Looking on the bright side vs. misrepresenting evidence: WPATH review of outcomes of medicalized minors

The health care systems of the U.K., Finland, and Sweden have each conducted systematic, comprehensive reviews of the safety and effectiveness of puberty-blockers and cross-sex hormones on adolescents with gender dysphoria.  Such reviews are the standard procedure when developing health care policy.  All three reviews concluded that there is little evidence of benefit off-setting the known and unknowns risks of medicalized transition of minors.

In updating its Standards of Care (version 8), WPATH published its own review of effectiveness (Baker et al., 2021).  Unlike Europe, however, that review did not include safety in the scope of the review and came to this very positive (if qualified) conclusion about effectiveness:

If one wanted simply to advocate for medicalized transition, one would just quote the highlighted portion of the abstract and call it a day.  A good researcher, however, would continue to the actual data tables to search for the source of the contradiction.

That source wasn't hard to find.  The article showed the outcomes across three tables, one each for transition results on quality of life (QOL), on depression, and on anxiety:

Table 2. 

Effects of Gender-Affirming Hormone Therapy on Quality of Life Among Transgender People

Table 3. 

Effects of Gender-Affirming Hormone Therapy on Depression Among Transgender People

Table 4. 

Effects of Gender-Affirming Hormone Therapy on Anxiety Among Transgender People

In short, the research included eight analyses of effectiveness on children: four showing improvement, and four showing failure to improve.  Yet, instead of describing these results as "mixed" or "inconsistent," the abstract reads "Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety."

To the authors' credit, the article did include another important result, one which I have yet to hear applied in discussions of the issue: "It was impossible to draw conclusions about the effects of hormone therapy on death by suicide" (Baker et al., 2021, p. 12).

References

Achille, C., Taggart, T., Eaton, N. R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T. A. (2020). Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: Preliminary results. International Journal of Pediatric Endocrinology, 8.

Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021). Hormone therapy, mental health, and quality of life among transgender people.  Journal of the Endocrine Society, 5. https://doi.org/10.1210/jendso/bvab011  

de Vries, A. L. C., Steensma, T. D., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8, 2276–2283.

de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134, 696-704.

López de Lara, D., Pérez Rodríguez, O., Cuellar Flores, I., Pedreira Masa, J. L., Campos-Muñoz, L., Cuesta Hernández, M., & Ramos Amador, J. T. (2020). Psychosocial assessment in transgender adolescents. Anales de Pediatría, 93, 41–48.

WPATH (2022). Standards of Care, version 8. https://www.wpath.org/soc8

What I would have told Jon Stewart

 Jon Stewart recently interviewed Leslie Rutledge, the Attorney General of Arkansas, regarding medicalized treatments of children with gender dysphoria.  Unfortunately, they both were missing information that, if brought out, would have led to a very different conversation.  (For the record: I am not taking any position on any public policy, in Arkansas or elsewhere, and am instead providing the missing information to help any policy be based on the best evidence available.) 

Stewart repeatedly referred to clinical guidelines of four American associations as research-based and peer-reviewed.  That claim is incorrect.  Of these groups, only two have actually released clinical guidelines (the American Academy of Pediatrics and the Endocrine Society, see below).  The other two (the American Medical Association and American Psychiatric Association) have released various statements on the topic, but not guidelines or standards, and none of any of these groups undertook peer review with any of these documents.

When asked, Rutledge was unable to name which medical bodies reviewed the existing research and found it wanting.  Those bodies are: the National Health Service of the U.K. and the National Board of Health and Welfare of Sweden.  Both governments engaged in systematic and comprehensive reviews of all the research available and concluded that the evidence does not support medicalized treatment for minors with gender dysphoria.  That is, Stewart asked the wrong questions: Rather than asking why someone would depart from the American associations, he should have been asking why the American associations are out of step with the international health care systems conducting the systematic reviews that the American associations are not.

Stewart repeatedly named the Endocrine Society and the American Academy of Pediatrics (AAP) as if doing so were sufficient evidence of a scientific base; however, neither the Endocrine Society nor the AAP guidelines provide any such thing. The Endocrine Society assessed the science and clinical recommendations with these ratings:

[S]trong recommendations use the phrase “we recommend” and the number 1, and weak recommendations use the phrase “we suggest” and the number 2.

Cross-filled circles indicate the quality of the evidence, such that ⨁◯◯◯ denotes very low-quality evidence; ⨁⨁◯◯, low quality; ⨁⨁⨁◯, moderate quality; and ⨁⨁⨁⨁, high quality.

