Did Big Pharma Invent Trans Girls? Let's Read: Bob Ostertag's Sex, Science, Self. A Social History of Estrogen, Testosterone, and Identity.

Sex, Science, Self, as a piece of scholarship, is a work I deeply disagree with. But to say that would be too kind for it, for it would imply a possibility of productive contention, but there is very little chance for that, because above all else, Sex, Science, Self as a piece of scholarship is just plain bad, and I can't believe that I've typed almost 18.000 words about it just to arrive at this most tepid conclusion.

this might be the most hurtful thing you can say about a work
 
What a banger, not even a page. But I want to elaborate on this:
Similar issues abound throughout Sex, Science, Self. To give another example, Ostertag mentions Iran in his analysis, and its high rate of sexual-reassignment surgeries (p. 136-138). In doing so, he repeats the popular media myth of the fact that this rate must be attributed to forcing such surgeries upon gay people, a myth that Najmabadi characterizes as a:

So, I am personally in Iranian studies, and my education in fact focuses on modern Iran despite my personal affection and greater interest in classical Iran. I was shown screenshots of what, precisely, Ostertag had to say about transition in Iran and to say it made me raise an eyebrow is perhaps something of an understatement. I managed to acquire a pdf of the book for myself, and investigated his sources, which seem woefully lacking in actual data. To source the incredible claim that Iran does forcibly transition homosexual people, he claims a fetva from Khomeini issued in 1987, though his writing makes it seem to appear as if it was part of the very platform of the declaration of the Islamic Republic of Iran though he does not in fact source this text. Indeed, his only source is a documentary movie, which seemed to me rather strange for such an extraordinary claim.

Now, if Ostertag had done his research, he would have known that a universal aspect of any fetva is a petitioner, or a questioner. That is to say, the fetva or religious ruling is issued in response to a question. In some cases this can be as simple as Sistani's ruling that it would be permissible to depict the Prophet or his companions, as long as it was respectfully done, in a movie in response to a question inquiring as to that or it can be, in Khomeini's question, a trans woman having been beaten and bloodied by his own guards begging him to consider her as a woman and a Muslim. Her entire appeal is rooted in the essence of her womanhood, and indeed in the femininity of her soul. As far as I know, having skimmed the text of Khomeini's fetva in Persian, he at no point claims that homosexuality can be "cured" with gender affirming procedures such as hormone therapy or surgeries and indeed the examples of Iranian scholars he gives are all strictly against this.

To expand on this, he cites the well known Hojjatoleslam Mohammad Mehdi Kariminia as a "leading expert on transgender theology". This is wrong. Very little of agha Kariminia's work is in any sense involved with "theology", but rather with the strictly legal status of trans people within Islamic law. He is a legal expert first and foremost. The entirety of Karimi-nia's position is in fact built on maintaining a wall between homosexuality and transgenderedness. In fact, Karimi-nia is perfectly aware of how homosexuality can exist on the margins of the Iranian transgender community, he considers this an unfortunate consequence, not a desired result. In fact, if he had done his research, he would have become familiar with the fact that the stories of the Iranian state's compulsory transitions originate likely as garbled versions of how some gay men (and women!) get a "certificate of transsexuality" from the Legal-Medical Organization of Iran to confirm their gender and then go on to live otherwise normal homosexual lives. Karimi-nia's position specifically is that this cannot be overruled, and in fact should not be because some trans people consider that all they need to live their lives. It is in fact the purest expression of what Ostertag otherwise refers to as "celebrating different expressions of gender". But his blinkeredness and lack of willingness to do any kind of research on this topic shows that he was not in fact, truly interested in this topic for its own sake.

Again and again, we return to the fact that Ostertag has simply not done his research. Najmabadi's work, which came out in 2013, in fact illustrates the suspicion which some Iranian psychiatrists show towards "transsexuality" despite the state's supposedly friendly attitudes towards (binary) transgenderedness on paper, and reports psychiatrists just as gatekeeping about it as you might see in Europe or elsewhere. One trans woman reports being forced to attend what might effectively be called conversion therapy with a psychiatrist who did not believe that transness was truly possible for over thirty sessions until her father threatened that he would sue, at which point she was permitted to begin on hormone therapy. And indeed, the other example that Ostertag cites is an unnamed, unsourced leading surgeon in Iran who specializes in gender confirming surgeries, likely vaginoplasties given the he/him pronouns used in the English translation as Persian does not have gendered pronouns. This surgeon specifically mentions that his way of discovering if someone is a "true" transsexual is through describing the surgeries in detail, emphasizing the harm that they cause and the pain that can result afterwards. To him, a "true transsexual" would enjoy this and embrace it while a homosexual would flee or panic. Again, this shows that the state and legal-medical complex of Iran is deeply and strongly invested in maintaining a difference between transsexuality and homosexuality. A Great Wall of China as Karimi-nia described it in his discussions with khanum Najmabadi.

