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A Review of "Irreversible Damage" by Abigail Shrier

How grand narratives obscure the complexities of reality.

Among the multitude of minor internet blowups in 2020 (minor in comparison to the unwinding of the Trump presidency and COVID-19, at least) was the controversy over the new book by journalist Abigail Shrier, Irreversible Damage: The Transgender Craze Seducing Our Daughters.

The book posits that a sudden surge in the number of teen girls identifying as trans boys is due not to gender dysphoria or transgenderism but rather to girls with other mental conditions who are mistakenly self-identifying as trans because there is social capital built into marginalized identities.

Some parents see their own families and daughters in this book and believe it speaks to real issues their daughters are facing. (Note: I will use the term “daughter” here as it reflects Shrier’s view and is intended to reflect only biological sex; it is not intended by me to erase their self-identified male gender.) However, many trans activists have decried the book as transphobic, hostile, and harmful to trans individuals more broadly. Adding to the conflagration, the book was also subject to efforts to limit its sale, arguably endorsing a form of non-governmental censorship.

I’ve recently read the book and, below, I offer my thoughts on it. I’ll say upfront: I find this to be a complex and nuanced issue. However, modern discourse seldom allows for nuance or complexity on either side of emotional debates.

This is regrettable as, fundamentally, this appears to be a situation where two things can be simultaneously true, namely that, a) most individuals including youth who identify as trans are indeed trans and would benefit from a medical transition, and b) there may be some subset of individuals who, as a youth, identify as trans, but have other mental health conditions such as borderline or other personality disorders or autism spectrum disorder which cause identity confusion, and these individuals may benefit less from medical transition.

I do also want to note two other things: First, I feel the evidence is pretty clear to me that, contrary to the slogan “gender is a social construct” (endorsed by Shrier in large part), neurobiological evidence has found that gender identity resides in the hypothalamus and, as such, is largely immutable. Put rather simply, it is literally true that trans individuals have the body of one sex, yet the brain of another. Such individuals deserve respect and compassion, should be free of harassment and bullying, deserve to have their preferred pronouns and name respected, and should be free to find love, marry, and have or adopt children as they see fit.

At the same time, evidence also suggests that borderline personality disorder often either occurs with or is misdiagnosed as other high-profile mental illnesses such as multiple personality disorder (dissociative identity disorder) or bipolar disorder. Thus, it is also possible that some (though certainly not all or the majority of) individuals who identify as trans may have wider issues of identity confusion.

Reading Irreversible Damage, I found myself with several serious critiques. In the main, I had concerns that Shrier’s attention to science was, at times, superficial. This is, of course, hardly unique to this book, but on such an explosive topic, I would have liked to have seen more nuanced coverage of some of the scientific debates. Shrier does include data and opinions of some scholars in this field and covers some important (but disputed) work such as Lisa Littman’s controversial study of what she calls “rapid-onset gender dysphoria” (which itself was subject to censorship efforts which, whatever the merits of the study, were scientifically deplorable).

However, I found myself dismayed by Shrier’s pat dismissals of the idea that gender identity is biological despite a wealth of evidence to suggest just that. At one point, Shrier writes, “It is biologically nonsensical to suggest that a girl’s brain — every cell of it stamped with XX chromosomes — might inhabit a boy’s body.” I all but face-palmed at this lack of understanding of how androgen exposure in utero, irrespective of chromosomes, can influence hypothalamic development and influence gender identity in turn.

Of course, this view is hardly a creation of Shrier’s but is reflective of “gender critical” feminists (typically the opposing “side” to trans activists in this highly contentious debate), with roots traced back at least to second-wave feminism. Indeed one of the interesting things about this dispute is the degree to which it often reflects the emotional disdain between two groups of left-wing advocates rather than the traditional right/left divide.

Shrier is also weirdly obsessed with the internet and the notion that too much time on the internet is causing girls to identify as trans. She cites the work of Jean Twenge on how social media can influence mental health, failing to inform the reader that many of Twenge’s claims have been pretty thoroughly debunked. Her return to this kind of moral panic was distracting and made me wonder to what extent the whole concept of rapid-onset gender dysphoria might also be moral panic.

All that having been said, I’m not willing to dismiss her thesis entirely. The truth is, we don’t really seem to have good data on whether there really is or is not an increased proportion of girls identifying as trans. Anecdotally, even in my own social circle, I’m hearing a bit more about this, but anecdotes aren’t evidence, and we need more solid data.

There is evidence that, in addition to borderline personality disorder, gender dysphoria is also more common among autism spectrum adolescent girls. In this sense, the affirmative approach, wherein a youth’s professed gender identity is accepted as a move toward medical transition without any further diagnostic evaluation, has obvious risks. This appears to be the reasoning behind a recent UK court decision skeptical of this approach for medical transition.

We need better data on which youth would most benefit from a swift move toward medical transition and which might benefit more from different interventions. None of this need impinge upon the rights and welfare of trans individuals and the respect that is owed to them. Scholars need room to research whether rapid-onset gender dysphoria is real or not. I am confident that peer review and scientific replication and correction will elucidate this matter, whereas scientific censorship in response to Twitter anger will only confuse matters.

In conclusion, I think that there are some valid ideas here to consider. But particularly in an age of inflamed identity politics, we need more data-based pieces willing to consider the complexities of data and the nuances of difficult situations, and intellectual humility to acknowledge where more information is needed.

I would encourage people to read Irreversible Damage if only to understand the arguments it makes, as well as to oppose the loathsome efforts to censor it. However, if we were hoping for a book that carefully hews to science, this is certainly not it and, in that respect, the negative reaction it has garnered in the trans community is entirely understandable. I hope the future will see high-quality, preregistered, open science, scientific efforts free from internet censorship efforts that may help us understand these complicated issues more clearly.