Transgender meta-analyses are pointless
It’s the meta-analysis, stupid! Or is it? Authors of a systematic review ask a specific clinical question, perform a comprehensive literature search, eliminate the poorly done studies and attempt to make practice recommendations based on the well-done studies. And a meta-analysis is a systematic review that combines all the results of all the studies into a single statistical analysis of results. Both fall under Evidence-Based Medicine (EBM), which is the integration of best research evidence with clinical expertise and patient values. According to the EBM pyramid, meta-analysis is apparently top-notch science. So what do a few recent transgender meta-analyses out there say?
“Evidence suggests that transgender people have lower QoL than the general population. Some evidence suggests that QoL improves post-treatment. Better quality studies that include clearly defined transgender populations, divided by stage of gender affirming treatment and with appropriate matched control groups are needed to draw firmer conclusions.” — Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223813/
Current evidence does not support an adverse impact of hormone therapy on cognitive function, whereas a statistically significant enhancing effect on visuospatial ability was shown in aF. New longitudinal studies with longer follow-up should explore the long-term effects of hormone therapy, especially the effects on younger individuals, where there is greater scarcity of data. — Source: https://www.sciencedirect.com/science/article/pii/S0306453020301402
Evidence of low quality suggests that gender affirmation surgery will likely improve the QoL of transgender individuals. Better overall QoL results were found in the trans men population that underwent chest surgery. — Source: https://link.springer.com/article/10.1007/s13178-019-00394-0
Based on the findings, SRS could improve some dimensions of QoL, including bodily pain, emotional role, and mental health in MtF transsexuals, and physical function as well as physical role in FtM transsexuals. Nevertheless, further research is necessary in this area. — Source: https://sites.kowsarpub.com/ijpbs/articles/69086.html
You might think this is more than enough to pwn the TERFs and other transphobes, but don’t be so sure. Meta-analyses in the face of the replication crisis can still, and do indeed, suffer from publication bias and questionable research practices. Whilst meta-analyses can overcome the limitations of any single randomised controlled trial (RCT) by systematically integrating results across studies and identifying and contrasting outliers, and potentially resolve inevitable contradictions in findings among trials, they are constrained by the quality and quantity of available studies.
The validity of meta-analyses also depends on the level of adherence to established standards in their conduct and reporting, as well as the willingness of those doing a meta-analysis to concede the limits of available evidence and refrain from going beyond it. Yet meta-analytic malpractice is widespread, where authors with agendas strive to make their point more strongly than the evidence warrants. For example, a meta-analysis author could offer reassurance that they have checked for publication bias, but not note that tests for publication bias are statistically low-powered and not meaningful with small numbers of studies.
Occasionally you’ll come across a Pachankis-Bränström kind of debacle, capitalised on by critics of transgenderism, where the authors’ “study used neither a prospective cohort design nor a randomized controlled trial design” in order to boldly conclude that “the longitudinal association between gender-affirming surgery and lower use of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them”. Though, post-conclusion correction, the study is still nowhere near the quality of a meta-analysis that the critics would like to make it out to be, the replication crisis (especially in psychology), publication bias and questionable research practices are still problems for meta-analyses in any discipline.
I’m not anti-science, but I no longer believe that using science to ‘settle’ political and social debates is the best way to go about it. I’m both a trans harm minimalist and a classical liberal (both can go hand-in-hand), and last year I wrote about a harm minimisation approach to trans issues. This year I contrasted that approach with Dave Rubin’s illiberal approach on trans children. Essentially, whatever you believe the true science to be, the best approach to trans issues is generally non-initiation of force (or advocacy thereof) on any adult (with or without children), and to be consistent and mutually respectful about it. I don’t write this to be a fence-sitter and take the easy way out, after all, the culture war on trans issues will have no winners.
I think we have to be careful about thinking that gender-affirming healthcare is all bad. We have gotten here, including the detransition phenomenon, because of the disaster that is transphobia in previous decades. People are now over-correcting with (at times, blind) support for gender-affirming healthcare. Yes, this can have bad consequences, like rubber-stamping, the detransition phenomenon etc, and this should be addressed. In fact, let’s get to the point where we can have a meta-analysis on detransition!
But when you read the available detransition literature, it’s very common to have those interviewed admit that had anyone tried to talk them out of it at the time they would have lied to get it, or been very angry and obstinate. Just as it’s unfair for healthcare professionals to rubber-stamp a new affirmation bias, it’s also not fair to expect them to overturn the mindset of a person determined to get something, who also presents with self-harm risks. The exception of course is that parents of trans children ultimately have the final say anyway, unless the State intervenes — despite popular belief, children don’t untimately “decide”.
Gender transition, especially for children, is trickier than what your typical gender-affirming healthcare advocate makes it out to be. But remember, people who are against others transitioning, or parents supporting such, are likely those who want to control people’s individual lives. That is bad, and the healthcare profession should not align with that. That said, the meta-analyses summarised above are not Gospel either. It makes you wonder, how does the Woozle effect play into the reliability of meta-analyses?
Is hard science the only real science, whereas soft science is just scientific art that can be Woozled? Science is objective and art is subjective; art expresses knowledge subjectively, whereas the scientific method acquires knowledge to generate hard science, free from the replication crisis, and unfazed by publication bias. According to scientific art, I’m a transitioned trans woman, and there’s no one right way to transition. But according to hard science, I’m artificially intersex — specifically, I’m mostly genotypically male, but mostly phenotypically female. I get that science is a spectrum, but at some point, a line needs to be drawn in the sand to prevent science from being artsy. Unlike scientific facts, truth is complicated, which is why science and art shouldn’t mix, otherwise we won’t get a clear and distinct picture of either.