General note: As with any long thing I publish on Medium without the benefit of outside editing, I reserve the right to quietly fix mispellings, tense mismatches, missing words, and other minor errors that have no bearing on the argument of the piece. Any more substantive changes will be logged, here at the top of the post, as an update.

Introduction/General Blerg-ing

Two days after my Atlantic cover story on gender-dysphoric young people went up last June, ThinkProgress posted a searing rebuttal: “Atlantic cover story is a loud dog whistle for anti-transgender parents,” goes the headline.

I got mad when I read it. It’s not, in any meaningful way, a response to what I actually wrote, or to the issues I actually raised in my article. Rather, Ford’s article is designed, top to bottom, to simply paint my article (and, in some cases, me) in as evil a light as possible. And it does so in a deeply dishonest, manipulative, scientifically illiterate manner. Over and over, the text of my article is misrepresented, parts are selectively left out, other, in-fact-nonexistent parts are selectively inserted, and legitimate debates currently going on among clinicians and researchers who know a great deal about gender dysphoria are treated as laughably ignorant anti-trans talking points.

In a true journalistic low point, Ford takes quotes from an interview he conducted with a famous clinician months before my article came out and positions those quotes as though that clinician was responding to my article — the sort of journalistic fraud (that’s what it is) that gets you a suspension, or at least a very stern talking-to, at most legitimate publications. (He has since updated the piece to make the chronology clearer — acknowledging that the quotes had been wrongly used — but he only did so after I emailed him to tell him I was preparing this post, and that it would include this allegation. I’ll explain more soon.)

I wanted to respond to Ford’s piece over the summer, but I also got tired whenever I looked at it. There’s so much there. That’s why Ford’s article, more than others, is seen as the response to my own piece. He wrote thousands of words and seemingly debunked point after point after point — how could my article not be bad if Ford was able to respond at such impressive length and in such impressive detail to it?

That’s how the internet works, unfortunately — people see a long article with a headline they agree with, and that article, mostly regardless of its actual content, is then viewed as “evidence” supporting the position they already hold. A tiny, tiny fraction of the people who read my original article or Ford’s hit piece will read this response to the response. But I’d argue that it’s still worth setting the record straight. Part of that, of course, is ego: It isn’t fun to have your work misrepresented as bigoted, to be presented with bad-faith arguments of the form, “Well, your article says dogs are cute, but I have inferred from a deep reading of its subtext that really, the point of your article is to get the American people to hate dogs and possibly to incite the murder of innocent puppies, particularly puppies with big eyes and adorably floppy ears.”

But there’s something more important at stake here than whether I’m being misrepresented. As I noted in a post I did on the subject of online disinformation and gender dysphoria last month, liberal journalism is seriously fumbling this subject at the moment, and that matters. It matters whether or not outlets get this stuff right, whether they present readers with accurate information. Anyone who reads Ford’s rebuttal to my piece, or much of his other work on this subject, will be given inaccurate information about gender dysphoria. Ford positions himself as a deeply concerned advocate for transgender people, but you can’t claim to care for a group of people and then willfully spread misinformation about a subject that matters a great deal to them. That isn’t true social justice, and it definitely isn’t journalism.

Before proceeding, I should emphasize that none of what follows should be taken as evidence that I don’t think there are good-faith critiques of my article to be made. There are plenty of them. But Ford’s piece appears to be one of the most viral responses to my story, and it wasn’t a good-faith critique. Not even close.

Some Background on Zack Ford’s Work

Anyone who follows either Ford or myself on Twitter probably knows that there’s something of a beef between us. I have been vocally critical of his work, and he of mine. In my view, Ford writes a huge amount about gender dysphoria without having done much of the necessary homework to understand the present state of either research into the condition or how it is approached in clinical settings. He often appears to exhibit a basic lack of familiarity with the way these subjects are discussed by experts.

Instead of drawing on an informed approach to the subject of gender dysphoria, Ford tends to instead endlessly recite the talking points of a small group of activists whose views often don’t line up with the mainstream discussion going on among clinicians and researchers. This isn’t a more generalized knock on activists, of course. Plenty of activists are working from a place of mainstream scientific understanding, and the ones who aren’t also have a right to make their claims, because sometimes they’re right and the mainstream views are wrong. But I would argue that the activists Ford disproportionately draws on do not have a great track record — I think they’re wrong about a lot of stuff. And I recognize their views in his work because there is almost no daylight between the claims they make in their articles and blog posts and the claims he makes in his, and because there is a great deal of daylight between what Ford claims and what I hear and see in my reporting on this subject.

Ford has a long, established history of espousing radical, unsupported views on gender dysphoria in his work and on social media. I could go on at length about this. But since I’m about to provide thousands of words worth of new evidence of this tendency, I’ll keep this rundown brief. Desistance, or the phenomenon in which people (usually younger ones) who have gender dysphoria find that that dysphoria goes away, in time, on its own, is a great example. In one exchange with me on Twitter, Ford opined that “The research that informs desistance is bunk. IF desistance exists, we have nothing currently available to substantiate it as a claim.” He also claimed that “My sources all rejected the legitimacy of the research you rely on that defines desistance as a concept that even COULD happen.”