The Endocrine Society guideline for adolescents is:

In every category, without exception, the research quality was rated low or very low (⨁⨁◯◯ or ⨁◯◯◯).

As noted, the AAP’s guidelines did not undergo any peer review either; however, my own published fact-check of AAP’s claims did undergo peer review and showed, point-by-point, not only that the AAP’s claims were unsupported by the sources they cited, but also that those sources showed the very opposite of what AAP said they contained.  The AAP has never responded.

When asked to compare paediatric cancer to gender dysphoria: With cancer, we have objective evidence of a physical disease, as demonstrated by objective and highly accurate diagnostic procedures.  The risk:benefit ratio is quite different from gender dysphoria, which consists of only subjective evidence, running opposite to all physical indicators of health, all in the absence of any diagnostic test or demonstration of accuracy of anyone's clinical judgments.  In cancer, one removes objectively diseased tissue.  In trans, one removes objectively healthy tissue.

The Attorney General claimed that 98% of children later cease to feel transgender.  Stewart called that number made up, but never provided the correct number.  The correct number is actually a range: There have been 11 studies following up prepubescent children, and across the large, prospective studies, 61–88% of the children ceased to feel gender dysphoric by puberty.  (I’ve listed the 11 studies and their results here.)

The final major point they discussed regarded death by suicide as a consequence of failing to permit children to transition.  The evidence does not align well with the idea that refusing or delaying transition leads to suicide.  The evidence aligns very well, however, with the hypothesis that adolescents with Borderline Personality Disorder (or other issues) are mistaking their experience to indicate gender dysphoria when they are actually experiencing something else.  Although the American Psychiatric Association has not produced treatment guidelines, they have produced a diagnostic manual, including these two symptoms of Borderline Personality Disorder (BPD):

• Identity disturbance: markedly and persistently unstable self-image or sense of self
• Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behavior

That is, unstable identity issues are being mistaken for gender identity issues, and the suicidality of BPD is being mistaken for suicidality from transphobia.  Like adolescent-onset gender dysphoria (the type most commonly approaching clinics today), BPD begins to manifest in adolescence, is three times more common in biological females than males, and occurs in 2–3% of the population, rather than 1-in-5,000 people.  By mistaking cases of BPD as cases of gender dysphoria, we fail to direct these youth to the types of therapy they actually need.  (The state of the art therapy for BPD is called “Dialectical Behavior Therapy.”)

Finally, I was surprised to hear Stewart treat the word “experimental” with a symmetric burden of proof: In medical ethics, “do” and “do nothing” are not interchangeable.  Primum non nocere.

 

 

CAAPS, ROGD, and the science neglected

A statement was just released by the Coalition for the Advancement & Application of Psychological Science (CAAPS), calling for the elimination of the use of Rapid-Onset Gender Dysphoria (ROGD), “given the lack of rigorous empirical support for its existence.”  CAAPS is an umbrella organization of other psychology associations with the expressed purpose of promoting evidence-based practice, and their full ROGD statement is available here.

Despite the mission of the organization, CAAPS’ statement not only failed to arrive at the scientifically correct answer, but also it failed even to ask the correct scientific question.  The question has never been (and isn’t supposed to be) whether ROGD exists: The question is whether the recent and explosive increase in trans referrals being reported across the world (e.g., de Graaf et al., 2018; Frisén et al., 2017; Kaltialo-Heino et al., 2020; Wood et al., 2013) represents one of the previously well-characterized profiles of trans people (so we would know what to do) or something new (wherein we can’t).

The available evidence suggests it is something new: These people are quite dissimilar from previous groups on multiple objective variables, including age of onset, sex ratio, and comorbid mental health issues (Aitken et al., 2015; Ashley, 2019; Becker et al., 2014; Kaltiala-Heino et al., 2015; Littman, 2018; Wood et al., 2013).  That is, we cannot merely assume that the outcomes research from the already known trans profiles applies to this one.  Despite some initial indication of improvement on some variables after transition for adolescents (de Vries et al., 2011), such benefits have largely failed to replicate, despite multiple attempts, instead emerging as a general lack of improvement relative to controls (e.g., Achille et al., 2020; Carmichael et al., 2021; Costa et al., 2015; Kuper et al., 2020; van der Miesen et al., 2020).  The researchers repeatedly concluded that “[M]ost predictors did not reach statistical significance” (Achille et al., 2020, p. 3, italics added) and “The present study can, therefore, not provide evidence about the direct benefits of puberty suppression overtime and long-term mental health outcomes” (van der Miesen et al., 2020, p. 703, italics added).  Indeed, even de Vries’ original report of improvement was only mixed—although improved on some variables, the sample worsened on others, including on body satisfaction.  Notably, another claim of improvement (Bränström & Pachankis, 2019) was withdrawn after its statistical errors were identified and its data re-analyzed (Kalin, 2020).  One of the authors of that now retracted finding (Pachankis) is one of the two people whom CAAPS’ offers as media spokespersons for GLBTQ+ issues (full list here).

