June 3, 2020

Over the last few years, there’s been an explosion of awareness about the condition known as gender dysphoria — a sense of deep, painful discomfort with one’s biological sex, the gender associated with it, or both. Gender dysphoria can cause devastating anguish when the person suffering from it lacks access to treatment. As I put it in an Atlantic article from a couple of years ago, it has been described by some people who have it as “a weight, a buzzing, an unavoidable source of rumination and worry”.

For some people with gender dysphoria, simply changing their hair, clothes, and other aspects of their appearance to present in a more stereotypically male or female or androgynous manner is enough to bring relief; for others, only hormones, surgery or both will suffice. But the only treatment for severe, persistent gender dysphoria for which there’s any real evidence is transition.

While the LGBT community has ever-shifting labels that mean different things at different times, it’s safe to say that most people who identify as transgender have or had gender dysphoria, and transitioned in part as an attempt to alleviate it.

Despite the significant gains made by the trans rights movement in recent years, the scientific underpinnings of gender dysphoria and its treatment are still almost completely unknown. Even the available evidence for the efficacy of hormones is only, according to a 2010 systematic review, “very low quality.” As the British Journal of Medicine pointed out on its website in 2019, drawing on two more recent systematic reviews of youth GD treatment, “There are significant problems with how the evidence for Gender-affirming cross-sex hormone has been collected and analysed that prevents definitive conclusions to be drawn.”

Furthermore, there are also some increasingly-heated culture wars going on in this area that hinge a great deal on certain scientific questions no one knows the answer to: How concerned should we be about what appears to be a growing number of ‘detransitioners’ — that is, people who transition their gender and then transition back? How common is detransition in the U.S. or the U.K.? How often do kids with GD experience ‘desistance,’ or their GD simply abating in time? 

(Desistance is itself an immensely controversial and complicated discussion, and some people wrongly claim it is quite rare — I went deep into the weeds here and here if you’re curious about what the literature on it does and doesn’t say.)

Given all this uncertainty, and given the stakes for people trying to better understand their own struggles with GD, it seems like a particularly important time for the scientific study of this subject to operate in a transparent, careful manner. 

Instead, it is becoming more and more difficult for researchers to study this subject without accidentally stepping on certain political landmines — landmines that are understandable given some of the dark history associated with the scientific establishment’s treatment of gender nonconforming people, but which really are hindering scientific progress.

And an incident that unfolded this spring at a neuroscience journal shows just how bad things are getting. It suggested that only a very particular, very narrow storyline is allowed — and if you deviate from it, you risk professional and reputational damage. In the long run, this sort of science-by-petition, in which activists who can make a loud enough racket can get research retracted that wouldn’t be retracted otherwise, is exceptionally harmful.

Back in December, the journal eNeuro published a paper entitled “A New Theory of Gender Dysphoria Incorporating the Distress, Social Behavioral, and Body-Ownership Networks.” The paper was tagged as “Theory/New Concepts,” and it indeed challenged a common understanding of gender dysphoria.

That understanding holds that, to oversimplify somewhat, gender dysphoria arises from having the body of a male but the brain of a female (or vice-versa). While far from dispositive, some past studies have suggested that transgender individuals with gender dysphoria have brains more like the sex they identify with than their natal sex. (Some of these studies were performed posthumously on trans people who had been on hormones, raising the possibility that the hormones caused the observed brain differences.)

Not so fast, argued the author of the eNeuro article. Stephen Gliske, a researcher who trained as a physicist but who gained sufficient expertise in neuroscience to be hired as a research assistant professor in the University of Michigan Medical School’s department of neurology, posited a new theory questioning “the relevance of cerebral sexual dimorphism in regard to gender dysphoria”.

Instead, he argued that “in individuals with gender dysphoria, the aspects of chronic distress, gender atypical behavior, and incongruence between perception of gender identity and external primary sex characteristics are all directly related to functional differences in associated brain networks.”

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Almost immediately, Gliske’s paper was denounced by a group of researchers and activists who accused it of peddling dangerous ideas about trans people. Unfortunately, eNeuro did not respond with agility. Over a disastrous, opaque, flawed process that took months to unfold, the journal first demanded Gliske choose between cutting one section of the paper and having it retracted. After he agreed to the cut, the journal put an edited version online. Then, when academics again complained, this time launching a Change.org petition, the journal launched yet another round of reviews and eventually retracted the paper.

