It’s never a good thing when I log onto Twitter and see Bill Maher trending as a topic, as I know that he must have said something offensive or pseudoscientific, given his long history of bad takes on vaccines and “Western medicine.” (Indeed, out of curiosity, I looked up the first time I ever took note of Maher’s antivax stylings. It was March 2005, when Maher falsely claimed that vaccines don’t prevent disease and that Louis Pasteur “recanted” on his deathbed.) Unfortunately, that’s exactly what happened over the weekend. It didn’t take me long to find the source of the problem, which was a Tweet that appeared to indicate that he’d gone full transphobe:
Which led to the usual suspects amplifying and praising this part of his New Rules segment:
It didn’t take long for the “Bill was only joking” and “Can’t you take a joke?” contingent to come out and defend him, claiming that Maher was trying to make a “legitimate point” with humor. There’s no doubt, too, that Maher was making a point with humor, but his point was far from benign. Indeed, the point he was trying to make was a transphobic one, namely that regional differences in the prevalence of transgenderism call into question whether there is a biological basis to being trans. Interestingly, at more than one point he claimed that being transgender is “innate.” It wasn’t clear to me, though, what he meant by that. Did he mean genetic? Biological? And if being trans is “innate,” then how could being trans by “trendy,” as he used these regional differences in prevalence?
As it turns out, Maher’s shtick was an argument that immediately sounded very, very familiar to me—disturbingly so—and it didn’t take me long to realize why it sounded so familiar, albeit in a very different context than I had been used to hearing it. In fact, Maher was recycling an argument that antivaxxers used to like to make back in the day to call into doubt the science concluding that autism is mainly (but not exclusively) genetic in nature. Basically, antivaxxers would ask, in essence, the same two bogus arguments:
- If autism is primarily genetic in etiology, then why has its prevalence been increasing so markedly since the early 1990s? (The subtext or direct claim was that, obviously, the expansion of the childhood vaccine schedule in the early 1990s must have caused this “autism tsunami.”)
- If autism is genetic in etiology, then why are there such large regional variations in its diagnosis? (The subtext or direct claim was that, obviously, these differences must have to do with differences in vaccine uptake, GMOs, pollution, etc., because obviously it’s the vaccines, sometimes plus other things.)
As much as I hate to do it and was tempted to reference just his Tweet above, here’s the YouTube video of Maher’s nine-minute bit. Watch it if you can stomach it—or not:
Let’s compare and contrast what Maher did when he repurposed bogus antivax talking points from a couple of decades ago to mock what is known about the science and medicine behind treating trans teens. As much as Maher said a couple of times during his bit that he believed that being gay or transgender is “innate” (whatever he meant by “innate”), he contradicted that claimed belief by citing changing prevalence and regional differences in the number of people identifying as trans to support jokes about how coming out as trans is now “trendy” and that “influencers” and peers are out there seducing teens to come out.
Indeed, Maher went on to mock the idea of gender-affirming care of transgender adolescents in a manner that left me with no doubt that he is indeed a transphobe. His routine was replete with references to cutting dicks off, pumping kids full of puberty blockers and hormones for the opposite gender, and tired variations on the only two old and hack jokes that transphobic comedians—I’m talking to you, Ricky Gervais—seem to have:
- “I identify as X,” with X being something like Black (or any other race besides the comedian’s own), a dog or other animal (even a dolphin!), or something else that the comedian thinks to be ridiculous to identify as. It’s the one joke all transphobes regurgitate in seemingly endless variations of the same boring punchline. The idea is to mock trans people for identifying as a gender to which they weren’t assigned at birth. Amazingly, Maher actually managed to refrain from making a variation of this hack joke, but he did make this next hack joke.
- “Kids often say they want to be X at that age, but we don’t indulge them because we know go through phases and if you wait long enough it’ll be something different.” (Maher cited a dinosaur phase, a Hello Kitty phase, and others.) For Maher, his X was apparently his wanting to be a pirate when he was a kid, which led him to quip that he was glad that no one scheduled him for eye removal, amputation, and a peg leg, the idea being to attack medications and any gender reassignment surgery. This allowed him to “jokingly” compare gender reassignment surgery to mutilation and denigrate gender dysphoria (designated in the DSM-5 as clinically significant distress or impairment related to a strong desire to be of another gender experienced by many trans youth, symptoms that can be treated with puberty blockers, hormones, and, if it comes to that and the patient wants it, gender reassignment surgery) by likening it to childish fantasies of wanting to be a pirate or a cowboy. So very droll, Mr. Maher, particularly with your bits about how stupid kids are.
