The Inconvenient Truth about Byrne's Flawed Attack on Affirming Care

Who is Alex Byrne?

Before diving into the substance of Byrne's arguments1, it's worth examining his background and qualifications to write authoritatively on this topic. Alex Byrne is a Professor of Philosophy at MIT who has recently positioned himself as a prominent "gender critical" voice.2 In 2023, he published the book "Trouble With Gender: Sex Facts, Gender Fictions" which pushes back against what he calls "the new gender revolution." 3

While undoubtedly an accomplished philosopher, Byrne does not appear to have any specialized clinical training or research background in gender dysphoria, transgender health, or child and adolescent development. His recent focus on sex and gender seems to be more of a philosophical and ideological crusade rather than an extension of his core scholarly expertise. A scroll through his Twitter feed reveals a preoccupation with "gender critical" talking points and selective amplification of research that supports his views.

This certainly does not disqualify Byrne from weighing in on the persistence of childhood gender dysphoria. But it's important context for evaluating his bold claims and selective reading of the scientific literature. He is writing as a philosopher with an agenda, not an unbiased expert in the clinical phenomenon he is analyzing.

Debunking the Myth of the "Myth of Persistence"

With that background in mind, let's turn to the substance of Byrne's letter, which aims to debunk the "myth" that gender dysphoria persisting from childhood into puberty is unlikely to resolve without medical intervention. Byrne makes several flawed arguments:

1. Byrne traces the origins of this "myth" back to a single paper - Wren (2000) - which he argues relies on weak evidence. However, he ignores that Wren's conclusions drew heavily on her own clinical experience with adolescents, not just her cited sources. More importantly, the evidence for persistence of puberty-onset dysphoria extends well beyond Wren, which Byrne downplays or disregards. Several studies have shown persistence rates of childhood gender variance into later development ranging from 10-39% 4. Two follow-up studies from the Netherlands in particular have examined the trajectories of children treated for gender dysphoria5 6, providing further evidence that the research base is not limited to a single study. More recent research has also found high rates of persistence among adolescents with gender dysphoria78.

2. Byrne emphasizes in his letter the lack of ideal prospective studies tracking untreated dysphoric adolescents into adulthood. While such longitudinal research would be valuable, Byrne overstates its absence to dismiss the evidence that does exist from multiple follow-up studies. For instance, he cites a study (Smith et al. 2001) that did examine untreated adolescents, but discounts the key finding that their dysphoria often persisted into early adulthood, albeit attenuated. However, Byrne does not mention the actual findings from the untreated group in Smith et al. (2001). The study reports:

   "Those without surgery or hormone therapy were assessed at a mean of 17.3 years and 21.6 years at follow-up. Their gender dysphoria had significantly declined from a mean of 46.7 on the Utrecht Gender Dysphoria Scale to 31.1 (range 12–60, with higher scores indicating more dysphoria. Subthreshold for GD corresponds to a mean of around 40: Steensma et al., 2013b)." This finding suggests that while dysphoria declined in the untreated group, it often remained above the threshold for a gender dysphoria diagnosis into early adulthood.

3. Byrne argues that studies on the trajectories of childhood-onset gender dysphoria (Drummond et al. 2008, Wallien & Cohen-Kettenis 2008, Steensma et al. 2011) debunk the idea that dysphoria persisting into adolescence almost invariably continues into adulthood91011. However, while these studies focus primarily on prepubertal children, they still provide evidence of significant persistence rates for dysphoria that continues into puberty. For example, Steensma et al. (2011) found that the intensity of early pubertal dysphoria was a key factor in persistence.12 Although not demonstrating near-100% persistence, these findings challenge Byrne's implication that desistance is the norm for childhood-onset dysphoria that persists into adolescence.

4. Byrne argues that a recent study and an article from dubious sources (Rawee et al. 2024, Sapir 2024) fail to demonstrate the persistence of childhood-onset gender dysphoria. However, neither reference provides reliable evidence for his claims. Rawee et al. (2024) examined "gender non-contentedness," not gender dysphoria13, so its findings cannot be directly extrapolated to persistence rates. Even more concerning, Byrne cites Sapir (2024), which is an article published in the City Journal, authored by a conservative think tank fellow, not a gender dysphoria researcher. The City Journal, if you are not aware, is a quarterly magazine published by the Manhattan Institute for Policy Research, a conservative think tank based in New York City. Relying on such a questionable source in a scientific debate raises serious doubts about the credibility of Byrne's argument.

