I first want to applaud the article for saying research is not conclusive. Researchers and scientists, well the ethical ones, say that there is no absolute truth.
A few critiques I have for better understanding and clarity of the article’s premise are as follows (this is a professional critique, it has nothing to do with a stance for or against):
- When reporting information to the public on these types of platforms, I would start with the absolute truth disclaimer. You know full well people are treating your information as such. That’s common sense.
- Next, I could not read your article, even after trying to use my university to sign in (which has worked every single other time). Even my pastor does not tell people to trust him blindly, but to look what he says up. So, I’d like to read your whole article and analyze it.
- I'm sorry if this one seems "all over the place," but research is complex work. You may have covered this in your article, but you did not cover it in the Medium story. The research gaps. One gap is any bias from the author (which we all know there is bias present. Everyone has them). Your Medium story goes from "defensive" words in the beginning, such as saying what others have said against the hypothesis, if you are calling it a hypothesis, to then describing what gender-affirming surgery is, briefly. Another gap is disclosing what opposing research says. Such as, many psychologists and counselors say working with pre-surgery individuals is similar to others who have negative feelings towards their outward appearance (obesity, anorexia, etc.). And whether to have GAS surgery or not to have surgery should not be a feeling-based decision. I agree. If I do not like my physical appearance for whatever the reason, but I come to a mentality where those feelings do not impose decisions, then I can approach a treatment WHILE in good head space. Treating the emotions is not replacing surgery. That is not what counseling does. There are zero, I repeat, zero instances in life in which we should make decisions based on emotions (that should be an absolute truth). Again, someone can be in good head space and still choose the treatment. For someone who is obese, not hating themselves anymore does not influence their decision to not work on it. They still should if that is the right decision for them. But hating oneself is never healthy. I did not read any mental health counseling in your Medium story. The last time I checked, which was only a few years ago, 70% of the T and Q part of the LGBTQ+ community were at some point in their life in mental health counseling. It is very important to discuss the statistics of what those cases are for and if surgery is right for them. What if gender-affirming surgery is not good for 60% of the pool who want it? That is a question the researcher is ethically inclined to answer (not to me, obviously, but in the research). It is not new to research that people who have sexual trauma history, especially teens, will do things to make themselves less attractive, such as not showering, shaving their heads (girls), and more. Additionally, there has been cases where teens wanted to transition to the other sex after sexual trauma. Many red flags for a surgeon there. That is a most crucial topic as well for the research to cover. I did not read anything about vetting out these individuals until a later time when they have completed counseling. Your article points to 100% of people who think they should be the other sex, should get affirmation that that's right, they should. That is more alarming than comforting for me. Another gap is a cognitive bias. How do doctors and patients really know they are becoming male or female? That is a valid question, because of the philosophical beliefs behind sex and gender of the doctors and patients, from their own mouths. I think we all can point to hundreds of raw videos of people who claim a community and give their philosophical beliefs. What do they really say? Straight from there, that point, a same person who says there is no definition of woman (biologically), then goes into surgery. That is malpractice on the doctor. I’m pretty sure that is legitimate malpractice if I asked a lawyer. A person who can have the surgery is a person in good head space who can explain very well the details of how their body does not line up with their brain chemicals (which is the point for many opposing scientists and doctors who say that is not actually backed by science). For a researcher or doctor to say, “We can change those brain chemicals,” now we are not talking gender-affirming care. You are fully aware of that. This surgery is sexual preference. Not the same thing.
- On the same lines as that, scientifically, how does a doctor putting working ovaries into a male body make the body female? And does the body interact with the ovaries as a female body does? What is the percentage of average female changes and psychological and neurological reactions, 5%, 20%, 70%?
- You used breast cancer to relate to gender-affirming surgery. It is no wonder that women want their breasts back. Haha! My aunt did, too. Nonetheless, you are obligated to actually discuss what people who transition back say. I do not see a correlation between cancer and GAS. I heard a guy who transitioned into a woman, back to a man, back to woman, then back again. He said none of the surgeries helped his mental health. At the end of the day, he still knew how he was born. That is a mental health counselor’s job. Not a surgeon. This point was made earlier. There are cases out there. How many? And should researchers and doctors who push 100% be liable? I think they should.
- The article that opposed you talked about a number being a couple thousand off. That would be good to either annotate in the article itself or get the article removed, if so, and start over. Ethically speaking, you can’t keep an article up if that error is present. I can almost guarantee 100% that the situation is covered in the APA, AMA, and all the others.
- Another interesting topic that should be mentioned in this research article is the fact that over 30% of people are in counseling a year after they became what they wanted (GAS). You did not mention counseling before surgery, and you failed to report this after-surgery care. 30% is not an outlier — not even 10%. One out of 10 is pretty large.
- As you mentioned from an article that opposed you, the 8 years discussion, why did your research only go to a year after surgery? Or, like the guy I mentioned, his first transition was like 40 years before his interview. There is a major gap here. The research was not completed.
- Your wording right after this last point is also a critique. You said, “consensus among experts.” Was the opposing article not done by a PsyD? Could you have said, “consensus among most experts in our research?” A transferable skill between my military police and mental health experience is wording. It sounded like you were pushing the idea that the opposing article was just a journalist.
- Lastly, overlapping with previous points made, it is imperative that the definition of transgender, pre-surgery, be defined – again, excluding our exceptions. There are exceptions for surgery, what are they?
Thank you for the story!!
