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Rigging the Science
On the Collateralized Debt Obligation of Transgender "Science"
The ersatz “scientific consensus” cited on behalf of “gender affirming care” rests upon a foundation of quicksand. It is a Collateralized Debt Obligation constructed out of a mass of underpowered — at best methodologically flawed, at worst downright fraudulent — individual studies that make only the most perfunctory attempts to qualify as data-gathering. Each constituent part is invalid in itself and is aggregated into a larger whole that compounds rather than mitigates the weakness of the individual parts. The resulting structure is then blessed with a Triple-A rating by a credentialed member of the scientific clerisy with activist commitments to the cause whose declaration that the benefits of “gender affirming care” are “settled science” is then uncritically broadcast by the NGO lobbies that dominate Democratic party messaging and mainstream media coverage of the issue.
It takes only a very cursory understanding of research method to be able to see this once you look into the studies themselves. The studies are that slapdash, almost contemptuously so at times. The manufacture of this pseudo-consensus based upon confident pronouncements issuing from what we’ve all been led to believe are authoritative institutions is one of the many dimensions along which the transgender movement has corrupted the integrity of truth-seeking in pursuit of an overreaching sociopolitical agenda. This agenda amounts in practice to propagating medicalized self-harm onto children under the guise of affirmation of authentic selves.
The process of exposure of this fiasco has been ongoing. The sexologist James Cantor dismantled the evidence cited on behalf of the American Academy of Pediatrics policy statement regarding pediatric gender medicine back in 2018. Michael Biggs wrote this important critique of the Dutch Protocol that is the most often cited piece of evidence in support of the efficacy of pediatric gender transition, which was further elaborated in 2022 in a separate critique. Leor Sapir did a thorough fisking of 16 studies at Reality’s Last Stand. Jesse Singal’s Substack has been covering this issue continuously in recent years. He recently published an overview of this subject in the publication Unherd. And the British Medical Journal recently weighed in with a reported feature covering similar territory. All of these publications confirm what comprehensive evidence reviews undertaken in Finland and Sweden have found — that there has never been any high-quality evidence in support of the safety or efficacy of pediatric gender medicine. These findings in turn serve as the basis for both of those nations restricting pediatric gender medicine to formal research protocols.
Today’s post, by a PhD holder in social psychology with an interest in how political bias in media and academia results in the broad circulation of false claims, adds to that literature by zeroing in on two case studies and supplementing them with a basic primer on what is and is not good research. His somewhat abrasive, polemical tone is a useful supplement to the more well-mannered approach adopted by those constrained to rely on ironic understatement to convey the Twilight Zone-like unreality of the studies offered in support of a macabre practice that the powers that be of the Western have decreed must be spread as widely as possible. He concisely, brusquely, bluntly shows what a pathetic con it has been all along, with no end in sight. He will soon be ramping up the publication of similar such unmaskings at his Substack.
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By José Duarte
Last year, anesthesiologists at the Boston Children’s Hospital (BCH) described how they put under 65 girls aged 15-17 to have their healthy breasts cut off in the Journal of Clinical Medicine. The minor girls joined a separate group of 139 young adults who underwent a range of surgeries including the removal of breasts, penises, testicles, and vaginas also referenced in the study.
The authors wait until the end of the article to provide some sort of justification for their actions. They cite one source:
Gender-affirming surgery has been shown to improve quality of life. Although current research has been focused mostly on adults, a study of 136 youth demonstrated significant improvements in chest dysphoria in transmasculine individuals undergoing chest reconstruction.
That’s a 2018 questionnaire study from the Los Angeles Children’s Hospital (CHLA), another enterprising group that has evidently cut the breasts off hundreds of girls aged 13-17. We can conservatively estimate that they did so to 644 from 2016-2022.1 (It’s possible they’ve gone younger since the study period – any age requirement is inconsistent with the ideology driving this practice.)
The Boston claim is false. The LA team didn’t even try to measure improvement. Moreover, the LA “study” is invalid. It was rigged. After cutting off their breasts, CHLA gave girls a “chest dysphoria” questionnaire with items like:
I sleep with a binder on at night
I get gendered as female because of my chest
I have to buy/wear certain clothes because of my chest
I worry that people are looking at my chest
I trust you see the problem. The questionnaire asks girls whose breasts they have just cut off about breasts they no longer have. (A binder? To bind what?). The questionnaire thus gets floor-level responses to the meaningless survey items (girls answered zero to almost every item, a huge red flag). Improvement!