That’s completely out of line with the vast majority of research and expert opinion on this subject. There is significant debate about certain aspects of some of the research showing that desistance occurs, as well as how common an occurrence it is. In fact, it’s probably ill-advised to even imagine one could generate a “clean” estimate of desistance that’s divorced from extremely contextual factors like a given society’s views on gender nonconformity, a given clinic’s approach to treating gender-dysphoric young people, and so on. But there is very close to zero debate, among actual clinicians and researchers, that genuine desistance is a thing that happens, and while the precise mechanisms aren’t known, it isn’t exactly a mystery given that everyone understands that kids’ understanding of gender, and therefore of gender identity, evolves a great deal as they develop (as does almost everything else about their cognitive abilities). There also isn’t a single published paper I’m aware of that is drawn from data on actual kids which suggests desistance is rare by any reasonable definition of that term. (Some people online have been bandying around an as-yet-unpublished study out of Australia which supposedly “proves” a much lower desistance rate — in this online world, one study showing what you want to be true is worth half a dozen showing what you don’t want to be true — but that one tracked a cohort of kids who had already started hormones, while the other studies in the desistance literature tended to examine cohorts of kids who were tracked from a much earlier age, often well before physical interventions were even on the table. This makes all the difference in the world in light of what we know about gender-identity fluidity, which, on average, appears to diminish as people get older.)

None of these basic ideas are much in dispute. If, that is, you spend a lot of time talking to actual experts and reading rigorous research. Which Ford doesn’t seem to do. Later on in our desistance exchange, Ford seemed to misunderstand, or be unfamiliar with, the very widely used initials “TGNC” (“transgender and gender nonconforming”). That is not a good sign.

An excellent example of how Ford’s reliance on radical, unsupported claims about gender dysphoria can get him in journalistic trouble came in an article Ford wrote lauding a paper that was critical of the desistance research. If you read the article, you’ll see a pretty big correction at the bottom: “CORRECTION: An earlier version of this article referenced child and adolescent psychiatrist Scott Leibowitz and his colleague Laura Edwards-Leeper in a context that misrepresented their work. It has been updated to remove reference to them.” That’s because Ford, without interviewing Leibowitz and Edwards-Leeper — two very experienced and respected clinicians I met with and interviewed at length for my article who are not, by the way, “colleagues” at the moment — originally described them as having views outside the mainstream of the field in which they work (Ford made this claim because they, like everyone else, believe in desistance). It was a completely unfounded, journalistically irresponsible claim for ThinkProgress to have leveled, and I’m glad the site removed it. But this is a useful signal about the quality of Ford’s work: It is not rare for journalists to have to correct stuff. It is rare for a journalist to mess up a description of two individuals’ work and professional standing so badly they are forced to simply remove those individuals from a story entirely, rather than just correct the text in question. (It’s also rare for them to portray quotes harvested in February as responding to an article that came out in June, but we’ll get there, I promise.)

Because Ford seems to mostly source his stories from a relatively small circle of activists, it shouldn’t be a surprise that he came across a rumor, which briefly flared online many months before my article came out, which claimed that 1) my story was about “rapid-onset gender dysphoria”; and 2) its publication was imminent. The rumor was wrong on both fronts, but Ford proceeded to conduct some interviews in preparation for a response.

So my basic theory of the case here, which as you’ll see there is some evidence for according to Ford himself, is that Ford simply recycled a lot of the reporting and writing he did for what was supposed to be a rebuttal to my (nonexistent) ROGD piece. But he didn’t fully update it — it still reads largely as a response to a piece I didn’t write throwing my support behind ROGD, a concept I have very mixed feelings about that I’m not going to get into here, other than to briefly say 1) no parent should “diagnose” his or her kid as “having” ROGD with any degree of confidence, given that it’s such a new and under-studied idea, and given that sometimes kids appear to suddenly have gender dysphoria but have actually grappled with it in secret for awhile; 2) some of the claims about the purported weaknesses of Lisa Littman’s controversial study on the subject are overstated and could just as easily be applied to studies viewed in a positive light by her critics; and 3) the backlash to the study has been, in certain senses, disproportionate — and has backfired, anyway, by drawing much more attention to it from the outside world than it would have received otherwise.

Fisking Ford’s Story About My Story

There is unfortunately no way to fully capture everything wrong with Ford’s response to my article without giving it a good ol’ fashioned fisking — that is, working down from the top, item by item, and responding to every false or misleading claim. This is going to be fairly long, and I don’t expect most people to read all of it. I just hope that anyone who found his article convincing at least comes across this re-rebuttal and approaches it with an open mind.

Let’s begin:

Hailed as “balanced” and 12,000 words long, Singal never actually mentions the thing he’s clearly talking about throughout the piece: “Rapid Onset Gender Dysphoria” (ROGD). ROGD is a fake diagnosis that was recently invented by groups of parents who advocate against affirming transgender youth. The premise is that teenagers who were assigned female at birth are being influenced by social media to suddenly decide that they are transgender boys, but that they are not legitimately transgender.

I appreciate Ford telling me what an article I spent hundreds of hours on is “clearly” about, but, again, the article is not about rapid-onset gender dysphoria. In fact, I had been working on it for dribs and drabs for more than two years before it came out — it started as a somewhat straightforward profile of detransitioners that evolved and got delayed as other stuff popped up in my professional life and as I learned more about gender dysphoria.

More about ROGD:

In his Atlantic feature, Singal never mentions ROGD by name, but references many of these groups’ talking points — several of which appear to be borrowed directly from advocates for ex-gay conversion therapy. Parents may be “convinced that their child is in pain,” he writes, “but also concerned that physical transition is not the solution, at least not for a young person still in the throes of adolescence.” At another point, he refers to “when parents discuss the reasons they question their children’s desire to transition.” Whether a parent doubts the legitimacy of a child’s transition has zero relevance to whether transitioning is best for their child. Humoring this doubt is exactly what makes the story so harmful.

