The most difficult part of writing this article was figuring out where to start. Upon coming out as non-binary amidst a moral panic, I have had plenty of exposure to anti-trans rhetoric—so much so that many of the arguments blend into a kind of ever-present sludge that fries my eyes as I doom-scroll through social media instead of going to bed. I could write about how many of these arguments are ill-formed, illogical, and in bad faith. I could analyze a Tucker Carlson segment and debunk it point-by-point, finishing the essay with a half-hearted call to action that justifies the essay’s existence. This might be a worthwhile exercise and a valid piece of analysis, but ultimately the use value of such a “debunking” approach is limited. I understand why people (especially trans people) write this way. Like many in my community, I am intrinsically motivated to argue for my place in society– but that motivation has also been irrevocably shaped by my major and lifelong love of medical science. That science is also under attack. Some of the first moves that our new reactionary administration made were to dismantle the CDC, freeze NIH funding and withdraw from the World Health Organization. Anti-science and anti-trans backlash are inextricably interlinked and perpetuated by a pervasive scientific illiteracy that is deeply rooted within our culture.

Abigail Shrier’s controversial book Irreversible Damage: The Transgender Craze Seducing Our Daughters (2020) is an illuminating example of the way scientific illiteracy creates opportunities for anti-trans moralists. Although the title itself already hints at the rhetorical and ideological intonation of the text, it is useful to analyze closely how the author frames gender-affirming medicine. In the book’s opening pages, Shrier talks about a “girl” named Lucy and their experiences with gender dysphoria. Lucy, before wanting to transition, was a “girly girl” with no interest in changing their body–according to their mom. During this opening anecdote where Shrier describes the course of Lucy’s transition, one sentence stands out: “The next step—if she took it—would be ‘top surgery,’ a euphemism for a voluntary double mastectomy” (p. 2). A mastectomy is an operation where the surgeon removes as much breast tissue as possible, often in order to prevent the spread of a malignant carcinoma. In the process, the patient's nipple and entire breast are cut away: it is a painful but ultimately life-saving procedure. Chest wall reconstruction surgery is an operation where some mammary fat and tissue are removed in order to invoke the appearance of naturally formed pectorals. Many top surgery recipients report overwhelmingly positive outcomes such as increased confidence and comfort within their own skin (Coleman et al., 2022; Junn et al., 2021; Patel et al., 2021). These are different surgeries, and yet Shrier willfully or unwittingly conflates them. In this specific case, it seems probable that the conflation is a deliberate rhetorical choice. Mastectomies (especially double mastectomies) are intensely traumatic for the patients that are forced to undergo them. By intentionally conflating these two procedures, Shrier can convince her audience that top surgery is entirely negative since it is not in response to a deadly illness; it’s “voluntary,” and therefore trans people are delusional or “brainwashed” for wanting to undergo it. Shrier’s rhetoric highlights the subtle ways anti-trans moralists can mislead people with low scientific literacy.  While an inaccuracy in nomenclature may seem insignificant, most laypeople unfamiliar with trans medicine will not know the difference and may adopt their worldview on the basis of the incendiary connotations that come with conflating the two procedures. As a result, socially reactionary pundits face less difficulty when undermining the expertise of physicians or scientists, especially since laypeople are more prone to science denial in an era of growing medical mistrust.

Medical mistrust is, in itself, a highly complex sociological phenomenon. It is a deep-rooted issue that has been exacerbated by systemic discrimination in the US healthcare system as well as by conservative figureheads. In quite a few cases the mistrust has been earned: atrocities such as Tuskegee syphilis studies continue to scar the collective consciousness of black Americans. The Syphilis Study, alongside governmental oppression and Jim Crow Laws, has led to increased rates of vaccine hesitancy in the black community as well. However, the level of vitriol that arose from vaccines and masking ordinances during the Covid-19 pandemic was well beyond well-informed mistrust: it was a full-scale assault on science, which was enabled by a pre-existing dissatisfaction with the medical institution. Covid conspiracies and their ideological underpinnings allowed science denial to flourish and affect many different healthcare disciplines, such as trans medicine. The narrative that doctors are all too willing to send trans kids into affirmative surgery has been heavily sensationalized by many of the same reactionaries that tried to undermine the scientific community on issues such as masking. Governor Ron Desantis threw away Covid restrictions just as quickly as he cracked down on providers specializing in trans-affirming medicine. It is no coincidence that this line of reasoning appears all throughout Shrier’s work. Her central thesis is that “unnecessary medical transition causes irreversible damage,” and she believes that hormone replacement therapy and other affirmative procedures are being propagated by medical professionals as some kind of “cure-all” to gender dysphoria that only serves to maim their recipients. Yet practitioners implement rigorous bio-psycho-social protocols for care and regret rates for transgender surgeries are exceptionally low. Large studies on transgender healthcare outcomes report regret statistics as low as 0.3% (Coleman et al., 2022; Jędrzejewski et al., 2023). Throughout the crusade to erode civil rights for trans people, doctors are caught in the crossfire–despite the century of animosity harbored between the medical professions and the LGBT+ community. Many transgender people have experienced discriminatory barriers when trying to pursue necessary medical treatment, which begs the question: what do people like Shrier and Desantis have to gain when they undermine medicine, a profession that is not known to be welcoming towards gender diverse people? The most relevant answer is that despite implicit biases among healthcare providers, the available biomedical research contradicts anti-trans claims. Science is made by humans, it is prone to error, but it is also built on a strict process of peer review. While having a degree of skepticism is beneficial, outright rejection of scientific knowledge is dangerous: especially when that rejection is not based on informed skepticism but propaganda.