Before explaining the way things spiraled out of hand, it’s important to acknowledge that the initial critique of Gliske’s paper had some merit to it. The first version contained a section entitled “Implications for clinical practice”. In it, Gliske argued that “The use of gender reassignment as a therapy is sometimes motivated on the assumption that the distress is due to the individuals having a brain sex different than their gender assigned at birth and that the desire to change genders is based on a correct sense of true gender.”

If, as Gliske’s own theory suggested, this is false, it could call into question such treatments, he argued. “Our new theory furthers the discussion regarding biologically-based treatments independent of gender identity affirmation that might address distress and body ownership in individuals with gender dysphoria.” That is, “treatments based on our new theory could instead involve targeting the distress and/or body ownership networks, perhaps specifically seeking to restore a sense of ownership over body parts perceived as incongruous.”

Anyone even faintly aware of the politics surrounding trans rights will understand why this was an ill-advised passage. While the present state of the evidence that transition works is not as sturdy as it could be, and some people with gender dysphoria are actively hoping for other options, it is still the case that transition is the only real game in town at the moment, and that access to it feels like a life-and-death matter for many trans people. Moreover, there’s also a dark history of attempts to biologically alter LGBT people to ‘fix’ them. 

It’s not unreasonable, then, that a trans person, or someone who simply cares about them, might be alarmed reading a paper that raises, without much context, the possibility of “biologically-based treatments independent of gender identity affirmation that might address distress and body ownership in individuals with gender dysphoria”.

On 7 December, with the article up on eNeuro’s website in a near-final, post-peer-review form, the journal’s editor-in-chief, Christophe Bernard, a French neuroscientist, emailed Gliske. After laying out some of the concerns raised about the paper, Bernard wrote, “We therefore ask you to remove the Implications for Clinical Practice section, as well as any other reference to clinical implications throughout the article, abstract, and Significance Statement, before final publication. These changes will be noted to journal readers with a formal published notice. … If you decline to make these changes, the Editorial Board will move to retract your article on the grounds that the clinical implications are not supported by the available data.”

Whether or not this critique was well-grounded (and, again, I believe it was, although the bit about the “available data” didn’t make much sense given that Gliske was positing a new theory) this is an unusual situation. It isn’t common for the author of a paper that has already gone through the peer-review process to be told he or she has to delete one particular section or choose to have the entire paper retracted. But what came next was even stranger.

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Some of the activists criticizing the paper were not mollified by the revisions made to it. Instead, a group of them led by Troy A. Roepke of Rutgers University, launched a Change.org petition demanding not only retraction of the paper, but revisions to eNeuro’s editorial process which would ensure that “at least one reviewer should come from the community directly impacted by these types of papers to ensure that language and intent are not dangerous, deleterious, or damning”.

The petition distorts and misrepresents the contents of the paper in basic ways. After claiming, without any evidence, that “the clear intent of the paper was to do harm to the transgender community, one of the most vulnerable communities across the globe” (bolding in the original), it argues that there is a “basic assumption that transgender people are a deleterious deviation with a disordered network of brain regions which pervades the entire manuscript”. 

But the paper isn’t about, and makes no moral claims of any sort, about transgender people — it’s about the neurological origins of gender dysphoria. It doesn’t take a particularly sophisticated grounding in philosophy to understand that whether GD is the result of one brain theory versus another doesn’t, on its own, prove anything about the moral status or worth of people with gender dysphoria.

The most vicious homophobic bigots, after all, are just as enthusiastic about gay-bashing whether the theory is that homosexuality is genetic (in which case the responsible genes need to be wiped out), or the result of corrupt cultural influences (in which the responsible influences need to be wiped out). This is just a wild moral leap on the part of the petitioners, and it’s surprising that the journal would pay any mind to such a confused and inflammatory petition.

But not only did the journal heed this group’s input, it let Roepke and eight coauthors pen a response that was published on the eNeuro website alongside the original article. That response is just as strange as the petition, exhibiting a lack of familiarity with the evidence base for treating gender dysphoria, and with the specific arguments of Gliske’s paper. For example, the authors accuse Gliske of making claims which conflict with existing empirical observations about gender-affirming intervention, ignoring the fact that he quite specifically states that treatment can alleviate distress — and they themselves cite a paper pointing out the weakness of the evidence base for hormones.