Regarding that last part, I found this to be a good response:
Let’s take a look at Maher’s bit. If you are trans, I warn you. It’s bad, although trans people have nearly all heard worse at one time or another. Actually, if you are LGBTQIA, it’s bad, because the conspiracy theory—and yes, that’s what it is, a conspiracy theory—that more people are identifying as trans now due to the malign influence of others is very similar to conspiracy theories from last century that more boys were coming out as gay because gay men were “grooming” them.
Maher goes beyond antivax to be a transphobe
Let’s start with Maher’s opening statement from the last part of his Friday “New Rules” segment and see if it sounds familiar:
New Rule: When something about the human race is changing at a previously unprecedented rate, we have to at least discuss it. Broken down over time roughly, the LGBTQ community seems to be roughly doubling every generation according to a recent Gallup Poll.
Then, less than a minute in:
I’m just saying that, when things change this much this fast, people are allowed to ask, “What’s up with that?” All the babies are in the wrong bodies? Was there a mixup at the plant, like Cap’n Crunch’s “Oops! All Berries”?
He likened being trans to a mixup at a cereal plant and even managed to add a bit about berries! So hilarious…not.
Then, there was this;
And it’s OK to ask questions about something that’s very new and involves children.
Let me just change Maher’s statement to something that I heard in a lot of variations 10-20 years ago: “When something about the human race is changing at a previously unprecedented rate, we have to at least discuss it. Broken down roughly, autism prevalence seems to be increasing very rapidly.” I don’t even have to change the second two quotes, “I’m just saying that, when things change this much this fast, people are allowed to ask, ‘What’s up with that?'” and, “And it’s OK to ask questions about something that’s very new and involves children.” I can totally envision antivaxxers saying exactly these things about increasing autism prevalence and vaccines back around 2005, when I first really got involved refuting vaccine-autism pseudoscience.
Indeed, what Maher is doing with statistics about trans people is exactly the same sort of JAQing off that antivaxxers used to like to do back in the day about rising autism prevalence and whether vaccines were the cause (which shouldn’t be surprising given Maher’s long history of antivax utterances). In the case of antivaxxers, the “cause” of increasing autism prevalence just had to be vaccines (because it’s always the vaccines). It couldn’t possibly be due to other causes, such as more screening, more awareness, more acceptance, and better case ascertainment, because it had to be the vaccines. In Maher’s jokes, the “cause” of rapidly increasing numbers of people coming out as LGBTQ just had to be…something else. If you’re familiar with the narrative transphobes have built up around trans teens, you’ll know what that “something else” must be.
After noting that 0.8% of the Silent Generation, 2.6% of Baby Boomers, 4.2% of Generation X, 10.5% of Millennials, and 20.8% of Generation Z self-identify as LGBTQ, Maher then “joked”:
…which means if we follow this trajectory, we will all be gay in 2054.
Maher even extrapolated his graph to drive home his joke:
I was immediately reminded of an antivax narrative from days gone by.
The autism “tsunami” vs. the trans “epidemic”
Back in the day (10-20 years ago), the primary belief driving antivaxxers was that childhood vaccines caused autism. (It still is, but the growth and metastasis of antivaccine beliefs during the pandemic have distracted from that previous core antivax belief.) There were two ways that antivaxxers thought that vaccines could cause autism. The first, pioneered by Andrew Wakefield through his long ago retracted paper published in The Lancet in 1998, was that the measles-mumps-rubella (MMR) vaccine somehow caused autism, while the second was that the mercury that was part of the thimerosal used as a preservative in a number of childhood vaccines before ~2001 was the cause of autism; the first “causation theory” was primarily a UK phenomenon, while the second tended to predominate in the US, although both could be found employed on both sides of the pond to varying degrees.