Calling the claim “Referring adolescents for physical interventions is a fraught decision that should be made carefully” (that’s my paraphrasing, not a direct quote from my article) an anti-trans “talking point,” again, simply shows that Ford is completely unfamiliar with this area of research.

Here, from the article he ostensibly read closely enough to write a long critique of, are the guidelines from that notorious anti-trans group, uh, WPATH, and from the APA:

There is no shortage of information available for parents trying to navigate this difficult terrain. If you read the bible of medical and psychiatric care for transgender people — the Standards of Care issued by the World Professional Association for Transgender Health (WPATH) — you’ll find an 11-page section called “Assessment and Treatment of Children and Adolescents With Gender Dysphoria.” It states that while some teenagers should go on hormones, that decision should be made with deliberation: “Before any physical interventions are considered for adolescents, extensive exploration of psychological, family, and social issues should be undertaken.” The American Psychological Association’s guidelines sound a similar note, explaining the benefits of hormones but also noting that “adolescents can become intensely focused on their immediate desires.” It goes on: “This intense focus on immediate needs may create challenges in assuring that adolescents are cognitively and emotionally able to make life-altering decisions.”

I’m going to keep hammering home at the theme of how damaging this sort of journalism can be: It is incredibly irresponsible to tell readers of a mainstream liberal publication that it’s inherently anti-trans to have questions or qualms about a teen’s desire to transition, or to want to approach physical interventions for this age group with careful forethought. This runs exactly contrary to the guidelines put out by WPATH and the APA, both of which sagely counsel caution without exhibiting undue skepticism about physical interventions.

But over and over in his article, Ford keeps pulling the same rhetorical move. I’ll claim X in my Atlantic article, where X is backed up by informed belief delivered via quotes, citations, or both, and Ford will obscure this sourcing from the reader, instead portraying X as some sort of deranged bigoted falsehood perpetrated by anti-trans forces. Again: When it comes to vital information about gender dysphoria, this is an incredibly irresponsible approach to science journalism.

And I need to shine a special spotlight on this:

Whether a parent doubts the legitimacy of a child’s transition has zero relevance to whether transitioning is best for their child. Humoring this doubt is exactly what makes the story so harmful.

This is so, so, so wrong. It’s so wrong. But don’t take my word for how utterly wrong it is. Take WPATH’s. Scott Leibowitz screenshotted this paragraph and responded on Twitter, writing, “Arguments that reinforce absolute narratives- such as the one below (of many in the story)- demonstrate: 1. Lack of any understanding of what it means to work with children, teens, and families. 2. Desire to perpetuate controversy not dialogue.”

WPATH’s own Twitter account first retweeted Leibowitz’s tweet and then responded, “Well said, Dr. Leibowitz.” Again: Why is someone for whom this is a primary beat so out of touch, over and over and over, with what the leading authorities on the subject believe? Why is there so little evidence he has spent any time talking to clinicians who actually work in this field? Shouldn’t it concern Ford, or his editors, or anyone, that WPATH itself saw fit to chime in to push back against his view about “exactly what makes [my] story so harmful”?

As Leibowitz’s tweet implies, all you have to do to know this claim of Ford’s is wrong is spend a bit of time speaking with clinicians who work with TGNC youth. There are definitely parents who are unnecessarily skeptical, and part of a competent clinician’s job is to get those parents on the right page, to explain to them the science and evidence behind blockers and hormones and to help them understand that their child will suffer if they are not granted access to these treatments. But there are also skeptical parents who provide clinicians with valuable insights that might change the clinician’s view of the situation — if their child’s GD appeared to have just popped up alongside severe anxiety and depression, for example, then of course that’s relevant to getting a holistic picture of the kid, and of course it might be a reason to slow things down a bit on the transition front. (I can’t tell you how many times clinicians brought up that concept — slow things down — with me. “Look, I’m old, you’re young,” the well-known Diane Ehrensaft told me she often tells her young patients. “I go slow, you go fast. We’re going to have to work that out.”)

There are also situations where the presence of a particularly doubting or hostile parent might frankly be a good reason for a kid to wait a bit, as long as they are otherwise stable, seem to have the resiliency to wait, and so on — I’m not talking about a situation where intense dysphoria has a kid on the brink of suicide. If you’re a clinician and you have a trans male patient who just turned 15 in a state where he can go on hormones of his own volition at 16, and where at that age he will have saved up enough to move out to live on his own, and his single-parent dad is an abusive asshole who just might beat him up if he starts growing facial hair as a result of going on T, then of course the jerk-dad’s skepticism matters to whether or not the kid should transition at that very moment. This is a very specific situation, of course, but if you talk to clinicians — I am begging Ford to just spend more time on the phone with clinicians — they will tell you all kinds of stories about their work that will make you laugh and cry and scream, and many of those stories entail considerations and complications that you will never, ever hear about if you only read the ThinkProgresses of the world. That’s why blanket statements like Ford’s — or absolute narratives, to borrow from Leibowitz — are absolutely inimical to careful clinical work with TGNC youth.

More Ford:

Singal also insists that gender identity is so fluid in children that it may be impossible to tell whether a child’s gender is just a phase. “What does it mean to be affirming while acknowledging that kids and teenagers can have an understanding of gender that changes over a short span?” he asks at one point. Not only does this approach undermine the validity of what young people say about their own gender, it’s another nod to parents who might not approve of what they hear.

