Science Will Not Save Us: Medicine, Research Ethics, and My Transgender Body

Earlier this year, Dr. Keith Ablow — a member of Fox News’ “Medical A-Team,” whatever that is — argued that, in his estimation, there is no scientific evidence supporting the existence of gender dysphoria. “I don’t believe,” he wrote, “we have definitive data… that any male or female soul has ever in the history of the world been born into the wrong anatomic gender.” Days later, writer and activist Brynn Tannehill took to The Huffington Post to refute Dr. Abbow’s claims, pointing to more than a dozen studies that suggest there may, in fact, be a biological basis for feelings of discomfort with one’s anatomical or assigned sex. As Tannehill argues, “the body of evidence showing biological origins of gender dysphoria, of having a mis-matched brain and body, is overwhelming.”

Indeed, the proliferation of research confirming a biological foundation for gender dysphoria (the diagnosis of which is often a necessary prerequisite for hormone therapy and other supervised medical interventions for trans folks) has become a staple of trans advocacy, both formally and informally. Agreement in the scientific community on a biological foundation for gender dysphoria stands to give trans folks its own “born this way” argument; it offers, at least superficially, vindication of the familiar trope of trans folks feeling “trapped in the wrong body.” The science is on our side, I’ve been told. The growing “body of evidence” emerging from biological and medical research, according to some commentators, speaks loudly and clearly: transgender people exist, science says.

Of course, we already knew that. On a deeply personal level, I’ve never needed a “body of evidence” to confirm the existence of my own transgender body.

In saying this, I do not mean to seem anti-science — I’m actually a big science fangirl! I marvel at my friends who are neuroscientists, awed by their ability to navigate the complexities of the human brain. I devoured recent stories covering the successful implantation of lab-grown vaginas, fascinated by regenerative medicine and its benefits. With regard to my trans sisters and brothers, I certainly do not deny the value of a robust scientific understanding of our particular medical needs. Research that points towards more effective interventions (hormonal or otherwise) is vital to improving the trajectory and quality of our lives. Moreover, I actively welcome any defensible “body of evidence” that can help persuade gatekeepers of all sorts that access to appropriate mental and physical care is necessary to alleviate the pain and anguish that marks many of our lives, as was the case with the recent overturning of Medicare’s ban on transition-related healthcare.

But, like any good fangirl, I am also critical of the enterprise. I’m especially critical of any overreliance on scientific evidence to validate the existence of trans identities — not because science is bogus, but because science (like any professionalized endeavor) is defined, in part, by what it excludes. It relies on certain practices, discourses, and “ways of knowing” in order to distinguish itself from, say, religion or the humanities. Or, you know, alchemy. But these “ways of knowing” do not appear out of nowhere — they are the result of centuries of social, political, and historical development. Simply declaring “science is on our side” flattens an otherwise diverse terrain of politics and history that inform different branches of science and its sub-fields. Any responsible approach to folding science into advocacy efforts should not only understand what scientific research says, but how and why it came to say what it does. For those interested in trumpeting a biological basis for gender dysphoria, this means understanding the history and limits of medical research in particular.

“Ontological” Limits of Medical Research

One of the limits of medical research for understanding trans people is ontological. If you went to college, you might remember being terrified by the term “ontology” and its metaphysical connotations (The Study of The Nature of Being and All Existence or Whatever). In less intimidating terms, an ontology is a particular way of identifying things and describing how those things relate to one another. Different domains employ different ontologies to make sense of the world — they name and arrange things in different ways, they allow for certain relationships and not others, and they render invisible those concepts or objects that do not fit into its scheme. In short, ontologies represent conditions of possibility: they set rules for what can and cannot possibly be within a given domain.

But ontologies are not born out of nothing. Instead, they emerge from (and are shaped by!) the active, open-ended, and everyday practices of the world they purport to describe. Annemarie Mol has referred to this process as one of “ontological politics” that influence how “problems are framed, bodies are shaped, and lives are pushed and pulled into one shape or another.” In the context of medical research, trans bodies are shaped by a variety of practices and tools — they are enacted through data gathered by researchers, as well as the instruments, languages, paperwork, statistical methods, and work structures that allow medical researchers to make sense of their data. In the clinic, trans people are shaped through a different set of practices and tools. In this setting, my transgender body is still shaped by instruments and paperwork, but they’re different instruments and paperwork. Rather than dealing in more or less comprehensive datasets, there’s just the one data point (me, waving “hello!”).

