“Gender-affirming surgeries are not common among those under age 18 and are usually limited to “‘top surgery,’ or a mastectomy. Breast reduction surgery is also one of the most common forms of plastic surgery in cisgender teenagers.”

I have no words. This is so disingenuous and absolutely NOT comparable.

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May 7·edited May 7

Thank you, Jesse! Here is a relevant story to this regrettable chapter on the state of gender science in America today:

When the New York Times published the article "They Paused Puberty, but Is There a Cost?" (https://nyti.ms/42pM5ak) on Nov. 14, 2022, one of the letters they received was from Marc B. Garnick from the Beth Israel Deaconess Medical Center (https://bit.ly/3VHHtKn), and more importantly, one of three academic principal clinical investigators of studies that led to the initial F.D.A. approval of Lupron [the puberty blocker drug that gets used most often] for the treatment of metastatic prostate cancer. Yes, for metastatic prostate cancer. That letter (see https://nyti.ms/3nwblwJ), published two weeks later on Nov. 28, 2022, said this (and I will quote it in full for those who might not have access behind the paywall): "As one of three academic principal clinical investigators of studies that led to the initial F.D.A. approval of Lupron for the treatment of metastatic prostate cancer — and having studied this class of drugs, which includes puberty blockers, for more than four decades — I can say that physicians are still learning and continue to be concerned about the safety of these agents in adults. Woefully little safety data are available for the likely more vulnerable younger population. Bone loss in adult men who have been on these agents is significant [Jesse, you mentioned this topic in your article - that you were less familiar with - it turns out that the concerns you heard were true], and a leading cause of morbidity with long-term administration. Other safety issues include cognitive, metabolic and cardiovascular effects, still under intense investigation. The prudent and ethical use of such agents in the younger population should demand that every pubertal or pre-pubertal child be part of rigorous clinical research studies that evaluate both the short-term and longer-term effects of these agents to better define the true risks and benefits rather than relying on anecdotal information."

So opines the principal investigator of the drug. Need we say more?

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And then people wonder why "trust in the experts" is at historic lows....

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Jesse, this is another great piece of careful critique, but I'm baffled that you continue to maintain this attitude of naïve optimism around SciAm's reporting as if they're just making a good faith effort to be impartial journalists, but are allowing themselves to make careless and sloppy mistakes in their coverage and editing (eg "Her editors were not careful." and "The good news is that since it’s very clear what has gone wrong, there’s no reason these outlets can’t do better").

There's no way you don't understand that this article is part of a massive ideological agenda by gender ideologues that has nothing to do with careful adherence to the facts and maintenance of journalistic standards. A day before this article came out they also published a related piece explaining how biological sex isn't binary. I doubt you'd argue that that was due to an understandable failure to carefully read biological textbooks. These "errors" aren't failures of process. They are by design.

Your insistence on treating this as a sincere attempt at science journalism feels as foolish to me as if you had taken an article from the The Discovery Institute promoting intelligent design and treated it as a serious scientific paper deserving of thoughtful criticism. It might simply be an effort to be charitable to your opponents, but honestly, IMHO, not acknowledging what's really going on here only makes you look gullible and clueless.

ETA: I don't think you *are* clueless. But I feel this makes you *appear* so.

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She claimed that breast reduction is the leading plastic surgery among adolescents. It’s not it’s rhinoplasty, a.k.a. broken noses I think she just made this up this claim.

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I am the (lifelong liberal, I feel the need to point out) father of a 19 year old daughter who has believed she is a boy for the past 5 years. Your writing about the suicide myth, or what I think of as the "weaponization of suicide" by Trans Rights Activists, is extremely well researched and prescient. Thank you for that. Allow me a moment to make vivid how this affects families of trans-identified teens.

I believe that any suicidal ideation my daughter has had is iatrogenic, or caused by the suicide myth about "gender dysphoria." When vulnerable teen girls are seduced by the allure of the trans cult and told that they will feel suicidal if they don't become boys, it turns out they are more likely to feel suicidal. Helping our daughter to gain a more healthy (and reality-based) sense of herself, and preventing her from medicalizing her trans delusion, has become the all-consuming focus of my family.

