Response to Dr Quentin Van Meter’s Webinar on ‘Transgenderism’

15 March 2021

TransgenderSG is aware of the recent webinar on ‘Transgenderism’ hosted by Jason Wong of Focus on the Family in his personal capacity. The speaker was Dr Quentin Van Meter from the American College of Pediatricians (ACPeds).

ACPeds is a radical fringe advocacy group that is not to be confused with the internationally recognised American Academy of Pediatrics (AAP), a federal, professional pediatrics association. ACPeds’ membership is approximately only 0.03% of AAP’s, and has been widely criticised by numerous medical professional associations as misrepresenting data and propagating ideology unsupported by scientific research (1, 2.) Worryingly, ACPeds’ agenda targets and seeks to undermine medical policies and approaches that have long been backed by scientific consensus.

We believe in the importance of dialogue with those who disagree with us. That is how we learn from each other and grow as a society. We share Jason Wong’s stated desire for further conversation on this topic and for Singapore to approach transgender issues from a medically sound, evidence-based standpoint rooted in empathy and compassion.

However, we have deep concerns over some of the claims that Dr Van Meter expressed in the webinar. Many involved fundamental misunderstandings of what gender dysphoria or being transgender is, misrepresented scientific research, and included his personal theories that contradict both scientific evidence and the lived experiences of transgender people.

In several instances, the studies that Dr Van Meter referenced to support his arguments were in fact directly opposed to the points he was making. Others were older sources whose findings have become outdated as new data and research have emerged. Yet other references were blog articles from anti-trans propaganda websites with no scientific foundation.

We would like to address three of his more prominent claims.

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CLAIM: That transition worsens mental health and increases suicide risk

In this webinar and his previous interviews, Dr Van Meter conflates intersex and transgender individuals. Intersex people are born with physical sexual characteristics that are not typically male or female. In cases of ambiguous genitalia, intersex infants may have their genitalia operated on for a more normative male or female appearance.

Historically, most intersex infants were surgically reassigned to female, as it was ‘easier’ to remove an under-formed or ambiguous penis than to make it larger. With it often came the permanent loss of sexual sensation or function. This was deeply traumatic to many of them as they grew up, especially for those who had male gender identities but had been raised as girls and medically treated through their lives – often against their will – to further feminise their bodies.

Dr Van Meter describes and accurately speaks of the “mental anguish” of these intersex people. However, he erroneously refers to them as “transsexual adults”, and uses them as his prime example to prove that hormone therapy, genital surgery, and living as a gender other than your “biologic sex” will lead only to trauma and despair.

Instead, the despair those individuals experienced resulted in part from being forced to live as a gender and with sexual characteristics that did not match their gendered sense of self. This is exactly what transgender people seek to resolve with gender transition.

Regarding the claim that transition worsens mental outcomes for transgender individuals, researchers at Cornell University did a systematic literature review of all published peer-reviewed articles (from 1991–2017) on the effect of transition on mental health and suicide on transgender people.

(Links to all included studies are in the link)

They found that 93% of those studies showed that transition “improves the overall well-being of transgender people”, while the remaining 7% reported mixed or null findings. None of those studies found that transition was overall harmful. It further concluded that there was “robust international consensus in the peer-reviewed literature that gender transition, including medical treatments such as hormone therapy and surgeries, improves the overall well-being of transgender individuals”.

Suicide Risk

Dr Van Meter supports his claim of trans people’s increased suicidality with reference to a 2011 Swedish study that found that transgender adults who had undergone sex reassignment surgery had suicide rates 19 times higher than the average population.

However, the study adds an important caveat: “The results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment.”

The study’s lead researcher, Swedish psychiatrist Dr Cecilia Dhejne, has publicly spoken out against this manipulation of her work:

“Of course trans medical and psychological care is efficacious […]

However trans people as a group also experience significant social oppression in the form of bullying, abuse, rape and hate crimes. Medical transition alone won’t resolve the effects of crushing social oppression: social anxiety, depression and post-traumatic stress.

What we’ve found is that treatment models which ignore the effect of cultural oppression and outright hate aren’t enough. We need to understand that our treatment models must be responsive to not only gender dysphoria, but the effects of anti-trans hate as well. That’s what improved care means.”

Mental Health

Dr Van Meter references the many studies finding elevated risks of depression and anxiety in transgender youths. He claims this as proof that transitioning is detrimental to mental health. However, the studies he cites (Becerra-Culqui et al, 2018 and Toomey et al, 2018) do not distinguish between transition status; in fact, the first study included gender non-conforming youths alongside transgender youths.

Dr Van Meter acknowledges the viewpoint that poor mental health in trans people is primarily the result of rejection and discrimination rather than innate psychopathology. However, he dismissed this criticism, calling it “unfair” and moving on without further elaboration in his webinar.

There is robust data showing that social support, acceptance and transition drastically reduce suicidality and poor mental health in trans youths. For example:

1. A 2012 study of 433 transgender youths in Canada found that those with “very supportive” parents reported only a 4% attempted suicide rate in the past year, vs. 57% of those whose parents were “somewhat to not at all supportive”;
2. A 2020 study of 40,000 LGBTQ youths in the US found that transgender youths whose gender identity and pronouns were respected by “all or most people in their lives” had half the suicide attempts of those who lacked any such acceptance;
3. Transgender children who were accepted in their identities and allowed to socially transition had developmentally normal levels of depression, and only marginally higher anxiety than their non-trans peers (Olson et al, 2018 and Durwood et al, 2018). The researchers noted: “Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex,” and, “These findings lessen concerns from previous work that parents of socially transitioned children could be systematically underreporting mental health problems.”
4. A 2014 long-term study on 55 transgender youths who had socially transitioned and undergone medical intervention at puberty found them to score similar or better on measures of mental well-being compared to their non-trans peers (deVries et. al, 2014). That was the first time that a group of trans adolescents was found not to have worse mental health than their peers, and the key difference was their access to social transition and desired medical interventions within a supportive environment.

