Thread by @asymmetricinfo

Hello, Twitter. It's time to tweetstorm my latest print column. It's about trans kids.

washingtonpost.com/opinions/who-s…

It's also about selection bias, which is where it shades over onto my beat.

It was touched off by Jesse Singal's long, exhaustively researched, and very thoughtful Atlantic feature on the topic. theatlantic.com/magazine/archi…

I'm going to take the highly unusual step of actually outlining the central argument of the column, because this is such a sensitive topic, and misunderstandings are so quick to happen.

When it comes to talking about what we should do about trans kids, the consensus on the left, and especially in a lot of culturally powerful institutions, seems to be that we should let trans adults tell us what's best for kids with gender dysphoria.

That seems obvious and intuitive. After all, they've been through it. Who would know better?

Well, actually, there's another group of folks who experience gender dysphoria as kids. Their gender dysphoria resolves, a phenomenon known as desistance, and they embrace the gender that matches their natal anatomy.

We don't know what percentage of kids will desist today, or would desist in a world in which there was no anti-trans bigotry. But it might be a majority; current studies show strong majorities, but they're contested by trans activists.

It's what's known to statisticians as a "dark figure": there is some number of kids who will desist, but we can't see what that number is.

But if that number is significant--and especially if that's a majority--that introduces an enormous problem with the "let trans adults tell us what to do" idea.

So there's a general policy problem with "dark figures": people hate not having numbers. I get this all the time as a writer.

An editor will say "We need this number" and I'll say "Yes, that would be splendid, but unfortunately, that data doesn't exist." And the editor will push me to use whatever number is closest.

(To be clear, my editors at WaPo and Bloomberg have always been very willing to hear "There's no data, and the data we have isn't close enough to be useful. I will omit the names of the places where this has happened, in the hopes that they have reformed.)

It's just a natural human tendency. You don't have information; you grab a proxy bit of information.

Unfortunately, we then generally forget that we're using a proxy and treat it as if it's the number we actually want.

This is an absolutely huge problem with, for example, the way journalists and others use statistics about false claims of rape.

oregonlive.com/opinion/index.…

So consider what happens to gender dysphoric people. Roughly there are two paths: they decide to transition, or they decide they identify more with their natal anatomy. What do they then do?

For trans people, transition is one of the central facts of their lives. They form a community. They form activist groups to combat ongoing discrimination. They're very vocal, because they've suffered greatly, and still are from ongoing social bias.

People who never transitioned don't have anything like that. (Detransition is a separate question). It's not a central part of their lives in the same way; they don't form identities and communities around it.

So on these issues, trans adults are going to have a unified, loud, prominent voice. Desisters will be a whisper, if that.

As I noted in the column, I absolutely believe trans adults when they say that medical intervention as early as possible would have been best for them.

I'm a 6'2 cis woman. Distracted people frequently call me "sir". This caused me great distress as a young woman, because it didn't match my self-conception of myself as a woman. And it's a tiny fraction of what trans people go through.

It seems just bleeding obvious that trans adults will be better off if they got treatment during puberty so that their phenotype matches their self-conception.

But if the desisters are a majority, we can have a situation where the trans adults can be absolutely right about what's best for them, and still not right about what's best for the majority of gender dysphoric kids. Which is why the phenomenon of desistance is so controversial.

And when we're designing guidelines we absolutely must remember that this skew exists, that the data we're getting--"What would have been best for trans adults?" is not necessarily the data we want--"What is best for the greatest number of gender dysphoric kids".

To be clear, we don't know if desisters are the majority. We're on an information frontier, and the irreversibility of puberty is forcing us to make hard choices with imperfect information. I'm just saying: we need to be conscious at all times that the information is imperfect.

And not just grab our favorite statistic, and shout louder at each other, as if we had data we don't.

So far, most of the questions about the column have been quibbles over word choice. So I'll just answer all of them at once: it's a print column. I have a hard word limit. This prevents me from adding modifiers that would reduce ambiguity. Try to read charitably.

Which brings me to the end of this tweetstorm, at least for now. If I get more questions, I'll probably reopen it. In the meantime, I'll close by saying that this is not a brief against listening to trans adults. We absolutely SHOULD listen to them. They've been there.

Meanwhile, read the column, which touches on other things I didn't get to here, like the hope that we can finesse these issues by setting up high-quality gender clinics. washingtonpost.com/opinions/who-s…

Okay, so actually I'm going to reopen this right now, and make one more point, to conservatives: yes, there are people who have detransitioned, and some of them appear to have gotten bad medical advice.

But conservatives frequently treat these people as if they're some sort of measure of the "real" truth about gender identity treatment. That's silly.

*Any* medical intervention is going to be given to some patients who shouldn't have gotten it. Those people will be worse off. Often much worse off. There are people who have had the wrong leg amputated, so they ended up as double amputees. That's not an argument against surgery.

We don't know how many people have been pushed into an inappropriate transition by bad medical care. There's no data. There's a bunch of articles using the same three anecdotes. I feel terrible for those people, but this is basically useless for assessing policy.

We should get the data. I urge you to go get the data if this is an issue you feel strongly about, or donate to someone else who will do the work to get the data. But don't treat your anecdote as the data you don't have.