Scientifically, it doesn’t actually matter if ROGD exists as CAAPS considers: What matters is whether and what kinds of transition benefit the people fitting this profile, which we cannot know.  To declare that ROGD doesn’t exist without pointing this out, however, is to recommend treating ROGD as if it were ‘regular’ gender dysphoria by default, despite that we already know the people fitting the ROGD profile significantly differ from the samples represented in the gender dysphoria outcomes research.  One cannot conduct the ethical task of a risk:benefit ratio while lacking knowledge of the latter.

It is quite plausible that ROGD doesn’t exist as a gender dysphoria.  “ROGD” is only a shorthand description of the most salient feature by which people with this profile differ from the known profiles (they lack a childhood history of gender dysphoria; Littman, 2018).  I suspect very many such cases will turn out to be better helped if treated as manifestations of other, already known phenomena, such as Borderline Personality Disorder (which includes identity disturbance and unstable self-image) or an autism spectrum disorder.  Such was largely the case with ‘Recovered Memory Syndrome’: In an era when cases of child sexual abuse were finally receiving overdue attention, other people with unhealthy needs for attention began claiming the same, and credulous clinicians failed to challenge clients, instead becoming enablers of the unhealthy bids for attention.

Lacking from CAAPS’ statement was any indication of what might falsify their belief:  On how many (more) objective—i.e., non-self-report—variables do differences have to be demonstrated before we can treat ROGD as a different phenomenon from previous groups of trans people?  How many (more) failures to replicate evidence of benefit to transitioning for this new profile would merit a slow-down to transition-on-demand for the people showing it?

None of this should be taken at all to be denying/dismissing people’s reports of dysphoria or distress.  Rather, I point out (by way of analogy) that clinicians need to do different things to help people with major depression vs. bipolar depression vs. postnatal depression, despite that they can feel similar and would be described similarly.  Although we do not yet have enough evidence to tell us exactly what ROGD is, we do have sufficient evidence to know what it is not.  Treating this demonstrably new presentation the same as the known ones is to declare, ‘They all look alike to me.’

Updated 16-Aug-2021

References

Achille, C., Taggart, T., Eaton, N. R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T. A. (2020).  Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: Preliminary results. International Journal of Pediatric Endocrinology. doi: 10.1186/s13633-020-00078-2 

Aitken, M., Steensma, T. D., Blanchard, R., VanderLaan, D. P., Wood, H., Fuentes, A. … Zucker, K. J. (2015).  Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. Journal of Sexual Medicine, 12, 756–763.

Ashley, F. (2019). Shifts in assigned sex ratios at gender identity clinics likely reflect changes in referral patterns [Letter to the Editor]. Journal of Sexual Medicine, 16, 948–949.

Becker, I., Gjergji-Lama, V., Romer G., & Möller, B. (2014).  Characteristics of children and adolescents with gender dysphoria referred to the Hamburg Gender Identity Clinic [German].  Prax Kinderpsychol Kinderpsychiatr, 63, 486–509.

Bränström, R., & Pachankis, J. E. (2019). Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study. American Journal of Psychiatry, 177, 727–734.

Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., Skageberg, E. M., Khadr, S., & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLosONE, 16(2): e0243894.

Costa, R., Dunsford, M., Skagerberg, E., Holt V., Carmichael, P., & Colizzi, M. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. Journal of Sexual Medicine, 12, 2206–2214.

de Graaf, N. M., Giovanardi, G., Zitz, C., & Carmichael, P. (2018). Sex ratio in children and adolescent referred to the Gender Identity Development Services in the UK (2009–2016) [Letter to the Editor]. Archives of Sexual Behavior, 47, 1301–1304. 

de Vries, A. L. C., Steensma, T. D., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8, 2276–2283.

Frisén, L., Söder, O., & Rydelius, P. A. (2017). [Dramatic increase of gender dysphoria in youth]. Lakartidningen.  Retrieved from http://lakartidningen.se/Klinik-och-vetenskap/Klinisk-oversikt/2017/02/Kraftig-okning-av-konsdysfori-bland-barn-och-unga/.