Well, “improvement” if they had also given the survey before cutting off the girls’ breasts. They didn’t. They only surveyed those girls once, post-op. Improvement is change over time, and thus requires more than one measurement, e.g. pre and post. They compared the post-op girls to other girls still thinking about having their breasts cut off, but improvement can only be measured within a person, not across people. There’s no reason not to measure pre- and post-op in this context, assuming that something valid was being measured in the first place.
Moreover, the LA authors excluded 26 post-op females from their analyses, 28% of their original pool. They claim not to have had a working number for some; others did not respond to voice mails; still others experienced difficulty “coordinating a time”. Some backed out of the survey. You can guess why some of those girls would not participate. We should also linger on the implications: they didn’t follow up with these girls, or knock on doors to check in with them. They abandoned them. (Though any billing issues would surely have resulted in energetic follow-up.) You might also linger on the implications of the authors conducting and publishing a study of this nature after cutting the breasts off hundreds girls and women. A study. One measure – “chest dysphoria”. A study. Cutting off girls’ healthy breasts. It might take a while to grasp the implications.
Thus, Boston Children’s Hospital’s sole evidentiary support was an invalid, rigged questionnaire study asking girls about breasts they no longer had. Moreover, they falsely claimed the LA team had measured improvement on the tautological construct of “chest dysphoria”.
Finally, their numbers are false. Only 33 post-op youth were surveyed, not 136. The remaining 35 post-op respondents were adults aged 18-24. The pre-op group adds another 68 respondents, including 39 minors, yielding a total of 136 participants. (All ages are at the time of surgery, not survey.) The LA team did not disclose the ages of the abandoned 26 lost to follow-up.
The gravity of this situation is difficult to overstate:
LA “Children’s Hospital” conducted and published a rigged, tautological questionnaire study asking girls about breasts they no longer had (because LA Children’s Hospital had cut them off).
LA “Children’s Hospital” abandoned 26 girls and women after cutting off their breasts, with excuses that sound like a Tinder date’s. In truth, they abandoned many of their patients – there was no follow-up other than their one-time meaningless questionnaire.
The relevant category here is Children, Subcategory: Things We Do to Them. This means we’re called to be at our best, ethically and scientifically: ruthlessly rigorous, smart, honest, thorough. The normal junk standards of academia are not tolerable here. What CHLA did falls short of even those junk standards.
Boston Children’s Hospital cited this rigged, invalid questionnaire study as its only ethical justification for cutting off the healthy breasts of 65 girls, some as young as 15. It also falsely described the study as having measured improvement, and gave a false, inflated “youth” sample size.
The category here is Children, Subcategory: Things We Do to Them. This means we’re called to be at our best, ethically and scientifically, ruthlessly valid, smart, honest, thorough, careful, everything triple-checked. The normal junk standards of academia are not tolerable here, and what BCH did falls short of even those junk standards.
Loop through 1-5 at your leisure.
Everyone involved here should be finished, professionally speaking. Further, we simply cannot tolerate Orwellian deception in this domain, or political ideologies that traffic in it – children are too important. Rigged studies are unacceptable, should never be published, and those who publish them should be escorted out of whatever buildings they’re in, cardboard box in hand.
Unfortunately, it’s normal for academics to publish false and/or invalid research – chalk it up to decades of no accountability, extreme ideological bias and uniformity, poor education in epistemology and scientific validity, and no innovation or progress in journal review processes. I doubt the reviewers here even read the survey items or attended to the scores, and the survey was the entire study here.
This isn’t the only rigged study.
The Dutch Swap
The Dutch protocol study is one of the morsels of purported evidence for the benefits of puberty blocking, hormones, and scalpels for children, likely the most cited. It’s also rigged, and thus fully invalid.
At the start of their study, the Dutch team measured gender dysphoria with a sex-specific 12-item questionnaire. After the puberty blockers, hormones, and breast removal or castration/penectomy (“vaginoplasty”), they switched the questionnaire to the opposite, desired sex. In other words, they had girls completing the boys questionnaire, and vice versa.
From the girls version: “I hate having breasts.”
Boys version: “I dislike having erections.” Girls answered this after puberty blockers and breast removal.
Conversely, boys got “I hate menstruating because it makes me feel like a girl.” after puberty blockers and possibly castration and penectomy (the authors withhold the numbers for the surgeries). These boys will never menstruate, of course, since hacking away at them won’t change their sex.
The authors reported that “gender dysphoria” fell dramatically after their ministrations. You can see why.