Of course, these different ways of shaping trans bodies are not mutually exclusive — they frequently come into contact with one another, like when my hormone levels are evaluated according to “standard” (or “desirable” or :: shudder :: “normal”) levels as determined by medical research. If my hormone levels fall into a desirable range, then the clinic and the research lab coincide. But if my hormone levels fall outside this desirable range, the two different contexts come into conflict — and it is in this conflict that different possibilities do or do not present themselves. If I don’t match some standard set by the research lab, I might want to make adjustments to my medication in order to move closer to a desired range. Or, if I report feeling great and being happy with my progress in spite of my hormone levels — and if my doctor confirms that there is no other immediate threat to my health — we might decide not to change anything, in which case I will continue on with my life despite falling — hormonally, at least — outside of a “standard” or “normal” range.

These same continuities and conflicts play out when it comes to research into the origins of gender dysphoria. If I were to report feeling like “I have a girl’s brain trapped in a boy’s body,” then my account is roughly continuous with medical research suggesting that, indeed, a brain can follow a developmental pattern similar to that of females while the rest of the body develops along a path typical of males. If, however, I were to reject that familiar trope and instead say that “I didn’t hate being a boy but I like being a girl better,” the connection between my own account of my identity and scientific descriptions becomes less clear — in fact, it might even be seen as conflicting with the understandings that emerge from medical research. Put another way, the former description is easily reconciled with the ontology of medical research while the latter comes into conflict. But a problem arises when we seek to reconcile this conflict: which account “counts?” Which account is considered valid? Which one is dismissed?

Dominance of Scientific Explanations

Most often, the account offered by medical research wins out. Science — of which medical research is only a part — carries a lot of currency in our post-Enlightenment world. It is built on proven methods, employs transparent procedures of evidence, and is confirmed through rigorous testing and peer-review (ideally, at least). And this certainly isn’t a bad thing! Our lives and understandings of the universe have been greatly improved in some ways (she says, estrogen pill dissolving under her tongue as she types on her laptop computer). Of course, “bad science” gets through, but we’ve got people looking out for that (as Julia Serano so excellently does). But, as feminist discussions of science, technology, and knowledge have long pointed out, being critical of science goes beyond simply challenging “bad science.” It also also means attending to the ways in which established methods, procedures, and peer-review structures might be otherwise biased. As Sandra Harding has put it, we need to pay close attention to “the problematics, agendas, ethics, consequences, and status” of science as it is commonly understood. As a student of both moral philosophy and science and technology studies, I’ve watched and cringed as scientific explanations for my transgender identity have been picked up and wielded without complication, without regard to consequences or ethics.

One consequence of adopting scientific explanations is that other, non-scientific accounts either need to be reconciled with science or they get pushed out entirely. Perhaps no recent example better illustrates this than when the otherwise awesome Neil deGrasse Tyson dismissed philosophical inquiry and “deep questions” as “distracting” for the contemporary scientist. If humanistic speculation or questions of ethics get in the way of scientific progress, Tyson seemed to be saying, they should be left behind.

But, while scientific discourse is often totalizing, its understandings of the world aren’t total. Nonetheless (and as evidenced by Tyson’s comments), science tends to obscure or reject those things or explanations that don’t fit its ontology. To demonstrate just how forceful scientific explanations can be — and what they are capable of obscuring — consider Greg Grandin’s recounting of the aftermath of the voyage of the Joaquín, a Portuguese slave ship that saw the death of 270 kidnapped East Africans while sailing between Mozambique and Uruguay in 1803:

“City officials convened a commission of inquiry to explain the deaths…, calling on the expertise of five surgeons — two British doctors, a Spaniard, a Swiss Italian, and one from the United States. The doctors testified that before boarding the Joaquín, the captives would have felt extreme anguish, having already been forced to survive on roots and bugs until arriving on the African coast emaciated and with their stomachs distended. Then, once on the ocean, crowded into a dark hold with no ventilation, they would have had nothing to do other than listen to the cries of their companions and the clanking of their chains. Many would have gone mad trying to make sense of their situation, trying to ponder ‘the imponderable.’ The surgeons decided that the East Africans had died from dehydration and chronic diarrhea, aggravated by the physical and psychological hardships of slavery — from, that is, what they called ‘nostalgia,’ ‘melancholia,’ and ‘cisma,’ a Spanish word that loosely means brooding or mourning.”

