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I said two months ago I would reply to a comment about this study on the mental health effects of gender transition. I have only now managed to find the time, so I'm going to post my reply as a top-level comment lest it get buried. You can find the previous discussion here.
To be honest, some of the statistical manipulation seems dubious, but that's above my pay grade, so I'm going to assume the study was conducted in good faith with no shenanigans.
In short, the study finds that, contrary to assumptions that transitioning should improve mental health, the share of people needing mental health treatment rises drastically after transition. Anti-trans people conclude that this means transition actually worsens mental health, and, hence, people should not be allowed to transition.
There's some nitpicking to be done here, for example, maybe the patients already needed mental health treatment and just found out they needed it at the same time as they found out they're transgender, or that just seeing a mental health professional regularly doesn't necessarily mean that your mental health is worse than it used to be.
But my fundamental objection is to the conclusion that no one should be allowed to transition. Suppose the anti-trans side is completely correct on the facts, that transitioning did, in fact, directly worsen the mental health of many or even most patients. There are still some patients who are better off. There are countless anecdotal reports online of people who are happier after transitioning. The most you can conclude is that the criteria for who should transition need to be changed. (If I'm interpreting the data right, the likelihood of needing mental health treatment after transitioning was higher in those born later, consistent with the rapid-onset gender dysphoria (ROGD)/social contagion hypothesis.) But if you care about people's happiness, some people should still be supported in transitioning.
Obviously if you believe all trans people are delusional and object to transition and treating people as their stated gender regardless of the effect on their mental health, this does not apply to you. But in that case the study isn't an argument you can use.
Speaking of ROGD, its rhetorical use by anti-trans people is a peculiar example of a self-contradictory motte-and-bailey: usually the bailey is a stronger version of the motte, and thus necessarily consistent with it, but here the bailey ("all trans people are delusional and none of them are their stated gender") contradicts the motte ("some trans people with a specific presentation – primarily adolescent girls – are not actually their stated gender") because the latter presupposes that some trans people are, in fact, their stated gender. If you believe all trans people are delusional, why do you care about the specific etiology of the transness of a specific subgroup of trans people? The treatment, whichever you prefer, should be the same.
I consider myself pro-trans, but I believe ROGD/social contagion may well be a real thing. If you agree about the possibility of social contagion, you should try to minimize the attention trans people receive, yet anti-trans activists have been the main publicists of transness for about a decade now – trans people really entered the mainstream with the North Carolina "bathroom bill". It used to be that you would only find information about transness if you went looking for it because you were questioning your gender, but now that trans people are everywhere (thanks to anti-trans activists), you get impressionable young people who were not predisposed to questioning their gender hearing about it and joining in for the standard reasons impressionable young people join trends. (Cf. media coverage of school shootings encouraging more school shootings – a common argument among anti-gun-control people.)
This is fundamentally just a really bad way to judge whether a treatment works, one that we rightly dismiss for other treatments. There are also countless anecdotal reports of people who recover from cancer after faith-healing. And unlike spontaneous remission of cancer, which is rare, regression to the mean in mental health is the norm. "My mental health got so bad that I sought out X treatment, after which I got better" is the default result.
Go read Scott's Alcoholic Anonymous post (another treatment that a lot of supposed beneficiaries swear by that some critics accuse of being cult-like). Notice both how the evidence base is a complete mess (because it's really hard to test these things) and how the ultimate conclusion seems to be that AA (and pretty much all other treatments tested) is similarly effective to your doctor spending a few minutes telling you that alcoholism is bad and you should stop. Well, the evidence regarding gender transition is even worse. If it turns out outcomes for gender transition are equal or worse than your doctor spending a few minutes telling you "puberty can be scary but you'll be fine" or "accept yourself", that's something we really want to know rather than continuing with a standard treatment with so many downsides. Really it's something we should have known before establishing it as a standard treatment, but instead it went from "so rare you can't do decent studies" to "so common and standard that it would be unethical and difficult to have a real control group" without the step where we actually find out if it works.
A lot of arguments regarding gender transition research seem similar to other arguments that you pick up reading about medical research from people like Scott or Derek Lowe, just with the additional politicized element.
A lot of treatments are based on popular theories on how things work that make the effectiveness of the treatment seem like an inevitability, then crash and burn in randomized control trials. Suggesting a biochemical pathway is bullshit is less likely to get you fired than suggesting "inborn gender identity" is bullshit, which makes it even worse.
"The trial doesn't look good but maybe it works in a subgroup" is the sort of dubious cope you see all the time. At least the p-hackers saying "efficacy was shown in middle-aged hispanic women" have some sort of evidence, saying "okay but assuming the treatment works we just need to do a better job of diagnosing the people it'll work on" is even worse. The only saving grace is that the negative studies on gender transition aren't high-quality randomized control trials because none of the studies on the subject are.
Most fundamentally, everyone knows that the vast majority of prospective treatments fail and the burden of proof is with the people who think they'll succeed. You can have a clear mechanism, anecdotes, observational trials pointing the right direction...and people know not to get too excited. Yes there are standard treatments that are grandfathered in without going through the FDA or equivalent, but the reason why that works isn't really "standard of care", it's "so incredibly obviously effective that the result was clear with much lower standards of evidence". The argument would be that gender transition is such a case, but the various negative studies (and "positive" studies that are pretty negative on closer examination) seem to show it's not really that obvious.
Because it calls into doubt both the advisability of the current standard of care and the theoretical framework the treatment is based on. If "diagnose people with gender dysphoria if they say they're trans" is an effective diagnosis method, why is it getting so many apparent false-positives? If "gender identity" is an inborn trait that people have an internal sense of, how are all these people getting it wrong? Why don't they just feel "gender dysphoria" the first time someone calls them "he" and immediately stop? For those who think they're not false-positives, why does it seem to so obviously spread socially? If the answer is something like "because the born-trans members felt more comfortable coming out", how does it get such absurdly high rates among not-very-selected subgroups? If 40% of a classroom in a private girl's high-school comes out as trans, does that mean we should believe 40% of all women throughout the world and all of history are closeted transgender people? I don't think you have be certain about whether you think "inborn transgenderism isn't real" or "inborn transgenderism is real but 99% of post-surge ones are false-positives" or "more than 1% are real but there's a large fraction of false-positives" to point out the ways the dominant theoretical framework and treatment methodology doesn't really make sense. Nor is there going to be a lot of a agreement on those among critics. Also "Are there a group of people with an inborn 'wrong gender identity' disorder that is best treated through gender transition?", "Are those people 'really' the other gender?", and "Would it be best if society did X to encourage or enforce classifying them as the other gender?" are three different questions.
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