Misplaced Focus on Feelings

When The Title Of Your Article Tells On Yourself and Prejudice Masquerades as Reason

Sometimes I come across an article so densely packed with falsehoods, fallacies, and misrepresentations, that I need to take a deep breath before diving in. Today’s specimen comes from Lisa Shultz (@EyesOpen Substack), who recently published ‘Misplaced Focus on Feelings.’ This is a lovely example of a self-defeating exposé and a rare example of how the author’s title is so honest that it says it all. Let’s dive into the liturgy of logical fallacies and falsehoods and set the record straight, shall we?

The ‘Feelings vs. Facts’ False Dichotomy

Shultz opens with a declaration that they ‘cannot apologize for not affirming an ideology.’ This framing is the first clue we’re not dealing with someone engaging with the medical consensus. Gender-affirming care isn’t an ‘ideology’ – it’s healthcare backed by decades of peer-reviewed research and supported by every major medical organization worldwide. [1]

They write: ‘Feelings have usurped common sense, facts, and truth and are seemingly worshipped in a manner that isn’t helpful or healthy for society as a whole.’

This statement creates a caricature of evidence-based medicine as mere ‘worship of feelings’ rather than addressing the actual scientific basis for gender-affirming care. The American Academy of Pediatrics, the American Medical Association, the American Psychological Association, and dozens of other medical organizations support gender-affirming care based on evidence, not emotion. [2]

It is also a portent of things to come, and serves as some foreshadowing - Shultz is essentially telling on themselves already.

The Medical Reality They’re Missing

Shultz characterizes gender-affirming care as giving ‘children and teens access to body-altering and life-altering drugs without question.’ This misrepresentation couldn’t be further from reality.

Gender-affirming care follows strict clinical guidelines that include comprehensive psychological evaluation, ongoing therapy, and staged interventions appropriate to age and development. [3] For younger adolescents, care is typically limited to social transition and sometimes puberty blockers, which are reversible. Hormone therapy isn’t typically considered until later adolescence, and surgeries are rarely performed on minors - in extremely rare cases with special clinical circumstances, but these are not standard practice and would represent the rare outliers rather than typical care. All care for minors is with consent of their legal guardians.[4]

Shultz’s claim about ‘profiteering industries’ exploiting transgender youth contradicts basic economics. If medical organizations were truly profit-driven, they’d focus on more lucrative specialties rather than the relatively small transgender population that faces significant insurance barriers. [5] I mean, if you wanted to make bank in healthcare, would you really choose a specialty that serves less than 2% of the population and faces constant insurance battles? That’s like opening an ice cream shop in Antarctica. Sure, there might be a passionate fan base, but it’s hardly the path to easy profits.

Who’s Really Centering Feelings?

This section deserves special attention because Shultz’s projection is striking. Let’s examine their actual words:

‘A belief system that tells our youth they must take synthetic hormones… doesn’t sit well with me. Undergoing surgeries… sets off loud alarm bells that I am unable to turn off.’

‘I cannot apologize for not affirming an ideology…’

‘I deeply care about the long-term health of our physical bodies and minds…’

‘I believe that sexed bodies are not mistakes to be fixed…’

Notice the pattern? While Shultz builds their entire argument around condemning the supposed prioritization of feelings over facts, nearly every key point they make is prefaced with their personal feelings, beliefs, and discomforts. They offer no citations, no studies, no data – only emotional assertions wrapped in righteous indignation.

It’s the argumentative equivalent of shouting ‘Stop being so emotional!’ while sobbing uncontrollably in a fit of despondant anger. The irony would be amusing if their doing so was not causing harm to the the very people they claim to be trying to protect.

Meanwhile, they dismiss the clinical guidelines developed through rigorous research and professional consensus as mere ‘feelings.’ Guidelines, I might add, that are supported by longitudinal studies consistently showing improved mental health outcomes and quality of life. [6] When you boil it down, it seems Shultz isn’t actually opposed to centering feelings in healthcare decisions. They just want healthcare to center around their feelings instead of the patients’ well-being. So long as it aligns with Shultz’s world view and does not offend their sensibilities, then it is ok.

Shultz’s Feelings Don’t Care About Facts

So let’s break down some of Shultz’s claims and see how they stand up to facts, data, and reality.

Claim (emphasis mine): Gender-affirming care gives ‘children and teens access to body-altering and life-altering drugs without question or consideration for the wide range of ramifications.’