Kalin, N. H. (2020). Reassessing mental health treatment utilization reduction in transgender individuals after gender-affirming surgeries: A comment by the Editor on the process. American Journal of Psychiatry, 177, 765.

Kaltiala-Heino, R., Sumia, M., Työläjärvi, M., & Lindberg, N. (2015). Two years of gender identity service for minors: Overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health, 9, 9.

Kaltialo-Heino, R., Carmichael, P., de Graaf, N., Rischel, K., Frisén, L., Suomalainen, L., & Wahre, A. (2020). Time trends in referrals to child and adolescent gender identity services: A study in four Nordic countries and the UK. Nordic Journal of Psychiatry, 74, 40–44. 

Kuper, L. E., Stewart, S., Preston, S., Lau, M., & Lopez, X. (2020). Body dissatisfaction and mental health outcomes of youth on gender- affirming hormone therapy. Pediatrics, 145, e20193006.

Littman, L. (2018). Parent reports of adolescents and young adults perceived to show signs of a raid onset of gender dysphoria. PLoS ONE, 13(8), e0202330.

van der Miesen, A. I. R., Steensma, T. D., de Vries, A. L. C., Bos, H., & Popma, A. (2020). Psychological functioning in transgender adolescence before and after gender-affirmative care compared with cisgender general population peers. Journal of Adolescent Health, 66, 699–704.

Wood, H., Sasaki, S., Bradley, S. J., Singh, D., Fantus, S., Owen-Anderson, A., … Zucker, K. J. (2013). Patterns of referral to a gender identity service for children and adolescent (1976–2011): Age, sex ratio, and sexual orientation [Letter to the Editor]. Journal of Sex and Marital Therapy, 39, 1–6.

Bill C-6

On October 1st, the Canadian government proposed legislation banning conversion therapy on anyone under 18, using this definition of conversion therapy (C-6 proposal):

320.‍101 In sections 320.‍102 to 320.‍106, conversion therapy means a practice, treatment or service designed to change a person’s sexual orientation to heterosexual or gender identity to cisgender, or to repress or reduce non-heterosexual attraction or sexual behaviour. For greater certainty, this definition does not include a practice, treatment or service that relates

(a) to a person’s gender transition; or 

(b) to a person’s exploration of their identity or to its development.​

Unfortunately, that definition repeats a common error: It treats sexual orientation and gender identity as the same.  As pointed out previously however, there is no such thing as conversion therapy for gender identity: The existing evidence pertains to sexual orientation and only to sexual orientation.  [For a review, see Cantor (2019) or Cantor (2018).]

Although the proposal includes language apparently aimed at protecting legitimate therapy from the ban, the language is ambiguous (at best), so provides only ambiguous protection.  Especially in the current environment, we have every reason to expect extremists to declare that anything and everything other than immediate affirmation counts as conversion therapy.  Because there do not exist any manuals or research on conversion therapy for gender identity (again, there actually is no such thing), I do not know how a person, court, or policy-maker might decide what might be in or out.  Everyone has, so far, merely adopted something from sexual orientation conversion therapy attempts and imagined a gender identity equivalent.  One would reasonably predict a chill effect across licensed mental health providers making the service essentially unavailable.

I do not understand the language of part (a).  A practice that “relates to a person’s gender transition” would seem to cover every aspect of the entire issue, including efforts to avoid a gender transition.  Similarly incomprehensible to me is part (b), which together with the intro says, “conversion therapy means a practice…designed to change gender identity to cisgender [but] does not include a practice...that relates...to its development”.  It is not possible for something to relate to development and not relate to change.  Moreover, because the (purported) point of conversion therapy is to develop a new orientation/identity, this language would appear to excuse all of what it is attempting to ban.  I can imagine only that there must be legal/political meanings I am not appreciating, as this appears to me to be self-contradictory word salad.

 

Next, to refer to anything as an “exploration” is to assume there exists something solid and unchanging that we need only to observe.  Although the evidence indicates that sexual orientation fits that description, there is no evidence that gender identity does.  

 

Ultimately, the text does not resolve the basic situation: A child attends a clinic and does not know what their identity is.  “Exploration” can meaningfully include doing one’s best to feel comfortable with the original gender before approving medical or other dramatic interventions.  The efforts to become comfortable in the original gender would be indistinguishable from (or misrepresentable as) conversion therapy wherein cisgender is the goal rather than being the step that happens to have the least associated risk and therefore gets tried first.

