There's an additional serious transparency issue here ... Reporting the results of a study on ClinicalTrials.gov is supposed to be mandatory.
This law has been in effect for about 15 years. Yet it took FDA until 2021 to issue its very first Notice of Non-Compliance to a drug company (which merely hints at the possible imposition of penalties). In practice, researchers have been able to flout the law for years.
Failing to report your results when you have written them up for a medical journal is even more egregious. Especially when the journal article willfully conceals the Endpoint Switching that made the trial look more positive than it was. (And especially when the number of subjects is small and the data is relatively simple.) Failing to even post a link to that journal article as part of your ClinicalTrials.gov registration adds a particularly nasty twist.
A decent history of the toothless state of this reform measure here:
This seems like a growing problem with gender affirming care. Assessing whether an intervention “works” can be thought of in two ways: did removing breasts make the patient feel better because they no longer have breasts, and therefor it “worked”? And then the question of whether the mastectomy worked in terms of reducing gender dysphoria and/or improving general mental health.
So often it seems like these studies say, It worked! But they only assess the first question, and then claim it answers the second question, as if the one obviously follows the other.
But does it?
Anecdotally we hear a lot about an incessant, almost Sisyphean quest to find the next thing that will assuage GD--first the blockers, then the hormones, then a suite of surgeries, always looking for the next one that will make them pass better or maybe make them feel that they are more “truly” the target sex.
I think the difference between question one and question two is profoundly important, and the latter is probably the one that matters the most: if an intervention doesn’t resolve dysphoria and/or improve the mental health of the patient, what’s the point?
It's hard to think of any other area of care where the "treatment" is to encourage a mentally ill person to overwrite reality with their fantasies. And then, as you note, it is not surprising that it becomes necessary to double down again and again, and castigate in ever harsher terms anyone who objects to forced participation in the farce. The whole thing just becomes continually more baroque and insane.
Well that’s the tension between the two sides within the activist movement--is it a condition to be treated, alleviating stress and discomfort? Or is it just a way of being with no clear boundaries and an issue of bodily autonomy, with some admittedly radical social changes.
I think many people are sympathetic to the idea of someone being in so much distress and the only way to alleviate that is to approximate looking like the target sex--so long as the boundary of reality remains in place, ie so long as the individual is cognizant if the fact that they are not, actually, the opposite sex in some meaningful circumstances.
It’s when TWAW is taken literally, when individuals insist they are just a different type of biological woman, etc, that things go off the rails.
No. I believe most men and women are not sympathetic to the idea of hundreds of thousands of grown men in this country parading about out in public disguised as women through their pronouns, dress, make up and/or cosmetic surgeries. This is a serious mental disorder that needs to be treated with psychotherapy not "affirmed" in any way by the majority. Because we've already seen the harm that comes when these "gender-bending" inmates take over the asylum.
No. It's simply reality. You can fool some of the people some of the time. And all of the people all of the time. But you can't fool all of the people all of the time. And people are catching on to the "transgender" con game.
I'll tell you what "harsh" is. What's harsh is sending men who were convicted of rape and with intact penises into a women's prison where they can beat, rape, and impregnate women prisoners with impunity.
What's "harsh" is sending four year olds into a drag queen story hour at the public library and filling their heads with "transgender" lies.
What's "harsh" is assaulting Riley Gaines for stating the obvious. Men do not belong in women's sports.
I don't think there should be any place in medicine for this "social justice" kind of trratment.
Gender dysphoria is a disorder, even if it has replaced "gender identity disorder" at the demand of "trans" activists. Just as in Body Integrity Identity Disorder, BIID, where people want healthy limbs amputated, this is a psychological malady and the real treatment is to treat the psychology, not slice off healthy body parts.
And that's the real dysphorics; the other 99.9% of "trans" who are not even dysphoric should not be coddled at all but should go directly into psychological treatment with the intent of having them get another hobby, and getting them off social media.
The last time surgery was used for a psychiatric disorder was lobotomy, which is now regarded as unethical. Why anyone regards "gender affirmation" as ethical is beyond sane commprehension.
“To most people, trans is a sort of "super-gay", drag is just what gays really want to do, and transvestism is all the same, both the male prostitutes seeking to deceive customers and the straight men who get a thrill out of secretly wearing an item of women's clothing.”
This is fascinating; if asked, I would not have known to assert these things. It’s hard for me to know what “most” people think; my experiences are pretty far out of the mainstream, I suppose. Not sure on that, but seems true.