It would have been strange enough for the eNeuro editors to give so much oxygen to Roepke’s bad-faith petition and response. But it’s what happened next where this story tips over from ‘strange’ into ‘bizarre’ — for now Gliske received an email from eNeuro informing him that, actually, the paper was being retracted. 

The editors’ reasoning is explained in a ‘synthesis statement’ which, again, contains many odd claims that don’t quite line up with the paper that was actually published. It often reads as though the editors simply threw as many complaints at the wall as they could — many of them picayune and easily debunked by reading the paper or the editorial comments sent to Gliske during the editing process — in an attempt to make the paper seem extremely sloppy.

At one point, for example, the authors note that Gliske used the word transsexual, and that this, along with some other terms in the paper, are “no longer adequate terms to be used and  should be adjusted for a more respectful language”. But in the body of the paper itself there is a single use of this term: “I also use the term ‘transgender’ throughout this manuscript, though I recognize that some references instead use the word transsexual to refer to the same concept.” So his only use of this term is to explain that he is not going to use it, and to explain why it appears in the citations (transsexual is simply the older term for “being trans,” and is seen by some trans people as outdated or offensive, while others embrace it).

Similarly, the synthesis statement asks: “[W]hat exactly is the author trying to say in the paragraph noting that trans people have been found to have elevated presence of autistic traits within relation to their theory?”

But in an exchange still visible on the eNeuro site (archive), a reviewer recommended that Gliske add a mention of autism to the section on common gender-dysphoria comorbidities — not a surprise given the well-established link between the two conditions. Again, this is simply strange: in a public statement, the journal’s editors criticised the author of a paper for making an editorial decision the journal itself asked him to make.

But all these odd and nitpicky complaints could be seen as moot, because the reviewers give away the game in a sentence that clearly reveals their gripe is political, not scientific:”[T]he author appears disrespectful to the community because he/she does not seem to believe that a transgender person’s statement of belonging to one or the other gender is taken at face value and believed to be true.” 

This is worth exploring. The authors of the synthesis statement don’t bother explaining what “belonging to one or the other gender” could possibly mean in a neuroscience context. Gliske’s paper has no bearing on the question of whether a trans person is ‘really’ a woman or a man (or neither in the case of a nonbinary person), because of course no theory of gender dysphoria could, on its own, settle such a philosophical and sociological issue.

His paper, again, is simply an attempt to posit a new theory about gender dysphoria. The only neuroscience-related explanation of this phrase which could apply here is something like “Gliske does not seem to believe that a transgender man/woman has a male/female brain”. But that, of course, is exactly the theory he is arguing against! If this is actually what his critics intended to mean, they are claiming that it “appears disrespectful” to posit that the brainsex theory of gender dysphoria is false.

This would be news to many gender dysphoric people. There is, of course, a vast diversity of opinion about what causes gender dysphoria among those who have or had the condition. There are desisters, who appear to outgrow the condition over time, usually in their younger years — they, of course, do not think that they were “trapped in the wrong body,” because their GD didn’t turn out to be permanent.

Detransitioners, meanwhile, don’t tend to believe in the brainsex theory either. While some destransition because they lack the money or support to continue living as their felt gender, others realize they simply weren’t really trans. A subset of detransitioners continue to have gender dysphoria, but do not believe the solution is to transition, because it didn’t work for them — in fact, when some detransitioners in this category tried to hold panels at a trans health conference, one on detransitioning and one on alternate treatments for GD, those panels were abruptly cancelled due to the outcry of activists

Many happily transitioned people, too, believe that whatever GD is, it’s more complicated than having one ‘type’ of body and the other ‘type’ of brain, or the closely related idea of having an innate and immutable ‘gender identity’: Trans writers ranging from Andrea Long Chu to Natalie Reed to Natalie Wynn (aka Contrapoints) to various ‘gender-critical’ trans women have all critiqued these ideas, which they tend to view as oversimplifications which don’t capture the full texture of the trans experience.