Open Letter of Resignation from the Society for the Scientific Study of Sexuality (SSSS)

My 27-year association with SSSS must come to an end.  In the present culture war between science and popular appeal, the SSSS Board of Directors selected the latter. This is not the first time the SSSS Board abused their authority to silence science opposing their personal political views, and no valid organization can be in the name of science in name only.  I am grateful to the other sexuality scientists who have resigned in sympathy, both publicly and privately.

 

To acknowledge the facts: I have long posted news items and opinion pieces to SSSS’s member listserv.  In July, I posted an essay of my own, When is a TERF not a TERF, challenging the extremism that has taken over public discussion of trans issues, pointing out, for example, that the unwillingness ever to recognize anyone’s transition is different from citing the research suggesting children should wait until age 12 to transition.

 

A debate ensued, not focused on any argument or evidence submitted, but on whether such discussions should even be permitted.  The cessation of open, critical discussion is antithetical to the purpose of a scientific society.  Participating in the debate were three SSSS Board members and roughly a dozen general members, expressing a roughly 50/50 opinion [full thread downloadable here].

 

I then received an unsigned email informing me that I had been suspended from the listserv.^footnote-1  Outrage among members ensued, triggering society resignations, list unsubscriptions, and a statement from the SSSS President, Zoë Peterson, defending the Board’s intervention.^footnote-2

 

The Board took SSSS across the Rubicon on several levels:

1.     The board does not actually have the authority to suspend people from the member listserv.  The listserv policy (here) leaves such decisions to the list’s moderator, to whom the Board may only provide feedback.

2.     Although the SSSS President, Treasurer, and Student Representative each took active sides in the pertinent discussion, as shown in the thread, they did not recuse themselves from the Board’s official actions.

3.     While intervening in her role as SSSS President, Petersen indicated explicitly during the thread that she actively sought out views—not of mine, not of the 50/50 of list members expressing their opinions—but only of those who had expressed the same views that she herself did, without so much as a pretense of due process.

The SSSS Board did not respond to my emails pointing out these abuses of their authority.^footnote-3

 

This is not the first time SSSS demonstrated its privileging sociopolitical opinion over science: In 2018, another researcher, Kevin Hsu, won the Ira and Harriet Reiss Theory Award for “the best social science article, chapter, or book published in the previous year in which theoretical explanations of human sexual attitudes and behaviors are developed,” a prize by the Foundation for the Scientific Study of Sexuality.  An audience member disliked the content of this award-winning, published article.  In response to the ensuing complaint, the SSSS Board informed members they had not had input into the Reiss Award; thus, “Moving forward, The Foundation for the Scientific Study of Sexuality will be incorporated into SSSS.  Starting in 2019, we will be maintaining full oversight of the awards process.”^footnote-4  The Founder of the Award, Ira Reiss, condemned the SSSS Board, highlighting again its abandonment of the scientific mission.^footnote-5 (See also https://doi.org/10.1007/s10508-019-1420-y.)

 

SSSS’s demonstrable and repeated history of anti-scientific grand-standing gives scientists strong reason to pause before sending their manuscripts to the journal SSSS owns, The Journal of Sex Research (JSR).  Given that the SSSS Board already violates its own procedures to censor list members, take-over foundations, and disregard donors’ wishes, there is no reason to believe they would hesitate to abuse their authority with regard to JSR articles.  The SSSS Board has now forced manuscript authors to avoid JSR when evidence might potentially challenge someone’s political expectations, and they have compelled JSR readers to wonder “Does this content reflect the best science?  Or just the science we want people to hear?”

 

Moreover, the SSSS President, Zoë Peterson, was Associate Editor of JSR until last year, handling manuscripts, including the selection of reviewers.  Given her failure to follow SSSS policy for topics about which she has strong views, all scientists whose manuscripts were assigned to her must now question whether she treated them fairly or treated them as she did me: choosing to seek input only from those who share her views.  Although Peterson claimed “The SSSS Board of Directors would never attempt to block, censor, or interfere with the publication of a journal article that had been subjected to and withstood the peer review process,”^footnote-2 such a promise is empty.  Given an already repeated history of violating even formal established policies, authors have no reason to trust SSSS will not simply violate any such promise once again, as soon as anyone objects.  A scientific journal cannot be owned by an anti-scientific society and remain unaffected. 

 

It is unfortunate to have lost SSSS as a genuinely scientific organization, but there is little point in the collective pretense that it hadn’t already happened a while ago.

