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Investigation of Claims in "TRANSGENDER DEBATE: Crowder Argues Science vs. Julie Rei Goldstein | Louder With Crowder"

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The following essay is an analysis of the claims made and references provided in the video “TRANSGENDER DEBATE: Crowder Argues Science vs. Julie Rei Goldstein | Louder With Crowder”1.

Minute-by-minute

2:44 - 3:37

Goldstein: There’s actually studies which so that over 80% remain orgasmic post-surgery.

Crowder: 100% of [cis] men experience orgasm.2 […] Those who transition, it’s as low as 65%. [C2]

The NSSHB website2 is very thin, containing only a few bullet points on the page. There are a number of publications listed originating from the project but I could not find any which looked directly relevant to Crowder’s claim. If Crowder’s claim originates from one of the papers, Crowder should have cited the paper directly. According to one article I have found3:

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, states that only 25% of men routinely achieve orgasm in all sexual encounters. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, the prevalence remains constant until age 50 years and then the rate steadily increases with men in their 80s complaining twice as much as men less than age 59 years.

Crowder’s claim about post-transition orgasm results also do not hold. From the paper4:

Seventy-eight percent of the total group was able to reach an orgasm through masturbation. No significant difference was found between female-to-males and male-to-females regarding the ability to reach orgasm during sexual activity with their partner,

It appears that Crowder is specifically citing from Table IV for the statistic “Orgasm during masturbation, (almost) always” specifically for MTF trans persons, which is given as 65.2% after SRS with no statistic for before SRS. This is contrasted with a 94.7% value for FTM trans persons. Additionally, Table II describes an change of “Frequency orgasm in sexual intercourse, (almost) always” from 41.7% to 50% for MTF and 45.5% to 77.8% for FTM persons, indicating that SRS tends to aid transgender people with achieving orgasm.

It is also important to remark that Crowder is not comparing like-for-like statistics here: one statistic is about cis people, the other is about trans people, so it is expected that there would be a difference because in the relationship members of each of these groups have with their bodies. It is more useful to consider cis rates to pre-operative trans rates, and then pre-operative trans rates to post-operative trans rates, to determine if surgery can improve the outcomes for trans people, which Crowder’s paper4 indicates is the case.

6:15 - 6:36

Goldstein begins to describe one of her own orgasmic experiences pre-surgery and Crowder puts her down because he is “uncomfortable with this territory” and because it is “anecdotal”:

Crowder: I don’t necessarily know that [this] helps the people watching right now.

If Crowder is uncomfortable discussing trans people’s orgasms maybe he shouldn’t have brought it up for discussion in the first place. Further, as a subjective qualitative experience, aside from EEG or nerve data, any report about an orgasm is inherently anecdotal and the study that Crowder himself cited4 was based on a survey of trans people i.e. a statistical analysis of anecdotal evidence.

9:02 - 11:14

Crowder: The Belgian study5, I think it was 107 people who participated, 43% of them dropped out meaning we have no idea what happened to them by the end. We have no idea if they’re still alive. So 43% of people who started the study were not included at the end, […] that distorts the number quite a bit.

Crowder: The Canadian study6 covers one year, it asks people within the last year of their surgery if they’ve attempted suicide.

Crowder: When you look at those studies which objectively frame the parameters […] it’s 19 to 18 times more likely for post-operative transgenders to commit suicide across the board.7

Crowder misrepresents the story of participants for the Belgian study [C3]. This was not a longitudinal study and participants did not “drop out” of the study, instead the authors of the study attempted to contact 107 people as part of the initial phase of gathering subjects:

One hundred and seven Dutch-speaking transsexuals (63 male-to-females and 44 female-to-males) who had under-gone SRS between 1986 and 2001 were eligible for inclusion in our clinical study with a minimum postoperative delay of one year. This one-year period is often called the honey-moon period and does not present a representative picture of the long-term emotional and psychological status. Of these eligible 107 individuals, 30 persons could not be reached (28%, 22 male-to-females and eight female-to-males). Fifteen persons (14%, six male-to-females and nine female-to-males) refused to cooperate because they did not wish to be confronted with their past, six agreed to co-operate on condition they were not required to come to the clinic. The latter completed the questionnaires that were sent to them and returned them by mail. The 56 other participants (33 male-to-females and 23 female-to-males) were personally interviewed by two psychologists and examined by a surgeon and an endocrinologist.

