Physicist Sabine Hossenfelder Screws up on Trans Kids’ Care
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Last year, I made a video talking about how the mainstream media was screwing up the reporting on the nuclear fusion breakthrough, and in that video I referenced Sabine Hossenfelder, a theoretical physicist with a popular and often entertaining YouTube channel in which she goes over science news…a lot of physics stuff but also she does cover other science and tech news as it arises.
When I made that reference, I subscribed to Hossenfelder but I honestly don’t watch everything I sub to so I actually went on her channel and scanned through her videos to make sure she was mostly staying in her field and most importantly not being problematic about social issues. Because hey, the stereotype of an older physicist turning into a giant crank about topics outside their field isn’t entirely without merit. Like, no one is going to be right about everything all the time but I don’t want to promote someone who turns out to, I don’t know, mindlessly parrot transphobic talking points or something. Right? Ha ha. Ha.
“Sabine Hossenfelder and TERFs,” read the subject line of an email I got from a viewer named Daniel a few days ago. “Oh dear,” I thought as I opened it. Daniel explained that Hossenfelder’s latest video was title “Is being trans a social fad among teenagers?” And he was wondering whether it seemed just a bit…well…TERFy. TERF stands for “trans-exclusionary radical feminist,” and it’s a craze that has really taken over in England and elsewhere (though in America our transphobes tend to not pretend to be feminists – they hate all of us, cis women and trans people alike), and generally you can recognize a TERF because they are cis people who for some reason cannot stop thinking, talking, worrying about, and hating trans people. I’m not talking about people who have measured disagreements about things like “should we have clubs specifically for cis women” or “do trans women who went through puberty before transitioning have an unfair advantage against cis women in professional sports?” No, I’m talking about people who believe that any gender affirming care, like using a child’s preferred pronouns, is child abuse, or that even adults should not be able to transition safely. That’s TERFs. People like Graham Linehan, for example, who TERFed so hard that his wife divorced him. If you want more examples, scroll down beneath this video and watch them lose their minds in real time in the comments.
Actually, on that note allow me to address something that happens every time I make a video about trans issues: inevitably, transphobes will comment to state that I am a transwoman, and the comment makes it obvious they expect this to be an epic burn. Friends, I need you to know something: I don’t actually think it’s an insult to be trans. Because I know a lot of trans women, I know that they have all kinds of appearances, including some being way hotter and more traditionally feminine than me. YOU, the person making the comment, are the one who thinks of it as an insult. Not me. That’s why it doesn’t work as an effective insult. It would be like me calling you a fascist: I think of that as an insult but you think of it as a perfectly legitimate political position, so it doesn’t work. I hope that helps you craft better insults for today’s video. Thanks.
Moving on, let’s talk about what Hossfelder said in her video. She doesn’t get off to the best of starts:
“Should transgender teens transition? This rather personal question occupies a prominent place in the American culture war. On the one side you have people claiming that it’s a socially contagious fad among the brainwashed woke who want to mutilate your innocent children. On the other side there are those saying it’s saving the lives of minorities who’ve been forced to stay in the closet for too long. And then there are normal people like you and I who think ‘both sides are crazy and could someone please summarize the facts in simple words,’ which is what I’m here for.”
Ah, the normal centrist has entered the chat. Excellent.
So sorry to stop her so quickly, but I guess since I am solidly on one of those “crazy” sides she mentions, I’ll address it: we’re saying that allowing transgender teens to “transition,” which I suppose means “get gender affirming care,” is saving lives. Yeah! It is, and here are some studies that back that up:
Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth, published in the Journal of Adolescent Health in April of 2022, found that the “Use of (gender-affirming hormone therapy) GAHT was associated with lower odds of recent depression and seriously considering suicide compared to those who wanted GAHT but did not receive it. For youth under age 18, GAHT was associated with lower odds of recent depression and of a past-year suicide attempt.
Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care, published in the Journal of the American Medical Association Open Network in February of 2022, found that “in 104 (trans and nonbinary) youths aged 13 to 20 years, receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.”
Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation, published in Pediatrics in 2020, found “a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.”
Psychological profile of the first sample of transgender youth presenting for medical intervention in a U.S. pediatric gender center, published in 2017 in the American Psychological Association’s Psychology of Sexual Orientation and Gender Diversity, found that “older (trans and nonbinary) youth (seeking medical intervention) experienced poorer self-competence, higher levels of anxiety, and decreased happiness and satisfaction than the younger patients. The results provide further evidence of the resiliency of a significant number of transgender youth, as well as the severity of mental health concerns for others. New to the existing literature are the results showing older transgender teenagers as more distressed, supporting the clinical recommendation to consider earlier medical intervention for appropriate youth, and to always incorporate mental health support and assessment.”