 

— James M. Cantor, PhD, CPsych, ATSAF

 

 

 

FOOTNOTE 1

 

On 2020-07-15, 8:51 PM, "SSSS" <thesociety@sexscience.org> wrote:

 

The SSSS Board of Directors has been made aware of several posts you have made that violate the SSSSTalk listserv guidelines, including the following:

 

Nasty, discourteous, unkind, uncivil, attacking, inappropriate, unprofessional, harassing, threatening, hateful, racist, sexist, homophobic, erotophobic, derogatory, or objectionable remarks or jokes that might be offensive to other people, abusive, defamatory, libelous, pornographic, obscene, invasive of another's privacy, or otherwise tortuous or unlawful messages will NOT be deemed appropriate. Courtesy is highly valued.

 

After a discussion and vote from the SSSS Board of Directors, your access to the SSSSTalk listserv has been suspended.

 

The Society for the Scientific Study of Sexuality 

1874 Catasauqua Rd. – PMB #208  |  Allentown, PA 18109-3128

 

 

FOOTNOTE 2

 

On 2020-07-16, 10:26 AM, "James Cantor" <jamescantorphd@gmail.com> wrote:

 

Please verify that I correctly understand:

·     Although “a discussion and vote from the SSSS Board of Directors” was taken, that is not the procedure outlined in the listserv guidelines.

·     Although the SSSS President, Treasurer, and Student Representative each took active sides in the pertinent discussion, they did not recuse themselves from that discussion or vote.  The email being unsigned masks the responsible leadership.

·     The SSSS President wrote, “Dear Finn, Jami, Jules, and others, I have corresponded with some of you privately, but want to say publicly that I hear you,” yet made no attempt to contact or hear “the defendant” or other critics of the view the President and other officers expressed holding.

·     The decision of the Board of Directors is the direct opposite of what a SSSS officer was quoted as saying: "I do not believe that he has violated any of the prohibited behaviors that, according to our policy, could invoke an investigation and potential termination of membership."  Although not communicated directly from that person, no officer corrected that statement (despite reassurances of listening), and no other warning or other indication of a change in what is acceptable was sent to me.

I will interpret lack of response as confirmation.

 

- James Cantor

 

 

FOOTNOTE 3

 

On 2020-07-20, 4:48 PM, "SSSS" <thesociety@sexscience.org> wrote:

 

Dear SSSS Members,

 

I love this organization. It is my academic home and has been the cornerstone of my professional life. I gave my first research presentation at a SSSS conference. As a student and junior scholar, senior SSSS members were my mentors and role models. Now, many of my most valued and loyal friends are people that I met in this organization. I agreed to run for President of SSSS because I care deeply about and am indebted to SSSS and many of its members.

 

Recently, I have heard from many of you who have contacted me individually or who have posted on the listserv. Some individuals have expressed concerns about the future of this organization. Those comments break my heart. I believe in this organization and its mission. I readily acknowledge that SSSS, as an organization, and I, as its leader, are far from perfect, but I also believe that SSSS and I have the ability to improve and grow.

 

It is usually my policy to provide a prompt response to all emails from SSSS members, but the volume of emails recently has prevented that. I want you all to know that I have been reading your messages. I am listening to you, and this letter is my attempt to respond publicly to the large collection of messages that I have received.

 

Before I continue, let me clarify one thing: I am currently the SSSS President, but I want to be totally clear that I speak only for myself. This is not an “official statement” from SSSS. Any official action within SSSS must occur by a majority Board vote.

 

That brings me to my main point: There was a majority Board vote to suspend a SSSS member’s access to our listserv. I know that some members are very upset about that decision. I want to help put that decision into context and into perspective.

 

First, we did not revoke anyone’s membership in our organization. We did not ban anyone from presenting at our research conferences. We certainly did not tell anyone that they could not review for or publish in our society’s journal. In fact, we did not even revoke anyone’s access to the listserv. We simply suspended one person’s access in accordance with our listserv policies. In the meantime, as a Board, we are discussing our policies and procedures around the listserv and considering the value and purpose of the listserv and whether the listserv is the best format in which to have the types of difficult but important conversations that have been occurring over the last week.

