The UK news organization, Daily Mail, reported that seeing trans people on TV caused young people to seek out medical transition.

Except, no, the actual research didn’t.

First, let me link to what I’m talking about:

• The Daily Mail story
• The actual research study

Science reporting is notoriously awful (ironically the linked paper also mentions the Daily Mail’s bad reporting of another science issue, the false link between the MMR and autism that destroyed public confidence in vaccines). There isn’t a simple reason for this, but it is worth looking at.

What did the research study actually study?

Looking at the paper, published in the JAMA Network Open “open-access” journal (which does have active peer review and is reputable), this research looked at the number of referrals received by a UK and an Australian children & adolescent gender clinic. In those state-run healthcare systems, these are the primarily organizations that provide medical transition services for part of their country. We know that the number of people seeking help for medical transition has risen over time, and there is a lot of curiosity (and politically-motivated theories) about why this is the case.

The research study asked a very simple question — and, of note, this is the only question the paper addressed with data: Do we see more referrals of young people to these clinics after local news media publishes a transgender story.

There is some nuance to how they defined a transgender story, but we’re essentially talking about news stories. In fact, they used Google News to do the searches (exact search terms are in the article) for local news.

What did the study find?

The study found that, at least in the short-term (1–2 weeks), there may be an association between referrals to gender clinics and the presence of more local news stories that talked about trans people, but no significant correlation after 2 weeks passes. That’s it.

The study did propose some theories as to why this might be — but it’s important to note that these theories were not proven, nor was the question about “why” even asked by the research.

What Were the Theories?

The study proposed three.

The Media’s Role in Facilitating Identity

First, that young people explore and learn about their identity through news media. I know I’ve heard many older (and wiser) lesbians tell me that when they were young they didn’t know there was a word for their sexuality. Once they learned that word, they could identify that way.

This is definitely a plausible explanation for part of the increase in apparent transgender prevalence. We know Autism diagnosis is significantly higher today than it was 40 years ago, but there isn’t actually an explosion in the number of autistic people, just the number recognized. This was studied extensively, just as the apparently growing prevalence of trans identity is studied today. Some false leads were followed — as well as out-and-out fraud for monetary gain that tapped into parents’ fears (such as Andrew Wakefield’s fraudulent MMR study). But other theories emerged, such as changing diagnostic criteria that now more fully recognize the diversity of autistic experience has allowed more children to receive an Autism diagnosis. Likewise, the criteria used by medical providers has changed over the last decades. For instance, a person wanting to transition to male, who was also attracted to men and not women, would routinely be denied treatment. You had to be straight to be trans! This of course isn’t the only change.

So, sure, seeing that this thing called “trans” exists on the TV news might help someone recognize they are trans.

The Media’s Role in Educating about Medical Services

If you’re reading this article, you probably already know that hormone therapy and surgical procedures can change someone’s body from having the traits of one sex to having the traits of another sex.

But, where did you learn that from? When did you learn it? Did you learn that hormone therapy was available for trans people from school? Probably not. From your parents at a young age? Also, probably not. I venture that most people learned about this possibility from TV. If you’re my age, you might have first seen it on the Phil Donahue show. And, once you heard about it, you might ask yourself, “Why would someone do that?” If you knew the answer, you might ask yourself some hard questions too.

Likewise, 20 years ago, if you’re old enough, what did you envision a trans person’s life like? I know what I envisioned: someone who was homeless, jobless, and lonely. Someone seen as “crazy” by the world. There wasn’t much attractive about that, so I pushed my identity down into myself, despite my own unhappiness. When I saw trans women living good lives, with people who loved them, in a comfortable home, holding a steady job, that rocked my world. Suddenly I didn’t have to choose only between being happy with my identity or being part of society. I had a third option where I could do both. And seeing that in the news could likewise be powerful.

I’ll add that I have one criticism of the study here: the study’s bias, written by researchers in the medical community, is clear through omission: not once in this section is the possibility addressed that medical professionals might see the media inclusion of trans people and think, “Oh! I wonder if that kid I saw last week is actually a girl, like the child was saying?” There is still a lot of the medical community that isn’t fully educated on trans people’s existence. But, regardless, this is theory and neither the study or me provided any data in this section.