The idea that vaccines caused autism was, besides mistakenly correlating correlation with causation (a lot of vaccines are given around the age that children first manifesting symptoms and signs of autism) an explanation for the large increase in autism prevalence reported over the last 30 years, an increase that antivaxxers sometimes called an autism “epidemic” or “tsunami,” the latter of which derogatorily describing the impending flooding of schools and the healthcare system with autistic people. How, antivaxxers would ask, can autism be primarily genetic when its prevalence has been increasing so much? (Also, it must be vaccines causing the “epidemic” or “tsunami.”)
Maher’s joke and graph reminded some Twitter denizens of another graph, specifically a graph of left-handedness from the early 1900s to the late 1900s that showed a rapid increase in the prevalence of left-handedness:
There are those who pointed out that left-handedness is a trait that is primarily genetic and whose prevalence has been rising and varies geographically; I myself, given my background dealing with the antivaccine movement, chose to point out that autism is a condition that is primarily genetic and whose prevalence has been increasing and varies geographically. (More on autism in a moment.) Whether it’s autism or left-handedness, we do it to demonstrate that it is quite possible for the prevalence of a primarily genetic condition to vary geographically and to change fairly rapidly with time. In the case of left-handedness, reasons for the increase were clearly less stigmatization and more acceptance, leading to fewer efforts to “fix” lefties. For autism, it’s a combination of broadening of the diagnostic criteria, combined with increased awareness and screening. As I like to say, if you don’t look for a condition, you won’t find it, and if you do start looking for it a lot more aggressively, you will find more of it, often a lot more. Basically, it’s a matter of case ascertainment, not a “true” change in prevalence in the population.
In fact, though, Maher’s “joke” reminded me very much of something that an antivax quack once predicted about autism. Does anyone remember Stephanie Seneff? Longtime readers will remember that she’s a computer scientist at MIT who’s antivax and anti-GMO and, as such cranks often do, fancies herself an epidemiologist. In 2014, she made herself “famous” by extrapolating based on then-current trends to predict that by 2025 half of all children would be autistic. In fairness, she didn’t blame vaccines, but rather GMOs and glyphosate, but she did feature a slide like this:
To be clear, Seneff was serious in her prediction. Because she didn’t believe that autism was primarily genetic, she couldn’t conceive of another reason why autism prevalence rates would be rising other than external factors, her favorite at the time being GMOs. Maher might have made a throwaway joke about everyone being gay by 2054, but his underlying point was clear. His protestations that he accepts that being LGBTQ is “innate” notwithstanding, he really believes that something else other than genetics is behind the increase in prevalence. In that he reminds of me quacks who are under the delusion that vaccines can turn children gay.
In the case of autism, for instance, screening, acceptance, and more financial support for families with autism mattered. However, let’s ignore acceptance or the oft-mischaracterized “better diagnosis” for the moment and consider an example I like to bring up whenever discussing the argument from incredulity that autism can’t be genetic because its prevalence is rising, something antivaxxers used to refer to as the “autism tsunami.”
Ductal carcinoma in situ (DCIS), a form of breast cancer. Well, actually, whether it’s really cancer or not is debatable, but it can clearly often be a precursor to cancer, although the percentage of DCIS lesions that progress to cancer isn’t precisely known. Be that as it may, before 1975 DCIS was a very uncommon diagnosis. Now it is very common. Indeed, back in the early 1900s, DCIS was rare because by the time it grew large enough to be a palpable mass, it almost always had become invasive cancer. Now, nearly forty years after mass mammographic screening programs became prevalent, DCIS is a common diagnosis. Indeed, approximately 40% of breast cancer diagnoses are DCIS, and a recent study found that DCIS incidence rose from 1.87 per 100,000 in the mid-1970s to 32.5 in 2004. That’s a more than 16-fold increase over a 30 year period, and it’s pretty much all due to the introduction of mammographic screening. This sort of thing should not be surprising to doctors, but apparently sometimes it is.