 

Second, the Board’s vote to suspend one member’s access to the listserv had nothing to do with the suppression of science. Like many SSSS members, I have devoted my career to science because I believe that it is critical to positive change. I also share the view expressed by many on the listserv discussion that science is neither infallible nor apolitical, and that is exactly why professional discussions, disagreements, and critiques of scientific ethics, methods, and interpretations are essential. I would not support suspending someone from our listserv simply for posting and/or politely and professionally discussing a scientific article or a research finding—even if that article or finding was controversial. Although I do not want to speak for any individual Board member, from my perspective, that is not what the Board was doing in this case. The suspension in question was not due to any single post; rather, the Board felt that, in this instance, there was a long-term pattern of harassment from one member against several other members—even after those other members had repeatedly asked that member to stop. The Board believed that this unwillingness to be responsive to other members’ entreaties violated the guidelines of the listserv.

 

Third and related to my prior point, I am aware that one or more individuals have suggested that, because we suspended a member from our listserv, we might also be willing to interfere in the editorial independence of the Journal of Sex Research, SSSS’s outstanding and well-respected academic journal. I would hope that it is obvious that suspending someone from a member listserv, for which the stated purpose is posting “announcements of workshops, conferences, and meetings; publications; professional news items; awards and honors received by SSSS members; employment opportunities; and recruitment solicitations for sexuality-related research,” is not remotely equivalent to censoring peer-reviewed science. Nevertheless, I want to be clear about this (and on this, and only this, point I speak for the entire Board of Directors with their agreement): The SSSS Board of Directors would never attempt to block, censor, or interfere with the publication of a journal article that had been subjected to and withstood the peer review process. The editor of JSR has always been granted complete editorial independence, and I, personally, would not support any infringement on that.

 

Fourth, I want to correct some misperceptions that I have heard expressed about our listserv. Although we retain the right to do so, no one monitors or reviews any posts prior to their distribution to the listserv. This means that no posts have been suppressed; there is literally no one to suppress them. Recently, there was a technical issue with our listserv host, and thus, there were some delays between when posts were made and when they showed up. Indeed, the Board’s own message was delayed for several hours after we posted it. The delayed posts were not being suppressed or even reviewed; they were simply stuck in cyberspace. Additionally, only one person received a suspension from our listserv. No one else has been removed from our listserv unless they failed to renew their membership or unless they asked to be removed.

 

Of course, even after these clarifications, I understand and fully accept that some of you will still disagree with the Board’s decision to suspend someone from our listserv. Some members will feel that the Board’s actions in this case did not go far enough; some members will feel that the Board went too far. Differences of opinion in an organization are inevitable. Although I have no expectation of agreement from all sides, I can assure you that the Board acted with good intentions, intensive discussion, and a genuine desire to improve our organization.

 

Finally, and most importantly, to our transgender, non-binary, and gender nonconforming members who raised this issue and who have expressed that they have long felt hurt, disrespected, marginalized, and unprotected on our listserv and within our organization, I hear you and I thank you for sharing your experiences and reactions with such honesty and courage. I am deeply committed to making SSSS a supportive, inclusive, and harassment-free professional home for you. Even as you read this, the Board is working on a specific action plan around this issue. I vow to keep all members updated on the process and to seek your input as we go. You will be hearing more from me and the Board going forward.

 

Let me close by thanking you—my academic family—for trusting me to serve as your leader. It is hard for me to watch a fracture grow in the organization that I love—especially when that organization is one I am helping to steward. I am optimistic, though, that we can work together to mend this fracture in a way that, ultimately, makes our organization stronger. SSSS is worth it.

 

Warmly,

Zoe Peterson

SSSS President (2019-2021)

 

 

FOOTNOTE 4

 

On November 15, 2018 at 4:18 PM SSSS <thesociety@sexscience.org> wrote:

 

Dear SSSS Members and Annual Meeting Attendees,

 

The SSSS Executive Committee is aware of past and more recent incidents of language and behavior that has made transgender persons and other attendees feel unwelcome, unsupported, marginalized, or attacked at our Annual Meetings. We apologize. We want to assure all Members and attendees that we fully support you and stand with you. We are trans-allies.

 

We want to be clear that the Reiss Theory Award was selected by The Foundation for the Scientific Study of Sexuality, which is separate from SSSS. The Members of the SSSS Board of Directors and the SSSS Annual Meeting Program Committee have not had input into decisions regarding the Reiss Award. Moving forward, The Foundation for the Scientific Study of Sexuality will be incorporated into SSSS. Starting in 2019, we will be maintaining full oversight of the awards process. This information is provided as an explanation, not an excuse.