Note that the scientific explanation for the deaths was dehydration and chronic diarrhea — not, you know, being forced into slavery and made to cross the ocean under inhumane conditions. While the explanation given by the surgeons is clearly rooted in prevailing racist attitudes, it also demonstrates a consequence of adopting scientific explanations for things: medical descriptions move to the fore and social or political explanations are pushed out. Later, Grandin also shows how “slavery helped in what might be called the disenchanting of medicine, that is, how concepts like melancholia cited by the surgeons were taken “out of the hands of priests, poets, and philosophers” and given meaning in a medical context (Ann Cvetkovich has offered a similarly enlightening discussion of melancholy being medicalized as depression). And this is the risk of an overreliance on scientific explanations: in order to preserve its ontology, science forestalls, co-opts, or transforms understandings that do not square with the ways in which science makes sense of the world.

Uneven Distribution of Science’s Benefits and Burdens

It must be pointed out that my choice of illustration above is a challenging one. As a white transgender woman, it would be disingenuous of me to summon or co-opt an example of racialized violence in order to support an argument that isn’t specifically about communities of color. Recognizing this challenge, however, reveals a further problem posed by the appeal to scientific explanations for justifying trans identities: it is a bad foundation upon which to build solidarity within the trans community, which includes people of color and the history of violence enacted upon them in the name of scientific inquiry.

Trans folks exist at the intersections of many different identities — racial, ethnic, sexual, socioeconomic, and beyond. Further, our trans identities relate to these other identities in complicated ways that are overlooked by any blanket appeal to scientific explanations. Not only does science have a tendency to muscle out other ways of knowing, but the benefits and burdens of scientific research (and medical research, in particular) have not been fairly distributed. Most often, marginalized racial, ethnic, and socioeconomic groups have shouldered a larger share of its burdens and reaped fewer benefits. Simply claiming that science is on trans folks’ side sweeps aside the ways in which the pursuit of scientific knowledge has been harmful to marginalized communities.

As the voyage of the Joaquín starts to suggest, modern medicine was built, in part, on the exploitation of enslaved populations. But you don’t have to reach back as far as the 18th and 19th centuries to find other examples; medical research has a rich tradition of exploiting certain populations well into the 20th and 21st centuries. Released in 1978, The Belmont Report — which sets out some basic ethical principles for research involving human subjects — was issued, in part, as a response to the horrors of the 40-year Tuskegee syphilis experiment. In the experiment, which exploited vulnerable populations of African-American men from 1932 to 1972, researchers sought to better understand the natural progression of syphilis in the human body — and it continued even after penicillin had been identified as an effective cure for the disease. Afflicted participants were denied access to the drug and, instead, researchers watched and took notes as many men suffered and died. Perhaps even more egregiously, the study continued even after the Nuremberg Code (an international code protecting the rights of research subjects formulated in light of the horrors of Nazi medical experiments) had been articulated at the end of the 1940s. Many of those complicit in the study’s continuance participated, in the words of John Heller, Director of the Public Health Service’s Division of Venereal Diseases, for “the glory of science.”

Even more recently, researchers at Arizona State University were reprimanded and fined for exploiting genetic material obtained from blood samples of the Havasupai Indians in the early 1990s. The samples had originally been gathered in an effort to better understand the devastation diabetes was causing the tribe. Later, however, samples gathered for the original study were reused for various other purposes, including “theories of the tribe’s geographical origins that contradict their traditional stories.” Again, scientific explanations risk squeezing out other ways of knowing. For the Havasupai, unsanctioned research into their DNA threatened to override and supplant native understandings of the tribe’s origins and history.

