Undark Examination of SEGM Includes Errors and Misinfo
A middle-of-the-road treatment of SEGM introduced errors and distortions into the topic of trans youth healthcare, based in part on the distortions advanced by people associated with the controversial organization.
Analysis, by Evan Urquhart
Disclaimer: Undark, the digital science magazine in which the story this article is critiquing appeared, is a project of the Knight Science Journalism Fellowship Program at MIT. The author, Evan Urquhart, is an incoming fellow with the program.
Any good map for reporters embarking on coverage of transgender issues would include a bold warning, Here be Dragons, over the activist group SEGM. The non-member members of this group, which passes itself off as a medical organization, are known for their propensity for spreading disinformation, as well as for the canniness and subtlety with which they do so.
That’s why it was not a surprise, though it was a disappointment, that a recent Undark examination of the group included two errors as well as misleading statements, some of which came in the form of quotes from prominent people connected with SEGM. New reporters beware, these SEGM people will mess with you, and then it will be very embarrassing when you get caught printing their distortions all because you never thought, for example, that a prominent Finnish expert might conceal her decade-plus history of opposing medical transition for youth so she could portray it as having been a more recent and evidence-based conversion.
The expert, of course, is Riittakerttu Kaltiala, who is quoted in the story as taking great umbrage with the idea that her opinions might not be entirely based on the medical evidence.
"In 2011, Kaltiala helped establish a pediatric gender clinic in her home country, but came to believe that patients who received treatment were getting worse,” writes Frieda Klotz, a senior contributor to Undark.
This is not strictly true. Kaltiala’s longstanding opposition to medical transition for youth is a matter of public record, if you happen to read Finnish language medical journals from 2011. However, this opposition has been dropped from Kaltiala’s biography in more recent English-language essays and interviews.Kaltiala wrote of her opposition to youth transition for the Finnish medical journal Suomen Lääkärilehti. The heading for her piece (which came as part of a set with her opposing a defender of the practice) translates to “Save the Children.”
taken from a pdf of the Suomen Lääkärilehti journal
Klotz can hardly be blamed for not realizing that a prominent doctor who presents herself as an expert would disguise what her views are, whether they’ve changed, and how long she had held them. In the confusing world of reporting on transgender medicine, reporters new to the beat often fail to anticipate just how misleading those on the anti-trans side of the issue are willing to be, an outlier in science journalism where doctors and scientist sources typically take great pains to be accurate (often at the expense of clarity and concision).
But Kaltiala’s consistent history of opposition to medical transition for minors is an inconvenience to the narrative of her as an honest doctor who once led a gender clinic but was more recently swayed by the medical evidence. So are the results of Kaltiala’s leadership of Finland’s youth gender program, which does not seem to have resulted in many, if any, Finnish trans youth who were treated with puberty blockers, and vanishingly few treated with cross-sex hormones before their 18th birthdays.
In service of the narrative, the truth is pushed aside, with the assumption being a reporter won’t have the resources to dig through Finish medical journals from 2011 to combat it.
The other error in the Undark piece is a little harder to excuse: Klotz originally wrote that the UK has banned puberty blockers for youth under 18. It has not. It has only banned the treatment of gender dysphoria with puberty blockers. The drugs continue to be allowed for the treatment of all other conditions, most notably precocious puberty, a disconcerting condition where a young person goes through puberty early. (The current version of the story updated the story to correct this issue, which was raised to Undark by Assigned Media before publication.)
Notably, precocious puberty has no known adverse health effects, and puberty blockers are considered safe enough to use for their presumed psychosocial benefits.
screenshot from the Mayo Clinic’s website
In addition to these two pieces of false information, Klotz’s story includes highly misleading phrasing of the sort SEGM traffics in, phrasing that often misleads and confuses readers new to the topic of gender-affirming healthcare. Specifically, Klotz exaggerates the frequency of medical treatments for gender dysphoria and downplays the use of talk therapy with no medical treatment in mainstream gender clinics. Referring to US gender clinics, Klotz writes “the standard practice is to offer puberty blockers and hormone therapy.”
But is this standard practice, really? It’s certainly true that gender clinics offer such treatments, but to call it standard practice implies that other options, such as therapy with no medical transition, are non-standard. This is the line pushed by SEGM, but it is not true according to any of the known reviews of gender clinic practices. For example, an investigation of a St. Louis clinic alleged to give out hormones and blockers to all patients automatically found that, in reality, fewer than half had received hormone blockers or cross-sex hormones.
The Cass Report, which is discussed in the Undark story as part of a push back against too-ready prescription of medications for transition, found only 27 percent of patients were referred to endocrinology, and not all of them received blockers or hormone treatments.
What treatments do young patients receive much more frequently? According to the youth and their parents, as chronicled by the Missouri Independent, the St. Louis patients received extensive talk therapy. Talk therapy is a far more standard treatment for gender dysphoric youth in the US than any form of medical transition, and is generally required alongside a lengthy assessment for trans youth to gain access to other treatment options.
You might not know it from reading Klotz’s story, but medical transition options are neither assured or automatic for trans youth in the US, or anywhere else for that matter.
You’d never know this by listening to Roberto D’Angelo, though. D’Angelo is an Australian psychotherapist and the current president of SEGM, and he’s quoted by Klotz talking at length about his preferred approach of treating gender dysphoria with therapy, which he misleadingly presents as representing a departure from the sorts of gender-affirming treatments offered to youth at more mainstream gender clinics.
screenshot from Undark
“In his own clinic,” Klotz writes of D’Angelo, “a psychotherapeutic approach does not preclude medical transition … but the medical path should not be rushed.”
Huh. If D’Angelo offers psychotherapy that does not rush patients (but does not preclude medical transition), and if mainstream gender clinics also offer psychotherapy that does not rush patients but does not preclude medical transition, where precisely is D’Angelo’s dispute with such clinics?
The outlines of an answer may be found in the sections where Klotz laudibly presents the arguments of SEGM’s many critics. She describes the findings of a Yale University team that summed up SEGM as “an ideological organization without apparent ties to mainstream scientific or professional organizations” and quotes Alejandra Caraballo saying, “Their entire strategy is the climate change model, where it is to undermine and attack the existing science and evidence without really providing any proper evidence of their own for counter view.” This portion accurately presents the group as disinformation peddlers with little or no expertise on gender medicine whose tactics are designed to confuse people about the state of the evidence in gender medicine.
Klotz’s balanced, moderate writing dutifully allows critics of SEGM to speak for themselves and present a more accurate picture of the organization’s misleading tactics. However, it also allows those associated with SEGM to speak for themselves without correcting their half-truths and misrepresentations. By presenting the story this way Klotz fails to fully inform Undark’s readers about a large number of things, from whether the statements of those associated with SEGM are likely to contain distortions, half-truths, and perhaps even falsehoods, to what the reality of gender-affirming healthcare for youth actually looks like.
Taken as a whole, the story suffers from the malady of being over-balanced, adopting a neutral stance that presents anti-trans activists who distort the truth to fit an agenda as equally credible to those on the trans-supportive side who did not engage in such distortions in their quoted statements. Reporters would do well to take extra care with any statements made by those associated with group, as they do not seem motivated to help ensure the stories they’re quoted in are fully accurate.
Evan Urquhart is a longtime freelance science journalist and the founder of Assigned Media.