Of course I don’t claim that it “may be impossible to tell whether a child’s gender is just a phase” in anything like the manner Ford suggests. In fact, my article goes to great lengths to explain what comprehensive assessments and mental-health evaluations look like for TGNC youths, and how (contra Ford’s claim here) it’s a false choice and a misunderstanding of trans-affirming care to act like clinicians can’t simultaneously affirm clients’ identities while understanding that those identities could shift over time. More broadly, here Ford is pulling that same old move: I say X, X being a relatively uncontroversial thing for anyone familiar with this area, and Ford claims that X Is The Sort Of Opinion An Anti-Trans Bigot Might Have — ignoring all the other, perfectly tolerant people in and around the field in question who agree with X.

Of course the above statements are uncontroversial among the experts:

[A] TGNC person’s experience of gender may also be shaped by other important aspects of identity (e.g., age, race/ethnicity, sexual orientation), and… the salience of different aspects of identity may evolve as the person continues psychosocial development across the life span, regardless of whether they complete a social or medical transition. … Psychologists working with gender-questioning and TGNC youth understand the different developmental needs of children and adolescents, and that not all youth will persist in a TGNC identity into adulthood. … Because gender nonconformity may be transient for younger children in particular, the psychologist’s role may be to help support children and their families through the process of exploration and self-identification. (APA, “Guidelines for Psychological Practice With Transgender and Gender Nonconforming People”) In children and adolescents, a rapid and dramatic developmental process (physical, psychological, and sexual) is involved and there is greater fluidity and variability in outcomes, particular in prepubertal children. (WPATH, Standards of Care 7) To be affirming of an individual’s identity at one point in development, yet take into account the various unknown factors shaping that individual’s identity, requires an approach that neither over- nor underemphasizes the potential complexities involved in determining how gender fits into the larger picture for a given youth [Citing APA Guidelines above] … Despite the reality that, for many adolescents, gender identity may not be fully consolidated, some providers may prioritize the physical aspects of gender, while others may emphasize the psychological complexities of TGNC adolescents and highlight the social, emotional, and developmental contexts of such adolescents being considered for physical interventions. For these reasons, among others previously described, we suggest that initiation of physical interventions with adolescents only be considered after multidisciplinary perspectives are considered, which includes thorough psychological evaluation. (“Affirmative Practice With Transgender and Gender Nonconforming Youth: Expanding the Model,” a 2016 paper by Laura Edwards-Leeper Scott Leibowitz, and Varunee Faii Sangganjanavanich published in Psychology of Sexual Orientation and Gender Diversity)

Yet more Ford:

Conspicuously, the piece never references the refrain “insistent, persistent, and consistent” — shorthand for how psychiatrists identify when children are expressing gender dysphoria — perhaps because it would directly contradict his assertion that gender is impossibly fluid.

I never use that precise language, but I repeatedly explain that gender-identity stability is one feature clinicians look for when assessing whether a young person will benefit from transition. No one who actually read my piece could possibly come away from it believing that I think that “gender is impossibly fluid” as a general matter, because I never make that claim and repeatedly indicate otherwise. I even use two of the three terms Ford accuses me of never using, albeit at separate points:

Accounts of successful transitions can help families envision a happy outcome for a suffering child. And some young people clearly experience something like what these caterpillar-to-butterfly narratives depict. They have persistent, intense gender dysphoria from a very young age, and transitioning alleviates it. … [Clinicians] want to make sure that a given patient has gender dysphoria, as defined in the DSM‑5, and that their current gender identity is a consistent part of who they are. If a teenager finds that his dysphoria lessens significantly when he presents himself in a more feminine way or once his overlapping mental-health problems have been treated, he may develop a different view on the necessity of hormones or surgery. … Scott Padberg, one of Edwards-Leeper’s patients, is a good example of how her comprehensive-assessment process looks for teenagers with a relatively straightforward history of persistent gender dysphoria and an absence of other factors that might complicate their diagnosis and transition path. … For some people, it will pass; for others, it can be resolved without medical interventions; for still others, only the most thorough treatment available will relieve immense suffering. [emphasis mine]

Let’s keep going:

Singal also highlights the supposed “causes” of transgender identities frequently referenced by the parental groups. “Trauma, particularly sexual trauma, can contribute to or exacerbate dysphoria in some patients, but again, no one yet knows exactly why,” he claims with no citation. There are zero studies supporting that claim, but it’s a common justification among proponents of ROGD for rejecting trans kids. If the trauma can somehow be healed, parents believe the kid will end up not being trans. Singal simply asserts it as truth.

I covered this in detail in another blog post. It is simply impossible to have any considerable journalistic or research experience in this area and to have not come across references to cases in which trauma appears to spark gender dysphoria. It is a giant red flag that this was news to Ford. If you want more information, including examples, just click on the link.

Yet more:

Toward the end of the piece, Singal is even less subtle about his allusions to ROGD, directly referencing parents’ concerns about “social contagion” and the possibility their kids are somehow being “influenced by the gender-identity exploration they’re seeing online and perhaps at school or in other social settings, rather than experiencing gender dysphoria.” Attributing the phenomenon only to “some anecdotal evidence,” he tells the story of Delta, an Oregon teen whose social circle was hit with “a wave of gender-identity experimentation.” Delta ultimately met with a therapist who helped her address some other mental health issues, Singal writes, following which her “gender dysphoria subsequently dissipated, though it’s unclear why.” His retelling of her experiences, however, suggests she was never actually diagnosed with “gender dysphoria,” making this another baseless claim.