Unlike the case for autism, the diagnostic criteria for DCIS remained pretty stable over that 30 year period. Pathologists in the 1970s and pathologists in the 2000s would likely agree on what constitutes DCIS, which makes it particularly striking how, if you look for a disease or medical condition more intensely, you will always find more of it—often a lot more. Always. If this principle works for something that is diagnosed by an objective test, namely a biopsy, how much more so is it likely to be for a condition that has no unequivocal biochemical or tissue test to nail down the diagnosis, like autism, particularly for a condition whose diagnostic criteria has changed considerably over the last 25 years to be more inclusive? This brings up diagnostic substitution, in which diseases or conditions are classified differently now than they were 30 years ago, such that, for example, some children who might have been classified as mentally retarded 30 years ago receive an ASD diagnosis now. There is actually a fair amount of evidence for such a phenomenon, in which the decrease in diagnoses of intellectual disability are nearly completely offset by the increase in diagnoses of ASDs.
To boil it down, if there was no “autism epidemic,” there was no way that vaccines cause autism. Over the years, there has been quite a bit of evidence that the “true” prevalence of autism has been fairly stable for quite some time. For instance, one study examined autism prevalence using stable diagnostic criteria between 1990 and 2010 and found “no clear evidence of a change in prevalence for autistic disorder or other ASDs between 1990 and 2010. Worldwide, there was little regional variation in the prevalence of ASDs.” Steve Novella has summarized several of these studies. If I were to use Maher’s “reasoning” (if you can call it that), then autism and DCIS must be “trendy.”
This brings us back to Maher, who said more than once that being LGBTQ (he also specifies trans) is “innate.” Again, it’s not clear whether by that he meant genetic or exactly what, and in his case it doesn’t matter. I don’t think he believes it, because everything about his routine was designed to mock the idea that being trans is “innate” or genetic or biological or whatever you want to call it. Of course, Bill Maher being Bill Maher (an antivaxxer and quackery supporter going back at least to 2005, supporter of quackery, and generally a bad skeptic), he didn’t exactly represent that poll correctly, as was rapidly pointed out to him, along with some rather obvious reasons why more Americans identify as LGBTQ:
Also, if you look at the actual results of the poll, the numbers are far less “alarming” and harder to make fun of.
As is obvious from the graph above, the vast majority of the increase in the percentage of people who identify as LBGTQ among Generation Z and Millennials is driven by those identifying as bisexual, not those identifying as trans or even gay or lesbian.
And then there were the caveats in the poll:
Surveying sexual orientation and gender identity is inherently imprecise, Jones admitted, given shifting definitions and varying levels of outness.
“People may think of it differently, in the same way they may have different ideas of what a liberal or a moderate or conservative is,” he said. “Basically, we try and use terms that are familiar to most people, that are fairly well understood. But we recognize that people may understand the terms differently.”
When one takes the caveats into account and the fact that the overall percentage of people who identify as transgender remains under 2% even among Generation Z. Basically, Maher gets it half right in pointing out how lack of acceptance or options for support and treatment, coupled with outright hostility from society and government “shame” LGBTQ people, particularly trans teens, from coming out in many parts of the country. If he had stopped there, he would have been making a valid point. Unfortunately, he did not stop there. He went on to make his silly joke about how more LGBTQ-accepting states like California are “making them” and we’ll all be gay by 2054. In doing so, he echoed a common conspiracy theory about trans teens that being trans is “trendy” and “influencers” are “seducing” our kids to come out as “trans” because being gay isn’t “trendy” enough anymore, coupled with lies about how doctors just can’t wait to get these kids in their clutches to pump them full of puberty blockers and hormones to start transitioning and then to “cut off their dicks.” Again, does any of this sound familiar?
Given a diagnosis as complex as gender dysphoria and transgenderism, is it surprising that its diagnosis could be affected, even dramatically, by acceptance, screening, changes in diagnostic criteria, and even possibly diagnostic substitution? If there’s no “trans epidemic,” there’s no way that “influencers” are the cause of the increase in percentage of adolescents coming out as trans, which is exactly the answer to the questions Maher asked while JAQing off.
Quoth the transphobe: “We’re literally experimenting on children”
Let’s now look at regional variation in the number of people who identify as transgender. In fairness, there is one point where Maher basically came so very, very close to offering a plausible explanation for regional differences in the number of transgender people; unfortunately, although he should have stopped there, he did not. Let’s go back to his Tweet:
Bill even tried to claim the mantle of science for himself:
If we can’t admit that, in certain enclaves there is some level of trendiness to the idea of being anything other than straight, this is not a serious science-based discussion. It’s a blow being struck in the culture wars using children as cannon fodder.