 

We are taking steps to help all Members and attendees feel safe and welcome at SSSS events. For example, SSSS is currently creating a new Civility and Anti-Harassment Policy to supplement our mission and ethics statements. The policy will include prohibitions against harassing, demeaning, or discriminating against any identity group. It also will include expectations that scientific and philosophical disagreements and challenges be expressed in a respectful and civil manner. We will be inviting feedback from the membership on this policy in the coming months.

 

As a part of the Annual Meeting, all attendees will also receive a post-conference survey, on which anonymous feedback can be provided that can assist us in making improvements in preparation for SSSS 2019 in Denver.

 

We care deeply about the experiences of our Members and conference attendees, and we are working hard to ensure a more welcoming and inclusive environment at all SSSS events. We wish to continue serving as your professional home.

 

SSSS Executive Committee

Eric Walsh-Buhi, President

Zoe Peterson, President-elect

David Bimbi, Treasurer

Terry Humphreys, Secretary

DJ Angelone, Membership Chair

Mandy Peters, SSSS Executive Director

 

 

FOOTNOTE 5

 

On 2018-11-16, 5:50 PM, "ira reiss" <irareiss@COMCAST.NET> wrote:

 

Hello to all:

 

Back in 2006 I founded the Reiss Theory Award Plenary in order to develop social science, research tested, theories concerning sexual behaviors and attitudes.  I feel the need to respond to the SSSS executive board’s email yesterday concerning Kevin Hsu’s published article on transgender behaviors and attitudes that won the Reiss Theory Award at this year’s SSSS Montreal meetings.

 

The response from the SSSS executive board Thursday, to this paper was, inadequate, inaccurate, and inappropriate for a scientific organization.  I did not attend the meeting but I contacted both Kevin Hsu and the moderator of the session, Jean Levitan, and I read the many emails that came in from SSSSTalk and Sexnet.  It seems that Christine Milrod had rudely interrupted Kevin’s talk on some transgender issues.  Jean Levitan told Milrod to let Kevin finish his paper and then raise her comments or questions.  The audience also came in asking Milrod to wait until Kevin was done.   It was an unfortunate disturbance but it was not created by Kevin and was effectively contained by Jean Levitan the moderator.  After the talk Jean Levitan apologized to Kevin for the actions of Christine Milrod.   Ken Zucker, an expert in the area of this talk was there and summed up his reaction by saying that Kevin gave a “superb talk with amazing data.”

 

When I read the email yesterday from the SSSS executive board Members I was shocked to see what seemed like a statement criticizing the selection of this paper for the award.   Was it Kevin’s fault that he was criticized by Milrod?  Was he expected to use only the terminology and conclusions that Milford wanted?  SSSS is supposed to represent in their actions scientific based conclusions and explanations.  The executive board in their email to the SSSS membership never cited any flaws in his research or theory work that was presented.   Where was the scientific evidence that supported the boards statement that the problem was in “the awards process”?

 

Paul Vasey, the Award Committee chair at that time and the members of his Reiss Theory Award Committee voted to select Kevin Hsu’s paper.  That Award Committee examination of publications and voting on a winner was the award process that was followed since 2006.   Nothing specific was said in the SSSS executive board’s message to back up their criticism of the award process and it seemed to me that they were likely reacting to some objection from Milrod or others that Kevin Hsu didn’t agree with their perspective.  Kevin was presenting his findings and his explanations. and some of his work seemed to clash with what Milrod wanted to hear.  A scientific award doesn’t change because someone without convincing evidence just objects or was bothered by the findings.  No specifics on the problem the board had with the award process was in the executive board’s email yesterday.

 

Also, the promise that the SSSS executive Board would from now on “take full oversight over the awards process” sounded authoritarian. I would expect them to say they would keep the award process fair and science based and would not yield to emotional outbursts or positions that lacked scientific support.   Would the executive board when they “took full oversight” make their “award process” decisions the same way they made them in this executive board Message?  Would they cancel an award by the Reiss Theory Award Committee because someone found the publication offensive or disturbing?  The answer to that question is not clear and is of serious concern. 

 

This is not a minor issue that will just pass.   Today the emails coming in are asking SSSS members to resign from SSSS.  The executive board cannot just claim they wanted to keep things civil.  Their actions express a non scientific perspective and they need to clarify and discuss their views.    It’s time for the executive board to discuss scientific concerns that I’ve expressed above and those expressed by many others in their emails.  The board needs to build confidence in the membership and in the public that they will act in line with the name of our organization which was founded as--The Society for the Scientific Study of Sexuality.

 

Ira

 

Ira L. Reiss

Website: https://sites.google.com/a/umn.edu/reiss/