Scientific literacy is a skill that all people should familiarize themselves with at some level. The ability to recognize misconstrued data and faulty study design is necessary in an era where biomedical research has been heavily politicized. Unfortunately, this is not something that most people have the opportunity to learn unless they are pursuing careers in STEM. The inequity of scientific literacy can be blamed on numerous intersecting systemic issues within our public education system such as discrepancies in funding and access to quality STEM instruction. If most Americans were taught to understand research methods, what constitutes a valid study, and when to trust the science, anti-trans pundits would not have the degree of influence they have over the public. By informing ourselves and learning to inform ourselves we gain the ability to resist those who try to exploit our ignorance for profit. However, building scientific literacy within a larger population when institutional means of socialization have failed is difficult. There are solutions, albeit imperfect ones. I would like to highlight the role of science communicators and other intermediates who translate evidence-based research to the public. Their work promotes intellectual curiosity and critical thinking while making the scientific process more understandable to laypeople. Another way to increase accessibility is to allow lay people access to research by removing institutional barriers such as paywalls to journals, which will also help combat the stigma towards academia for being elitist and detached from the rest of society. Increasing support for science communication and making research more widely available are both potential means to combat scientific illiteracy within American culture.

I want to conclude this article by affirming the role of science within our society. As disciplines, science and medicine have touched the lives of nearly everyone while being both inextricably intertwined to society, shaping one another in a dynamic equilibrium. When one part of the equilibrium decays the other will follow. In almost no other specialty does the relationship between science and society reveal itself so clearly as in gender care, a field that has to treat the consequences of social constructs and their biological underpinnings, all while navigating the effects of cultural backlash. Science offers the tools of rationality in a society that has become dominated by irrationality and false consciousness. I live these effects as I watch laboratories I used to work with fall apart due to the reactionary dismantlement of the NIH and see my own grant proposals get rejected. Upon writing this article I have taken it upon myself to spread the tools of scientific thought to my colleagues. Starting this semester I have offered an academic course on gender care to inform my classmates and help them engage with science and medicine that underlies it. Will my class catalyze a greater societal shift to save biomedical research, no, but hopefully it will inspire my little world to become more scientifically literate and less prone to uncritically believing people like Shrier.

Sunny Hunt is an aspiring physician-scientist who cannot seem to escape their literary roots. They have dreams of becoming an oncologist due to their interest in tumor biology, chemotherapy chemistry, the stories many cancer patients bring with them into the clinic, and hope to make treatment more tolerable. Throughout their journey as a transgender person pursuing medicine, Sunny has become acutely aware of how the social world shapes science after encountering discrimination and discrepancies in research. Alongside studying brain cancer at the Cleveland Clinic, they are a semi-passable digital illustrator and enjoy writing science/dystopian fiction.

References

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., … Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, Version 8. International Journal of Transgender Health, 23(Suppl 1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644

Jedrzejewski, B. Y., Marsiglio, M. C., Guerriero, J., Penkin, A., Connelly, K. J., OHSU Transgender Health Program “Regret and Request for Reversal” Workgroup, Berli, J. U. (2023). Regret after gender-affirming surgery: A multidisciplinary approach to a multifaceted patient experience. Plastic and Reconstructive Surgery, 152(1), 206. https://doi.org/10.1097/PRS.0000000000010243

Junn, A., Khetpal, S., Smetona, J., Dinis, J., Hirschman, A., Mozaffari, M. A., Singh, A., Ching, A. H., Alperovich, M., Lu, X., & Persing, J. A. (2021). Hockey stick incision: A modified technique for chest wall masculinization. Annals of Translational Medicine, 9(7), Article 7. https://doi.org/10.21037/atm-20-7678

Patel, D. P., Goodwin, I. A., Acar, O., Kocjancic, E., & Hotaling, J. M. (2021). Masculinizing gender-affirming surgery for trans men and non-binary individuals: What you should know. Fertility and Sterility, 116(4), 924–930. https://doi.org/10.1016/j.fertnstert.2021.07.004

Shrier, A. (2020). Irreversible damage: The transgender craze seducing our daughters. Regnery Publishing.