And yet! He still concludes, despite mounting evidence against his position and despite the listing of transsexuality under ekhtelat-e hovâyat-e jensi (Gender Identity Disorder) in Iranian psychiatric manuals and despite the double negative (I will get to this) in Khomeini's fetva which he so cites, that the Iranian state must, as an extension of the Big Pharma he so fearmongers about, be forcibly transitioning homosexuals due to his own inability to see beyond the "born this way" homosexuality defence. It is plain bad scholarship.

And all of this despite the fact that if he had bothered to actually cite and read Khomeini's Tahrir al-Wasilah, he would find that:

Article:
The prima facie [al-zahir] view is contrary to prohibiting the changing, by operation, of a man's sex to that of a woman or vice versa; likewise, the operation [in the case] of a hermaphrodite is not prohibited in order that s/he may become incorporated into one of the two sexes. Does this [sex change operation] become obligatory if a woman perceives, in herself, the inclinations which are among the type of inclinations of a man [literally the root/origin inclinations of a man], or some qualities of masculinity; or if a man perceives, in himself, the inclinations or some qualities of the opposite sex? The prima facie view is that it [sex change] is not obligatory if the person is truly of one sex, and changing his/her sex to the opposite sex is possible (volume 2, 753–55).
Source: Tahrir al-Wasilah


If he had been, in any way, shape or form, interested in what he was actually studying, citing and sourcing, he would have known that this exact double negative of "contrary to prohibiting" and "not obligatory" is in fact cited in Iran, by Iranian trans people and homosexuals, as well as parts of the medico-legal-religious establishment, to permit this form of "transition without hormones" and nowhere in any sense of the word demands the forcible transition of homosexuals. But either because of an incapability to conceive of why this would be beneficial or plain scholarly laziness, he chose not to do this, despite the options being available to him, and instead produced a piece of plain bad scholarship. It has committed one of the worst sins that an academic book can commit; it is not interesting.
 
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Also, this is a small, petty aside, but this book contains one of the most baffling arguments against insurance covering gender affirming care I have ever seen:

Article:
Anyone who would argue against health insurance for transgender care should know that the list of available technologies is expensive. If health insurance does not make these technologies available to those without the means to pay for them, there will be an increasingly visible divide in the transgender world between those whose appearances reveal that they were able to pay for more and those who could afford less. This will happen in any event, as it is extremely unlikely that insurance will ever cover all the available options, which continue to expand. So this visible class divide will become more pronounced one way or the other. But without health insurance it will become much more so.
Source: p. 165


I tried to keep this sort of reaction to minimum in my commentary, but since it is concluded, I can let myself go a bit and say, from the bottom of my hear, the single word that needs to be said here:

bruh
 
Also, this is a small, petty aside, but this book contains one of the most baffling arguments against insurance covering gender affirming care I have ever seen:

Article:
Anyone who would argue against health insurance for transgender care should know that the list of available technologies is expensive. If health insurance does not make these technologies available to those without the means to pay for them, there will be an increasingly visible divide in the transgender world between those whose appearances reveal that they were able to pay for more and those who could afford less. This will happen in any event, as it is extremely unlikely that insurance will ever cover all the available options, which continue to expand. So this visible class divide will become more pronounced one way or the other. But without health insurance it will become much more so.
Source: p. 165


I tried to keep this sort of reaction to minimum in my commentary, but since it is concluded, I can let myself go a bit and say, from the bottom of my hear, the single word that needs to be said here:

bruh
That's supposed to be an argument against insurance? It reads like a (somewhat muddled) argument for it.
 
As far as I can tell, Ostertag does not come either in or against explicitly, but it is clear from the text that he believes that providing medical insurance for gender affirming care is highly problematic on several grounds; tellingly, he does not stop to consider the way it may be actually beneficial to trans people, as he remains generally suspicious of the possibility of a transition in general. But he also fumbles with a lot of those arguments that can be trivially re-read as cases for health communism.

But, really, this book takes the heck off in its conclusions. One reviewer has affectionately termed it as anxious and paranoid, which I do not think is entirely unfair.
 
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This is likewise visible in the way that Ostertag curiously refuses to actually discuss the experiential side of hormone usage among trans people. Much of his book is devoted to establishing—and successfully, I believe—that a lot of our knowledge about what hormones do is built on weak foundations, and that even the assignment of "sex" to those hormones is a cultural process. In doing so, he constantly suggests, though never fully states outright, that he does not believe that hormones have any beneficial effects, or, to be more precise, any "true" effects. This is evidenced by his decision to use the word "transition" as always surrounded by scare quotes, a decision which he himself admits that:

Article:
I am painfully aware that there are many in my own community who will take offense when I put "transitioning" in scare quotes, as I have done throughout this book. This is not my intention and I mean no disrespect. But to take the scare quotes away would be to accept the claim that testosterone and estrogen are substances that cause gender to transition.
Source: p. 165


Again, setting aside the fact that disrespect not meant is not a disrespect not evidenced, it is hard not to frown at the implications here. Ostertag seems to operate under the assumption that trans people believe that hormones are what transitions their gender, and that they are in fact the essence of transitioning. I understand that this claim is possible to defend using a motte-and-bailey routine, where one notes that what is criticized here is the centrality of hormones to trans conceptions of their gender, not the idea of transgender life itself, but I am profoundly uninterested in engaging in such games. The problem is that Ostertag fundamentally misunderstands what trans people get out of hormone use, or why do they take them in the first place. He does not stop to ask, instead believing that there is a perfect congruence between the medicalized vision of transsexuality and trans people's own self-image; just as importantly, he does not actually wonder why so many trans people feel like being on HRT is effective.

