NYT Investigation Offers Biased Reporting on Puberty Blocker Concerns

The standards for mainstream reporting on trans issues are distressingly bad.

by Evan Urquhart

In good journalism, expert sources who are relied on in the analysis need to be named.

The New York Times has published an in-depth look at puberty blockers for treating gender dysphoria in trans youth. (These are drugs that stop the release of sex hormones, and are used in a variety of medical contexts for children and adults.) It’s an overtly biased piece of work, and will no doubt spur a heck of a lot of articles from trans people, and allies, seeking to fact check and provide context and criticism on where the Times reporters, Megan Twohey and Christina Jewett, went so wrong. As our specific beat is media criticism, this piece will highlight the clearest journalistic errors, weaselly phrasing, and other poor choices made in the writing and editing of this piece.

The article starts by mentioning three stories: A trans girl for whom puberty blockers were successful, a trans boy whose parents ceased puberty blockers when a bone scan yielded concerning news, and a young woman who made the decision to detransition after being on blockers and, later, testosterone therapy. (The NYT language in the first few paras teases these stories, but is less trans friendly and less clear on who is who.)

From the very start, the tone of this piece is one of deep concern. That alone is not a journalistic failure, though. But it doesn’t take long to find an actively misleading choice, with more to come.

The next screenshot comes from the introductory section, while the overall picture is still being laid out. The authors reference the number of adolescents in the US who have said they identify as trans in some way. This is a fairly large number, 300,000, and the paragraph suggests there are many more youth, ones below the age of 13, who haven’t been included here.

Well below the above selection, near the end of the article, it’s made clear that the number of youth on puberty blockers, for the entire US, is likely around 5000 (though it could be slightly higher due to families who pay out of pocket for the drugs).

There are over 25 million youth between the ages of 13 and 17. The percentage of US children ages 13-17 on puberty blockers, therefore, calculates to .02 percent. The percentage of trans identifying youth on blockers, according to this article’s own numbers, would be less than 2 percent of trans-identifying youth. This kind of choice, to include a large number that’s not really representative of the problem, is a common one we’ve found in right wing outlets that engage openly in anti-trans propaganda to further GOP political goals. It has no place in the paper of record.

Still, we might have put it down to coincidence if the writers split a second fact from it’s context later one. The same trick we saw above is again employed when discussing the lack of specific FDA approval for the use of puberty blockers in trans youth (as opposed to its long and well known use for other conditions, such as precocious puberty).

This sounds concerning, but those familiar with the subject know it’s very similar to how other medications for youth are handled, due to a combination of high regulatory burdens, lack of barriers to off-label use, and the expense of conducting trials in young patients. A grudging acknowledgement of this fact is made, but it comes many paragraphs lower down. This makes it unlikely a reader who is unfamiliar with the subject matter will connect the dots.

The Times piece also has a section giving insights into the story behind the story, with a slide show offering tidbits in that vein. These tidbits “Behind Our Reporting on Puberty Blockers” are quite bizarre, because they manage to run completely counter to good reporting norms. For example, here’s the second slide, which you see if you click through for “a closer look.”

The two reporters here seem to be implying that they have put the judgement of medical professionals on an equal footing with the rhetoric of Republican politicians. This in a climate where some Republican pols have acted to have families investigated for child abuse merely for acting on the best available medical advice. “Behind the reporting,” at the New York Times, all context apparently drops away and Times reporters struggle to weigh the knowledge of experts against ideological extremist statements by politicians well known to lie and distort the facts on the very issue at hand.

This is not good reporting, much less good investigative reporting, a style of journalism that holds itself above the ordinary fare. One suspects the Times would easily recognize the bias and shoddy work done here, if the issue was anything other than trans youth.

Of course, the article is not wholly without factual content (though in some ways that makes its issues worse). There are reasons for medical professionals and parents to be concerned about the potential side effect of bone density loss in youth who recieve puberty blockers. While all medications have side effects, and there’s evidence that bone density largely recovers after puberty starts, individual patients’ needs do vary. The Times correctly points out that young people with pre-existing bone density concerns may not be as good candidates for blockers, and that scans of bone density are important (and may not always be performed).

The above passage is also notable for actually having named an expert, which happens far more rarely here than would be the norm, particularly for journalism that bills itself as an investigative deep dive. Without naming and directly quoting most of the experts consulted, it is impossible for readers to judge the relative credentials and merit of that expertise. The story makes excuses for this choice, but ultimately the standard for investigative work is that you need sources who are willing to be identified by name in a situation like this. If you can’t include those names, normally, your editor would simply say you have no piece.

In all, this very long and complex article seems to have been done in an extremely shoddy way, ignoring some of the most fundamental aspects of good reporting, and showing clear bias throughout. The parts that are factual and important are overwhelmed by issues including the lack of named experts and the sneaky tricks that separate alarming sounding facts from context, as detailed above.

Ultimately, as a transgender reporter, this makes the job of communicating to a trans and trans allied audience about the topic of puberty blockers so much harder. It’s difficult to engage with the question of how best to ensure bone density concerns are on the radar for trans youth, their parents, and doctors who offer this option when the paper of record does such a piss poor job.