Being transgendered is not being “super gay.” The LGB part of the acronym is about sexual orientation--whether sexual attraction is experienced toward same or opposite sexes. One of my kid’s experiments measured eye movement toward pictures; the hypothesis being tested is that gaze will move toward and stay longer on content that fits orientation.
Fetishes are different than orientation; I don’t know much about them. Maybe wearing women’s clothing is classed as a fetish. I would think so.
It’s definitely not true that “drag is just what gays really want to do.” Most gay people that I’ve met, including lesbians, want to live their lives and find people that love and accept them. There is also a whole subculture for sexual hookups; some of this is unhealthy, for sure. And, of course, gay people want many things, just like the rest of us, like good jobs and being competent. Pete Buttegieg is a good example of a gay guy who has internalized most of the values of middle America; he has chosen to “be gay” in ways that are (somewhat) acceptable to the mainstream. If you look like them, talk like them, and behave like them, perhaps you belong with them. Because gays have historically been misunderstood and stigmatized, they’ve created subcultures that are more important to many of them for their own wellbeing than trying to fit into the dominant culture. Some of that involves acting out; my son wore a purple bathrobe to school after being beat up for finding a jock attractive and being outed by a female “friend” that he confided in. He also tried that goth crap for a while. It was hard.
The "effeminate gay man" was an enclave identity that is rapidly fading out. Go to a gym and probably 40% of the men there are gay. When I came out in 1974 my gay-acting period was a few weeks and then I went back to my old self, threw out the flowery shirts and platform shoes. It ain't me, babe.
While gay people have made disproportionate contributions to society, gay culture really didn't contribute anything. It was toxic and cruel and the quicker it fades out, the better.
Of course men, with penises, who were convicted of rape should not be sent into a women’s prison. I completely agree.
Drag queen story hour ... we’ll have to agree to disagree here. I could “converse” about it with you, but that would require that both of us were interested in having a conversation.
I saw posts that claimed someone assaulted Riley. I hope that she pressed charges.
What I can't understand is the support for drag from the radical gender ideologues and, apparently, most feminists, at least their organized public voices. Can't they see what's in front of their nose, that drag - the extreme gowns, the frightening make-up, the preposterous wigs - is mockery of femininity? The humor of drag, such as it is, comes from the irony that it's really a man under all that getup. It may be associated with gay men, but that's not necessarily so; Dame Edna Everage (Barry Humphries) is as straight as they come.) I suppose the vast majority of the public, those who don't have a direct interest in the issues, don't really understand or care about them. To most people, trans is a sort of "super-gay", drag is just what gays really want to do, and transvestism is all the same, both the male prostitutes seeking to deceive customers and the straight men who get a thrill out of secretly wearing an item of women's clothing. Lately, I've come to suspect the trans ideologues, especially those who aren't trans themselves, are deliberately conflating all these groups to advance their own agenda, the postmodernist project of destroying the very idea of truth.
John - I think you make some very important points. My work investigated deradicalization. I don’t know much about political activism, although I’m learning now that I have time to get involved; there, I’m focused on election reform.
I was just thinking about what makes drag funny, e.g., in Tootsie, is that “it’s really a man.” Maybe that is evolving. Maybe now it’s more like wearing Star Trek outfits or whatever other costumes make people happy. I’m actually more offended by young girls being made up like sexualized, adult women than I am of older people wearing drag as entertainment. I’d rather not see bare asses on the street, so I’d be fine with limits. But I was just at the Eno Festival and women there wearing a thong was fine as long as she’s cisgender and straight seems unfair.
but ultimately I don’t care about all that, because it’s in the category of live and let live for me. What I’m interested in are mostly these two questions: 1) Why are people suffering and what can be done to help them? and 2) What potential harms might be done and how do we prevent harm?
You're so right about young girls. The worst I've seen was once at the Halloween party given for the kids by the day Care operated by my Y. One little girl, I'd guess about five, was costumed presumably by her mother as a street hooker complete with black miniskirt, fishnet hose, and platform heels. I thought CPS should have gotten a call.
As for the humor, what's most vivid for me is the memory of the one time I went with some buddies to the show at the famous My Oh My club in New Orleans. The jokes and the musical numbers (parodies of pop songs) were mostly R rated innuendo not out of place at a conventional strip show but made even more funny by the irony. Almost 60 years later, i still remember one song, "A Hard Man is Good to Find". (Hope this doesn't get me barred!)