As is his wont, Ford leaves out several truckloads worth of context. In this case, context about who is providing the “anecdotal evidence” in question:

[S]ome anecdotal evidence suggests that social forces can play a role in a young person’s gender questioning. “I’ve been seeing this more frequently,” Laura Edwards-Leeper wrote in an email. Her young clients talk openly about peer influence, saying things like Oh, Steve is really trans, but Rachel is just doing it for attention. Scott Padberg[, a trans teen I interviewed,] did exactly this when we met for lunch: He said there are kids in his school who claim to be trans but who he believes are not. “They all flaunt it around, like: ‘I’m trans, I’m trans, I’m trans,’ ” he said. “They post it on social media.”

In another article, published in the Washington Post around the same time mine came out, the Bay Area trans clinician Erica Anderson, who I also interviewed for my piece, said, “I think a fair number of kids are getting into it because it’s trendy.” Okay, so that’s two clinicians with thousands of hours of combined experience working with TGNC youth (one of whom is herself trans) who say they have seen this, a trans boy who told me, unprompted, that this is happening in his class, and a formerly trans kids who said that it happened to her, and whose mom agreed.

Leaving Anderson out because I didn’t quote her on this particular subject in my piece, I guess it could be that Laura Edwards-Leeper and Scott Padberg and Delta are all lying or mistaken about this idea. That could be what Ford is suggesting. But he doesn’t explain why we should distrust them, and this seems like an unfair reaction to them providing me with on-the-record quotes pertaining to different types of first-hand experiences. Of course Ford doesn’t have to claim Edwards-Leeper and Padberg are lying or mistaken because he simply doesn’t tell the readers of his piece that that’s where some of my anecdotal evidence comes from. The only source he mentions is Delta, who he then pretends, for some reason, didn’t really have gender dysphoria — so we can discount her claim — simply ignoring the text of my article: “Edwards-Leeper told Jenny and Delta that while Delta met the clinical threshold for gender dysphoria, a deliberate approach made the most sense in light of her mental-health issues.” Whether or not she was officially diagnosed with GD at that time, or with the other mental-health problems, isn’t relevant given that a psychologist explicitly said she met the threshold.

Oh God there’s still more:

Incidentally, Singal does not reveal that Delta’s mom, “Jenny,” is a part of 4thWaveNow, one of the anti-trans parent groups. On Twitter, she described the site as her “lifeline in supporting my dysphoric teen” and expressed disappointment that he didn’t mention the group in the story.

I met with Jenny for lunch to hear Delta’s story. Then I met with both of them. Then there were a ton of followup emails, plus a rigorous fact-checking process. I believed and believe what they told me, because I pestered them with a trillion questions, and because there was zero sign Delta had been unduly influenced by her mom (Delta was perfectly happy to let me know when she disagreed with this or that thing her mom was saying — but there was almost no disagreement about her gender-trajectory). The idea that we should discount their story because Jenny wrote a piece for 4thWaveNow just isn’t really how good journalism is supposed to work. Again, if Ford has some evidence to suggest I didn’t tell this story accurately, or Delta was making it up, or her mom was, I’m all ears. But part of the point of flying across the country was to meet people face-to-face and be in a position where I could evaluate their claims critically. That’s what I did. That’s why both the desisters in the piece were kids I met with (with their parents) in person. That’s why there were a lot of other stories I could have told in The Atlantic, but didn’t, because I wasn’t able to meet with the participants in person. Under no circumstances was I going to call up some mom or dad and accept at face value their claims about their kid without consulting the kid him- or herself.

Chugging right along:

[Ford excerpting me:] In vast swaths of the United States, kids coming out as trans are much more likely to be met with hostility than with enhanced social status or recognition, and their parents are more likely to lack the willingness — or the resources — to find them care. But to deny the possibility of a connection between social influences and gender-identity exploration among adolescents would require ignoring a lot of what we know about the developing teenage brain — which is more susceptible to peer influence, more impulsive, and less adept at weighing long-term outcomes and consequences than fully developed adult brains — as well as individual stories like Delta’s. [end of excerpt] As he does throughout most of the piece, Singal fails to reference any research supporting this theory.

What “theory” is Ford referring to? It can’t be the “theory” that the teenage brain “is more susceptible to peer influence, more impulsive, and less adept at weighing long-term outcomes and consequences than fully developed adult brains” — that’s really basic neuroscience that, if memory serves, even my wonderfully thorough fact-checker at The Atlantic didn’t bother to ask me for sourcing on.

If Ford is instead referring to the “theory” of the “possibility of a connection between social influences and gender-identity exploration among adolescents,” then Jesus, man, I don’t know what to tell you… At this point we’re about 11,500 words into the piece. The reader has met two desisters, some detransitioners, and a prominent clinician who have all expressed their belief that this connection exists, many of them as a result of personal experience, as well as a trans kid who has himself echoed this claim. To suggest it’s a stretch to posit even the possibility of this sort of connection just doesn’t make sense.