Again, notice the similarity between Maher’s rhetoric about trans children and antivax rhetoric about children. Antivaxxers used to say that children were “cannon fodder” in our war against childhood disease, thanks to the supposedly horrific effects of vaccines. Maher has simply updated that trope to claim that children are “cannon fodder” because of the supposed “trendiness” of being trans.
It is, in fact, very plausible that the reason that there are far fewer children coming out as trans in Ohio because of the stigma associated with being trans. It is very plausible that more people will feel safe coming out as trans in places where they are less stigmatized, where there is psychological and medical support, and where they don’t have to worry as much about being attacked or even killed, or, as Maher put, it, they are not shamed.
As one person put it:
Throughout his bit, Maher kept arguing that being trans is “trendy,” joking how it’s no longer “trendy enough” to be gay or bi, which is why there is so much societal “influence” working on kids to come out as trans, rather than gay, leading to this response:
Meanwhile, a trans woman responded with a far more blunt and disturbing personal anecdote:
It’s not just trans people either, but LGBTQIA people:
At this point, I also can’t help but note here that antivaxxers used to do a similar thing. They’d look at regional differences in autism prevalence and then try to correlate them with vaccination rates, all to try to demonstrate that (1) the cause of autism is not primarily genetic and (2) their preferred cause (vaccines) is plausible. For example, antivaccine activist J.B. Handley once published a report that used a cherry picked group of nations to try to argue not only that nations that require more vaccines have higher rates of infant mortality but higher prevalence of autism in children under five. He was far from alone; the father-son duo of antivaccine quack activists Mark and David Geier also tried to use a similar technique to “show” (incorrectly) that increased vaccine uptake was associated with and increased prevalence of autism. The similarity? Antivaxxers were trying to use regional variations in prevalence of autism to claim that autism was primarily caused, not by genetics, but by something else; unsurprisingly, that “something else” was vaccines.
He even mocked parents of trans teens in these “enclaves”:
The way Maher phrased his explanation for regional differences in the number of trans people made it clear to me that he was doing something similar. Again, note how phrased his joke; he said, “Either Ohio is shaming them or California is creating them,” the implication being that an accepting environment is leading kids to come out as trans when they are not trans because it’s “trendy.” I think the best response to this is to note the false balance of his criticism (which gives away the game), as P. Z. Myers did:
I see that “science-based” Bill Maher takes genetic determinism for granted. What do you mean, “all biological”? Culture also shapes biology (and vice versa). The reason it is regional is that there are cultural differences as well as biological biases. The most likely explanation is that the Midwest is more conservative and is shaming kids. Surprise, Bill: more open societies aren’t pressuring kids to become trans — I think you’d be hard pressed to find a single instance of parents forcing their kids to be gay or trans, but you’ll find plenty of conservatives threatening to disown or even kill children who don’t conform to their cis and heterosexual pattern. But Maher isn’t calling them out — that’s his audience of yahoos.
The science-based position is that your sexual preferences and identity is the result of an interplay between genetics and environment. No one claims it is all biological, but that you can’t separate biology from culture and experience.
After that, Maher went on to say that we shouldn’t listen to marginalized people (e.g., LGBTQ and especially trans) in this case because we are “literally experimenting on children.” I can’t help but note here the similarity with the antivax movement, which often falsely portrays the childhood vaccination program as “experimental” and has long claimed that the vaccination program is unethical experimentation on children, to the point that there’s long been a theme among antivaxxers that doctors, pharma, and public health officials should be tried by Nuremberg-like tribunals, a theme that has been amplified more than ever before by COVID-19 deniers. Maher justified his charge by JAQing off again, saying that we “just don’t know” the long term effects of puberty blockers, apparently failing to note that puberty blockers (like Lupron) have been used to treat precocious puberty for a long time.
