Free to Be(lieve) in Gender Pseudoscience

I ordered leading youth transition advocate Jack Turban's new book, "Free to Be," to examine the evidence he claims supports a biological basis for innate gender identity

Artwork by Christina Buttons

In April, the U.K.’s Cass Review, along with its associated systematic evidence reviews–representing the most thorough appraisal of pediatric gender medicine to date–found “remarkably weak” evidence supporting all interventions for gender transition in minors. Those who continue to advocate for “gender-affirming care” are promoting gender pseudoscience—a term I introduced two years ago. 

The other half of gender pseudoscience, which is less talked about, centers on the unsupported claims about a fixed and immutable gender identity. Advocates of this view argue that everyone possesses a gender identity and it is discernible from a very young age. If there's a discrepancy between the gender identity and the child's biological sex, the child is claimed to be transgender. 

If you haven’t been following the developments around trans-ideology closely, the evolving definitions and concepts can be difficult to grasp. Over the years, influential activist organizations and advocates have downplayed gender dysphoria as a meaningful diagnosis due to the stigma associated with psychiatric conditions. Instead, they advocate the perspective that being transgender is an innate trait, mirroring the successful "born that way" narrative of the gay rights movement.

Gay people, for the most part, do not choose their sexual orientation. As a liberal and staunch advocate of gay rights, I believe that other well-intentioned liberals support transitioning children because they have been led to believe that being transgender is exactly like being gay. Therefore, it is very important to understand the current state of biological evidence there is for an innate and immutable gender identity.

In February, psychiatrist and youth transition advocate Jack Turban announced his new book, Free to Be: Understanding Kids & Gender Identity, which presents research that he claims supports "a strong innate biological scaffolding for our gender identities." Turban is known for publishing deeply flawed studies on gender-affirming care and for his refusal to engage with critiques of these studies. His influence is notable: he recently appeared on PBS and is responsible for reviewing the American Psychiatric Association’s page on gender dysphoria. When Free to Be was released last month, I ordered a copy to gain insight into his arguments and supporting evidence justifying his position. 

Most of the book relies on emotion-filled stories to shape its narrative, featuring conversations with individuals who are or were trans-identified as children. Throughout the book, he offers many confusing definitions for gender identity, which he describes as a “complex multidimensional construct.” He also has a particular fondness for the word “transcendent,” using it seven times to describe a “transcendent sense of gender.” He explains that you "simply feel a certain gender," and it is a "hard-to-put-into-words feeling." (Yes, we can tell.) The clearest definition he provides is "one’s psychological understanding of oneself in terms of masculinity, femininity, a combination of both, and sometimes neither."

If gender identity were simply a psychological concept or a feeling, it might not be so contentious. However, Turban claims that gender identity has an “innate biological basis,” which he insists is supported by a large body of evidence.

Currently, there is no brain, blood, or other objective test that can detect gender identity or otherwise distinguish a trans-identified from a non-trans identified person, once variables like sexual orientation are controlled for (at the group level, not the individual level). Gender identity is subjectively determined by the individual based on how well they feel they align with sex-based stereotypes.

To represent gender identity as a biological property of human beings is an extraordinary claim. When this claim is used to justify medically transitioning children, among other things, you had better have good evidence for it.

From my observation of the research landscape, I often see researchers approach the inquiry into gender identity in a deceptive manner. A prime example is an influential review article by Dr. Joshua Safer, who co-authored two sets of clinical guidelines for the medical care of transgender patients. Instead of objectively assessing whether or not gender identity exists, their objective is to seek out “current literature that supports” their conclusion—a hallmark of pseudoscience.

Safer and colleagues compiled a collection of loose theories and cherry-picked studies that found evidence for sexual orientation, gender nonconformity, disorders of sexual development (DSD), and other conditions influenced by prenatal gonadal hormone exposure that contribute to natural human diversity. But none of these studies offer empirical evidence to substantiate the validity of an innate gender identity.

Turban does the same thing in Chapter 3 of his book, titled “Gender Foundation: The Biology of Diverse Gender Identities.” He claims there is “strong evidence that transness has an innate biological basis,” but an alternative interpretation is that this evidence supports the concept of gender nonconformity.

Gender nonconformity encompasses preferences, behaviors, and physical traits that deviate from what is considered typical for males and females. Today, "transgender" is widely used as an umbrella term that is conflated with common gender nonconformity. Ideologically-motivated researchers and clinicians typically use biological evidence for gender nonconformity as a stand-in for evidence of gender identity.

For such a "large body of evidence," as Turban claims throughout the book, I expected more than the same two studies on twins and genome sequencing that he referenced in his 2021 CNN op-ed, “Attacks on trans people are also attacks on science itself.”