And no, I don’t reference any specific literature on this specific issue at this particular point in the piece, but it’s an utterly orthodox belief among many clinicians that social influences play a role in gender-identity development. “Gender Identity Development: A Biopsychosocial Perspective” goes the title of a 2013 book chapter co-authored by some of the heaviest hitters in the field. Or here’s Diane Ehrensaft, who I know Ford is a fan of, in The Gender Creative Child, explaining her four-dimensional view of kids and gender: “Each child’s unique gender web is an interweaving of nature, nurture and culture (three of the dimensions) over time (the fourth dimension).” You may have noticed that two of those four dimensions very much involve social influences!

I hope my exasperation is starting to come through. Arguing that there could be a link between social influences and gender identity is such a frankly milquetoast claim. I could have framed it much more strongly and I would have happily stood by that framing. It takes two minutes of Googling, or the barest familiarity with the literature, to see that it fits perfectly well within present orthodoxy on this subject, stretching from Ehrensaft, toward the more liberal end of the spectrum of respectable clinicians and researchers, to some of the Dutch researchers who are viewed as a bit more conservative (but still as trustworthy experts who have produced some of the most important, pioneering research on the subject). For Ford to imply, as part of his ongoing obsession with the idea that my article that isn’t about ROGD is really an article about ROGD, that this is some sort of dog whistle, is just too much (, man).

Some more:

“Some teenagers, in the years ahead, are going to rush into physically transitioning and may regret it.” He provides no citation for this claim.

No, I don’t provide any citations for a claim of possible future events at the end of a 13,000-word article that includes multiple examples of those events having already taken place. Point, Ford.

Of course, it would be a bit more clarifying to Ford’s readers to put this sentence in its full context:

Some teenagers, in the years ahead, are going to rush into physically transitioning and may regret it. Other teens will be prevented from accessing hormones and will suffer great anguish as a result. Along the way, a heartbreaking number of trans and gender-nonconforming teens will be bullied and ostracized and will even end their own lives.

Details!

More with the ROGD:

Singal notes, “The detransitioners who have spoken out thus far are mostly people who were assigned female at birth,” consistent with the assumption that ROGD is more common among teenage girls.

It is true that the current cohort of detransitioners writing and making videos online are mostly AFAB. I don’t know what Ford is implying when he says that this is “consistent” with ROGD theories. Does Ford think it’s false that most of the current detransitioners who have come forward are AFAB? He doesn’t say. It’s genuinely uncertain what the critique even is here, other than something like “This thing that Singal said is also a thing that another group might say in another context.” Guilty, I guess? After all, if I say “I like vegetables,” I suppose you could, if you were bored or quite high or both, respond, “Saying I like vegetables is consistent with the idea that you think we should murder all humans to make more room to grow vegetables.”

Ford:

Singal defends the “desistance myth,” the claim that some 80 percent of transgender children will “desist” in their gender identity.

This is ridiculous. Here’s the entire passage in question:

A small group of studies has been interpreted as showing that the majority of children who experience gender dysphoria eventually stop experiencing it and come to identify as cisgender adults. (In these studies, children who suffer intense dysphoria over an extended period of time, especially into adolescence, are more likely to identify as trans in the long run.) This so-called desistance research has been attacked on various methodological grounds. The most-credible critiques center on the claim that some kids who were merely gender nonconforming — that is, they preferred stereotypically cross-sex activities or styles of dress — but not dysphoric may have been counted as desisters because the studies relied on outdated diagnostic criteria, artificially pushing the percentage upward. (The terms detransition and desist are used in different ways by different people. In this article, I am drawing this distinction: Detransitioners are people who undergo social or physical transitions and later reverse them; desisters are people who stop experiencing gender dysphoria without having fully transitioned socially or physically.) The desistance rate for accurately diagnosed dysphoric kids is probably lower than some of the contested studies suggest; a small number of merely gender-nonconforming kids may indeed have been wrongly swept into even some of the most recent studies, which didn’t use the most up-to-date criteria, from the DSM-5. And there remains a paucity of big, rigorous studies that might deliver a more reliable figure. Within a subset of trans advocacy, however, desistance isn’t viewed as a phenomenon we’ve yet to fully understand and quantify but rather as a myth to be dispelled. Those who raise the subject of desistance are often believed to have nefarious motives — the liberal outlet ThinkProgress, for example, referred to desistance research as “the pernicious junk science stalking trans kids,” and a subgenre of articles and blog posts attempts to debunk “the desistance myth.” But the evidence that desistance occurs is overwhelming. The American Psychological Association, the Substance Abuse and Mental Health Services Administration, the Endocrine Society, and Wpath all recognize that desistance occurs. I didn’t speak with a single clinician who believes otherwise. “I’ve seen it clinically happen,” Nate Sharon said. “It’s not a myth.”

It’s clear from this passage that I am not claiming the 80% figure is accurate — if anything, I am casting doubt on it without even mentioning it explicitly. I asked an editor at ThinkProgress to correct this clear factual error and was rebuffed.

Ford has been consistently squirrely on this question — sometimes he uses “the desistance myth” to refer to the 80% figure, and other times he uses that same term to refer to the belief that genuine desistance from gender dysphoria is anything but, as he put it to me, “ **extremely** rare.” (Again, there does not appear to be a single published study to suggest it’s rare, let alone extremely so.)

This slippery flip-flopping between two very different claims — It’s wrong to say the desistance rate is 80% (defensible) and It’s wrong to treat desistance as anything but an extremely rare phenomenon (indefensible) — comes through in Ford’s very next paragraph, where he makes exactly that switch:

While he notes there are some “credible critiques,” Singal argues that “the evidence that desistance occurs is overwhelming.” He provides no new research to support this “overwhelming” evidence, however, instead relying upon statements several organizations have made based on studies that don’t actually support the claim.