It has mostly wrecked us.

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Jesse, I read pretty much every article of yours on the topic of gender medicine for minors. I hugely appreciate your work, but here's what I don't understand. You have been writing about this for years. You know all the evidence and lack thereof. There is no evidence to suggest that these medical interventions are helping gender dysphoric kids, but there is evidence to suggest that kids who are given time to go through their natural puberty are very likely to grow out of their gender dysphoria. There is no evidence to suggest that dysphoric kids who are not given blockers and cross-sex hormones will therefore commit suicide, but there is evidence to suggest that going on blockers and hormones will result in physical harm (bone density loss, vaginal atrophy, increased risk of stroke, etc.). There is almost zero evidence on how these kids are functioning as adults, and the evidence we have seems to point to less-than-great outcomes.

So why are you *not* in support of bans? How can you justify dispensing these drugs to kids? Or are you saying that we need to allow a very small number of kids access to these drugs in the context of medical trials with long-term followups? I just don't understand how a person with your knowledge of the situation can be in favor of blockers and hormones for minors, other than as part of a very solid, very long-term trial.

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The issues with side effects from Lupron are legendary: https://www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/ and https://lawanswer.org/what-you-should-know-about-lupron-class-action-lawsuit/ for two examples. It reminds me of the push to claim "opiates are not addictive" by the Sacklers, who made billions on Oxycontinwhile causing countless deaths. These myths push a harmful agenda while claiming to be "science" , causing immeasurable harms and making tons of cash for the companies involved. This scandal has yet to blow, but thank you for your careful voice of reason.

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I don’t think the editors of the magazine realize the damage this does. In their minds I bet they think that by printing those statements they make them true somehow. But all they do is make me less likely to believe them about anything else.

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May 7·edited May 8

Thank you for another excellent analysis!

About this " I’m not sure it’s accurate to say that there is a “consensus among the scientific and medical community based on the latest research” I agree. You discuss WPATH consensus...but there is no way that WPATH represents the expert community on its own, it seems to be an organization dedicated to medical intervention for gender dysphoria. So it leaves out entire treatment pathways. There is a great article on the lack of consensus more broadly and what is wrong with the WPATH recommendations by Block: https://www.bmj.com/content/380/bmj.p382 . Peer reviewed investigative article.

As far as kids regretting, going on to hormones from puberty blockers is not the same as who stops treatment or not, for hormones, one study that acutally did try to follow-up in the US found about 30% stopped taking them within 4 years (there is a Dutch study with a different finding, it's all unclear). The ~30% is Roberts et al., 2022, the same cohort that found psychotropic drug use increased.

The other thing is that Abbruzzese et al., 2023 ( https://pubmed.ncbi.nlm.nih.gov/36593754/ ) report on some preliminary findings of long term outcomes from the Dutch Model carefully chosen kids and it seems some are not doing that great, having problems:

"Nearly a quarter of the participants have felt that their bodies were still too masculine, and over half have experienced shame for the “operated vagina” and fearful their partner will find out their post-surgical status—despite registering low “gender dysphoria” UGDS scores (Steensma et al., 2022).[...] the reported relationship difficulties reported by Asseler, with over 60% of individuals in their early to mid-30’s still single, also deserve serious consideration. The apparent sexual difficulties reported by male-to-female transitioners by van der Meulen (around 70% have problems with libido, have pain during sex, or have problems with achieving orgasm), combined with reproductive challenges, may be contributing to this outcome."

"the rate of cross-sex identification was not as stable as originally expected, with a sizable percentage reporting one or more instances of identity changes after treatment completion, especially among the individuals on the autistic spectrum (Steensma et al., 2022)."

Thank you for reporting on all this!!

