Fact check: Pamela Paul's Latest Anti-Trans New York Times Article Filled With Disinformation
The New York Times has leaned heavily into anti-transgender, pseudoscientific writing targeting transgender people in recent years. Pamela Paul's latest article repeats many errors.
The New York Times has a disinformation problem regarding transgender people, their rights, and their medical care. A primary source of this issue is their opinion columnist, Pamela Paul. Four months ago, Paul published a 4,500-word, error-filled article so severely flawed that she later released a follow-up piece in response to criticism, backpedaling and admitting a lack of knowledge. Now, it appears any self-professed ignorance has been discarded. In her latest piece, Paul claims that gender-affirming care "doesn’t work," and asserts that anyone who supports it — including some of the largest and most credible medical and psychological organizations in the world, backed by dozens of scientific studies — is merely "pretending." However, Paul's writing falls far short of supporting such a claim. A fact check of her latest article reveals it is built on much of the same often-debunked disinformation that underpinned her earlier work.
Before proceeding, it is important to recognize the philosophical underpinnings of Paul’s opposition to transgender people and their care. Pamela Paul has targeted LGBTQ+ organizations for including those who identify as queer and has implicitly accused transgender people of "erasing" women. In her previous piece, Paul defended marriage and family therapist Stephanie Winn, who suggested that transgender people be subjected to acupuncture as a way to dissuade them from being transgender. Winn stated this was to "see if they like having needles put in them," implying that "the child’s hatred of needles could spark desistance." This is a clear form of aversive conversion therapy. Paul misrepresented Winn’s horrific advice by portraying it as "approaching gender dysphoria in a more considered way," without actually explaining what it entailed.
Like Paul’s previous work, her latest piece utilizes a “Gish Gallop” approach, spreading several false and misleading claims throughout a lengthy article, making a comprehensive fact check challenging. This fact-check will highlight clear examples of her most egregious errors and disinformation to illustrate the lack of consideration for truth that, some may argue, was intentionally woven into the article.
Claim: Dr. Hillary Cass, author of the UK-based Cass Review targeting transgender care, only met with DeSantis’ handpicked, anti-trans medical board members a single time and thus could still be considered “unbiased” and “neutral.”
Fact: Members of the Cass review held several meetings with DeSantis appointees to ban care and even testifying in favor, challenging claims that that the team was “unbiased” and “neutral.”
“In the absence of an official response to the Cass Review or updated guidance from our medical or governmental institutions, a number of trans activists and L.G.B.T.Q. advocacy groups have baselessly accused Cass of bias and of assuming right-wing talking points. One activist criticized her for meeting with a pediatrician who worked with Gov. Ron DeSantis in Florida, an emphatic adversary of trans advocates. But that was just one of more than 1,000 meetings she held with various experts and stakeholders from all perspectives as part of her review.”
One routine talking point used to support the Cass Review—a review in the United Kingdom that has been cited to ban transgender care—is that Dr. Hillary Cass and her team served as unbiased assessors of transgender care. The review's credibility hinges on the claim of independence and impartiality. For example, the review deliberately excluded transgender individuals from the advisory committee or team, stating it "deliberately does not contain subject matter experts or people with lived experience of gender services." Paul portrays the lack of subject matter experts as a benefit to ensure independence: "To ensure independence, the National Health Service chose Cass for precisely this reason," she says.
For this reason, Paul pushes back heavily against claims that the Cass Review met with DeSantis appointees to ban care, albeit misleadingly. As Paul correctly notes, DeSantis is a vehement opponent of transgender and LGBTQ+ rights. Any involvement between the Cass team and DeSantis appointees undermines claims of independence. Furthermore, the Florida review, which is remarkably similar to the Cass Review, was later discovered to be purposefully designed and manipulated with the intention of having "care effectively banned" from the outset, as revealed by PowerPoint slides in court documents. Paul dismisses the criticism, stating she only had a single meeting and can still claim independence.