Again, this is why I’m bothering with this fisking: You have to read this stuff so closely to understand the subtle ways Ford is being misleading. One paragraph he’s wrongly implying that I supported the 80% number; the next he has switched to a much broader claim. At least in this paragraph Ford is replying to something I actually wrote, which is progress, but still: This is a clear misreading of the available evidence. Of course the combined evidence collected and presented by the American Psychological Association, the Substance Abuse and Mental Health Services Administration, the Endocrine Society, and WPATH — constitutes “overwhelming” evidence that desistance exists to a clinically significant extent. Ford’s reference to “studies that don’t actually support that claim” would be justifiable, arguably, if he meant “that claim” to be the 80% number, but it’s clear he’s genuinely attacking the idea that there’s all that evidence for the existence of desistance itself as anything but the rarest sort of phenomenon.

Continuing:

Singal does provide stories of two teens for whom transitioning was the right decision, but juxtaposes them to show that one was clear-cut and the other wasn’t. In the case of the second teen, a trans boy named Orion Foss, his mother was not on board for many years, which led to his hormone treatment being delayed. The purpose of sharing the anecdotes appears to be convincing the reader that making kids wait to receive treatment isn’t a big deal.

In Ford’s universe, almost every single story I present in a complicated 12,000-word article with many perspectives is replete with hidden claims invisible in the text itself but somehow down there, in the hidden meanings I am trying to communicate to readers implicitly, and he seems to view it as his job to excavate that true meaning from all that pesky explicit text. Of course I would never, ever, ever support as absolute a narrative about care for gender dysphoric youth as “making kids wait to receive treatment isn’t a big deal.” My article emphasizes, repeatedly, how important access to care is for people with gender dysphoria, and points out how in some cases the question of timing can be crucial. And in Foss’s case, it explicitly relays why he might have benefited from the mental-health resources he had access to prior to transitioning:

Looking back, Orion sees the value of this process. “If I had been put on hormone therapy when I didn’t have my identity settled, and who I was settled, and my emotions settled, it would have been crazy. ’Cause when I did start hormone therapy, hormones shoot your mood all around, and it’s not exactly safe to just shoot hormones into someone that’s not stable.” He ended up seeing [his therapist, Lourdes] Hill for weekly appointments, talking about not only his gender-identity and mental-health issues, but a host of other subjects as well. “She weeded through every possible issue with me that she could get to,” he said. “I’m glad she made me wait. And I’m glad the structure was there so I couldn’t just throw myself into something that probably would have made me worse off.”

Would it have been better for Foss to have not gone through this process that Foss himself believes he benefited from? Does Ford think that that would have been a good outcome? He doesn’t say, of course — by reducing this complicated story to the part about Foss’s mom’s skepticism (which, to be fair, was true and was a factor), Ford simply memes it like he memes so many of the other personal accounts in my story. This could be used by bad people to make bad arguments. He turns human beings telling human stories into political pawns.

Okay, now to the really fun part:

Dan Karasic, a psychiatrist at the Center for Excellence for Transgender Health, told ThinkProgress that he doesn’t think anyone believes that “transition is always the answer, though it often is.” The affirmative approach is about “supporting the young person in having an opportunity to explore what they are experiencing and understanding the risks and benefits of any medical or surgical treatment option.” Karasic also dismissed ROGD and Singal’s allusions to the fake diagnosis. Some adolescents may suddenly announce to their parents that they’re trans, he acknowledged. but “most often they have had symptoms of gender dysphoria that have been persistent.” It’s just that they reach a point where they are “able to put a name to what they are experiencing and have worked up the courage to tell their parents.” Parents might perceive the onset as sudden, but that doesn’t mean it was. Likewise, “It is not social contagion that makes youth trans, but peer support might help them feel able to come out to family,” Karasic said.

That was the text of this section of the article as of last night, December 17th, when I sent Ford an email. Karasic is clearly being portrayed as critical of my article, especially in the line “Karasic also dismissed ROGD and Singal’s allusions to the fake diagnosis.”

I emailed Ford about a rumor I first heard shortly after his article came out: that these quotes from Karasic came from an interview that took place months before my article was published, when Ford was preparing his response to my (nonexistent) pro-ROGD piece. If true, this would be a problem — it’s a clearly dishonest way to frame the section. Karasic is portrayed as responding to an article that didn’t exist at the time of the interview.

Over the summer I emailed Karasic, got him on the phone, and recorded an on-the-record interview in which he said that, yes, in his recollection this was what happened — these three paragraphs’ worth of quotes all came from from an interview in February. (There was also a followup interview with Ford after my article came out, but Karasic did not believe any of the above quotes came from that interview.) Which makes sense, because not much of what Karasic says in this section is really a direct response to anything in my article — Karasic is responding more generally to the concept of ROGD and to certain conceptions of “social contagion.” I subsequently emailed a higher-up at ThinkProgress and attached the audio of my Karasic interview, asking her to clarify the situation for readers. She told me that she empathized, and that she had heard that same rumor herself, but there was nothing she could do unless Karasic himself complained.

That didn’t really make sense to me as a response. I had included audio of an on-the-record interview with Karasic saying that this had happened, so all this editor had to do was listen to that audio and, if she felt it supported my account (which it did), ask Ford what had happened and go from there. But after she told me there wasn’t much she could do without Karasic complaining, I dropped the issue until last night, when, having finally decided to write up this post, I posed the question directly to Ford.

