There’s no way to summarize this all because it’s many thousands of words long and, like most things Singal writes, the whole point is to dig into the details. To his credit, your eyes will not glaze over reading this. On the contrary it’s all very interesting if you have the time. All I can really do here is to highlight the piece as an excellent look into a much wider argument that deserves attention.

The piece starts with a discussion that happened on a podcast called Science Vs. The host and guests were discussing the use of puberty blockers and hormones in trans children and the consensus was that there is broad agreement that these things are not only not harmful but are associated with benefits. Here’s a bit of the transcript that Singal examines.

[Zukerman:] So overall, hormones have some risks, and they’re not easily reversible – but the top dogs in this space, they’re all on board with this – not only hormones but puberty blockers too.

[Turban:] American Medical Association[115], the American Academy of Pediatrics[116], the American Psychiatric Association[117], the American Academy of Child and Adolescent Psychiatry[118], I could go on and on

[Zukerman:] Not controversial at all?

[Turban:] No

[Zukerman:] And the reason that it’s not controversial is because – again – we need to look at what happens if you do nothing. Like you don’t allow your kid to go on hormones. And just last month – a study from Seattle was published looking at just this. It had followed about 100 young adults, and compared those who got this gender affirming care – to trans folks who didn’t.[119] And they found that while those who got this treatment ultimately felt better afterwards,[120] those who didn’t felt worse and worse.[121] And by the end of the study, those who got gender affirming care were 73% less likely to have thoughts of killing themselves or hurting themselves.[122] Other research suggests the same thing.[123][124][125][126][127][128]

The positive thing here is that Science Vs is really trying to pin down its own commentary to specific studies which can be examined by listeners, hence all of the citations in the transcript. But as Singal points out (again, at great length) there’s actually a lot of what he calls “citational mischief” going on. The bulk of Singal’s piece is actually focused on the the claims at the end of that transcript. But before getting to that, he goes through the earlier part, i.e. what the show’s host called the “top dogs” opinions. I’m just going to quote a bit of what he wrote about that.

I don’t want to be accused of ignoring Zukerman’s claim that the “top dogs” are all on board with youth gender medicine. After all, if all the experts really are on the same page about this, and have done their homework, I could be accused of nitpicking if I found weaknesses with Science Vs’s specific choices of study citations. Maybe there are a bunch of other studies, cited by the major authorities in this space, that do show there’s no controversy here…

I’m going to do only a brief treatment here that hopefully will show why I don’t take Science Vs’s top-dogs argument seriously: All of the documents here are either irrelevant or contain plainly misleading citations.

The American Medical Association document is “Health insurance coverage for gender-affirming care of transgender patients,” an “Issue Brief” coauthored by that organization and an organization called GLMA: Health Professionals Advancing LGBTQ Equality. A key claim in it: “Recent research demonstrates that integrated affirmative models of care for youths, which include access to medications and surgeries, result in fewer mental health concerns than has been historically seen among transgender populations.” The footnote points to this study, this study, and this study. None of the three studies includes any outcome data at all. It’s very bad form for the AMA — an organization that we would hope would adhere to the highest standards of evidence — to claim X, and then point to not one but three studies that offer no statistical evidence in support of X.

The American Academy of Pediatrics document is “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents,” a “Policy Statement” published in Pediatrics. It’s written to be a general rundown of these issues for medical providers, and it barely touches on the evidence question. It does include the claim that “There is a limited but growing body of evidence that suggests that using an integrated affirmative model results in young people having fewer mental health concerns whether they ultimately identify as transgender.24,36,37” That’s a strikingly similar sentence to the AMA/GLMA one. And sure enough, those three endnotes are… the exact same three citations, in the same order, as are found in the AMA document. You know, the ones that offer no evidence about the outcomes of kids who go through this protocol…

The American Psychiatric Association citation points to two documents. The first is “Best Practices” from “A Guide for Working With Transgender and Gender Nonconforming Patients.” This document has nothing to do with the debate at hand — there’s no mention of youth treatment anywhere. The “Medical Treatment and Surgical Interventions” section of the document, for example, deals entirely with adults, with not a puberty blocker in sight. So Science Vs is simply pointing us to an irrelevant citation.

The second APA document is “Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth.” That one includes the sentence “Trans-affirming treatment, such as the use of puberty suppression, is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth.” The citation supporting that claim points to… oh, there isn’t one. Okay.

There’s one more citation to a document by the American Academy of Child & Adolescent Psychiatry. That document makes a claim about the topic with three citations, none of which really support the claim. Singal concludes this sections saying, “yes, it is technically true that the ‘top dogs’ have published documents supporting youth gender medicine. The quality of those documents is another story.”

Again, this is barely scratching the surface of the work he’s done here but its enough to give you the idea of what he means by citational mischief. Citations only bolster your argument if they refer to facts or studies that actually support the claims being made. Unfortunately, most people don’t have time (or expertise) to read through all of the studies for themselves if that’s true. And as we can see in this case, it’s often not true. Fortunately, Jesse Singal has both the time and the expertise. Again, the whole thing is worth reading if you have the time.