I'd distinguish drag - entertainers, certainly not necessarily gay, e.g., "Dame Edna Everage" or Milton Berle - from transvestism - men who get a sexual thrill out of wearing women's apparel usually privately or even concealed such as panties under a business suit. Then, I've heard of gay male prostitutes who dress as women at least ostensibly to deceive customers. I do wonder whether customers are actually deceived or the costume allows the customer to maintain his self esteem by pretending to himself the transaction is not what it actually is. The human capacity for self deception is truly astonishing.
Honestly, I have no idea what most feminists are doing these days. I became a feminist in the Bay Area of California between 1968-1983, when I had my first baby, a little gay boy. There were lots of unintended consequences from the sexual freedom movement, of which my father was a part. I suffered as a result. I’ve learned a lot. Post-traumatic growth is something I’ve studied and experienced personally.
Darg queens who read stories are clowns. Their impersonations are not serious, if anything they are making fun of women in a good-natured way that is not going to warp any kids. Republican rage about this is as stupid as everything else Republican.
It’s not accurate to assume that transgendered people are mentally ill. Any more than it was accurate to assume that being homosexual is a mental illness.
Gender dysphoria is in the DSM, and if it was not a disorder it would not require expensive treatment. Unless you are using the new expanded definition whereby everyone who is nonconforming to traditional gender roles is "transgender."
On your second point, that some people appear to be moving toward an understanding that “everyone who is nonconforming/gender atypical is ‘transgender’.” I absolutely do NOT agree with that. My father was a bisexual male who occasionally wore a dress or went naked to make a statement about his atypicality or to raise $$ for AIDS awareness or STD treatments, or whatever. He did not have a dress fetish. Fetishes are another sexual “disorder” that gets attention sometimes. A clear, shared understanding of what constitutes a “disorder” might be helpful. In general, with the DSM, classifying something as a disorder means that you’ve met a bunch of the clinical criteria. So, you can have post traumatic stress ... but you don’t have PTSD until the dis-ease renders you functionally incapable in some way, on a chronic basis. I believe.
My PhD is in human development and although I am a positive psychologist, not a clinician--who extensively studies pathologies and how to treat them--I do know quite a bit about the DSM and mental illness/health in general, and specifically as it pertains to trauma.
Dysphoria is a condition that is experienced along a spectrum, as many are. Higher levels of dysphoria, or discomfort, warrant more “invasive” treatments, i.e., those that have significant side effects or involve surgery are more invasive than talk therapy, obviously.
Those people are all either male and female. They are most definitely not "transgender."
By the way, "doc." the fact that you have a PhD, doesn't earn you any points around here since it is widely known that the universities have all been captured by woke, and specifically "transgender" ideology.
“ Problems in research beyond variable terminology include variable population estimates. Research has generally estimated that 1.7% to 4% of people go on to actually have intersex variations (Carroll, 2005; Fausto-Sterling, 1993; OII Australia, 2012b). Given that many elements of sex (chromosomes, genes, hormones) are not apparent without testing, current estimates of the incidence and types of intersex variations seen in humans may be conservative.”
Does this apply to body dysmorphia around weight? Should I have liposuction or take Ozempic because, despite being thin since I was 18, I invariably feel fat and see a chubby teenager in the mirror instead of a lithe 40-year-old woman?
>Anecdotally we hear a lot about an incessant, almost Sisyphean quest to find the next thing that will assuage GD--first the blockers, then the hormones, then a suite of surgeries, always looking for the next one that will make them pass better or maybe make them feel that they are more “truly” the target sex.
I'd argue that they've tried all these options, found they haven't really worked that well, and are now trying to engineer society to uncritically accept their gender in the vain hope that THIS will alleviate whatever emotional pain they feel.
This won't work - by annihilating the concept of sex entirely and replacing it with some radically individualistic, unknowable, soul-like concept of gender, they're eliminating any common reference point they might have with other people around gender.
I don't know what's more disturbing - that next to no people in this space have thought these consequences through. Or that they have, and they actually WANT to make our entire society miserable so that we all feel as adrift and isolated as they apparently feel.
I agree. We do see people talking/complaining about not being able to trust if others “really see me as” the sex they want to be, even when all the pronouns are respected and exceptions are made etc etc.
Some of these stories are almost heartbreaking. They have been led to believe they’ll be and be believed as the other sex only to have reality slam them.