The people who could not be reached are not counted as subjects in the rest of the paper or its statistics and so this does not affect the results of the paper. It may be interesting to consider why 28% of the potential subjects were unable to be reached but we do not know and this was not the subject of the study.

No citation was provided for the Canadian study.

The control group used in the Swedish study7 consists of cis people:

For each exposed person (N = 324), we randomly selected 10 unexposed controls. A person was defined as unexposed if there were no discrepancies in sex designation across the Censuses, Medical Birth, and Total Population registers and no gender identity disorder diagnosis according to the Hospital Discharge Register.

This is problematic for Crowder’s framing because it means that the study is not looking at the change in suicidality or morbidity of trans people as they undergo surgery, but instead is comparing the suicidality and mortality of post-operative trans people to people without gender dysphoria or a trans identity. In other words, the study does not answer the question “does surgery improve the death and suicide outcomes of trans people?”, instead it answers the question “are (post-operative) trans people more likely to die or commit suicide than cis people?”. This is discussed in the conclusion:

Given the nature of sex reassignment, a double blind randomized controlled study of the result after sex reassignment is not feasible. We therefore have to rely on other study designs. For the purpose of evaluating whether sex reassignment is an effective treatment for gender dysphoria, it is reasonable to compare reported gender dysphoria pre and post treatment. Such studies have been conducted either prospectively, or retrospectively, and suggest that sex reassignment of transsexual persons improves quality of life and gender dysphoria. The limitation is of course that the treatment has not been assigned randomly and has not been carried out blindly.

For the purpose of evaluating the safety of sex reassignment in terms of morbidity and mortality, however, it is reasonable to compare sex reassigned persons with matched population controls. The caveat with this design is that transsexual persons before sex reassignment might differ from healthy controls (although this bias can be statistically corrected for by adjusting for baseline differences). It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, 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. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia. This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit.

Emphasis mine. Goldstein goes on later to make this very point.

It should also be noted that the confidence intervals on the quoted hazard ratios are quite wide: Crowder cites a 19 times higher rate of suicide but the 95% confidence intervals for adjusted ratio over the period 1973-2003 are 5.8 to 62.9. I am not a statistician but the potential for the estimated value to vary by an order of magnitude seems questionable to me and warrants further investigation.

13:07 - 13:57

Crowder: So what we are debating here is the idea that post-operative transgenders have improved suicidality rates. […] It doesn’t, and the overwhelming number of studies that are performed objectively using objective parameters show that it doesn’t.

Unfortunately Crowder provides no citations for this claim. To contrast, I found a meta-analysis8 which disagrees with Crowder:

We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68–89%; 8 studies; I2 = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56–94%; 7 studies; I2 = 86%); 80% reported significant improvement in quality of life (95% CI = 72–88%; 16 studies; I2 = 78%); and 72% reported significant improvement in sexual function (95% CI = 60–81%; 15 studies; I2 = 78%). Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.

Suicide attempt rates decreased after sex reassignment but stayed higher than the normal population rate. In one study, although most individuals reported improvement in their psychological status (19/23); the remaining individuals worsened and had increased intake of alcohol and anxiolytics.

We should note that the paper indicates that many of the studies included in the meta-analysis are of low quality and that more research is needed:

The evidence in this review is of very low quality due to the serious methodological limitations of included studies. Studies lacked bias protection measures such as randomization and control groups, and generally depended on self-report to ascertain the exposure (i.e. hormonal therapy was self-reported as opposed to being extracted from medical records). Our reliance on reported outcome measures may also indicate a higher risk of reporting bias within the studies. Statistical heterogeneity of the results was also significant. Furthermore, since hormonal therapies were administered as a part of sex reassignment, inferences regarding hormones solely are very weak and are confounded by the effects of sex reassignment surgery and psychotherapy, which were provided implicitly or explicitly in most studies. Benefits noted in individuals undergoing this transition can certainly be attributable to these two coadministered interventions. We excluded studies that did not mention hormonal therapies to remedy this indirectness of evidence; this exclusion poses another limitation to our review because it may have diminished the total body of literature. Lastly, the heterogeneity of methods, in which the outcome of satisfaction with sexual function was assessed, may further limit inferences about this outcome. This limitation does not apply to other outcomes such as gender dysphoria, which was assessed across studies with standardized scales.

