around, say, an experimental drug for some physical condition versus the risks associated with taking puberty blockers, now also considered an “experimental drug”. Yes, PBs have some side effects, but those are either not very likely to occur, or they are likely, but those taking them accept those risks. This is the case with almost all medical treatments: you are told the risks and you accept them. I might drive a car because I want to get somewhere, and in doing so I will accept the idea that I might crash and die. I judge that it is worth it, and I have the right to make that decision about my body.
Your comment about genitals: firstly, these are not the be-all and end-all of the sexed body. Secondly, some surgeons do not need a lot of penile skin in order to create a vagina: there are alternatives. (Oestrogen makes the penis shrink at whatever age it is taken). More importantly, puberty has a huge number of other effects on the body, such as the voice breaking, body shape changing, and so on, which are difficult or impossible to reverse. A cis person deciding that it’s appropriate for transfeminine individuals to go through a male puberty so that they might be able to have surgery is a hugely inappropriate decision to make for someone else.
[I have now written a letter to Ian Hislop about penile skin. Envy me.]
I was surprised to read your steadfast defence of the paper about ROGD. The World Professional Organisation for Transgender Health states that “[ROGD] is not a medical entity recognized by any major professional association, nor is it listed as a subtype or classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD). Therefore, it constitutes nothing more than an acronym created to describe a proposed clinical phenomenon that may or may not warrant further peer-reviewed scientific investigation.” I am more inclined to believe this than a paper that was challenged — and yes, reinstated, but not based on anything like replicable, precise data: instead, interviews with parents who disapproved of their children transitioning. I don’t think this is the same as only letting holy writ go unchallenged.
[I was particularly proud of this!!]
Your comments about the rise of being left-handed are interesting, but I have two rebuttals to your point. The first is that social change can happen so much faster now than at any time in the past – thanks to the internet and other features of modern society that allow for greater connectedness in social networks. There are countless examples of this. Secondly, the idea that GNC children are being “forced” to be trans is absolutely untrue. If it were true, would there not be more effort to shorten GIC waiting times? To make hormones easier to prescribe? The establishment is making it harder for GNC children to receive treatment, not easier.
Finally, you say that “whistleblowers and a court judgement have painted a picture of well-meaning people trying to help distressed children, and seeing any (normal, expected) interrogation of their methods as inevitably destructive and motivated by bigotry.” I’m not trying to speak for anyone apart from myself. I reiterate my earlier point: that to attempt to tell people that their gender distress is a result of too much time online; of autism; of anxiety or depression; or of the vicissitudes of growing up — is to imply that you know their identities better than they do. It is deeply infantilising, patronising, and conservative.
I go back to my initial point: that the aim of many of your arguments is to make sure that it is as hard as possible for GNC children to transition and that they have minimal agency in the process (being dependent on the medical and now, in the UK, legal establishment). All this gives the impression that to transition or to be transgender is a bad thing. That to be trans is inherently worse than being cis. I hope the incipient transphobia is clear here.
[This is really the fundamental thing. The subtext of all of this ‘concern’ appears to be that being trans and having a transgender body is bad. Perhaps it’s icky, or disgusting, or scary?]
Lastly, I am absolutely not suggesting banning Shrier’s book: I was simply surprised to see such an uncritical examination of her arguments in Private Eye, and wanted to raise some important points that I feel a review ought to contain when discussing it.
All best wishes
Jess Harris
I didn’t get a response. If my post gets published in Private Eye, I will update this post accordingly.
If you made it to the bottom of this post, thank you! If you are trans and have any comments on the arguments I’ve raised, or want to clarify or correct anything I’ve said, please do post them below! And if you are reading this because you thought that Abigail Shrier is the bees’ knees and she’s just looking out for sad children, I hope I’ve helped you reconsider whether your concern is more helpful or harmful.
Travels and Books 
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