This is a cult ideology at work. A core tenet is that a girl who says she’s a boy is a boy, period. This is deranged on its face, but trans-activists do seem to mean it in every sense. They demand men be able to compete against women in sporting competition and demand that men be housed in women’s prisons. Trans-activist discourse often proceeds from the assumption that the only difference between men and women are their genitals or hormone profiles. This is a profound denial of reality. The Dutch authors even imply that they should’ve given girls the boys version of the survey from the outset, since by cult dogma they’re boys already, but they don’t explain why they didn’t. (If they had, the girls would be at floor level dysphoria from start to finish, never having erections to lament, etc.) This exposes the fact that measurement of gender dysphoria is theoretically difficult given the cult dogma. If you address a girl as a boy, you can no longer meaningfully ask about body-related anxieties because girls and boys have comprehensively different bodies.
Academic journals are publishing rigged, Orwellian research driven by followers of a delusional cult. In doing so, they’re endangering children by rationalizing the irreversible loss of major organs, and often sterility. It becomes extremely awkward to discuss purported evidence of the benefits of cutting off girls’ breasts or other ministrations concealed under Orwellian terms like “gender affirming care”. If we were better, smarter, more alert, we wouldn’t be willing to discuss it at all. But having erred in entertaining the thought, the next best option would be to think about it long enough to realize that there is no basis in reality for any of this.
These practices flow from the new “trans” or “gender identity” ideology, not from any scientific discovery of an innate “trans” identity layer in humans. The feeble effort to find benefits of these procedures skipped the necessary prior stages of the documentation of a separate, innate gender self-concept in humans, and the ability of all children of any age to know their true “gender” (with estimates of how often they’re right and wrong). All of this would require clear, well-defined terms and claims, not a nebulous political ideology whose proponents refuse to explain or clarify their terms rather than repeat its mantras and dogmas while threatening and maligning anyone who questions them.
It’s critically important to understand our limits. We barely know ourselves as a species at this point in history – psychologically, psychiatrically, medically, and philosophically. This is an arbitrary time and place: it just happens to be the time we’re alive. It’s a mistake to assume that what we call science in the time and place we just happen to be alive can answer any arbitrary question we have, that it’s particularly reliable in its claims, or that “it” (science) refers to a uniform domain. Enfolding psychology into “science” adds another layer of error. This ideology’s dogma that a girl who says she’s a boy is a boy cannot be scientifically addressed. There’s nothing that scientists can do with such claims.
Even non-delusional claims about some sort of innate trans identity are well beyond the abilities of today’s academics to support – they don’t have the methods, training, or rigor, and ideological bias is too pervasive. For example, there should be rich research on the effects of indoctrinating young children in gender ideology, on their subsequent discovery of an incongruous “gender”, as well as their psychological functioning, depression, anxiety, relations with parents, friendships, drug use, suicidal thoughts, disposition toward other human beings of various kinds, neuroticism, life satisfaction, cognition, self-esteem, and propensity for the dehumanization of outsiders. There is no such research. Such indoctrination is a screamingly obvious candidate cause of the mental health struggles we see in “trans” kids, including their reported rates of suicidal ideation.
A good example of the indoctrination in schools is the Portland schools K-3 package (see the bottom of that page for the slides). Children are told that they have a “gender” separate from their sex, that there are as many genders as stars in the sky, that only they know their true gender, and that each of us must discover our gender and assert it to others in order for them to know it. They’re also told that sex is “assigned” at birth, is a spectrum, and that white colonists imposed their “gender binary” (a construct alien to them) on the American Indians, who somehow weren’t aware of male/female or had more “genders”, a wildly false claim. Here as elsewhere, leftists are forcing their proprietary abstractions into the minds of the long dead – “gender” in the self-absorbed, separate-from-sex sense is a new construct, maybe 40 years old or less in its current wobbly form, and most humans and cultures have no use for it, or any exposure to it.
It would be very difficult to publish research on the effects of indoctrination in gender ideology in journals controlled by leftists. Leftists don’t value integrity, truth, reason, independence, or courage, and they’re not rewarded for demonstrating such virtues. Therefore, academia doesn’t value them – it values adherence to the package of race and gender based identitarian ideologies that the proprietor of this site calls “Successor Ideology.” It’s not possible to have a career in academia, pre-tenure, if you contest the Successor Ideology. (You have to write a statement affirming your agreement with those ideologies, and your track record of pushing them, as part of job applications at most universities.) Leftists will also lobby to retract any research that runs counter to their leftist ideology. For example, a journal is retracting a survey study documenting purported social contagion as a cause of kids claiming to be “trans” – Rapid Onset Gender Dysphoria (ROGD). The reason isn’t that it’s false or invalid, but rather a claimed ethical issue with IRB approval/consent. No one needs IRB approval to conduct a survey (e.g. Gallup and Pew don’t), unless they work at an institution with an IRB, in which case it’s given an expedited approval process. One of the authors works at such an institution, but the author who collected the data does not. It doesn’t matter – leftists would find a reason to retract it regardless, just as Nature retracted a peer-reviewed study simply because it reported worse outcomes for female mentorship in certain academic career contexts (leftists object to findings that seem unfavorable to women, and as noted, lack the base commitment to truth, reality, or curiosity that could override their political narratives.)