I suspect nothing will ever be enough to assuage GD because at the end of the day, as Nancy Robertson pointed out, sex is immutable. Putting wings on a dog won't make it a bird. The whole thing feels like a farce, and a cruel one at that, fed by a tempest of mental illness, anger, empathy (however misguided), and greed.... HG Wells's Island of Doctor Moreau.
This is an issue throughout medical science: the use of surrogate endpoints in research. Say you want to test if a drug lowers the risk of heart disease: heart disease takes a long time to form, so a study testing for prevalence of heart disease will be a very expensive (and long-term) study. But cholesterol levels are correlated with heart disease! Instead of doing an (expensive, long) study on how the drug interacts with heart disease, you can do a (cheaper, shorter) study on how the drug interacts with cholesterol, and then extrapolate that a drug that lowers cholesterol levels will also lower incidence of heart disease (in reality: it's complicated. Lowering cholesterol prevents future heart attacks in specific cohorts, but accomplishes nothing for the majority, and also will miss the people with regular cholesterol who have heart attacks anyway).
It's amazing how much of what I read about "gender affirming care" seems so tenuous and premised on quicksand. BTW, part of the reason I became fascinated with "gender affirming care" was that euphemism itself.......Why must there be affirmation? And specifically, What is it that is being affirmed?
It's odd to me that something that could start off as 6 or 7 year old boy liking fashion or dolls could eventually lead to procedures as invasive as orchiectomies or penectomies.
I share your curiosity about affirmation. As best I can understand, there is a sense among everyone from doctors to families to advocates that for whatever reason, this population is *so* fragile that any recognition of reality is earth shattering.
It’s my opinion that tactic will backfire both with every individual and with the population at large, and I’m not sure why this population is to be treated with kid gloves compared to any other difficult condition--say, dwarfism or being physically disabled, neither of which we go out of the way to avoid acknowledging in all cases.
Insulating people in a bubble of supportive unreality can’t ever work, except maybe for patients with dementia.
Yes, and the Utrecht Gender Dysphoria Scale specifically seems pretty useless as a measure as well.
Here's the FTM version (for starred items, agreement indicates less dysphoria, obviously):
1. I prefer to behave like a boy/man.
2. Every time someone treats me like a girl/woman I feel hurt.
3. I love to live as a girl/woman.*
4. I continuously want to be treated like a boy/man.*
5. A boy’s/man’s life is more attractive for me than a girl’s/woman’s life.
6. I feel unhappy because I have to behave like a girl/woman.
7. Living as a girl is something positive for me.*
8. I enjoy seeing my naked body in the mirror.*
9. I like to behave sexually as a girl/woman.*
10. I hate menstruating because it makes me feel like a girl/woman.
11. I hate having breasts.
12. I wish I had been born as a boy/man.
I understand that it's fishy as hell that this variable disappeared from the study, possibly because the results didn't look good. But I also don't know why this scale would produce data that looked good for mastectomy, *even if mastectomy does reduce gender dysphoria.*
Which items on this scale would you expect to change as a result of a gender-affirming double mastectomy, assuming this intervention is helpful? #8, sure. #11 has the same problem as the Chest Dysphoria Measure. #12, arguably — maybe now you like your body enough that you no longer wish that?
But most of these are things that, to the best of my understanding, affirming practitioners not only wouldn't expect to change, but would not WANT to change. No affirming treatment is intended to make an FTM start saying "I love to live as a girl."
So while I understand why the authors would want to discard this scale as a variable — I DON'T understand why they wanted to use it in the first place. It is obviously not measuring what they want it to measure.
(The same is true of the Dutch studies where they administered the opposite-sex version of this scale at followup. They claim the resulting low scores show that GD was "alleviated," but it doesn't follow. Wouldn't you expect an MTF to have a low score on the FTM dysphoria scale both before and after transition?)
Jesse writes, "Either science takes these kids’ lives and treatment decisions seriously, or it doesn’t. Disappearing a key variable without any explanation why could not be a clearer signal that at root, this was not a serious effort to understand the effects of these surgeries."
Exactly, but I'd go further: Attempting to use the UGDS to evaluate the effect of affirming treatments on gender dysphoria is *in itself* a signal of an unserious effort to understand the effects of these treatments.
I question the very first impulses that must have inspired "gender affirming medicine". I just can't get inside the head of the first person to think "Maybe cross sex hormones will help this person!" or "Maybe this type of surgery will help this person!" They both seem to fail a basic smell test.