It has become abundantly clear, however, that the team responsible for the Cass Review was not independent by any stretch of the word. Since its publication, the political opposition to transgender care among various members of the team has been unearthed. Members of the team and advisory board were found to be lobbying against conversion therapy bans, and some have ties to SPLC-designated hate groups. Outgoing conservative Women & Equalities Minister Badenoch admitted that “gender critical” individuals were placed in health roles to facilitate the Cass Review—a mechanism remarkably similar to how Florida’s review led to the banning of care in the state, borrowing from DeSantis’ strategy. Most importantly, there is evidence that members of the Cass Review were working closely with DeSantis appointees to ban transgender care in Florida, with many meetings occurring between them.
According to court documents over manipulated research done by the Florida review team, one email chain shows that Dr. Hillary Cass met with Dr. Patrick Hunter, a Catholic Medical Association doctor handpicked by Governor DeSantis to ban transgender care. In that meeting and in follow-ups, she shared information and took interest in their conclusions. Importantly, the Catholic Medical Association specifically states that doctors cannot find in their research that transgender care is beneficial.
This was not, as Paul deceptively implies, the only meeting taken. Dr. Riittakerttu Kaltiala, a member of the Cass Advisory Board (declared in her conflicts of interest), met with Desantis appointee, Dr. Hunter, “regularly.” She even served as a primary expert testifying to ban care in Florida.
This begs the question, if transgender people and subject matter experts were seen as too biased to serve as members of or advisors to the Cass Review, but people such as Dr. Kaltiala, with a clear political bias and history of advocacy against transgender care was not, can the review truly be claimed to be independent?
At any rate, this claim by Pamela Paul is misleading, and serves to deceive readers of the New York Times from the actual nature of Cass Review cooperation with Governor DeSantis’ appointees.
Claim: Gender dysphoria is temporary, transgender youth grow out of being trans, and we should treat transgender youth with therapy alone.
Fact: Transgender identification is rarely temporary. The vast majority of transgender youth continue to identify as transgender many years later. Even the Cass Review only found fewer than 10 detransitioners out of 3,000 patients.
“The Cass Review concluded that gender dysphoria is real and can cause significant distress, but that it is often temporary. Research has shown it tends to resolve with puberty and sexual maturation. Many kids who experience gender distress during childhood or adolescence grow out of it and are often gay or bisexual.
…
Trans activists warn that this approach is akin to the way the medical establishment wrongly treated same-sex attraction for years, as a mental illness. But then, no one ever needed to take hormones or have surgery to accept a same-sex attraction.”
For any disinformation researcher on transgender care, one of the first red flags indicating a poorly fact-checked article is the claim of high desistance or detransition rates. Pamela Paul has used such claims before: in her previous article, she stated that "eight in 10 cases of childhood gender dysphoria resolve themselves by puberty and 30 percent of people on hormone therapy discontinue its use within four years." These figures rely on heavily debunked and outdated information contradicted by newer studies. The 80% figure comes from outdated diagnostic criteria that conflated feminine gay boys with transgender people, whereas the latter statistic comes from a study on the use of Tricare during the Trump trans military ban and only looked at people who used Tricare to cover their medication, not the actual discontinuation of medication. Although neither of these studies are directly cited in Paul’s latest story—likely due to previous fact-checks on her work—her latest piece instead links to an old journal article from Dr. Kaltiala that refers to those same older studies.
Claims of high desistance from being transgender originate from conversion therapy advocate Ken Zucker’s 1990s research or Steensma’s 2011/2013, studies, both with the same methodological shortcoming: they used old gender identity disorder criteria, which lumped in overly effeminate boys and overly masculine girls with no desire to be another gender as “disordered." Ken Zucker infamously defended reparative conversion therapy, claiming "a homosexual lifestyle in a fundamentally unaccepting culture simply creates unnecessary social difficulties.” His own clinic was accused of practicing similar methods to ensure “desistance,” such as withholding cross-gender toys and advising parents "not to give in" to their trans youth's desires to wear clothing that aligns with their gender identity.
You can see the differences between the old DSM-IV criteria and modern DSM-V criteria here:
Modern studies, using current diagnostic practices, present a very different picture. A review by Cornell University found that regret rates for gender transition range from 0.3% to 3.8%. A 2022 study showed that transgender youth who socially transitioned had stable gender identities five years later, with only 2.5% returning to identifying as cisgender. Another very recent study from Australia reported that out of 552 youth patients, only 1% reidentified as cisgender after medically transitioning. This study did not suffer from “loss to follow-up,” with outcome data for 548 patients due to its unique methodology and the clinic's isolated location in Western Australia.