Bill Maher lies about gender-affirming care of trans teens
I’m not going to go into detail about gender-affirming care of trans teens, although I might well have to go into the evidence base for it in more detail at some point. I will, however, concede that it is not nearly as settled as the science behind vaccines and is evolving with new evidence. Of course, the higher level of uncertainty in the evidence base supporting gender-affirming care is exactly what transphobes like Maher weaponize against it to imply that it’s all arbitrary, not based on evidence, and ideology-driven, not unlike the way that antivaxxers do with vaccines. I will also point out that throughout his bit Maher grossly mischaracterizes what gender-affirming care entails. His mischaracterization is a common one that every transphobe likes to cite and included:
- The idea that doctors are putting trans teens willy-nilly on hormone blockers like Lupron and on hormones of the opposite gender without consideration of whether each teen being treated really has gender dysphoria or is really transgender.
- Fear mongering about the dangers of puberty blockers.
- Lots of jokes about cutting off penises (e.g., “hand me the dick saw”). It got so bad by the end of the bit that it made me wonder why Maher seems to have such an obsession with cutting off penises. Ew.
A longer post on these issues might well be in the future of this blog, but for purposes of refuting Maher, I’ll just point out that there is a long and complex evaluation of teens with gender dysphoria to determine what treatments are most appropriate, as documented in evidence-based treatment guidelines by organizations such as the World Professional Association for Transgender Health (WPATH). First of all, Maher carelessly—or not-so-carelessly—conflated children with adolescents. As Steve Novella has noted, though, the standard of care for children is that they receive no medical intervention other than psychological assessment and psychosocial interventions, with medical interventions reserved for once puberty arrives. Maher makes it sound as though doctors are rushing children to hormone blockers and “cutting dicks” off of young boys. They’re not.
In fact, as Steve described, in order for adolescents to receive puberty-suppressing hormones, the following minimum criteria must be met:
- The adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity or gender dysphoria (whether suppressed or expressed);
- Gender dysphoria emerged or worsened with the onset of puberty;
- Any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment;
- The adolescent has given informed consent and, particularly when the adolescent has not reached the age of medical consent, the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process.
Genital surgery should not be carried out until (i) patients reach the legal age of majority to give consent for medical procedures in a given country, and (ii) patients have lived continuously for at least 12 months in the gender role that is congruent with their gender identity. The age threshold should be seen as a minimum criterion and not an indication in and of itself for active intervention.
The Endocrine Society clinical practice guidelines provide similar recommendations, with hormone therapy for gender dysphoria only for those who, “have undergone psychiatric assessment, and have maintained a persistent transgender identity.” Moreover, gender-affirming care for trans youth is supported by every major medical association in the US, even the stodgy and conservative AMA. When used correctly, puberty blockers are safe and effective and recognized as the standard of care by medical experts.
Again, the claim that kids are being pumped full of puberty blockers willy-nilly tends to be based on anecdotes of a teen not adequately worked up and too rapidly placed on puberty blockers, these outliers being deceptively represented as the norm. Basically, as so many transphobes do, Maher made it sound that thousands of confused kids are having their “dicks cut off,” when in fact gender reassignment surgery is incredibly rare before the trans individual is of legal age and can provide informed consent.
At one point, Maher even approvingly referenced Abigail Shrier’s book Irreversible Damage: The Transgender Craze Seducing Our Daughters. Readers of my other blog might remember a certain…incident…nearly a year ago regarding that book that forced me to actually read it. Shrier is basically a conspiracy theorist, positing that “influencers” are “seducing our daughters” to mistakenly think they are trans and to come out, along with a medical cabal eager to start them on puberty blockers and testosterone and even do “top surgery” (bilateral mastectomy). While Maher seemed obsessed with trans teens assigned male at birth transitioning to female (and getting their dicks cut off), Shrier was, above all, obsessed with trans teens assigned female at birth transitioning to male. I’ve been meaning to write about Shrier’s book ever since last June, and I probably will at some point this summer.
I suppose that I shouldn’t be surprised that Bill Maher is broadening his antiscience conspiracy mongering to include trans adolescents and gender-affirming care. After all, he has a long history of antivax science denial. In fact, his anti-“Western medicine” bent goes beyond that, to include HIV/AIDS and cancer quackery. More recently, he’s expanded his antivax repertoire to include COVID-19 vaccines and COVID-19 minimization.
So, to return to the question in the title of this post: Is Bill Maher an antivax transphobe or a transphobic antivaxxer? Quite simply, he’s both.