14:38 - 14:54

Crowder: If you ask someone “Do you think your healthcare is better than the United States?” it doesn’t mean it’s better.

This is a faulty analogy. When assessing people’s subjective experiences of their own mental and physical health, sometimes you have to use surveys because there are no objective measures for the variable under consideration. For example, pain scales are subjective and self-report is a key component of their use in clinical contexts. These subjective observations are very different to observing something like a healthcare system which affects many people via objectively measurable outcomes.

16:25 - 16:37

Crowder: There’s also a more recent Canadian study that came from Toronto where [the rate] was 18 times more likely to commit suicide than the general population.910. These are post-operative transgenders.

Considering how much Crowder rails on surveys and ‘non-objective’ studies in this video, I find it amusing that he is now citing a survey. The study does not discuss post-operative trans persons – the respondents are a mixed cohort which is not broken down –, nor does it discuss the effect of surgery or other clinical interventions in improving the outcomes of trans people.

Additionally, neither the news article nor the survey itself include a statistic comparing suicidality between cis and trans populations, as Crowder claims.

18:39 - 19:55

Crowder: The truth is that minority groups in general actually have lower suicide rates.

Goldstein: The amount of abuse and violence that you see against LGBT people within their own family is much, much higher.

Crowder provides no source to back up his claim, which I find very troublesome because this is a significant claim in itself, even outside of the context of this discussion which is about the suicidality of trans people.

I found one meta-analysis11 which contradicts Crowder’s claim:

To ensure reliability of estimates, at least three prediction cases from three different studies were required to conduct a category analysis (e.g., three cases from two studies were deemed insufficient to conduct a category analysis). Overall, no risk category appeared to be particularly strong, with weighted mean odds ratios ranging from 0.93 to 2.65 (Table 2). Sex, family types and employment status were the only categories that produced significant results for suicide ideation. For attempt, five categories (i.e., age, sex, race and ethnicity, family types, and education level) significantly elevated risk, though the effects were small. For death, five categories (i.e., sex, race & ethnicity, education level, employment status, and SES) were associated with significantly greater risk for death. Sex was the only category that significantly predicted risk across all three outcomes.

Goldstein also does not cite any evidence for her claim. I found a meta-analysis12 which does support her claim:

The purpose of Analysis II was to examine differences in prevalence of victimization in LGB versus heterosexual individuals. […] Table 5 provides the weighted mean effect sizes comparing LGB participants with heterosexual participants across all samples, […]

From Table 5 we observe the following measures relevant to Goldstein’s claim:

  • Verbal assault from family, 20% more likely for LGB persons, 95% CI of 14% to 27%
  • Physical assault from family, 11% more likely for LGB persons, 95% CI of 8% to 13%
  • Sexual assault from family, 12% more likely for LGB persons, 95% CI of 9% to 16%

20:18 - 20:44

Crowder: They don’t have the same suicide rates, gays and lesbians, it’s not even close, it’s exclusive to the transgender community, and if you look at paranoid schizophrenics, […]

Again no citation is given for this. Crowder is correct that trans people have the highest rate of suicide among sexual minorities, but is incorrect that suicide rates are not disturbingly high for LGB persons. I found one meta-analysis13 covering sexual minority youths which found:

Sexual minority youths were generally at higher risk of attempted suicide (OR, 3.50; 95% CI, 2.98-4.12; c2 = 3074.01; P < .001; I2 = 99%). If estimated in each sexual minority group, the OR was 3.71 in the homosexual group (95% CI, 3.15-4.37; c2 = 825.20; P < .001; I2 = 97%) and 4.87 in the bisexual group (95% CI, 4.76-4.98; c2 = 980.02; P < .001; I2 = 98%); transgender youths were described as an individual group in only 1 study, which reported an OR of 5.87 (95% CI, 3.51-9.82).

Our findings suggest that youths with nonheterosexual identity have a significantly higher risk of life-threatening behaviour compared with their heterosexual peers.