Even Dr. Cass could not find high rates of desistance or detransition. Out of 3,000 youth patients either receiving care or on the waiting list, she found fewer than 10 desisted or detransitioned. Cass attempted to explain this by speculating that these individuals could detransition as adults—a purely hypothetical claim used to excuse the lack of evidence for high desistance or detransition rates.
As such, it is incorrect to assert high rates of desistance or detransition and an error Paul repeats in her recent article, suggesting that she is partaking in intentional disinformation.
Claim: “Gender medicine advocates and activists” found Cass’s criteria for including and evaluating studies unreasonably high.
Fact: The Yale Integrity Project is a group of researchers with “ 86 years of experience in caring for more than 4800 transgender youth and have published 278 peer-reviewed studies, 168 of which are in the field of gender-affirming care,” not “advocates and activists.”
“Other gender medicine advocates and activists found Cass’s criteria for including and evaluating studies unreasonably high. Her criteria disqualified guidelines and smaller studies that many American advocates prefer to cite as evidence.”
The Cass Review’s conclusions were rejected by many scientists and leading medical organizations experienced in treating gender dysphoria in transgender people. Notably, the Integrity Project, created by researchers at Yale University—a group of researchers in transgender medicine with a combined 86 years of experience and 278 publications—was among the critics. In a 2,700-word article about the Cass Review, the only mention of the Integrity Project's major rebuttal is a single line referring to the authors as “advocates and activists.”
Both Paul and Cass have a history of labeling their opponents as advocates and activists. For instance, Paul previously referred to Evan Urquhart, a transgender journalist, as an “activist” before having to correct her article. Cass herself is also guilty of dismissing criticism as activism. In an interview with The New York Times, Cass called the American Academy of Pediatrics, the largest professional organization of pediatricians in the United States, "a left-leaning organization," claiming their support of transgender care stems from activism and not science, despite numerous research articles produced by members supporting transgender care.
The Integrity Project, developed by Yale researchers and other esteemed scientists in transgender care, raised numerous scientific and methodological criticisms of the Cass Review. The Integrity Project determined that the Cass Review “repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation. Many of its statements and the conduct of the York SRs reveal profound misunderstandings of the evidence base and the clinical issues at hand.” Among these errors and violations were improperly classifying an increase in transgender clinic referrals as “exponential,” using a modified version of the Newcastle-Ottawa scale inappropriately, and switching scales after pre-registering in a way that allowed them to exclude more studies.
It is incorrect and misleading Paul to refer to the Integrity Project researchers as “advocates and activists.”
Claim: Gender-affirming care is overly risky and results in bone loss for transgender youth, infertility, the inability to achieve orgasm, and other negative impacts.
Fact: Fertility counseling is routinely provided to transgender youth, ensuring they understand the potential impacts of treatment on fertility. Bone density loss is typically minuscule and can be treated and prevented with calcium supplementation. Additionally, most transgender individuals report satisfaction with their sexual functioning, including the ability to achieve orgasm.
“Why would our government and medical institutions continue to frame gender-affirming care as medically necessary and lifesaving despite Cass’s assessment? Especially given growing concerns about the risks and irreversible consequences of gender interventions for youths, including bone density loss, possible infertility, the inability to achieve orgasm and the loss of functional body tissue and organs including breasts, genitals and reproductive organs?
According to an article published in the Journal of Adolescent Health, the idea that gender-affirming care is "unsafe" is a misconception. When presented with evidence and expert testimony, an Arkansas judge overturned the state's gender-affirming care ban, stating that "adverse effects from gender-affirming care are rare" and "the risks associated with [gender-affirming care] are comparable with many other treatments that parents are free to choose for their adolescent children after weighing the risks and benefits."