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I just want to point out that media aimed at the general public presenting poor-quality data as high-quality and definitive is bad for science overall. It doesn't take a degree in a scientific subject, or for that matter, a degree at all, to recognize some of the flaws in these studies. When the public is told by respected journalists that clearly flawed science is good science and anyone who is skeptical of that flawed science is a science-denier, members of the general public will start to distrust science. That's part of why this whole tendency to proclaim that "the science is settled" when it's an open question among scientists in the field is so dangerous for public confidence in science.

As an aside, I have never had someone call me stupid for saying "we don't know" and then explaining why something is unsettled in the world of science. If anything, people seem to think I'm smarter because I usually explain why we don't know and how we'd figure it out and that's an opportunity to bring up all sorts of things that make me seem smart.

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It is sad and lamentable that trans activists play the suicide card without evidence. It is even sadder and more lamentable when science journalists do so. When I began reading Scientific American in high school, it was a highly credible publication. It is certainly not that any longer.

Those activists and some science journalists claim that children are endangered if the transitioning process is slowed down. They asseverate that they care about children. But children can be at risk if their transition is fast-tracked, such as those who wind up detransitioning, or those who are harmed by puberty blockers.

These folk don't care about children, they care about advancing their ideology. It is very worrisome when science journalism - and science itself - is cannibalized by ideology. The scientific process should proceed with considerable skepticism, from all angles.

Instead, we are getting starry-eyed credulity. But it is not that science journalists lack skepticism, they are more than happy to take down studies that do not align with their ideologies. But do they exhibit skepticism towards trans activists' claims? Oh hell no, sooner would they cheer on Ron DeSantis and attend a talk by James Dobson and hail him.

Intellectual honesty is nigh on dead among the professional managerial class. RIP.

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Scientific American used to be great. You felt you could trust it because of it’s claimed grounding in foundational science and integrity.

No more. It has become another activist magazine with an agenda. Cancelled my subscription two years ago after getting tired of preachy and sloppy articles. After reading Jesse’s review, I see I made the right decision.

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Scientific American has become unreadable. This stuff is cosmically embarrassing.

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Regarding Jesse’s footnote, I think most observers would agree that activist pressure to remove so-called gatekeeping is absolutely why WPATH’s SoC8 removed age guidelines.

But I would add that it also seems fair to interpret the removal as an effort by WPATH to remove liability from clinicians who are, again, practicing experimental medicine.

WPATH is a *professional* organization advising *practitioners*--not a medical organization advising or protecting patients.

Removing the age guidelines protects clinicians as much as it “allows patients to get the interventions they need” or however they phrased it. If there is no age guideline, then no practitioner can be sued for violating the guidelines.

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Under its current editor (Laura Helmuth), Scientific American has trashed its own reputation. What used to be a serious science publication, has gone totally ‘woke’. See “Agustín Fuentes grossly misrepresents the sex binary in (guess where?) Scientific American; argues that those who accept a binary do so out of bigotry, transphobia, and racism” (https://whyevolutionistrue.com/2023/05/02/agustin-fuentes-grossly-misrepresents-the-sex-binary-in-guess-where-scientific-american-argues-that-those-who-accept-a-binary-do-so-out-of-bigotry-transphobia-and-racism/). Quote

“If you want a combination of an author and a venue guaranteed to produce ideologically-motivated nonsense, it’s Agustin Fuentes writing at Scientific American. The combination of a badly misguided author, distorting biology for political reasons, with a magazine devoted to promulgating “authoritarian progressive” ideology disguised as science, gives me the same feeling I’d have if my mother called me to dinner and announced that we’d be having liver and Brussels sprouts.”

Of course, it get worse. Scientific American actually published an article title “Visualizing Sex as a Spectrum”. The “evidence” was (well-known) chromosome anomalies that are rare disorders and quite discrete (as in no spectrum). Of course, chromosome disorders (for example, 47,XXY) don’t produce any sexual ambiguity and are not “new sexes”.

Of course, it gets worse, Scientific American actually published a column opposing scientific research. You can’t make this up. Scientific American published a column opposing scientific research back in 2013.

The rag should be renamed, I suggest ‘Religious American – Where faith smashes facts and doesn’t apologize’.

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