This is a bit that really stood out to me in the previous posts you'd made too: Ostertag seemed to describe the transgender view of sex hormones as an end in themselves, rather than the means to an end.
 
This book sounds horrific.

Anyway, the dude was doing interviews for a Podcast titled "Gender: A Wider Lens" run by Genspect and ReIME (which is mostly just Genspect again it seems) in 2022 so, like, I'm not inclined to be particularly charitable or sympathetic.
 
What an absolutely tedious book. I thank you for your effort and insight that's saved the rest of us from having to read it.
 
What an absolutely tedious book. I thank you for your effort and insight that's saved the rest of us from having to read it.

Let's be real here, since this is a monograph put out by an academic press - and not a high profile academic press, either - which got basically zero publicity outside of the really deeply baked academia-minded GC crowd, no one here was going to read it anyway.
 
Honestly, I am yet to meet a person who has. Ostertag, as far as I can tell, is mostly known for his musical and artistic contributions, not for his scholarship. Since 2016 he has been featured on some podcasts and like in the GC info-space, but does not seem to have made the jump towards being a career Man With Some Concerns, so in the grand scheme of things, this really is just irrelevant. I am just sad because I was really looking forwards to a comprehensive study of HRT written foreground a trans perspective that has not been written by Paul B. Preciado. It is kinda funny how equivalent book exists for facial feminisation surgeries, of all things, but not for taking titty skittles.
 
Article:
But there's more. Estrogen and testosterone, the so-called sex hormones, have become important to the queer community for reasons that go far beyond their use in transgender "transitioning." The idea that queers are "born that way" because of prenatal exposure to "sex hormones" has become the foundation on which many of the social and political claims of the community rest—enshrined in judicial rulings, legislation, health insurance policies, and medical practice, emblazoned on t-shirts, banners, and placards, and sung in pop songs. Few are aware that the science behind this claim, currently known as "brain organization theory," is shaky to nonexistent. Even fewer are aware that this same research is routinely invoked for social and political ends many would find appalling. When Lawrence Summers, one of the most powerful men in the nation and at the time the president of Harvard University, provoked a furor by arguing that men outperform women in math and science because of genetic differences between men and women, he was invoking exactly the same research used by queers to claim that they too are "born that way."
Source: p. 1-2



Huh. First off, love the essay, but I'm having a bit of trouble.... wrapping my head around this block of text. And your response that he's making a claim about it is really confusing to my non-academic brain. Like, the guy is clearly, very wrong in some parts, but there's just some parts of the book that I'm having trouble even parsing as a paragraph.
 
Article:
But there's more. Estrogen and testosterone, the so-called sex hormones, have become important to the queer community for reasons that go far beyond their use in transgender "transitioning." The idea that queers are "born that way" because of prenatal exposure to "sex hormones" has become the foundation on which many of the social and political claims of the community rest—enshrined in judicial rulings, legislation, health insurance policies, and medical practice, emblazoned on t-shirts, banners, and placards, and sung in pop songs. Few are aware that the science behind this claim, currently known as "brain organization theory," is shaky to nonexistent. Even fewer are aware that this same research is routinely invoked for social and political ends many would find appalling. When Lawrence Summers, one of the most powerful men in the nation and at the time the president of Harvard University, provoked a furor by arguing that men outperform women in math and science because of genetic differences between men and women, he was invoking exactly the same research used by queers to claim that they too are "born that way."
Source: p. 1-2



Huh. First off, love the essay, but I'm having a bit of trouble.... wrapping my head around this block of text. And your response that he's making a claim about it is really confusing to my non-academic brain. Like, the guy is clearly, very wrong in some parts, but there's just some parts of the book that I'm having trouble even parsing as a paragraph.

It is an exceedingly poor argument that relies purely on the strawman and guilt-by-association fallacy without presenting any actual evidence. This seems to be a common flaw in his work as there doesn't seem to have been much effort to research the subject material and search for evidence that can support or disprove his hypothesis. The book seems more like a pseudo-scientific/scholarly justification for what the author already believed rather than the product of a genuine search for truth.

On a more specific problem with the presented paragraph: I can't understand why he is claiming that "prenatal exposure to sex hormones causes people to be born homosexual" is key to the LGBT community because this is the first time I have heard this specific medical justification be called a foundation for the "born this way" phrase. My understanding is that "born this way" was primarily used by the LGBT community to reject the bigoted depiction of homosexuality as a choice that could be "fixed" and there have always been a wide variety of perspectives on the forces that shape human sexual identity. The brain organization theory was only one of many perspectives and never had a dominant position in cultural discourse or legal practice.

Am I missing something here or is it another case of the author being completely wrong about his subject material?
 
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