Fact Check: FALSE

The Standards of Care developed by the World Professional Association for Transgender Health (WPATH) and clinical guidelines from the Endocrine Society both require extensive assessment before any medical interventions. These include comprehensive psychological evaluation, ongoing therapy, family involvement when possible, and careful consideration of developmental appropriateness. [7] The process typically involves multiple healthcare professionals working together over extended periods, not the no-questions-asked scenario Shultz describes.

Claim: There is a ‘heavy promotion of pharmaceutical quick fixes’ motivated by profit.

Fact Check: FALSE

Far from being ‘quick fixes,’ gender-affirming interventions typically proceed slowly and cautiously, with thorough evaluation at each stage. The suggestion that profit motivation drives gender-affirming care ignores the reality that transgender healthcare faces significant reimbursement challenges and represents a tiny fraction of healthcare spending. [8] Additionally, many clinics providing transgender care operate at a financial loss and are subsidized by other departments.

Claim: ‘Many kids and young adults’ undergo surgeries to ‘remove healthy body parts and healthy reproductive organs’ upon demand.

Fact Check: MISLEADING

Gender-affirming surgeries for minors are extremely rare in the United States, limited primarily to chest surgeries for older adolescents who have demonstrated persistent gender dysphoria and have parental consent. [9] These surgeries require extensive evaluation and are never performed ‘upon demand.’ Genital surgeries are not recommended for minors under current guidelines. [10]

Claim: Patients are not evaluated but ‘actually being affirmed’ without proper assessment.

Fact Check: FALSE

Shultz quotes ‘Eliza Mondegreen’ a.k.a. Sarah Mittermaier, claiming patients aren’t properly evaluated, but this mischaracterizes the affirmative model of care. Affirming a patient’s gender identity does not mean automatically approving all requested interventions. Rather, it means approaching patients with respect while still conducting thorough clinical assessment. [11] Research shows that proper assessment remains central to gender-affirming care protocols at accredited centers. [12]

Consider the Source: Who is Eliza Mondegreen?

Here I feel compelled to discuss this quote of Mondegreen by Shultz a bit further, because we needs must consider the source of Shultz’s quote - Sarah Mittermaier a.k.a. Eliza Mondegreen. I believe this to be an important aside, because ‘Eliza’ is often quoted as if they are citing a credible expert on transgender healthcare, so this warrants critical examination.

'Eliza Mondegreen' is a pseudonym used by Sarah Mittermaier, an anti-transgender activist with no medical credentials who is affiliated with organizations designated as hate groups by the Southern Poverty Law Center. Mittermaier has explicit connections to the Society for Evidence-Based Gender Medicine (SEGM) and Genspect, both classified as anti-transgender hate groups by the SPLC. [16] Despite writing extensively on medical topics, Mittermaier's academic background is not in medicine or psychology, but rather in communications. Her master's thesis from McGill University (2024) focused on detransition narratives in online communities, particularly Reddit. [17]

Mittermaier is a prolific contributor to UnHerd, an anti-transgender platform, where she has published dozens of articles with titles like 'The dark truth about gender surgeries,' 'The violent rhetoric of trans activists has to stop,' and '2024 could be the year America's trans bubble bursts.' [18] This consistent pattern of publishing indicates she is not an impartial analyst but rather a dedicated activist with a specific ideological axe to grind.

When examining Shultz's use of Mondegreen's quote, it is worth noting they are essentially engaging in source shopping - selectively citing only those who already agree with their viewpoint while ignoring the vast body of medical literature that contradicts it. This creates an echo chamber effect where citing each other's work generates an illusion of credibility and consensus where none exists in the broader medical community. Neither individual possesses medical credentials or clinical experience with transgender healthcare, yet both present their opinions as authoritative.

This is particularly relevant when Shultz quotes Mondegreen claiming that patients are not properly evaluated but 'actually being affirmed' without assessment. This claim directly contradicts the published standards of care from medical organizations and the documented practices of gender clinics, which require comprehensive psychological evaluation before any medical interventions. [19]

Understanding who is behind the pseudonym ‘Eliza Mondegreen’ reveals why Shultz would find their work appealing. Not because it represents medical consensus or expertise, but because it aligns with and reinforces their pre-existing beliefs. This is a textbook example of confirmation bias, where one seeks out and elevates voices that confirm what they already believe while dismissing contrary evidence.