Okay, I’ll stop there but the evidence is absolutely overwhelming: gender affirming care, which includes the use of puberty blockers and, even more importantly, hormone therapy, most likely prevents suicides. You can disagree with those studies if you’d like, even if you’re just a physicist, but is it fair to call those researchers and the people who accept their findings “crazy”?
Hossenfelder’s opening statement is akin to saying “On the one side are people who think vaccines are a way for Bill Gates to inject us with micro transmitters, and on the other side are people who think vaccines are safe and effective ways to reduce the spread of disease. And then there are normal people like you and I who think ‘both sides are crazy and could someone please summarize the facts in simple words,’ which is what I’m here for.
This is known as “false balance,” or “bothsidesism,” a rhetorical trick that pretends to demonstrate an unbiased viewpoint, but in reality you’re being biased by default by comparing something backed up by reams of scientific data with something that has absolutely no basis in reality.
While it’s a terrible and fallacious start, the whole video isn’t THAT bad, luckily. She does correctly state that transgender people have been around for ages, that many cultures accept and codify the existence of a “third gender,” and that transgender people today are often stigmatized.
She goes on to say, though, that the number of children expressing gender dysmorphia is higher than the number of adults (6 min) which she calls “puzzling”. She refers to “rapid onset of gender dysphoria,” the idea that kids decide to become trans based on internet memes, and again we have false balance: she correctly states that the term was popularized by a paper written by Dr. Lisa Littman that was controversial as it only described the opinions of the parents of transgender kids, and those parents were all found on forums for people who don’t think transgender people exist.
She says the paper was criticized for not being a real study, but just surveys. That is a ridiculous summary: the paper was FRAMED BY THE AUTHOR as describing a real, scientifically supported phenomenon, a framing so dishonest that PLOS One had to issue an apology along with a major rewriting of the paper to make it clear that these surveys were used to DEVELOP a hypothesis that rapid onset gender dysphoria is real, which remains to be tested.
Hossenfelder goes on to correctly note that a follow-up paper found no evidence for “rapid on-set of gender dysphoria,” but she says that THAT study was ALSO criticized for vague survey questions, so she sums up that “there is no evidence either for OR against the existence of Rapid Onset Gender Dysphoria though it seems to be supported by doctors working in clinics that treat the children.” (10 min).
This is a stunning example of false balance: first of all, in science, if there is NO evidence FOR a hypothesis, then we cannot put any stock in that hypothesis. Period. It doesn’t matter if someone was critical of the study design of something that found no evidence. Where’s the study that DID find evidence? Oh, there isn’t one? Then we can safely dismiss that hypothesis until there is one. One side says the Easter Bunny exists, with a survey of 4-year olds who all attest to his realness. The other side conducted a survey of actual rabbits and found none with the ability to lay eggs, but many are critical of the authors’ use of Bayesian inference so at this point we simply cannot say one way or the other.
But to make the false balance even worse, Hossenfelder puts her thumb on the scale by saying “though (rapid onset gender dysphoria) seems to be supported by doctors working in clinics that treat the children.” Excuse me? Citation? She just tosses this out there with zero evidence, leaving the average viewer to say “Ah, no real evidence either way but if DOCTORS think it’s real, I guess it must be.” No. There is absolutely NO evidence that rapid onset gender dysphoria is anything other than a bogeyman made up by transphobes obsessing about trans people online.
Okay back to the not-terrible stuff, Hossenfelder gives what appears to me to be an accurate overview of ideal gender-affirming care and its timeline: a child can change their name or choose new pronouns, at around age 10 they can choose to go on puberty blockers to have more time to consider whether they’d like to transition, by 15 they can take cross-sex hormones, and then as an adult they can decide whether or not they’d like to have surgical procedures.
She goes on to say that side effects of puberty blockers include things like “bone density loss,” and that this is irreversible, which is a pretty un-nuanced take and, dare I say, untrue? As I said in a previous video on this topic, researchers are still looking into whether bone density loss is actually a problem and if so, how serious it is, and whether or not your body readjusts when you stop taking them, though a 2019 systematic review found that while “GnRHa treatment slows mineral accrual, after discontinuation (bone density) BMD appears not to be significantly different from that of their peers by late adolescence. Reports of BMD among children and adolescents verified a decrement in BMD at the achievement of near AH, while accrual resumed after therapy, regardless of whether or not calcium supplementation was given. By late adolescence, all subjects had BMD within the normal range.”