By noon or so the next day, that section of the article had been changed, and a correction had been appended to the end of the article. Now the section and correction read as follows, with the most important new stuff bolded (by me):

Dan Karasic, a psychiatrist at the Center of Excellence for Transgender Health, told ThinkProgress recently that he doesn’t think anyone believes that “transition is always the answer, though it often is.” The affirmative approach is about “supporting the young person in having an opportunity to explore what they are experiencing and understanding the risks and benefits of any medical or surgical treatment option.” ThinkProgress reached out to Karasic, Shumer, and Lev back in February amid rumors that Singal was preparing an article on ROGD. Karasic confirmed this rumor at the time, sharing that Singal had interviewed him, including asking him questions about ROGD and transition regret. Karasic was dismissive of the fake diagnosis at the time. Some adolescents may suddenly announce to their parents that they’re trans, he acknowledged, but “most often they have had symptoms of gender dysphoria that have been persistent.” It’s just that they reach a point where they are “able to put a name to what they are experiencing and have worked up the courage to tell their parents.” Parents might perceive the onset as sudden, but that doesn’t mean it was. Likewise, “It is not social contagion that makes youth trans, but peer support might help them feel able to come out to family,” Karasic said at the time. Upon reading the article in The Atlantic in June, Karasic confirmed that it reflected the approach he believed Singal was taking when he had interviewed Karasic months prior. He described him as having “started with an interest in understanding those for whom transition was not helpful.” (Karasic was not cited by name in Singal’s article.) … Correction: This article has been updated to clarify the timeline surrounding ThinkProgress’ conversations with psychiatrist Dan Karasic. The author spoke with Karasic on two separate occasions, first in February 2018, and again in June 2018. The timing of those comments has been adjusted accordingly. [emphasis mine in the body text, Ford’s in the correction]

Ford didn’t originally notify me that he was making the changes. Then, shortly after I tweeted about them, he emailed me to say “I meant to send you this this morning, but we did update the piece with some clarifications as per your comments.” This, of course, proves right exactly what I thought had happened: In the single instance in his long attempted takedown in which an established clinician appears to be criticizing my article, the quotes actually came from an interview that took place months before my article even existed. That’s the quality of journalism Ford is producing. That’s how seriously he takes the responsibility of doing journalism on a deeply controversial subject for a large, respected outlet.

Ford’s Parting Shot

After spending thousands of words misrepresenting my article in myriad ways and time-traveling some quotes months into the future to make it seem like a prominent clinician disliked my article, Ford isn’t quite done:

In addition to the anti-trans bias in Singal’s writing, several transgender women have expressed concern about the unprofessional — allegedly harassing — way he has interacted with them. The prolific transgender writer Julia Serano, who has countered Singal’s talking points herself, has publicly written about negative experiences she and other trans women have had with Singal. (He has responded to some, but not all, of these accusations on his Medium page.) Since his story was published, two more trans women have spoken out about similar interactions:

What follows is a bunch of tweets. It seems like Ford basically just namesearched me at a time when my article had dredged up a great deal of outrage and included as many disparaging tweets as he could. All the alleged instances of “harassment” involve online disputes. The Serano claims, for example — which you can read by simply clicking on the above link — stem from a series of tweets in which I snarkily criticized an interview she did for Vox in which, in my opinion, she presented detransitioners and detransition in an unfair and misleading way. After that article came out and I tweeted about it, Serano claims she received tweets from other people that she viewed as harassing and which she attributed to me lying about her interview on Twitter (I obviously disagree with Serano that I lied about her views — I criticized them). Therefore — because I snarkily criticized her and then other people harassed her on Twitter — I stand accused of inciting harassment, or something like that. It’s a wonderfully flexible allegation that could be leveled against just about anyone, at any time, in any circumstance on Twitter. Serano also accuses me of “slutshaming” her for — not making this up — saying that I liked an article she wrote about dating while trans in San Francisco and recommending to my readers that they read it.

The other claims of harassment are similarly questionable or outright false with the full context Ford doesn’t provide. I’ve already responded to the Serano claims elsewhere, but I’m not going to rebut the other ones Ford included one by one. If I do, it will re-ignite various dumb online fights and I will be accused of “harassing” people simply for responding to false claims about me (this is a favorite tactic among individuals who recast everyday disagreement and conflict online as “abuse” or “harassment” — when the alleged “harasser” attempts to set the record straight, that, in itself, is presented as proof that they are an evil harassing abuser). But all I can say is that the claims Ford amplified are either seriously exaggerated or so outright false as to be genuinely libelous (no, I’m not suing anybody), and that he made zero effort to check any of them. The goal of this section was to show that I’m a really, really bad guy, and Ford was perfectly happy to rely on internet scuttlebutt to make that case.

That’s It

I’m disappointed that ThinkProgress published this article given its extremely low quality and dishonest nature. I’m disappointed ThinkProgress didn’t take seriously my well-founded complaint of a really sleazy misuse of quotes. Now that Ford has acknowledged what he did, I hope ThinkProgress will respond appropriately. No, I don’t want Ford to get fired, and I don’t think there’s any chance of that happening, anyway.

But most of all, I’ll just emphasize, one last time, the dismal state of liberal journalism in this area and how damaging that could be in the long run. People who grapple with gender dysphoria, and their friends and families, deserve better than this. Misinformation harms vulnerable people.