I don’t quite understand what Crowder is trying to get at with this argument. Trans people and their allies are aware that suicide risk is very high for trans people, that’s why we are fighting for access to interventions which reduce this risk.

21:01 - 21:05

Crowder: American slaves didn’t have the same suicide rate.

Another claim without a source. This is particularly contentious because the period of history Crowder invokes is over 100 years ago, and presents a significantly different historical context from today. Firstly, scientific, statistical and evidence gathering processes have changed significantly over the years, so even if this data were recorded at the time, we would have to consider the assumptions made at the time of recording and the methodology used. Most critical however, is that history is a story written by those who hold power, so looking at data on suicide among Black slaves produced by white people – involved in the slave trade or otherwise – is inherently problematic.

I did find a Masters thesis14 which discusses this issue:

The suicide rate among African Americans temporarily peaked on the Middle Passage and soon after arrival. For the first generation, “suicide was the result of a preference for death over slavery … or undeserved punishment.” The suicide rate apparently dropped by the second generation. David Lester argues that changing suicide rates for slaves cannot be measured through empirical studies and statistics, yet the fact that suicide rates were high for Jews during the rounding up and transportation to concentration camps, but low during time at the camp, provides evidence that this phenomenon may very likely have occurred with slaves as well. While there are definite limitations to comparing the two different situations, his basic logic is that humans react more in times of stressful change than later when the same situation has become more familiar to them.

28:56 - 29:03

Crowder: 75% to 90% of children with gender dysphoria just completely grew out of it.15

Crowder is correct that the the majority of preadolescents desist from gender transition as they enter adolescence. This specific statistic from the paper is actually broken down by gender:

On the subject of treating children, however, as the World Professional Association for Transgender Health (WPATH) notes in their latest Standards of Care, gender dysphoria in childhood does not inevitably continue into adulthood, and only 6 to 23 percent of boys and 12 to 27 percent of girls treated in gender clinics showed persistence of their gender dysphoria into adulthood.

29:46 - 29:50

Crowder: That number goes down to 0% if you actually put them on puberty blockers.

Crowder is arguing that puberty blockers are a ‘gateway’ to trans identity. No source is given for this statistic.

I could not find any studies which either support or disprove the claim that puberty suppression treatment decreases the rate of gender transition desistance in youth. It may not be possible to distinguish between continued gender dysphoria and ‘just being on a puberty blocker’ as the cause of continuing transition because these factors are co-incident: adolescents who continue to experience gender dysphoria will remain on puberty suppression treatment because they are still dysphoric. It is expected that patients who no longer report symptoms of dysphoria would stop taking puberty suppression medication, but I could not find any studies about this.

The WPATH Standards of Care16 observes:

In contrast, the persistence of gender dysphoria into adulthood appears to be much higher for adolescents. No formal prospective studies exist. However, in a follow-up study of 70 adolescents who were diagnosed with gender dysphoria and given puberty-suppressing hormones, all continued with actual sex reassignment, beginning with feminizing/masculinizing hormone therapy (de Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2010).

33:55 - 34:00

Crowder: Antidepressants have less than a 50% success rate.

No study is cited for this statistic. I did not look for studies to support or refute this statistic because it is unclear what the criteria for ‘success’ is from this sentence alone, particularly given that we need to draw a distinction between short-term alleviation of acute depression and reduced incidence of repeat depressive episodes over time for people with chronic depression.

34:29 - 35:28

Goldstein: Something to consider is, if you don’t want us to treat gender dysphoric youth […] are you just going to not treat them and let them suffer from depression and suicidality?

Crowder: As far as puberty blockers, yes, I would ‘not’ treat them, I would absolutely treat them with therapy, […]

Treatment for youth gender dysphoria already begins with various types of psychological therapies before any medical intervention takes places, and the WPATH Standards of Care16 recommend this approach:

Before any physical interventions are considered for adolescents, extensive exploration of psychological, family, and social issues should be undertaken, as outlined above. The duration of this exploration may vary considerably depending on the complexity of the situation.