She then says puberty blockers might increase the risk of heart problems, “though none of those studies are particularly conclusive due to small sample size.” I had never heard of that so I went searching for her reference. Like me, she apparently includes her references with the transcript on her Patreon, but unlike me she hides those references behind a paywall. Huh. Being unwilling to part with my precious $2.50, I searched for any studies looking at heart problems in kids on puberty blockers but I was only able to find data about hormones and cardiovascular issues. I did find someone who points out that she might be talking about studies suggesting that “older men treated for prostate cancer with GnRH analogues as a testosterone blocker” may show an increase in heart problems, which seems like more than just a “small sample size” issue but who’s to say?
She goes on to downplay the huge number of studies that show an obvious benefit in mental health for those kids who are able to get gender-affirming care, reducing it to just the use of “puberty blockers” as opposed to the entire support system that a trans kid deserves, including hormone replacement therapy and a supportive community of family, friends, school officials, and government officials who don’t ban all the books about trans people from the local library. But even with the absolute basics of mental health resources, puberty blockers and the option to go on hormones, the evidence is simply overwhelming, but Hossenfelder dismisses them for often having a lack of a control group.
She does address one of the four studies I mentioned earlier, that showed a 73% reduction in suicidality, but she dismisses it for two reasons: first, because the mental health of the kids in treatment didn’t improve so much as the mental health of the kids who didn’t get treatment was way worse. Sabine, we call that a control group. You were literally just complaining about the lack of one in other studies.
And second, she circles that the untreated control group at the end was only 7 people, which IS a small number and also super disingenuous. The researchers noted “that depressive symptoms and suicidality were 2-fold to 3-fold higher than baseline levels at 3 and 6 months of follow-up” as well, NOT just at the end of the study, and those groups had 38 and 24 people, respectively. Out of 108 total subjects, that’s a perfectly valid amount for a control that is obviously going to get smaller as time goes on and more people (thankfully) access care.
But hey, that’s just a little evidence in favor of my hypothesis as opposed to the zero evidence in favor of rapid onset gender dysphoria so I can see why she thinks I’m CRAZY for being swayed by the former and not the latter.
She wraps up by saying “the current increase in gender dysphoria is caused by a mixture of causes: young people are more commonly being openly trans and some erroneously believe they’re trans bc they’ve heard about it. Anyone who says that one of those options doesn’t exist is pushing an agenda and shouldn’t be taken seriously.”
As bad as her “both sides be crazy” opening was I did have a little respect that Hossenfelder at least didn’t strawman MY beliefs, as I really do think the evidence shows that gender affirming care is “saving the lives of minorities who’ve been forced to stay in the closet for too long.” But now she ends with this strawman. I’ve never argued, and would never argue, that there aren’t kids out there who think they might be trans but aren’t. And I’m not aware of anyone who has argued that, but hey it’s a big old world out there. But Hossenfelder has presented no evidence of anyone stating that, and she’s also presented no evidence that those hypothetical mixed-up kids are managing to get themselves onto puberty blockers, and then hormones, and then surgery, without being properly vetted by doctors. There’s certainly wiggle room to debate the relative seriousness of the side effects of certain medicine and whether it’s worth it and what the best timeline looks like to protect the mental and physical health of patients, but here, Hossenfelder asserts (or at least implies) something with no evidence at all: that a significant population of kids falsely believe they’re trans because they’ve “heard so much about it” and are taking dangerous, irreversible drugs because of that. There is no evidence for that. There is only evidence of doctors working together with patients and their families to determine the healthiest path forward, all while dodging the roadblocks thrown out by transphobic legislation and our piss poor healthcare industry.
Look, this is exhausting, so I’m going to wrap it up here: do I think Hossenfelder is a TERF or just a plain old transphobe? Look, labels can be useful but people can be complicated. So I’ll just say that whether she meant to or not, she repeatedly used a misleading rhetorical device to elevate transphobic talking points to the same level as scientific evidence, and she did so for a very large audience. That would be bad enough for any topic, but in this case she did it with a topic that is related to politicians drastically ruining people’s lives here in the US: banning kids from even learning about trans people, banning books that mention trans people, requiring children’s genitals to be inspected before they can play school sports, stopping people from being able to change their identification to be more accurate, rolling back nondiscrimination laws so employers, businesses, and even hospitals can turn away trans people, censoring drag performances, blocking insurance from covering trans-related healthcare, forcing teachers to out trans students to their families, and much, much more. I’m sure that Hossenfelder would say she finds most if not all of those things abhorrent, but her video misrepresents the data in the same way many of the proponents of those bills do, and her lack of nuance convinces the average viewer to think that that “side” of the debate is worth listening to. And that, sadly, is dangerous to trans kids, trans adults, and even cis people who would prefer to not have their gender performance policed or their genitals examined just to be able to use a public bathroom.
In a time like this, we need more nuance, more compassion, and more scientific precision. Not less.
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