If you must navigate purported evidence of benefits, it will help to keep in mind the following proviso: Science only.
Here, this means studies only. When you ask activists/doctors for evidence, you’ll get a lot of deceptive verbiage. What you want are studies, and only studies. Studies are primary data collection. Studies have participants. A study is a team going out and collecting data by some method and reporting the results. There’s no guarantee that a study will be valid or true, as we’ve seen here, but they’re your starting point. Much like real-world mask efficacy re: COVID spread, there’s very little research in this area, so it’s easy to just read it. Forget “experts” and authorities – you can read all the research in maybe four hours. I don’t think judges realize that they could read the actual science here in roughly the same time it takes to read the amicus briefs from leftist activist groups.
When you ask for evidence, you’ll typically get artifacts like reports, policy briefs, guidelines, standards, recommendations, protocols, etc. None of these are evidence – they’re not studies. You’ll also get artifacts that aren’t about children/minors. To efficiently hone in on relevant studies, try these steps:
Is this a study? Are there participants and data?
Are the participants minors getting the puberty blockers, hormones, and scalpels?
Is the study rigged or invalid in some way? As we saw above, academic research is often rigged to support ideological narratives – never assume a journal article means anything until you’ve read it.
Is the data available?
Throw out everything with a No answer to 1 or 2. Generally, you’ll be left with 0-4 studies at that point, hence my generous estimate of four hours reading time. Throw out anything rigged, obviously, or where the data is not available. I’m not aware of any research that survives this basic standard. Yes, The Science™ comes down to zero studies by this basic standard (data availability alone does this).
In the future, if research emerges that survives the above standard, I recommend these steps:
What are the outcome variables (the “benefits”)? e.g. A depression scale score. Write them down, and be specific.
What percentage of the sample benefited? This is critical, and rarely disclosed. Academics use primitive statistics, typically based on mean differences. A minority of the sample can drive a change in means, and often does. For example, say 30% of a group reports less depression while the rest stays flat, or some even get worse – that can result in statistical improvement.
Where were these people at baseline? Meaning what were their depression, anxiety, etc. scores?
Where are they after the “treatment”, and how large is the reported improvement for those who experienced it? (e.g. on a depression questionnaire score)
How long did they track these outcomes? (e.g. only six months or a year)
Do you care about this? That is, do you care if X% of a sample saw a drop in depression from 40 to 32 on a 60-point scale at six months? How likely do you think such a result is for your child?
Note that I see the above as a baseline for laypeople, not a suitable standard for scientists or journalists. Their standards should be much higher and more rigorous. There are many other pitfalls, statistical tricks, data integrity and fraud risk issues that scientists and journalists should be mindful of. Unfortunately, American academics and journalists operate at a much lower standard than the lay baseline above – leftist ideology has been devastating to our truth-seeking institutions, making “experts” less reliable than random people.
Finally, a good adage I learned in graduate school is “A thing is how it’s measured.” That means the construct, whether it’s self-esteem or chest dysphoria, is how it’s measured, at least for the purposes of a given study. Always read the surveys or scales. If a paper doesn’t include its measures – every single item – throw it out. Let’s return to the LA study.
Here’s the full survey. Go ahead and read through the items.
I like looking at my chest in the mirror
Taking a shower/bath is difficult because I have to see my chest
I avoid going to the beach and/or swimming in public places because of my chest
I get gendered as female because of my chest
Dating/forming intimate partnerships is more difficult because of my chest
Physical intimacy/sexual activity is difficult because of my chest
I have struggled to make future plans because of my chest
I avoid exercise because of my chest
I avoid shopping/buying clothing because of my chest
I avoid seeking medical care because of my chest
I feel like my life hasn’t started because of my chest
I avoid swimming in private places because of my chest
I have to buy/wear certain clothes because of my chest
I sleep with a binder on at night
I avoid using locker rooms because of my chest
I worry that people are looking at my chest
I participate in life less than others because of my chest
You’ve already engaged more than the journal’s peer reviewers, and far more than the activists at leftist media outlets. Now, here’s the 4-point response scale:
0 - Never
1 - (authors didn’t disclose the wording here; let’s say Rarely)
2 - Frequently
3 - All the Time
What does it mean for a girl to answer Frequently to “I get gendered as female because of my chest”?