It makes no sense, then, to view theories of gender dysphoria as being off-limits if they tell a different story than brainsex-mismatch. To do so is to ignore the views of many, if not most, people with gender dysphoria. It’s also completely unscientific: When you don’t know much about what causes a phenomenon, you can’t draw strict boundaries about what sorts of explanations will be deemed worth exploring versus rejected out of hand.

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This episode bears certain noteworthy similarities to what happened to Lisa Littman, the M.D. who in 2018 published a PLOS One paper on “rapid onset gender dysphoria,” or the very young and mostly unexplored theory that in some cases young people (usually teenage girls) might develop gender dysphoria and/or a transgender identity quite suddenly as a result of peer influence or social media. (For what it’s worth, in my own reporting I have certainly come across kids who fit that bill, but I’m careful not to posit this as a definite explanation in any particular case because so little is known about ROGD and it could be harmful for parents to jump to this conclusion regarding a newly ‘out’ child.)

Like Gliske, Littman was proposing a new theory that was viewed as threatening by some activists (they believe that the concept of ROGD is a means of ‘invalidating’ the claims of trans youth). Like Gliske, she dealt with a wave of criticism within and beyond the academy that often seemed geared at producing a high quantity of claims about her research rather than high-quality ones.

And like Gliske, she had to deal with institutions caving in to activists, and with a bruising post-peer-review re-review clearly designed to appease those activists: Brown University retracted the press release announcing the study and issued a bizarre ‘apology’ without noting anything in the paper that had been wrong, and PLOS One issued a ‘correction’ consisting of many cosmetic updates and then acknowledged to me that there had been no errors in the paper. (I had never heard of a paper being ‘corrected’ when there weren’t any errors.) 

Littman subsequently published a paper showing that just about every critique issued at her paper in an attempt to invalidate it could also be applied to papers on trans youth that had garnered no complaints from activists, probably because those papers didn’t make any politically threatening claims.

“There is a clear double standard,” she told me in an email. “Research articles that do not adhere to the gender-identity affirming narrative are called out as unacceptable, even when their methods are consistent with those cited to support the use of the gender-identity affirming model of care. It appears as if groups are engaging in motivated reasoning — ‘I don’t want this research to be true, so I will aggressively question every single attribute of the work, even if I’m comfortable with those same attributes in research articles that support my view.’ Unfortunately, many people are misusing the terms ‘biased,’ ‘methodologically flawed,’ and ‘debunked’ when they really mean ‘challenges my assumptions,’ ‘comes to a different conclusion than me,’ and ‘has known limitations.’”

Littman, to her credit, hasn’t been deterred — she’s continuing to research this subject, and recently solicited the accounts of individuals who have desisted or detransitioned.

Maybe Stephen Gliske’s paper was completely off-base. Maybe it’s on the right track. Maybe it’s somewhere in between. Now that it’s been retracted, though, a message has been sent, loud and clear: Don’t try to look into this theory. That chilling effect is far more dangerous than any individual retraction or faux ‘correction’. In the long run, it will cut off entire avenues of research that could help lead us to better understand a very important and vexing subject.

Think about what the gender dysphoria research scene must look like at the moment to genuinely inquisitive, compassionate, brilliant 25-year-old neuroscientists, psychologists and psychiatrists-in-training? What possible reason would they have to want to attack this fascinating subject with any of the vigor and intellect they’d apply to other, less controversial subjects? All the incentives point in the opposite direction: Run far from here.

It’s heartbreaking to think of all the knowledge that will be lost as a result — and all the people who will suffer more than they needed to because of the way scientific inquiry was wrongly crimped.

 

Join the discussion


  • June 24, 2020
    Isn't anyone questioning the concept of "female brains" and "male brains"? Hasn't science tried and failed over many years to establish significant, concrete differences between brains based on biological sex that have any discernible effect on cognition or personality? Feminists have been... Read more

  • June 7, 2020
    A very interesting article, perhaps what is most troubling is not the howls of the affronted mob, but the failure of those in authority to hold the ring. By that I include editors, universities and the press. The deplatforming of those we disagree with has always been questionable. Much better to... Read more

  • June 6, 2020
    Well, 'gay rights' was a hijacking of the apolitical 'homophile movement' by the New Left as part of their backlash against 'the workers' in what became 'identity politics'. The category of 'male homosexual' was then with no justification broadened to include lesbians, who had not been subjected to... Read more

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