The Media Reflecting Society

The third possibility proposed for the increased diagnostic rate is that society may be becoming more tolerant of trans people. Here, I find this topic’s inclusion in the paper to be somewhat illogical and tangential.

Interestingly, this section talks about the reason we see more referrals, but doesn’t actually directly relate to the study’s question — the study was looking for an association between local news and increased referral rate, in short periods of time, while society’s acceptance likely is slower and more steady. I.E. you measure society acceptance in a timeframe of years, not in timescales of weeks like this study examined news articles and referral rates. Nevertheless, the study, for whatever reason, includes this theory not as an explanation for the study’s results, but as an explanation for the overall observation of increased referral rate over a period of years.

The relevance of increased social acceptance (I.E. portrayals in fictional films and TV series among other evidences of acceptance) to media coverage was also discussed, although, as I mention above, this is not likely linked to the question examined by the study, but a different question, namely, “Why is there more media coverage on trans issues? Is this a cause or effect of something?” That’s an interesting question, for sure, but it’s not actually what the study examined!

What Suggestions for Further Research are Presented?

I remember my science fair projects in Junior High: If you wanted to do good science, you always said, “Further research is warranted.” It was kind of an easy out to answering the hard questions! That said, it is true that good research usually leads to additional questions, so I say this mostly in jest.

The study also suggests some directions for further research, such as examining media impacts on different groups within the trans community, and their referral rates to medical services. For instance, is it possible that media portrayals have had more impact on trans men than on trans women? Where do non-binary people fit? Certainly, media portrayals have changed significantly over the years. When I grew up, if there was a news story on a trans person, it would have been on a trans woman. Today, it’s just as likely to involve a trans man or a non-binary person, which is clearly a significant change.

Finally, the study suggests research into types of media coverage. Is negative coverage of trans people associated with increased referrals, for instance?

So, Okay, Why Are You Upset at the Daily Mail’s Coverage?

Let’s start with the headline of the article:

An increasing portrayal of transgender characters on TV is ‘fuelling rise’ in the number of young people seeking medical help to change sex, says a leading expert

Unfortunately for the Daily Mail, that isn’t what the experts writing the article said. While I realize that headlines are distinct from the article, and often created independently of the article, by people who didn’t write the article, headlines are also a major take-away by many members of the public. Indeed, they set the tone under which the article is read.

The Daily Mail article itself also goes into this in more detail, saying:

Polly Carmichael, who is head of Britain’s leading trans clinic for children, said that programmes such as Orange Is The New Black, Transparent and Butterfly helped ‘normalise gender diversity’.

Polly Carmichael is indeed one of the authors of the paper (although I’ll note it’s unattributed as to which author actually wrote what parts of the article, although, presumably, she agrees with what was written in the research paper — but it’s interesting that this Mail article attempts to frame the entire article as primarily the thoughts of Ms. Carmichael). So what does the paper say about Orange is the New Black and Butterfly? From the research paper:

…It is likely that TGD-related [Transgender and Gender Diverse] media has improved the recognition and acceptance of gender diversity in wider society, and this may have helped to create an environment that fosters referrals. For example, the increasing media portrayal of TGD individuals not only in real life (eg, Caitlyn Jenner and Chelsea Manning) but also in popular fiction (eg, in television shows, such as Transparent and Orange Is the New Black) is likely to have helped not only create an incremental shift in public awareness but also normalize gender diversity.

This is from the section of the paper talking about greater social acceptance of trans people being a possible long-term reason for the increase in referrals. It’s a hypothesis, not a proven fact, and, as is clear from the presentation of three different reasons for increased referrals, only part of the picture. But this isn’t too far off from the Daily Mail article, although the Mail does lack some nuance. However, the Daily Mail article also said this, before talking about Orange is the New Black:

The increasing portrayal of transgender characters on TV is fuelling a dramatic rise in the number of young people seeking medical help to change sex, a leading expert has said.