What does it mean for a girl to answer All the Time to “I have to buy/wear certain clothes because of my chest”?
Or Never, Rarely, Frequently, or All the Time to any of the items?
What does a midpoint score of 26 on this scale mean? What does a 21 or 40 or 5 mean?
If you thought that science had answered these questions, no, that’s not the case. No one knows, and it’s not clear that there can be a universal or clinically useful meaning. There is no science here. The scale was created just for this study, by followers of this cult. They didn’t even validate it. That is, they didn’t relate it to any valid psychological or psychiatric constructs (not even their general “gender dysphoria” construct), or to any behaviors. They didn’t account for prior indoctrination in the cult, obviously, as driving self-reported “chest dysphoria”. They didn’t account for the proprietary cult terms in the items themselves, like the verb “gendered” – most humans on this planet will not understand that term. There’s no translation for most languages. I’m not even sure most Americans would understand it, though they might infer what it’s getting at. The academic leftist “gender” construct – an “identity” separate from and possibly independent of one’s sex – is completely optional, and most humans and cultures have no use for it.
Another sign that the authors were not qualified in scale development was that after the first item, the rest of the items point in the same direction. Sixteen of the seventeen items point in the agreement direction, where agreement means a higher score on “chest dysphoria”. This makes it easy for girls to go into autopilot, so to speak, to be less conscious in their answers, choosing the same or similar option all the way down. Competent researchers mix and balance the direction of the items to force participants to pause and think about their answers more.
As a parent, you should be able to make far more sense of your daughter’s answers to these questions than anyone else. I want to stress that when politicians, activists, and doctors tell you that you’re not a doctor, that various medical lobbies support these practices, that the science is settled, etc. ask for the science they speak of. This study is a good example of what leftists call “science” – a rigged survey study slapped together by cult members.
Note also that the details matter here. You should be less interested in your daughter’s numeric score on any scale than in her answers to specific items. Any given score can represent a markedly different pattern of answers on a 17-item scale. All of this is obscured in the way academics only analyze overall scores, take the average of those, and test changes in that average.
Besides the invalidity of the items, the reviewers also missed the implications of the scores. The authors reported the average sum scores, which is very unusual – each participant’s responses were first summed, and the authors took the average of these sums. Sum scores are harder for readers to understand because they have to know the number of items to give them meaning. This is a 17-item scale, with a 0-3 (Never – All the Time) response scale, so a girl’s sum score could range from 0 to 51.
The post-op average was 3.3. The reviewers likely missed that this was a sum score. This average means those girls answered 0 (never) to most items. That’s not normal for any scale, and would be a red flag to a serious reviewer. Those zeros make sense here because the girls have no breasts – e.g. what would they bind at night?
The average for the pre-op group was 29.6, which is close to the scale midpoint of 25.5 (max dysphoria is 51). (If you’re wondering why we’d cut girls’ breasts off given a mid-level score on a “chest dysphoria” questionnaire, that’s a good question.)
In any case, I highly recommend getting all measures or surveys therapists use with your children to be able to validate their claims and approach. It’s critically important that parents operate with a baseline adult human confidence in their own minds and judgment. Everyone in this mess needs to find their footing and believe in themselves as thinking beings who have a right to use their minds and ask reasonable questions. The abuse and intimidation from “experts”, corrupt and/or activist doctors, and medical lobbies is a form of gaslighting that amounts in practice to active collusion in propagating medicalized self-harm among troubled children. I also recommend avoiding any therapists or schools that would “affirm” your child as the opposite sex, or in any way set your child on a path to devastating medicalization. This is not a battle any of us expected to have to fight. I think we’re all at a loss for words, for an explanation, but ultimately we have to take reality as we find it and do what’s right, as best we can. Explanations and causes will have to wait.
Going forward, all this should end, but at the very least any research in this area must be conducted by non-leftists. Leftists have a profound conflict of interest here. It was absurd to let prejudiced leftist academics tell us about conservative psychology (PDF) for decades, but this is much more dangerous. At most, they should be retained as consultants, never as authors or researchers. In the second sentence of their paper, the CHLA authors referred to participants “assigned a female sex at birth”. Babies are assigned cribs, perhaps a nurse, but never a sex. This profound denial of reality has no place in any academic journal, much less a medical one. This cult is not just incompatible with science – it’s at war with it. If leftists are going to so squarely deny reality, they cannot be part of the conversation or research community here. Children are simply too important.
Thirty-three in the second half of 2016 (the study period) + 13 (half of the Abandoned 26) = 46 in six months. 2016-2022 inclusive is 14 such periods so 46 × 14 = 644. This excludes pre-2016 and any increase.