Claim: ‘Estrangements are at an all-time high’ due to children going ‘no contact’ because of parents not affirming them.

Fact Check: UNSUBSTANTIATED

Shultz provides no evidence for this claim. Research actually shows that family rejection of LGBTQ+ identities is a primary predictor of family estrangement, not children rejecting parents who don’t affirm them. [13] Studies consistently demonstrate that family support is protective against negative mental health outcomes for transgender youth. [14] Hitchens’ Razor applies: ‘That which can be claimed without evidence, can be dismissed without evidence.’

Logical Fallacy Identification

Shultz's article is not just factually incorrect; it is also riddled with logical fallacies that expose them as a wannabe demagogue relying on empty rhetoric. Logical fallacies are errors in reasoning that weaken arguments and often mislead readers who may not recognize these rhetorical tricks. By identifying these fallacies, we can better understand how transmisic arguments often rely on emotional appeals rather than sound reasoning. Let us examine the most prominent fallacies in Shultz's piece:

Special Pleading mixed with a False Choice/False Dilemma

Shultz repeatedly frames their ideological positions with phrases like "I cannot affirm" and "I cannot apologize for not affirming," presenting them as fixed constraints rather than what they actually are: deliberate choices.

• Special Pleading - This fallacy occurs when someone applies standards or rules to others while exempting themselves without justification. Shultz is essentially demanding that transgender individuals deny their identity while presenting their own unwillingness to affirm as somehow immutable or beyond their control.
• False Choice/False Dilemma - Shultz presents the situation as if they have no choice ("I cannot affirm") when in reality they do have a choice; they are simply unwilling to make a different one.

Counter: While Shultz presents their views as something they “cannot” change, the evidence shows that gender identity itself is not chosen. The irony is that Shultz demands transgender people deny or suppress their inherent identity while presenting their own ideological position as non-negotiable. Unlike Shultz’s views, which could change with education and exposure to evidence, gender identity is a fundamental aspect of personhood supported by research.

Appeal to Nature Fallacy

When Shultz states: ‘I believe that sexed bodies are not mistakes to be fixed; a child’s sex is wonderfully right, not inherently wrong.’

This assumes that what is ‘natural’ is inherently good or better. However, we routinely intervene in natural processes to improve health outcomes regularly. From correcting congenital heart defects to treating type 1 diabetes, to pacemakers to contact lenses and eyeglasses. The naturalness of a condition tells us nothing about whether intervention is appropriate.

Counter: Medical interventions should be evaluated based on evidence of their benefits and risks, not on abstract notions of naturalness.

Straw Man Fallacy

Shultz constructs a simplified, distorted version of gender-affirming care as being solely based on ‘feelings’ without medical standards or evidence.

Counter: Present the actual, evidence-based standards of care that include comprehensive assessment, ongoing monitoring, and staged interventions appropriate to developmental stage. Furthermore, point out that transgender identity is not merely based on feelings but involves a basis in biological, psychological, and social factors (biopsychosocial) based on studies, data, and treatment outcomes.

Appeal to the Future

‘History will harshly judge this time of gender ideology and medicalization practices. We will wonder how it went on as long as it did.’

This implies their position will eventually be vindicated without providing evidence for why it’s correct.

Counter: Medical and ethical judgments should be based on current evidence and outcomes, not speculative appeals to how future generations might judge us. There is no evidence to suggest that their assumption is going to be correct - this creates circular reasoning where their position is deemed correct simply because they claim future people will vindicate it. Additionally, it’s an unfalsifiable claim that cannot be tested in the present, making it rhetorically convenient but logically empty.

False Dichotomy

Shultz presents a choice between either rejecting gender-affirming care entirely or subjecting children to unregulated medical interventions.

Counter: Present the nuanced, individualized approach that actual gender-affirming care involves, highlighting the various options and careful assessment that occurs. The association of better mental and quality of life outcomes as a measure of care that is potentially life saving.

Guilt by Association

Shultz attempts to discredit gender-affirming care by associating it with profit motives in healthcare.

Counter: Address the actual evidence for the effectiveness of gender-affirming care, independent of broader critiques of healthcare financing. Furthermore, this alludes to another persumption of fact where there is no evidence to substantiate it - Hitchen’s razor applies: ‘What can be asserted without evidence can be dismissed without evidence.’

