Readers deserve better than misinformation about trans care; a response to Pamela Paul

This story was originally published on Erin In The Morning. Author’s note (Erin Reed): A copy of this article was submitted to the New York Times for publication in response to Pamela Paul. It was rejected, citing an internal policy on opinion pieces responding to New York Times columnists. Journalist Evan Urquhart and I have thus decided to make it freely available on our own platforms.

On Saturday, opinion columnist Pamela Paul published a deeply misleading 4,500-word article on gender-affirming care and detransitioners in the New York Times. While readers may be excused for taking her article as a fair representation of the science surrounding that care, transgender journalists like us immediately recognized the hallmarks of misinformation we routinely hear from right-wing groups whose mission is to oppose care for transgender people. Within hours of the publication of Paul's story on detransitioners, we published responses that quickly went viral, appearing on academic listservs, professional networks, and Twitter threads discussing the issue. Now, Paul has responded to our journalistic criticism directly by dismissing us as "activists," a label that does not accurately describe the work she is responding to.

While activism in a just cause is a noble pursuit, and one of us, Erin Reed, has proudly worn that hat at times, another of us, Evan Urquhart, is a professional journalist with a decade-long career in the industry who has never participated in organizing or activism of any kind. Regardless, the word “activist” was used by Paul to create doubt about the professionalism and reliability of our journalistic work, and as such is equally misapplied for both of us.

Paul claims that "we don't know" how many transgender people detransition. Although she is correct that studies on detransition have limitations, as virtually all studies do, Cornell University reports that transgender regret ranges from 0.3% to 3.8% in a review of over 72 studies. Criticizing Paul for portraying regret as high is not "activism," especially when she misleadingly states in her original article that "Studies show that around eight in 10 cases of childhood gender dysphoria resolve themselves by puberty" – numbers derived from decades-old data using outdated diagnostic guidelines that conflated effeminate gay minors with transgender youth, among other issues. Notably, these numbers originally stem from Ken Zucker, whose clinic was shut down after an independent review determined his practices were akin to “reparative” (conversion) therapy.

It also is not "activism" to point out that it is misleading to use citations that do not back up key arguments. For instance, in both the original article and her response to us, she claims there is data to support that "detransition rates are higher than transgender advocacy groups suggest," suggesting first that the scientific data on this topic was produced by advocacy groups when it was not, then citing a study of military prescriptions which did not examine detransition at all. Instead, this study looked at the use of Tricare, the military insurance plan, for hormone therapy prescriptions. Because there are dozens of reasons why one would not fill hormones through Tricare, such as Trump’s trans military ban (which occurred during the study) or the desire for privacy and the use of Planned Parenthood clinics, it does not support “higher rates” of detransition at all, nor does it purport to do so. She likewise neglects to mention that the authors themselves state that "our findings are likely an underestimate of continuation rates."

If we are accused of activism in our published responses to Pamela Paul, it is only fair to apply that label to her and some of the sources she uses as well. For instance, Pamela Paul claims that "The Society for Evidence-Based Gender Medicine" is "one of the most reliable nonpartisan organizations dedicated to the field." She relies on non-reviewed journal letters to the editor from this group in her original essay and response to us on multiple occasions as evidence of her claims. However, what she does not reveal is that according to the Southern Policy Law Center, SEGM has received significant funding from the same sources that support the partisan Alliance Defending Freedom and the Heritage Foundation, organizations known for drafting anti-trans legislation. SEGM is closely linked with anti-trans and anti-LGBTQ extremist groups, a connection mapped out by the SPLC’s analysis. Its founder, William Malone, was part of an anti-trans working group in 2019 where members asserted that "god's will" is being enacted through passing trans bans. In this group, he stated, "It might take years, but we're going to get them." If that is not activism, what is?

Paul seeks to dismiss our criticisms of her misinformation about trans care as activism, but readers deserve better. They should be aware that every major medical organization in the United States supports gender-affirming care due to the evidence behind it. It's important for them to know that multiple judges have determined the evidence supporting trans care is comparable to that of most pediatric care, overturning bans on care in the United States. Readers also deserve to understand that the narrative Paul presents about high detransition rates and stories of regret does not stem from careful journalism, but rather, anti-trans activist groups. Lastly, they should be aware that these erroneous narratives are now being used to justify legislation aimed at banning transgender “for everyone.”