In many cases, the risks Paul mentions are overstated or even entirely incorrect. For instance, Paul claims that gender-affirming care causes significant bone density loss. However, a review by Yale researchers on disinformation in debates over gender-affirming care bans pointed out that puberty blockers have “minimal” or “negligible” effects on bone density, and these effects are reversible. Even when bone density loss is a concern, it can be prevented and treated through calcium supplementation and exercise. As such, pediatricians routinely advise calcium supplementation for transgender youth receiving gender-affirming care. The informed consent form explicitly addresses this potential risk and its mitigation, stating, “It is important that patients on Lupron Depot® take other measures to protect their bones: keeping active and ensuring good calcium and Vitamin D intake.”
As for infertility, fertility counseling is an integral part of modern gender-affirming care practices. The World Professional Association of Transgender Health recommends that fertility counseling occur before treatment begins and that fertility preservation options be offered. These options include waiting to start puberty blockers until a later Tanner stage or temporarily discontinuing hormone therapy for some transgender girls and women. For transgender men, these concerns are lower, as many transgender men are still able to conceive. Importantly, these decisions are made based on each individual patient's circumstances, involving the patient and their family. Considerations include the severity of dysphoria, the likelihood of infertility, and the costs and benefits of timing.
Lastly, Paul claims that transgender people are unable to experience orgasm or experience orgasm with great difficulty. This statement is entirely incorrect. According to a more recent and applicable study than the one Paul cites, 84% of transgender youth who took puberty blockers reported being able to orgasm after gender-affirming surgery later in life, with 12% not having tried. These numbers are comparable to cisgender rates of anorgasmia. Furthermore, a study of young transitioners found that most reported being "moderately to very satisfied" with their sex life. A 2022 review of the research around transgender sexual satisfaction found that “the most well-established changes associated with HT are initial changes to libido and increased sexual satisfaction, likely through increased body satisfaction.”
The numerous errors about the risks of transgender care are suggestive of intent to misinform Paul’s readers.
Claim: Dr. Cass showed that there is no evidence that transgender youth will turn to suicide if denied care.
Fact: Transgender youth who transition are at a much lower risk of suicide. Additionally, whistleblowers in the NHS in England reported a spike in suicides after restrictions on transgender care were implemented, which Dr. Cass reportedly chose not report.
Nor, she said, is there clear evidence that transitioning kids decreases the likelihood that gender dysphoric youths will turn to suicide, as adherents of gender-affirming care claim. These findings backed up what critics of this approach have been saying for years.
There is a wealth of studies showing a lower suicide rate for transgender youth who can obtain care. According to Yale researchers, the Cass Review improperly dismissed many of these studies as "low quality" or excluded them outright.
A Cornell review of more than 51 studies determined that trans care significantly improves the mental health of transgender people. One major study even noted a 73% lower suicidality among trans youth who began care. A similar study found a 40% reduction in actual suicide attempts over the previous year. In a recent article published in the Journal of Adolescent Health in April of 2024, puberty blockers were found to significantly reduce depression and anxiety. A randomized controlled trial in Australia, which was only possible through an innovative methodology, showed a 55% reduction in suicidality for trans men able to start testosterone. In Germany, a recent review by over 27 medical organizations has judged that “not providing treatment can do harm” to transgender youth. The evidence around transgender care led to a historic policy resolution condemning bans on gender affirming care by the American Psychological Association, the largest psychological association in the world, which was voted on by representatives of its 157,000 members.
If these studies are not convincing enough, then consider the Cass Review itself. Whistleblowers who have come forward to the Good Law Project in the United Kingdom reported that suicides increased dramatically in the years following restrictions on transgender care. In the seven years before the restrictions, there was only one reported suicide, whereas 16 occurred afterward. (Update: The NHS disputes the rise in suicides in a recent report.) Despite being informed of these suicides, Dr. Cass did not detail them in her report, dedicating only a single paragraph that failed to mention the actual numbers, thereby concealing the rise.
The continual insistence by Paul that transition does not improve suicidality runs contrary to the science and lived experiences of transgender people.
Paul’s latest article decisively claims that gender affirming care does not work, relying heavily upon the Cass Review and disinformation about transgender care to do so. Like her previous attempt to launder anti-trans disinformation through the New York Times, her latest piece misses the mark and does a disservice to her readers.
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All of us are very glad, Erin, that you put the time and effort into exposing the rampant misinformation in the press wrt transgender medicine. It is pathetic that our country has come to this.
The amount of work put into this piece is astonishing. Thanks for all you do, Erin!