Simply put, the article doesn’t say anything about this “fuelling” a rise, certainly not a dramatic rise, and doesn’t draw this conclusion. A more accurate statement would be “The research posits that part of the reason for the rise in recognition of trans people may be increased social acceptance, as seen through popular media.” But again, this is unproven and not actually the subject of the study! A reminder about correlation vs. causation is also relevant: Was a show like Transparent created because there was increased social acceptance, because there was increased prevalence of recognized trans people, or was it the cause of one of these things? We don’t know.

However, the Mail article is clearly designed to scare people: Paraphrased, “if your kid watches Butterfly, your kid will be trans-ed.”

Indeed, the Mail article also mentions social contagion, an unproven hypothesis hyped by, frankly, badly done research lacking appropriate controls for bias (it reminds me of much of the research cited by anti-vaccine people, but that is for a different article). Nonetheless, the research paper also mentions this, and a comparison of the passages is enlightening.

From the Daily Mail:

And [Carmichael] claimed exposure to social media could be persuading some children to ‘erroneously’ believe they are transgender.

Followed a few paragraphs later by:

‘Increased media content (specifically via social media) might act as a double-edged sword or a means of social contagion… whereby some individuals erroneously come to believe that their non-specific emotional or bodily distress is due to gender dysphoria and being [transgender],’ [the paper]says.

This is presented as if Ms. Carmichael believes in the social contagion theory. What does the research by the six authors (including Ms. Carmichael) actually say? Here’s the relevant bit from the research paper:

However, we are also mindful that others have speculated that increased media content (specifically via social media) might act as a double-edged sword or a means of social contagion, whereby some individuals erroneously come to believe through exposure to such media that their nonspecific emotional or bodily distress is due to gender dysphoria and being TGD. Here, the implied outcome is that such individuals will then access gender-related medical interventions and eventually come to regret these once they realize that they are in fact not TGD. Historically, rates of regret are very low among patients attending relevant gender services. For example, among almost 4000 patients who attended the VU University Gender Clinic in the Netherlands between 1972 and 2015 and received medical treatment, only approximately 0.5% were identified as having regret, and there was no evidence that regret rates had increased over time. Nevertheless, as clinicians working in this field, we are highly mindful of the risk of regret throughout the assessment and treatment process, and it will be important to continue not only to provide adequate counselling before such interventions are undertaken but also to observe whether regret rates increase in the face of greater media attention and more referrals.

So, essentially, the authors say that others have speculated about this (perhaps the authors don’t share in this speculation?). In addition, the authors then reference another study that is fairly recent looking at data from 1972 until 2015, which substantially overlaps with the the current study (looking at data from 2009–2016), found low rates of regret and, indeed, no increase in regret — even though we know there was an increase in referral rates in the UK and Australia from the current study.

The authors are saying, “Ya, we know there is someone out there claiming that there is social contagion in trans people, and this will lead to a huge spike in regret, but we actually know of research that studied regret, which does not show that.”

In addition, the Mail selectively quoted the authors talking about what other people believe as if the authors (and, specifically one of the authors, as if the other five are irrelevant) themselves believe this. That’s putting words in the researcher’s mouths. Possibly this is due to journalistic incompetence, but also possibly this is due to a political agenda. I’m not sure there is a third possible reason for the Mail’s bad journalism here.

What Does the Mail Say About the Study’s Results?

Absolutely nothing.

Really. Absolutely nothing.

The Daily Mail article doesn’t tell the reader what research question was examined (remember, the question is whether news reporting is associated with increased referral rates). It doesn’t devote even one word to the thing the researchers actually studied and reported in the paper!

Nor does it talk about their results: news coverage is associated with higher referrals, at least in the first couple weeks after the story is published. Indeed, even the Mail’s article here would be such a story that might be associated with increased referrals! But, instead, the Mail talks about Butterfly, which isn’t local media coverage and thus outside the scope of the research (although the Mail article is within scope).

That someone would report on a research study, while not devoting even one word about the thing studied or the results, is not surprising, but one does wonder about the motivation for this type of reporting.

Certainly, it could be the result of an agenda.