Women’s health and transgender advocacy

How do we handle the math?


What if I told you that a study showed the number of breast cancer diagnoses dropped by 170,799 in some Year II compared to Year I? Would you think that’s significant? What hypotheses might you develop to account for the drop? Is a particular treatment method likely to be the cause? Is a particular prophylaxis likely to be the cause? Would that drop in breast cancer diagnoses perhaps cause a change in research priorities? Would it perhaps cause a change in funding priorities? Would it cause a change in resource allocation for diagnosis and treatment? Would it cause a change in treatment costs? In insurance coverage?

Or would a decrease of 170,799 breast cancer diagnoses be just a drop in the bucket and make no significant difference in the answers to any of those questions?

These are the questions I wrestle with as I ponder the larger societal effects of granting a blank check to transgender advocacy when it comes to defining the language used to defend the interests of people who may (or may not) be adequately identified as transgender. I should be clear at the outset about one thing in particular. I support equal protection under the law, full stop. If that leads me to uncomfortable dilemmas, I’m comfortable with that. What I’m not comfortable with is a rush to judgment without considering the possible consequences and assessing whether the possible consequences are worth the risk. How does one do the latter without considering the former. What I oppose is a new status quo wherein one is anathematized for the former, thus precluding any rational approach to the latter whatsoever.

So let’s break this down by the numbers and see where we end up.

Current population of the US: 327,200,000

Current population of women (as traditionally defined) in the US: 50.8% or 189,776,000

Current population of MTF (male-to-female) transgender women in the US: _____________

At this point, you may note that I’m citing no sources for my numbers. The reason is simple. People on all sides of this issue are going to dispute whatever numbers are used. Don’t take my numbers for granted. I’m no epidemiologist or statistician. I’m Rando of the Internet armed with Google and at least half a brain. If you don’t like my numbers, go get your own and do the math for yourself. In the end, the questions remain the same.

You might also note that I left the MTF transgender women population blank. Good luck finding a number for that blank that everyone will agree with. Estimating the transgender population overall is hard enough. Breaking it down even further to populations of transgender women and transgender men is even harder. Population studies span the globe and, from what I’ve seen, represent local populations, which means that the ratios might not generalize well to other regions. Other population studies are contaminated by confounding LGB communities with TQ+ communities. Studies are stymied by self-report and the myriad reasons self-report might result in undercounting. Those are only a few of the methodological problems with estimating the real size of transgender populations in the US.

If my napkin math even approaches reality, within a transgender population the ratio of MTF transgender people to FTM transgender people is about 2:1.

The best statistic I could find for the size of the overall transgender population in the US is approximately 1 million.

One primary takeaway from the searches I conducted is that population estimates are increasing over time, likely for a host of reasons having far more to do with methodology than etiology, i.e., nobody seems to be speculating as to causation of greater incidence. I’ll leave my tinfoil hat behind and concur with that silence by not supposing that some cause, e.g, food supply, is “causing” more transgenderism. I believe it’s all about the counting methodologies and the reliability of the data.

That said, I’m going to take the liberty of doubling that population figure and call it 2 million. Maybe that’s an undercount. Maybe it’s still too conservative a guess. It’s too soon to say. In any case, I’m trying to make the case most favorable to the transgender population that I can. Whatever affects the population of transgender people now likely affects far more people than we presently think it does. Based on that figure, if my 2:1 ratio is correct, then let us suppose the US population of MTF transgender people is about 1,333,333.

Now let’s look at another statistic: the incidence of breast cancer in the US. The rate of breast cancer among traditionally-defined women is 12.5%.

12.5% of the population of traditionally-defined women in the US is 23,722,000.

What if the population of US women needs to be adjusted to include MTF transgender people? Then the population of women in the US increases to 191,109,333.

Something interesting happens at this point.

The number of particular cases of breast cancer remains “static” (allowing for the usual/explicable causes in fluctuations in that number), or 23,722,000. The incidence among the population drops to 12.41%. Is a drop of 0.9% significant for all the aforementioned reasons? If we were talking about a 0.9% decrease in the incidence of breast cancer in the population of traditionally-defined women, there would only be 23,551,201 cases by comparison, or 170,799 fewer cases.

Conversely, if the rate were to hold at 12.5%, wouldn’t we expect to see 23,888,666 cases of breast cancer, or an increase of 166,666 cases? We might if breast cancer affected all women equally. As it is, there’s probably already racial and economic disparities in the incidence of breast cancer. Those can at least be studied as race and economic strata are at least more adequately defined for the purposes of study than would be the gender signifier “woman” were the population of women to increase without clarity as to how it did.

The concrete number of cases of breast cancer is actually static-ish, though, in the sense that the incidence won’t change as more women are added to the population figures as a result of improved reporting among the transgender community. The growth in that population figure doesn’t reflect a change in actual risk. The only thing that goes down is the rate.

One hopes that the science of epidemiology keeps pace with these changes. One has little hope that media will adequately report on the significance of a change in rate that doesn’t account for the new confound. One then wonders what effect all these numerical adjustments will have on the incidence of other health factors peculiar to a particular demographic, e.g., uterine cancer, cervical cancer, PCOS, endometriosis, and maternal mortality, to name but a few. One must wonder these things because in the current political landscape, the very idea of accounting for the change in the population of women is anathema as any methodology that sufficiently accounts for the change runs counter to the right to identify as proposed from within the ranks of transgender advocacy.

Will we be entering a golden age of improvements in women’s health as revealed by a trend of decreasing rates of incidence? If not, how will that determination be made? How will it be reported? How will it be reflected in the conjoined landscapes of politics, funding, research, and healthcare?

As I mentioned at the outset, I’m all for equality before the law. I’ll not offend Dear Reader by insinuating a “but” at that point. I’m merely aware that individual rights are a balancing act. One person’s right to free speech is an infringement on another’s right to equal employment opportunities, for instance. My right to private property, in turn, may well impinge on someone’s right to speech. My final question has everything to do with balancing the rights of 1,200,000 women against the rights of the rest.