In deferring to the work of science and medical researchers, trans people and advocates run the same risk: we make our own forms of evidence vulnerable to the totalizing effects of scientific discourse. Uncritical appeals to medical research ignore the relevance of trans folks’ diverse and complicated racial, ethnic, and socioeconomic identities. Turning to scientific explanations in a quick or thoughtless manner alienates us from our own stories. Most importantly, the claim that “science is on our side” fails to account for the uneven ways the benefits and burdens of medical research have historically been distributed. If you’re affluent and white, then, sure, science has (usually) been on your side — if you’re not (if you’re black or indigenous or poor, for example), not so much.

Preserving Diverse Understandings of Ourselves

As Laverne Cox has consistently and forcefully reminded us: “There’s not just one trans story. There’s not just one trans experience.” Practically speaking, however, when we defer to science to validate the identities of trans people, we bulldoze diverse understandings of our bodies and our experience in favor of medicalized explanations of our existence. We risk supplanting our community’s own explanations for scientific ones. Ultimately, while medical research holds out the promise of new understandings and new therapies to improve the quality and trajectory of our lives, too heavy or too dogmatic of an appeal to science to validate our existence runs the dual risk of pushing out alternative ways of explaining ourselves while simultaneously hindering the development of solidarity throughout the trans community.

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Anna Lauren Hoffmann is a queer trans woman and scholar working at the intersections of information, technology, culture, and ethics. She holds a PhD from the School of Information Studies at the University of Wisconsin-Milwaukee. You can find her on Twitter or at annaeveryday.com.

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14 Comments

  1. Thumb up 10

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    THIS. Whenever I see anything about science “validating” trans people, I wince a little. As a trans woman who’s very much outside of the dominant narratives for trans women, I feel like there’s a lot of potential for research to undermine my understanding of myself. I think about doctors and therapists that might tell me that I’m not trans because I didn’t know I was trans from an early age, and I think about doctors in the future telling me I’m not trans because I don’t match the results of their studies. I’m also extremely pro-science and medicine, but I don’t need either to validate my identity.

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    Everything you’ve written is absolutely true. Accepting science as a singular authority can squeeze out other ways of knowing — and with a scientific tradition built on cis male domination, it’s no wonder that trans experiences are understood in limited and distorted ways.

    I often feel the same way about (white) archaeologists studying (non-white) cultures outside their own — like, they see the world through a specific lens, and everything they encounter gets chopped up, rearranged and molded down to fit the ideas they already held. I don’t know — it’s hard to express these sort of thoughts without coming off as anti-science, which I’m not. But you’ve managed to do so.

    This is just so well put. Really beautiful.

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    Scientific validation isn’t the end-all for trans* people and I totally agree with Anna here. Science might say that there is grounding for me to exist as a transgender woman, but it also, at one point, said that non-whites were inferior, lazy humans… I’m wary of science in this capacity.

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    Articles about science and minority populations always make me wanna cry.

    I am a scientist, and I love it. I love the methodology of experiments, I love interpreting data. My favorite thing about science? The only certain answer it gives is…”We have no idea!”

    I work in a lab right now, and my current project is poring through scientific journal articles–like, 150 articles–and in every single one, you NEVER see absolutes. It would be against scientific integrity to print an absolute statement. It’s always “this data indicates…” or “These results suggest…” You would never, ever say “This protein does ___” or “This is proven by…”. Every single article has a built in section to describe potential errors, biases, etc., as well as reasons for potential false positives and false negatives. You are very very not allowed to leave out ANY data, even if it seems erroneous or doesn’t fit a trend.

    And the most common conclusion? “Needs more studies”. No decent journal will ever print something that claims to be the end-all be-all of knowledge. There are so many examples of “The reaction did not give the results we anticipated, we don’t know why, oh well we’ll just have to do more studies.” Even if it’s frustrating, leaving out any gray-areas, inconsistencies, or ambiguities is akin to academic dishonesty.

    And yet, when it comes to studying people rather than, say, the protein phospholipid scramblase, it all goes to hell. Not so much maybe in the original study or article, but in the coverage and interpretation of it by other people, who want an ultimatum or cut-and-dry answer and often write one in where there isn’t one. The news media is NOTORIOUS for this. It’s not “science says” unless you’re reading the original study; if a third party is reporting it, it’s definitely being misinterpreted, even if only slightly or just through accidental oversimplification. Also, doctors are not scientists, either, and their interpretations of a study may be just as biased (purposefully or accidentally)as a news anchor’s. Double for doctors being paid to go on TV–no one gets paid as a medical expert to sit up there and say, “Oh, the data has no clear answer”.

