Sabine Hossenfelder attempts to answer the question of transgender youth healthcare by applying a physicist mindset to the literature on this matter.   I've commented on this to her elsewhere, but, the fundamental error is applying a physicist mindset to science that is very different from physics.   Reading around the net some responses to this go on about how she's a "quantum physicist" therefore she knows more than psychologist about psychology.  This blog is as much of a response to that mindset among the public.  

She makes only one hard error of fact. The oft repeated notion that the UK is stopping all treatment for trans kids. Yes Tavistock is closing BUT they are opening new regional clinics to carry on the work.  The strongest point she makes and it is a good one is that studies supporting transgender health care for teens in particular often lack control groups.  When they do the size of those groups is not very large.

Having taken the time to talk about this with a psychologist I've had an online rapport with for over a decade (same with Dr Hossenfelder FWIW) ... he said this about the issue of control groups.

This sounds reasonable.  Find teens with parents who consent to talk therapy and teens with parents who consent to talk therapy and full gender affirmation.  Then treat both for at least a couple of years and see what happens.  This way they are getting some kind of care.  We'd need to be careful though that the parents in either group aren't applying pressure to speed up or slow down transition or not transition.  

I may have misunderstood but her objection is often stated as "they could be feeling better by getting cared for at all. This is true... but it implies that to get high quality data that would satisfy a physicist mind on this ... some group of 100 or 1000 people would need to be denied any care at all. (I really hope she simply did not think that or did not think that implication through).  

By the strictest, physicist brain, standards we'd have to choose some group that wants, needs, and is distressed about not getting gender affirming care and deny them not only that care but any other care.  That's the only way to get an iron clad control group.  Giving one group therapy if both get even a little better then it can be argued that it was only the therapy that mattered.  If the no hormones group does not get better then the argument could be "they knew they weren't getting hormones and feel bad to not be in the hormonal treated group".    IT's a never ending carousel of objections.   that's the result of applying a physicist mindset to a non-physics area of science... without being very VERY careful. 

There is a well known phenomena that even has a meme about this.  The physicist life cycle.   

This is one panel from a whole comic strip (https://www.smbc-comics.com/comics/20120321.gif) It' gets the point across.

Psychological studies have to go through an "Institutional Review Board" and pass muster by an ethics committee. No ethical researcher, even a transphobic one, would want to withhold all treatment, even so called separative treatment, to have a real ,true, hardcore, control group. 


It would never happen.


The researchers in the field who do this, and also peer reviewed it, know it better than us physicists. Citing that paper A says one thing and paper B calls into question paper A in this way is fine.  Deferring to the consensus of another field is really what all scientist should do.  We physicists would not want a psychologist telling us how to do what we do.  (In this case this means going with the WPATH Standards of care.  They break down the whole massive body of research on this, and set limits on what it is ethical to do.  Yes you can find some instances of these not being followed.  That's not the norm though.)  Wanting to discuss the research methods of a different field, and declare them to be wrong is what we have a long term meme about.





Lets now add "Gender Identity studies don't have large enough control groups (given no care? I really hope she just didn't think that through. )

The Handedness Argument. 

She does miss the mark on the right and left hand argument.  For a long time people with left handed ness were discriminated against.  Children who were left handed were punished for using their left.  The word sinister actually refers to being left handed etc.  Then in the late 70's and 80's people stopped being discriminatory about it.  So the level of left handed ness rose exponentially then leveled off to a natural unsuppressed level. 

Where she gets it wrong is this.  Switching from writing with one hand to another does not change the fact one is left handed.  The lefty person back then had to just suffer doing things in a way that caused them discomfort and distress for no reason at all.  Transgender people or people who just don't adhere to strict gender norms face that... also for no reason at all.  

I agree this should not be rushed and follow WPATH in saying that hormones should not be started before 14, and only that soon in cases of well documented long term gender in congruence.  I agree with WPATH that surgery should not be done until the age of medical consent in a given jurisdiction.  This is the reasonable, logical, scientific consensus on the matter. The science on this really is as settled as it would ever get.  I'd bet every penny I have that even if some really draconian trials were done that had really purely untreated controls... would find what we already know. 

It'd be like having a randomized control trial to see if aspirin really works after we've used it for centuries, or if Tylenol really works after we've used it for decades.  

As for some of the other issues "oh she mentioned Jesse Singnal" etc etc. I don't care about that personally. That she's a physicist applying our mindset to an area of knowledge that is not physics... without much reservation... is the fundamental error. As learned people we can do it but we have to be VERY careful.

Here is a Reddit thread that gives a very understandable reaction by a transgender person to Dr Hossenfelder's video. 
Comment
by u/CassTastrophe33 from discussion Sabine Hossenfelder just made a bad video about trans-affirming care for minors
in 4trancirclejerk
 
I write about trans issues, and am a physicist. I have read and written about and discussed with psychologist these issues since the year 2000. I've learned about this life on paper and I've lived it. It's really complicated. So she messed up while probably meaning well.  

As much as I enjoy how much it bothers certain kinds of people when I tell them I am a theoretical astrophysicist, we really don't know more about science than a scientist in any other field.  From a certain perspective while what we do is perhaps the greatest challenge mentally ... on a fundamental level what we study is the most simple part of science. The things we study won't sue us, have no rights, and we don't have to worry about the ethics of slamming particles into eachother. 

Being a physicist I'm inclined to agree we have mastered the granddaddy of all sciences.   We can write precise equations, solve them by advanced mathematical methods, measure the results to 16 places behind the decimal point.  Psychology and medicine often have to be satisfied with a strong correlation. 

That said, I've personally done enough reading on this issue over the last 23 years to know that a physics mindset being applied to this is itself an error.   The science isn't settled, or mostly settled, on what causes being trans because I'm a physicist and I say so.  It is because those who dedicated their lives to this say so.  I follow the literature and respect it enough to read the conclusions published by the experts in those fields.  When I question the methods of a paper I just look for another paper the one I am reading and see if it questions them.   

If workers in a given field are satisfied who are we physicists to overrule them?    

Overall I'd give the presentation an A but it is by no means perfect.  Any physicist should be very VERY careful when talking about anything that is not physics.  


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