Among transgender adults, merely being able to obtain gender-concordant legal documentation (e.g. official identity cards) was significantly associated with a lower prevalence of serious psychological distress and suicidal ideation (Scheim et al, 2020).

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CLAIM: That the vast majority (80-90%) of gender dysphoric children do not grow up to be transgender adults.

This widely-repeated claim was based on a handful of small studies in the mid to late 20th century. Crucially, these were mostly studies of effeminate boys, not transgender children. Some of them (e.g. Zuger, B., 1984 and Money, J., & Russo, A.J., 1979) specifically sought to identify future homosexuality in boys based on childhood femininity, and transgender identity was not a focus of the study.

In the largest study quoted in support of the claim, the children were primarily feminine boys and a few masculine girls referred to a gender clinic due to gender dysphoric symptoms. A 2013 follow-up study noted that only a minority of those children expressed that they were or wanted to be another sex, and found that these were the ones who most often grew up to become transgender adults.

Other referenced studies involved children who met the diagnostic criteria for Gender Identity Disorder in the DSM-III (1980), DSM-IV (1994) or DSM-IV-TR (2000), which required that children express a wish to be another gender but placed greater emphasis on non-adherence to gender stereotypes. Notably, not all those children were found to even meet that diagnostic criteria but were still included in the studied group.

These criteria were revised in the DSM-V (2013) diagnosis of Gender Dysphoria, in part to address the high rate of false positives by focusing more on gender identity and other factors found to be associated with persistent transgender identity. There is thus no reason to believe that transgender children assessed under the revised criteria would likewise have the same high desistance rate.

Those who go so far as to socially transition, desire medical intervention at or after puberty, are assessed as suitable for that and can afford the substantial cost of treatment are only a further fraction of this already much smaller group; and as the 2014 study among others have showed, the long-term outcomes for these youths have been overwhelmingly positive.

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CLAIM: Transgender youth “become” transgender because they are seeking to escape their suffering and are convinced by social media that changing their sex will make them happy.

This was Dr Van Meter’s personal theory, which he called “the perfect storm”:

1. A child or adolescent experiences one or more adverse childhood events
2. There is secondary anxiety and/or depression
3. There is perceived lack of acceptance among peers
4. There is suggestion, via social media, that identifying as a gender opposite from sex will solve all ills
5. There is a sense of celebrity from coming to this conclusion

However, there is no basis for this claim.

• It fails to understand that gender dysphoria is the primary motivating factor for most trans people to transition;
• It ignores that much of the suffering experienced by trans youth is the direct result of others mistreating them due to their transgender identity;
• It ignores that coming out as transgender is far more likely to worsen that mistreatment and “lack of acceptance among peers”, rather than resolve it, and that many trans youths are often terrified of coming out precisely because it would make things worse;
• It ignores that transition is presented as a solution to suffering only to those who are transgender, where the suffering in question is living as a gender they do not identify as. It would make no sense to tell all youths as a whole that changing their sex would solve all their problems, and Dr Van Meter provides no evidence that such a thing is happening.

Related to this, he cites a paper on what the author calls ‘rapid onset of gender dysphoria’. The author spoke with parents on “on-line forums” whose teenagers had came out as transgender. The parents claimed there had been no signs before that, and blamed it on social media and peer pressure, referencing their friends who also came out as transgender.

The rise of youths coming out as transgender has certainly risen alongside social media influence. This is largely due to the increased access to information that enable youths who have been struggling with their gender to finally put words to what they have been feeling, and find and befriend others who feel the same. It is thus to be expected that many of their new friends would also come to realise they are transgender, giving the impression of peer pressure. Puberty is also the point when latent gender dysphoria often emerges or worsens, due to biological changes that can help clarify a teen’s gender identity.

However, the article does not give a fair presentation of this phenomenon. Its own methodology specifies that these “on-line forums” were in fact three websites that are explicit in their opposition to transgender identities and people. These forums attract parents who disagree with their childrens’ transgender identities, refuse to let them transition, and (in the case where their children were adults) had rejected them after their transition.

While those parents’ stories are still valuable, this was not a neutral nor representative group of parents of transgender youths. Following criticism over the methodology, the study’s author revised the paper to say that it was meant as an exploratory study, and removed its original conclusions.

(For those who are interested, here is a more in-depth criticism of the study by biologist Dr Julia Serano, including links to the original and revised paper.)

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We agree with Minister for Education Lawrence Wong’s exhortation that Singapore should not import the culture wars around transgender issues, and ask only that this not be selectively applied when transgender people express anger and pain over the injustices they have faced.

As cultural conflicts over transgender issues are relatively new to our shores, we also have the opportunity here for Singapore to exemplify a new, better way forward: one that focuses on dialogue over division, on collaboration and cooperation, on truly listening to one another and recognising our common humanity, even and especially when we disagree. This applies all the more for those who are not transgender and do not have their lives and social inclusion constantly challenged and put up for debate – we ask for your graciousness, patience and understanding when those who are suffering and have been harmed by malice and ignorance are unable to always extend the same.

In our call for dialogue, we also ask that the transgender community be invited to participate in these discussions of issues that intimately affect our lives, rather than sit on the sidelines while others talk about us without us.

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