The twins study, a 2011 review of older research, revealed only a 40% concordance rate among twins, which is considered low for such studies. Additionally, many of the twins were same-sex attracted, a factor often associated with gender nonconformity and potentially leading to the adoption of a transgender identity—especially when gender nonconformity is now viewed as synonymous with being transgender.

The paper concludes, "These findings suggest a role for genetic factors in the development of GID" (emphasis added). Contrary to Turban’s claim, this does not provide strong evidence for an innate gender identity. Rather, it suggests that genetic factors may contribute to gender nonconformity, which can cause distress and a desire to be the opposite sex, previously diagnosed as gender identity disorder (GID).

The second study Turban cites is a 2019 genome sequencing study. Recent research in this field has increasingly leaned towards activism, either explicitly or implicitly. The authors of this study consider the lack of biological understanding of transgender identity as an obstacle to individuals obtaining medical interventions.

This study's methodology is questionable due to a small sample size and lack of a control group, as well as missing data on sexual orientation. Among the 30 participants (13 transgender men and 17 transgender women), no single gene variant was found in all or most of them. Most variants were unique to individuals, with a few shared by small groups of 2-4 people. This is typical in genetic research of complex traits, where no single gene determines the trait.

Turban claims that although no "transgender gene" was found, the study provides evidence for a biological basis of gender identities. However, this is dubious because the broad definition of transgender includes gender nonconformity, making it more likely that gender nonconforming people identify as transgender. Thus, Turban's interpretation might better be seen as evidence for a genetic basis of gender nonconformity.

The genes identified are linked to pathways that affect sexually dimorphic brain development and behavior, relating to gender expression and behavior—essentially gender nonconformity. The study may be identifying genetic variants common in transgender individuals, but these traits are not exclusive to or definitive of transgender identity. In a culture equating gender nonconformity with being transgender, it may appear that way.

So that’s the best Turban’s got. 

In Chapter 3, Turban gives an honorable mention to the brain sex studies, which were once hailed as proof that transgender people have brains matching their gender identity. However, these studies were refuted when researchers controlled for confounding variables and found that sexual orientation was responsible for the observed brain differences. All Turban can muster is “the results have been inconsistent.”

It's important to highlight this failure because “brain sex” conjecture was baked into clinical guidelines for medical transition and legislation for employment, healthcare, and education. The narrative that transgender people have brains matching the opposite sex, explaining their condition, was pervasive in the media and even appeared in the influential 2014 children's book "I Am Jazz," where Jazz states, "I have a girl brain but a boy body. This is called transgender. I was born this way!" When the brain sex studies were debunked, activists shifted their narrative.

I Am Jazz (2014)

Nowhere in this chapter are the body perception neuroscience studies mentioned, which I believe have merit and are worth exploring. The “own-body perception” theory proposes that reduced structural and functional connectivity between certain brain networks is responsible for gender dysphoria. However, these studies show only an association, not a causal link. Abnormalities in body perception networks in the brain are not unique to those with gender dysphoria; they are also associated with many other conditions, including body dysmorphic disorder, anorexia, body integrity identity disorder, schizophrenia, and autism.

Perhaps this theory was omitted because it isn't useful to advocates trying to disassociate the psychiatric condition of gender dysphoria from being transgender. "It’s important to acknowledge that gender dysphoria and being transgender are not the same thing," Turban says. The "ultimate goal" stated on the American Psychiatric Association page is to categorize it under an "endocrine/medical diagnosis." The WHO's new ICD-10 diagnosis, gender incongruence, classified as a "condition related to sexual health," is a step towards that aim, explicitly done to reduce stigma.

The concept of a fixed, innate, and unchanging gender identity is refuted by a substantial body of desistance research in children and a growing population of detransitioners. Their existence is a major inconvenience to proponents of the innate gender identity narrative, who often downplay their presence.

Nothing I am saying contradicts the view that transgender people exist and deserve dignity and respect. My definition of a transgender person is someone who has taken social or medical steps to be perceived as the opposite sex, usually to alleviate what they experience as gender dysphoria. I say this not to discount their experience—there is genuine distress involved—but to acknowledge that this distress can sometimes be misattributed. In my conversations with detransitioners, some have said that they did not have gender dysphoria and were misdiagnosed, while others have said that they did have gender dysphoria, but it later resolved.

In conclusion, biological factors are associated with being transgender, but being transgender itself is not an inherent condition one is born with. The studies seeking to discover biological factors associated with transgender identity are most likely evidence of gender nonconformity, and misinterpreted as evidence of innate gender identity.

A more appropriate title for Jack Turban’s book would be “Free to Believe” because gender identity only exists for those who believe in it, and claiming that scientific studies support its existence is gender pseudoscience.