   
   While acknowledging the limitations of the study and article for establishing persistence rates, Byrne still uses them to support his claims, suggesting his argument is not well-grounded in reliable scientific evidence. If robust, peer-reviewed research backed his position, why resort to a City Journal article by a think tank fellow? This highlights Byrne's reliance on Sapir (2024), a non-peer-reviewed piece by a non-expert, as a major red flag. It undermines his argument's credibility and highlights the paucity of strong evidence for his position. Neither Rawee et al. (2024) nor Sapir (2024) reliably support Byrne's claims about the persistence of childhood-onset gender dysphoria. His use of these dubious14 sources exposes the lack of solid evidence for his stance and underscores the need for a more rigorous, evidence-based approach to this complex issue.

In sum, Byrne's selective review of the research fails to overturn the prevailing view that gender dysphoria persisting into puberty often continues, even if not always at the same intensity. Multiple follow-up studies indicate that dysphoria clearly persisting past early puberty tends to endure into adolescence and adulthood151617.

Byrne fixates on limited evidence like Wren (2000) while downplaying more recent research showing that gender dysphoria intensifying in puberty usually persists. He overstates the lack of ideal longitudinal studies to dismiss the evidence that does exist. Significant gaps remain in the research, but Byrne's letter exaggerates the case against persistence while neglecting considerable data supporting it.181920

Philosophical Overreach

At the core of Byrne's letter is an attempt to poke holes in the scientific consensus on the persistence of childhood-onset gender dysphoria post-puberty to further his philosophical agenda. But in doing so, he oversteps the bounds of his expertise as an analytic philosopher into clinical territory where he lacks real expertise.

Byrne is certainly entitled to his philosophical views on sex and gender. But as we have seen, he crosses a line when he misrepresents and cherry-picks scientific evidence to lend his ideology a veneer of empirical legitimacy. His letter betrays a commitment to a predetermined narrative over an even-handed analysis of the research.

This is not an abstract philosophical debate. There are real-world clinical and policy implications to spreading misconceptions about the trajectories of gender dysphoria in young people. Byrne's selective skepticism of the evidence for post-pubertal persistence could promote undue delays in gender-affirming care, which the research shows can be crucial for those whose dysphoria does persist. This is to say nothing of the potential damage it can do to kids and families as parents latch on to this as “proof” and “evidence” to deny their kid not only the freedom and latitude to explore themselves safely, but the necessary care they may end up needing as they grow older.

Responsible philosophical analysis on a sensitive scientific and clinical topic like this requires more epistemic humility. No one is expecting a philosopher to have all the answers on the development of gender identity. But we should expect more than confident assertions based on a selective and skewed reading of a complex literature21.

Trouble With Byrne's Letter

Ultimately, the real "trouble with gender" in Byrne's letter is his uneven application of scientific scrutiny in what appears to be an effort to further his philosophical agenda. Perhaps City Journal commissioned him for this, or perhaps the think tank he works for leveraged their publication as a megaphone for Byrne to perform his role as a mouthpiece to further a conservative agenda. Quite timely, as elections are on the horizon and the primary GOP candidate seems to be wading ever deeper into fearmongering over “the transgender debate/issue.” Byrne makes unreasonable demands for unassailable evidence for post-pubertal persistence of dysphoria while accepting much weaker evidence against it. His selective review of the research doesn't nullify the "myth of persistence" so much as expose the myths underlying his own position.

Byrne is a serious philosopher grappling with a complicated issue. But in this instance, his philosophical reach exceeds his empirical grasp. His letter reads more like a lawyer's brief than a scholar's analysis, cherry-picking studies to support his argument while ignoring contrary evidence.

As a philosopher, Byrne has every right to interrogate the concepts of sex and gender - as do we all (and we should!). But when he wades into clinical questions, he has a responsibility to represent the full scope of the scientific evidence. Unfortunately, his letter falls well short of that standard in its unbalanced and ideologically-motivated review of research on the persistence of gender dysphoria.

The philosophical questions around sex and gender are complex, and there is room for good-faith debate. But that debate must be grounded in a fair reading of our best scientific understanding, not a selective review to justify a predetermined position. On that score, Professor Byrne's letter is long on trouble and short on light.