Did those people know anything about human evolution? (Apparently not!)
It's also part of the difference between Evidence-Based Medicine and Science-Based Medicine (although the blog named after the latter has sadly fallen). Not just does an RCT support a given intervention, but does the intervention even make sense in the first place, in a worldview based on science?
You continue to give these researchers the benefit of the doubt. Why? All the obfuscation, misrepresentation & non responsiveness points at this point one way & that way is not in support of the evidence they were sure they would find.
Are we really to believe that if they had better (or any) data showing “affirmative care” be it puberty blockers, opposite sex hormones or surgeries was net beneficial to kids that they wouldn’t be screaming it from the rooftops?
Are we really to believe that “affirmative care” providers just don’t have the data required to answer these questions?
Or are we to surmise that they have a very good idea of what the data will say & would prefer not to think too much about it because it could put their not just livelihoods but that which gives their lives meaning (in their own conceptions) at risk?
I won’t mention the potential impacts on these researchers’, clinicians’ & activists’ future employment prospects & community standing if the data turns out to show “affirmative care” on net 𝘩𝘢𝘳𝘮𝘴 the majority of its recipients.
Every time you discuss how weak and/or misrepresented pro-“affirmative care” studies are you go to pains to stress that “yes, it absolutely helps some people”.
Can you explain in what way the fact that there exist some people for which a poorly at best evidenced medical intervention produces some benefit supports using that intervention indiscriminately in any patient that presents with any of a very broad range of symptoms?
It sounds to me that what you are really saying is that the fact that these studies don’t show that “affirmative care” 𝘩𝘢𝘳𝘮𝘴 patients that the weakly quantified benefits justifies the provision of said care.
If the treatment in question was for Alzheimer’s or terminal cancer I would agree. But that is not what we are talking about. There is nothing 𝘱𝘩𝘺𝘴𝘪𝘤𝘢𝘭𝘭𝘺 wrong with gender dysphoric kids and, as you have related previously, the suicide stats are bullshit.
Even if they were not bullshit, in what other instance is suicidality treated with 𝘱𝘩𝘺𝘴𝘪𝘤𝘢𝘭 interventions (other than physically sequestering a patient somewhere so that they cannot physically harm themselves)?
The onus is 𝘯𝘰𝘵 on providers of a novel treatment to show patients are 𝘯𝘰𝘵 harmed, but to show that the a treatment’s is net beneficial taking into account all associated 𝘳𝘪𝘴𝘬𝘴.
To Jesse's credit he is saying this makes them, this research, this field, and science in general lose it's credibility when researchers operate this way.
I disagree with your summary of Jesse’s views, but your frustration with the medical professionals is righteous and shared.
For so many years, the evidence that this treatment helped could be found in the Dutch studies. Obviously there’s new scrutiny with that study, and as you say, it’s not like it was ever intended to be used the way it is in the US and elsewhere.
To the extent that Jesse carved out a caveat for some individuals, it always seems he has the Dutch protocol in mind.
Okay, I'm not giving you legal advice, but just as a point of information, most FOIA processes contain an appeal process to get a 3rd party set of eyes on the request without requiring a lawyer or filing a lawsuit. As a point of interest, Illinois has a public access counselor (https://foiapac.ilag.gov/) who handles such things and may be able to assist you.
This is not legal advice, I am not representing you, or providing legal services to you.
This is permanent surgery removing healthy tissue. Glad the subjects are happy 3 months later. Their breasts are gone forever! How will they feel in 5 or 10 years?
I'm confident that all of these researchers will unanimously agree that there's no need to conduct long term studies to check the subject's wellbeing. And they'll give detailed justifications for this too - we're not allowed to see them though, and they're conveniently exempt from FOI if you try to find them.
Just listen and believe in the infallible science, as interpreted by the equally Infallible researchers... /s
I have a friend whose grand daughter had puberty blockers, hormone treatment and breast removal before the age of 15. When I asked how she/he was doing, I was told she/he had never been happier. Well, I said, so that must have worked. Maybe my friend said. Or it could be all the antidepressents and and antianxiety meds she/he has been taking for years.