Furthermore, for those youth who do begin puberty suppression treatment – the first physical intervention step – there are studies which demonstrate that puberty suppression treatment may promote better mental health outcomes for gender dysphoric youth. I could not find a study which specifically examined suicide ideation or attempts, but I did find a literature review which discusses the effect of puberty suppression treatment on numerous mental health inventories17:

In a prospective follow-up study of the first 70 eligible candidates for puberty suppression and CSH therapy at the VU University Medical Centre in Amsterdam, psychological and general functioning was assessed at baseline, and again after an average of 2 years of GnRH agonist treatment (at initiation of CSH therapy). Neither the gender dysphoria nor the dissatisfaction with primary or secondary sexual characteristics had subsided at follow-up. This outcome might have been because the misalignment between body and gender identity had not yet been rectified, a finding that was consistent with those of several earlier studies. By contrast, the investigators noted significant reductions in symptoms of depression, as assessed by the Beck Depression Inventory, from a mean of 8·31 (SD 7·12) to 4·95 (6·72; p=0·004). Global functioning, as assessed by the Children’s Global Assessment Scale (CGAS) had also significantly improved from a mean of 70·24 (10·12) to 73·90 (9·63; p=0·005). Additionally, the proportion of adolescents scoring in the clinical range on the internalising and externalising subscales of the Child Behaviour Checklist decreased substantially (from 44% to 22%), although measures of anxiety and anger remained unchanged. The assurance that sexual development would not continue to unfold in line with gonadal sex and the guarantee that sequential phases of gender-affirming treatment would be explored were probably helpful for the study participants. These patients had also received regular appointments with a clinical psychologist or psychiatrist; it is therefore unclear to what extent these benefits could be specifically attributed to puberty suppression.

Employing a longitudinal design, Costa and colleagues examined psychosocial functioning in adolescent patients who had been referred for gender dysphoria at the Gender Identity Development Service in London, UK (n=201). Psychosocial scores, as measured by the CGAS were collected at baseline and every 6 months over an 18-month period, for a total of four assessments. Following an initial diagnosis at baseline (T0), all patients received 6 months of psychological support, standardised in accordance with WPATH guidelines. Eligibility for puberty suppression was then assessed, and the sample was divided into two groups based on whether they were considered immediately eligible (n=100) or delayed eligible (n=101) for GnRH agonist treatment. The delayed eligible group required additional time, such that psychiatric comorbidities or psychological difficulties could be sufficiently addressed by a mental health professional. Within each group, a preliminary comparison of baseline psychosocial scores with scores from the second assessment (T1) indicated a significant improvement in the delayed eligible group only, from a mean of 56·63 (SD 12·80) to 60·29 (12·81; p=0·05). For the remaining 12 months of the study, the delayed eligible group continued to receive psychological support only, although the immediately eligible group also received GnRH agonist therapy in addition to psychological support. No additional improvements were seen within the delayed eligible group at either the third or fourth 6-monthly assessments, reflecting 12 months (T2) and 18 months (T3) of psychological support, respectively. By contrast, the immediately eligible group exhibited substantially higher levels of psychosocial functioning at the fourth assessment (T3, after 18 months of psychological support and 12 months of GnRH agonist therapy) compared with the second assessment (T1, after 6 months of psychological support only), from a mean of 60·89 (12·17) to 67·40 (13·93; p=0·001). The findings within each group might result from several factors, including a general improvement over time, or a placebo effect. However, one plausible explanation is that psychological support could exert a clinical benefit, particularly when psychiatric comorbidities are indicated. Where coexisting issues have been addressed, suspending puberty might confer an added advantage over psychological support alone.

39:28 - 39:36

Crowder: I’m saying definitively there are male brains and female brains, they are definitively different.

Goldstein: Yep.

Although Crowder’s phrasing is a bit simplistic, I did find a meta-analysis which found that there are differences across sex in total volume and volumes of different brain regions18:

Regional sex differences in volume and tissue density include the amygdala, hippocampus and insula, […]

40:08 - 40:28

Crowder: You can’t say that someone identifies as a male or a female if gender is socially constructed, but then also imply that they have the wrong brain trapped in the wrong body.

