Jonathan Chait, Tavistock, and the Truth
Why are all his concerns drawn from anti-trans propaganda, and why don’t they engage wth the truth about Tavistock in the UK?
by Evan Urquhart
More than 14 million children live in the UK. If trans people constitute 0.5 percent of all people (a conservative estimate), that means the UK has more than 70,000 children who will one day grow up to be trans. If 1/10th of those children would be helped by early diagnosis and treatment, you would expect to see about 7000 children receiving treatment for gender dysphoria in that country before they turned 18, with many more screened and diagnosed. The Tavistock clinic has long been the only clinic serving youth with gender dysphoria in the UK, and according to a review of Hannah Barnes’ book in the Financial Times, it treated about 1000 children with puberty blockers between 1989 and the present.
I mention Barnes’ book because Jonathan Chait opened an essay for New York Magazine responding to criticism of the New York Times’ coverage of gender affirming care by talking about it. Chait believes, presumably after reading a book by a gender critical journalist, that the number of young people treated at the Tavistock clinic was too high.
But perhaps we should have started out with the story of a trans girl who hoped to be treated at Tavistock. Blessed with supportive parents, the young woman has socially transitioned, and she’s been on the waiting list for Tavistock for years. The wait has been so long that signs of puberty have begun as she waits to be seen. This was so distressing that her father joined an unsuccessful lawsuit that charged the NHS with discrimination over the excessive wait times. Her body changing irreversibly, she waits, and waits, and waits.
screenshot from bbc.com
If recent reporting by Vice is correct, this girl may not be seen by Tavistock before the clinic shuts down, and there have been no preparations for the two regional centers planned to replace it. But Jonathan Chait believes the problem with Tavistock is that they were too quick to prescribe treatments for the youth who’d been waiting for years just to be seen.
screenshot from New York Magazine
I bring up the wait times at Tavistock for three reasons. First, because long wait times have been one of the central issues associated with Tavistock. It’s highlighted in the Cass Report as one of the core criticisms of the service, it was the subject of the lawsuit mentioned above, and it’s one key reason why they’ve decided to replace it with regional centers. Second, Jonathan Chait doesn’t mention wait times in his essay at all. It’s not clear he even knows that this was one of the biggest issues with Tavistock’s care. Third, the existence of long wait times fundamentally changes the picture of whether prescriptions and diagnoses were being rushed. If every patient had already been waiting for years by their first visit, then the urgency of their need was almost certainly a factor in how quickly medication was prescribed. Medical care is generally better when it’s timely, and a key factor in the diagnosis of gender dysphoria in youth is how long it persists. If a patient’s symptoms have persisted for years while they were on a waiting list, it is self-evident they’ve not gone away on their own.
Chait’s rudimentary understanding of the problems at Tavistock don’t bode well for the rest of the essay. So, what does such a man have to offer to the discussion of coverage of gender dysphoria at the New York Times? Chait offers a cosplay of rationality, a pose of having carefully examined the evidence, and a rehash of anti-trans talking points with a tissue thin facade of judgement and moderate concern.
The NYMag essay is a response to a letter from over 1000 contributors (up from an initial 170) to the New York Times, criticizing the paper's coverage of gender affirming care for youth. Chait starts out in bad faith, describing the concerns of the signatories thus:
screenshot from New York Magazine
Chait claims that letter’s key premise was that the Times has whipped up public concern over a nonexistent phenomenon. That’s not true. The quoted passage comes from the eighth paragraph of the letter. The key premise is that the Times has shown bias in favor of the anti-trans side, obscured sources’ affiliations, amplified pseudoscience, and presented readers with a skewed picture of the state of gender affirming care for youth. Unsurprisingly, Chait does much the same here. He cherry picks anti-trans talking points while either ignoring or misunderstanding the arguments on the other side.
Chait’s premise is that something has radically shifted in the field of gender affirming care, and that reporting is accurately conveying that shift. He says there are more patients, the patients are different from past patients, and doctors are too quick to prescribe treatments such as puberty blockers and hormones.
screenshot from New York Magazine
There are 74 million children in the US. If 0.5 percent of them are destined to grow into transgender adults (again, a conservative estimate), that would mean 370,000 minors in this country would benefit from seeing a specialist in gender affirming care. According to reporting by Reuters, 121,882 children were diagnosed with gender dysphoria between 2017 and 2021, and only about fourteen percent of those went on to be prescribed puberty blockers or hormone therapy. The persistent narrative is that there are too many children seeking these specialists, and too many of those are receiving treatment to delay puberty or give them secondary characteristics of the opposite sex, but the numbers simply don’t support that view. What they do support is a growing awareness of treatment having led more people who might benefit to seek out specialist care. Meanwhile, there has been no explosion in the percentage of people who detransition, and even among people who detransition actual regret over medical steps taken seems very rare.
It’s true, as Chait and many others point out, that more female-assigned youth are seeking treatment. However, given the number of youth being diagnosed is still lower than the best estimates for prevalence of gender dysphoria in the population, the hypothesis that best fits this evidence is that many more male-assigned youth would benefit from seeing a specialist than currently doing so, not that there are too many youth seeking this care.
Chait believes clinics are rushing youth to transition, but provides no evidence for this. He believes detransition is growing more common, but provides no evidence for that. There is no such evidence. Instead he provides anecdotes, including the anecdote of the Missouri whistleblower, a woman who claimed to have witnessed clinicians fast-tracking young people into transition, but provided no specific descriptions of wrongdoing and made patently false statements about what gender affirming care even involves.
Above all, Chait presents himself and the Times as being invested in careful, honest journalism. But he himself completely fails to display it, credulously grasping at biased sources riddled with factual errors, and showing no awareness of the arguments on the trans-supportive side. He presents critics as wanting to suppress good journalism, but that is exactly what the signatories of the open letter were begging the Times to provide.
The most profound misunderstanding of the debate around gender affirming care is that trans people and their allies don’t want careful, thorough reporting, or that they don’t want to be made aware of bad clinics, poor diagnostic practices, or unethical doctors if such things are found to exist. Nothing could be further from the truth. Trans people want high quality research, high standards of care, and the best possible outcomes for youth. If there was some new treatment that had better outcomes with less medical risk, we’d want to know. If there were an explosion of transition regret, we’d want to know. The problem is that the possibility of these things keeps being floated by reporters who don’t flag that there’s no evidence for them in the real world. The central issue with the coverage is that it routinely advances the possibility that some other approach might work better, or something could be going wrong, and puts that on equal footing with the evidence, which shows no sign it actually has.
Good reporters go out into the world, look closely at all the available evidence, speak to people on all sides, and present an accurate synthesis of what they find. That’s all anyone is asking reporters to do in the case of gender affirming care for youth. That this simple request is so fraught speaks volumes about the state of the debate on transgender rights.