    The way I think about it is that science, as a discipline and practice, is not inherently wrong and doesn’t need to be thrown out; it is those who interpret and report scientific findings who have obviously fallible human qualities. Science is just a tool–one that can be used for good or evil. :P

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    As I’ve discussed with several friends who do social science research, they are well aware of the limitations of these kinds of research studies; and yet the scientists who are most successful in these fields are the ones overstating their claims. Bad science sounds definitive and decisive, good science sounds skeptical and hand-wavey; bad science wins out.

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    All of this resonates nicely with my thoughts and experiences. If you enjoyed this, I strongly urge you to read My Words to Victor Frankenstein Above the Village of Chamounix: Performing Transgender Rage by Susan Stryker, and essay published now a staggering 20 years ago. Writings like that are exactly why I tell anyone who will listen that the entire concept of ‘natural’ is useless, and only employed as a weapon against outliers and minorities.

    Our existence, every person’s existence, requires no justification by a scientific explanation permitting us to exist and be real. We are, each of us, self-evident.

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    Ok first off, even though it shouldn’t matter, I’ll state for the record that I happen to be a trans woman and also one of the non-standard ones that is supposedly threatened by scientific explanations.

    Science is about systematically changing your mind in order to obtain more accurate predictive models of reality. THE WHOLE POINT is to discard inaccurate models as soon as you realize they don’t fit the evidence. If a scientist has a model of how gender dysphoria works and upon observing a trans persons who doesn’t fit their model they decide to ignore the trans person’s existence, THEY ARE DOING IT WRONG! A good scientist updates their model to fit with reality.
    You don’t get hormones, you don’t get laptops, if you can’t drop your beliefs like a hot potato and admit that the alternative “ways of knowing” are just plain wrong. Tradition, authority, group conformity, and plain old making shit up have all proven to be terrible ways of explaining anything, and have their own histories of promoting oppression. Science is done by humans who are full of biases, but with each passing generation scientists get better and better at weeding out the biases and cultural baggage that hinders it. Science has never claimed to be the 100% absolute truth and it knows that it never can (because perfectly modeling all of reality would be computationally intractable). Science can only ever be less wrong.

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    You are right, Anna, in that science is not a tool of validation. You exist and have made yourself visible to me by writing this article, that’s proof of your existence enough. The whole proving one’s existence thing is overrated, there is no ‘debate’ and cannot be. Debating the existence of people sharing your space and present in your life is either idiotic or hostile – and tbh it rarely happens to be idiotic.

    Where you are wrong is – science (actually i prefer ‘technology’ to emphasise the tangible, working realities of this world) will save you, has done that many times already and will do so in the future. You’re not Nature’s. You, dear lady, are Mother Technology’s own – hook, line and sinker. People who aren’t are called poets and dreamers. Or for that matter they’re called Emperors and get a stiletto in the back before coming of age, as you of course should know the story of it happening, at least now and then. Unfair and a pity, because such Emperors given time and means would have also become Technology’s own.

    Three of the five…i’d like to say ‘women’ but that wouldn’t be true because one is strongly gender non-conforming, so people …who defined me and my thought …happen to just so be trans women, like you. The five are Donna Haraway, her disciple Roseanne Stone, Susan Stryker with that same Frankenstein piece mentioned above, Elena Rose and Lepht Anonym (the last being the individual whom i wouldn’t class as ‘a woman’). Three is an awful lot.

    And the five have a common theme. The natural and the technological. This is why it angers me off when the powerful Frankensteiniana metaphor gets banded about in a poorly understood way – as a reactionary ‘rebellion’ against society, people ‘recklessly playing God’ or most atrociously – against science and technology. No, the story is about loneliness in a world defined as natural, to which even the scientist par excellence, Victor von Frankenstein, could just so run back when things slipped out of control. That is not an option to monsters – which is what human evopsychology sees in children of technology. So be it. Do you even want to be part of xenophobia, genetic purity of the pack and unprovoked (unless existence counts as provocation) aggression that is ‘natural’? A rhetorical question because irl you don’t have the option to choose a side.