There is an interesting sleight of hand going on here. Nobody is making the argument that brains are inherently gendered or sexed or that transgenderism arises from a mismatch between the sex of the brain and the sex of the rest of the body. Even if gender is fully socially constructed, people can still identify as transgender – because this is an aspect of identity and self-concept – and/or suffer from gender dysphoria – because it is a psychological disorder.

41:52 - 42:33

Crowder: The Savic and Arver study19 which actually show that the changes occurred after [beginning hormones].

Crowder: There’s another one published in 201820 that found […] that some variations in transgender brains were a by-product of environment and culture.

The study19 does not compare pre- and post-cross-sex-hormone treated brains as Crowder claims, rather it compares the brains of trans women to cis men and cis women.

The results from the paper are mixed. Consider Table 2 which compares the structural volumes of different brain regions. It was observed that the trans women in the study had caudate volumes closer to the cis male controls, but putamen and hippocampus volumes closer to the female controls, with thalamus volumes sitting about midway in between19.

It is important to note that the study19 makes use of transphobic language which indicates that the authors may be biased:

Seventeen of the recruited MtF-TRs conveyed at the time of the scan experienced of only female sexual partners (and rated Kinsey 0-2), the remaining 7 reported that they never had a sexual partner but stated clear attraction to women and not men. The MtF-TR were, thus, non homosexual, attracted to women, and will throughout the manuscript be referred to as gynephillic (Smith et al. 2005) (autogynephillic according to Blanchard’s classification).

The study19 explicitly used heterosexual cis men and women as the comparative groups, but the trans women in the group all identified as lesbian, so another conclusion of the study could be that the observed differences correlate with sexual orientation rather than gender identity.

The study19 was included in a literature review21 which found a variety of other characteristics which do align between trans identity and cis controls:

In some of the largest studies available in hormonally untreated transgender persons, gray matter volume and total brain volume were similar for trans persons relative to their sex assigned at birth. Findings in other global measures, such as in the corpus callosum, are mixed and do not show any difference in size in trans persons before or after CSHT, although they indicate a corpus callosum shape consistent with their gender identity. As for subcortical structures, putamen volume is either larger or smaller in trans women relative to cisgender men, with other studies suggesting a larger volume in trans women relative to cisgender women. Coming close to providing a neurostructural correlate of being a trans person, a valuable histological study in 42 postmortem brains reported that the size of the hypothalamic uncinatenucleus (INAH-3) in 10 trans women resembled that in cisgender women, that is, it was consistent with their gender identity rather than their sex assigned at birth. Even though the trans persons in this postmortem study had been hormonally treated, the lack of testosterone did not appear to be the primary causative factor, given the absence of such an anatomical effect in nontrans castrated men, five of whom were also examined in the study. These data highlight the importance of paying close attention to regionally specific, minute structures when assessing which brain areas conform to gender identity rather than sex assigned at birth.

Emphasis mine.

The study20 makes reference to other papers regarding differences and similarities in various brain features, but itself contains no data. Instead, the paper only hypothesises that the observed changes may be a result of cultural and behavioural effects on brain structure according to a proposed model from an opinion piece22. The paper referenced by Crowder20 is purely suggestive, and draws no causal relationship or even correlation between particular behaviours, cultural practices, or beliefs, and any aspect of brain structure.

Conclusion

Of the 10 studies referenced by Crowder, only 1 directly supports the claim for which it is cited, and all other citations are misinterpreted, misrepresented, or do not include the statements that Crowder claims.

None of Goldstein’s citations are included in the video by Crowder, who is responsible for publishing the video. This is problematic because it does not provide us with the opportunity to make the same analysis of Goldstein’s claims.

The lack of references being included as links in the video description is frustrating and presents a barrier to fact-checking, because it requires us to manually type out the links. Additionally, many papers are locked behind paywalls which frustrates opportunity for discussion and fact-checking, hence the liberal use of Sci-Hub links throughout this write-up.