In Conclusion

What we see in this article is a perfect inversion of Shultz’s central claim. They accuse transgender healthcare of being emotion-driven while offering nothing but emotion-based arguments themselves. They criticize others for supposedly ignoring facts while presenting almost no factual evidence, and only seeks evidence from those who hold the same biased positions.

The real ‘medical scandal extraordinaire’ isn’t gender-affirming care. It is the willingness to dismiss mountains of evidence in favor of personal discomfort with transgender identities. If we’re serious about prioritizing facts over feelings, perhaps we should start by acknowledging the overwhelming scientific consensus supporting gender-affirming care. [15]

In the battle between feelings and facts, Shultz has inadvertently revealed which side they’re actually on.

Spoiler alert: it’s not the side with the peer-reviewed studies.

References

[1] American Medical Association. (2023). Health care for transgender and gender diverse individuals. https://www.ama-assn.org/press-center/ama-press-releases/ama-reinforces-opposition-restrictions-transgender-medical-care

[2] A4TE. Medical Organization Statements. https://transhealthproject.org/resources/medical-organization-statements/

[3] Coleman, E., et al. (2022). World Professional Association for Transgender Health. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1-S259.

[4] Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T’Sjoen, G. G. (2023). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869-3903. https://doi.org/10.1210/jc.2017-01658

[5] Dowshen, N. L., Christensen, J., & Gruschow, S. M. (2022). Health insurance coverage of recommended gender-affirming health care services for transgender youth: A multistate analysis. JAMA Pediatrics, 176(10), 824-833. https://doi.org/10.1089/trgh.2018.0055

[6] van der Miesen, A. I., Steensma, T. D., de Vries, A. L., Bos, H., & Popma, A. (2020). Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers. Journal of Adolescent Health, 66(6), 699-704. https://doi.org/10.1016/j.jadohealth.2019.12.018

[7] See 3 Above

[8] Padula, W. V., Heru, S., & Campbell, J. D. (2021). Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: A cost-effectiveness analysis. Journal of General Internal Medicine, 36(10), 2102–2111. https://doi.org/10.1007/s11606-015-3529-6

[9] Olson-Kennedy, J., Warus, J., Okonta, V., Belzer, M., & Clark, L. F. (2018). Chest reconstruction and chest dysphoria in transmasculine minors and young adults: Comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatrics, 172(5), 431-436. https://doi.org/10.1001/jamapediatrics.2017.5440

[10] Mahfouda, S., Moore, J. K., Siafarikas, A., Hewitt, T., Ganti, U., Lin, A., & Zepf, F. D. (2019). Gender-affirming hormones and surgery in transgender children and adolescents. The Lancet Diabetes & Endocrinology, 7(6), 484-498. https://doi.org/10.1016/s2213-8587(18)30305-x

[11] Ashley, F. (2020). Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth. Clinical Child Psychology and Psychiatry, 25(2), 223-236. https://doi.org/10.1177/1359104519836462

[12] Chen, D., Strang, J. F., Kolbuck, V. D., Rosenthal, S. M., Wallen, K., Waber, D. P., Steinberg, L., Sisk, C. L., Ross, J., Paus, T., Mueller, S. C., McCarthy, M. M., Michalska, K. J., Martin, C. L., Kreukels, B. P., Kenworthy, L., Herting, M. M., Herlitz, A., Guillamon, A., … & Garofalo, R. (2020). Consensus parameter: Research methodologies to evaluate neurodevelopmental effects of pubertal suppression in transgender youth. Transgender Health, 5(4), 246-257. https://doi.org/10.1089/trgh.2020.0006

[13] Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346-352. https://doi.org/10.1542/peds.2007-3524

[14] Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), e20191725. https://doi.org/10.1542/peds.2019-1725

[15] Cornell University. (2018). What does the scholarly research say about the effect of gender transition on transgender well-being? What We Know Project. https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

[16] Southern Poverty Law Center. (2024). Anti-LGBTQ+ Organizations. Retrieved May 15, 2025, from https://www.splcenter.org/fighting-hate/extremist-files/ideology/anti-lgbtq

[17] Mittermaier, S. (2024). Questions and doubts in online trans communities. [master's thesis] McGill University. https://escholarship.mcgill.ca/concern/theses/m326m754q?locale=en

[18] UnHerd. (2024). Author: Eliza Mondegreen. Retrieved May 20, 2025, from https://unherd.com/author/eliza-mondegreen/

[19] See 3 Above

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