    To monsters there is no recourse other than to stand and fight – and by ‘fight’ i mean using their edges in a strategic/tactical way….camouflage (the lack of which was so lamented by the hero of Frankenstein story) is as much ‘fighting’, if not more than aggression. A war does not need the other side to acknowledge it. And Technology’s gifts are your only edges in this.

    So yes, you are defined by science/technology. Majorly. It’s what animates you, gives you life instead of a script, and turns you from an object into an agent. The power to create yourself is technology, and you are an artifact of your own make, layer upon layer. As they say, You Do You – Cyborg Theory Edition ;)

    P.S. Kay – agreed, awesome.

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    I have just lived through the absolute confirmation of everything you are writing here. I learned who I was a few short weeks ago, because I was outed by my wife. 45 years of isolation and confusion came to an end because I had to deal with what people now knew. I came to the conclusion that I was this, a woman trapped in the wrong body, before I went online to look up what that actually meant.

    I had to believe it myself first. I wanted to use science to explain myself to my parents, and at first they seemed to agree, but they were very vested in finding contradictory or conflicting information, and for several days every conversation with them started with me feeling in a good mood, and ended in despair as they desperately attempted to ‘talk me out of it.’ My despair. I finally spent a long night contemplating suicide before I angrily asserted to myself, and then in a letter to my parents, that they were to go look themselves at what trans people are, look at my life as they knew it, and tell me what they thought I was and why they thought it.

    And that was the end of my desire to die. I realized I believed myself and that only strengthened it.

    Your overall point is really revealing that science can shift and move around according to who is doing the questioning. We cannot afford to pay too much attention to this because our very will to live depends on us believing that we are, who we are. I have found that this is self-evident in my desire to live, or die, according to who I thought I was. I am a woman. I can live knowing that. If I can’t know that or can’t believe it, I can’t live.

    What other proof could anyone offer me that is more compelling?

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    To start with, I would just like to say this was an excellently written piece. Technically succinct and easily understood. Lots of well rounded research and exhibits a thorough understanding of the topic.

    But having gone through a very long life of not really knowing or understanding who or what I am, why I am like I am, and having many misfires into this comprehension, I am finally comfortable with now knowing. That is not to say I am comfortable with the world at large knowing. I remain hidden for fear of rejection, fear of physical and emotional assault, fear of the prevailing attitudes by cis and LGB people alike. The more I learn about me, the more I want to stay out of their crosshairs.

    That all being said, I don’t desire one way or another for science to validate me. I know, for instance, that my brain functions – has always functioned – in a manner that is most definitely female. My body does not match this. The world at large sees male. The world inside is female. Thus, as far as I am concerned, I am female. My preferences, however, are female. This is both a physical and environmental thing for me. For all my years of life, I prefer female. Thus, I am – in my mind – lesbian. Much to the dismay of lesbians who wish not to acknowledge me as one of their own. But I have relegated my life to a solitary existence and don’t really care if they claim me or not. Its not like I will be going out and stealing anyone’s woman or anything.

    The world and science have no basis for all of this about me and reject me. But after so many years of struggle and depression and confusion, I don’t care what the world or science says about me. No one else can know me more than me. No one else can validate me more than me. And it took decades for me to know this. So how can science even attempt to validate me or disprove me? It can’t. We can only know ourselves and be comfortable with that knowledge. To traverse any other path is to travel the way of madness.

    (That is not to say if anyone flames me on this opinion it won’t hurt. But I will eventually get over it. I am, after, only human. Trans. But human.)

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    [Science] relies on certain practices, discourses, and “ways of knowing” in order to distinguish itself from, say, religion or the humanities. Or, you know, alchemy. But these “ways of knowing” do not appear out of nowhere — they are the result of centuries of social, political, and historical development.

    [Entire section on ontology]

    Science doesn’t rely on “ways of knowing” derived from social, political, and historical development. Science is, when done correctly, based purely on evidence and statistical analysis of that evidence. Ontology and any other forms of “metaphysics” also don’t play any parts in this. Considering that the problem of “determining whether trans people exist” is obviously impossible to formulate rigorously, anyone claiming to have any “scientific” findings is clearly lying.

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