References

  1. https://www.youtube.com/watch?v=CO3utRT3Hwk ↩

  2. “National Survey of Sexual Health and Behavior” https://web.archive.org/web/20180705165021/https://nationalsexstudy.indiana.edu/ ↩ ↩2

  3. “Delayed orgasm and anorgasmia”, Lawrence C. Jenkins, John P. Mulhall https://www.fertstert.org/article/S0015-0282(15)01957-3/fulltext ↩

  4. “Sexual and Physical Health After Sex Reassignment Surgery”, Griet De Cuypere, Guy T’Sjoen, Ruth Beerten, et al. https://sci-hub.tf/https://link.springer.com/article/10.1007/s10508-005-7926-5 ↩ ↩2 ↩3

  5. “Long-term follow-up: psychosocial outcome of Belgian transsexuals after sex reassignment surgery”, G. De Cuypere, E. Elaut, G. Heylens, et al. https://sci-hub.tf/https://www.sciencedirect.com/science/article/abs/pii/S1158136006000491?via%3Dihub ↩

  6. Missing citation ↩

  7. “Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden”, Cecilia Dhejne, Paul Lichtenstein, Marcus Boman, et al. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885 ↩ ↩2

  8. “Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes”, Mohammad Hassan Murad, Mohamed B. Elamin, Magaly Zumaeta Garcia, et al. https://sci-hub.tf/https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2265.2009.03625.x ↩

  9. “Most Transgender Youth In Canada Self-Harm, Consider Suicide, Study” https://www.huffingtonpost.ca/2015/05/06/transgender-youth-canada-study_n_7226282.html ↩

  10. “Being Safe, Being Me” https://apsc-saravyc.sites.olt.ubc.ca/files/2018/03/SARAVYC_Trans-Youth-Health-Report_EN_Final_Web2.pdf ↩

  11. “Demographics as predictors of suicidal thoughts and behaviors: A meta-analysis”, Xieyining Huang, Jessica D. Ribeiro, Katherine M. Musacchio, et al. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0180793 ↩

  12. “Victimization Experiences of Lesbian, Gay, and Bisexual Individuals: A Meta-Analysis”, Sabra L. Katz-Wise and Janet S. Hyde https://www.researchgate.net/profile/Nia_Mcclurkin/project/Independent-Research-Project-2/attachment/5818ad2c08aeda3fc98777a2/AS:423628044017665@1478012204200/download/article.pdf?context=ProjectUpdatesLog ↩

  13. “Estimating the Risk of Attempted Suicide Among Sexual Minority Youths”, Ester di Giacomo, Micheal Krausz, Fabrizia Colmegna, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583682/ ↩

  14. “African American Suffering and Suicide Under Slavery”, Linda Kay Kneeland https://scholarworks.montana.edu/xmlui/bitstream/handle/1/1654/KneelandL0506.pdf?sequence=1&isAllowed=y ↩

  15. “Ethical Issues Raised by the Treatment of Gender-Variant Prepubescent Children”, Jack Drescher and Jack Pula https://sci-hub.tf/https://pubmed.ncbi.nlm.nih.gov/25231780/ ↩

  16. WPATH Standards of Care https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English2012.pdf?_t=1613669341 ↩ ↩2

  17. “Puberty suppression in transgender children and adolescents”, Simone Mahfouda, Julia K Moore, Aris Siafarikas, et al. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(17)30099-2/fulltext ↩

  18. “A meta-analysis of sex differences in human brain structure”, Amber N.V. Ruigroka, Gholamreza Salimi-Khorshidib, Meng-Chuan Lai, et al. https://sci-hub.tf/https://www.sciencedirect.com/science/article/pii/S0149763413003011 ↩

  19. “Sex Dimorphism of the Brain in Male-to-Female Transsexuals”, Ivanka Savic and Stefan Arver https://sci-hub.tf/https://pubmed.ncbi.nlm.nih.gov/21467211/ ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  20. “Transsexualism: A Different Viewpoint to Brain Changes”, Mohammad Reza Mohammadi and Ali Khaleghi https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5953012/ ↩ ↩2 ↩3

  21. “Transgender Research in the 21st Century: A Selective Critical Review From a Neurocognitive Perspective”, Sven C. Mueller, Griet De Cuypere and Guy T’Sjoen https://biblio.ugent.be/publication/8542009/file/8542010.pdf ↩

  22. “A Culture–Behavior–Brain Loop Model of Human Development”, Shihui Han and Yina Ma https://sci-hub.tf/https://www.sciencedirect.com/science/article/abs/pii/S1364661315002004 ↩