This "affirming" nonsense - do shrinks affirm a patient who persistently and insistently "identifies" as Jesus? - is clearly a fad among the medical and related professionals, and I know such fads exist. About five years ago, in my 70s, I was diagnosed with skin cancer on my nose (a basal cell carcinoma, not exceptionally dangerous). About a year later, there was a squamous cell carcinoma on my cheek. Now when I was about 15, I had pretty bad acne that the dermatologist my folks sent me to attempted to treat with X-ray exposure. (It produced no detectable improvement.) I asked my current dermatologist whether that x-ray "treatment" was a widely accepted treatment at the time, about 1960. He said, "Oh yes. It was very popular at that time. Unfortunately, we later found out it was worse than useless." I bit my tongue rather than yell, "I could have told you that! And I was just a 15 year old high school sophomore!" So did it lead to the current situation? "It almost certainly was the cause of your problems." So when I learn of surgeons amputating healthy body parts and endocrinologists prescribing off-label use of the drugs approved by FDA for palliative treatment of metastatic prostate cancer, especially during the unbelievably complex changes in a child's body in puberty and adolescence, I can only shake my head and think, "You fools, you blind fools!"
Around 1949 my mother received a blast of X-rays for an ear infection. Nobody knew back then that ionizing radiation was carcinogenic. Decades later she came down with myelomonocytic leukemia, a rare cancer, and died at the age of 62.
That's awful, Chris. I keep thinking all those smart guys would have figured out the dangers of radiation seeing the delayed consequences of radiation from the atomic bombs used in Japan if not from the American troops used in the atomic tests. Yet it was not until some time in the early '50's that the fluoroscopic devices, used by consumers without supervision, were removed from shoe stores.
"If researchers aren’t transparent about their methods and won’t answer basic questions about those methods, they are not entitled to our trust."
+1000000
"Science is Real" was an epic failure of a slogan because it was implicitly "STFU and OBEY". It was not about transparency. It was not about the quest for knowledge. It paid no respect to the limitations of the scientific method to determine "truth".
It was just STFU. It was gross. It was stating that the narrative is reality. It was, by any definition, anti-science.
This is really bad from an ethical perspective. Investigators have an ethical obligation to publish the evidence that they said they would collect. Withholding data that might change the results means that patients will be making decisions based on incomplete and inaccurate information. If investigators only publish the scales that have a benefit and leave the scales that show no effect or a negative effect in their desk drawer, patients might choose a treatment that is ineffective or dangerous over one that actually works. That puts patients in danger.
This problem isn't confined to gender-affirming care. There's a long-standing problem with oncology trials not reporting all of the secondary endpoints. It's also been a big problem in reporting on psychiatric drugs for children and adolescents. It's socially more acceptable to talk about missing endpoints in oncology trials because oncology isn't politicized the way gender-affirming care is and many of those oncology trials are for expensive drugs made by large pharmaceutical companies while people providing gender affirming care mean well.
One other thing I would point out is that careerism may play a role. Scientists want to publish their work in the highest impact journal they can get. Thanks to politics, journal editors would probably be less likely to publish a paper that found mixed results than one that just reported the positive ones. And the paper might be published with an accompanying editorial that says the study isn't very good. Something similar happened to the DANMASK study. The study was powered to find a 50% reduction in SARS-COV2 infections in people wearing surgical mask and found a 20% reduction that wasn't statistically significant. It took a surprisingly long time to publish it and the journal accompanied it with an editorial that went on about its flaws and could have left the reader with the impression that the study should be ignored -- not a surprise when public health officials were claiming that universal masking could bring the pandemic under control or that masks were more effective than vaccines. Journal editors are subject to the same social pressures as everyone else.
Is there any doubt careerism plays a huge role in this issue? Try to imagine a non tenured academic submitting a paper for publication that contradicts what she knows is the prevailing opinion of the tenure committee. Or a PhD candidate proposing a research project that he believes is likely to cast doubt on his advisor's firmly held theory. It ain't gonna happen. Careerism may not contribute to the fad, but it must help smooth the path for its advance.
"Wouldn't you want to know if this didn't help the people you care about?"
"Opposing treatment is phobia"
I don't think the activists entertain that they could be wrong, and they seem to be running the institutions (not literally, but sometimes also literally).
I am duly exasperated. Maybe pro bono legal aid will be forthcoming to pursue a lawsuit. To purloin and repurpose the WaPo's slogan, science dies in darkness. It really says something that so many researchers are not close to transparent in their practices. They often treat data and methodologies as proprietary.
Our country is rife with silly liberals running around saying, "trust the science." Well no, don't trust the science until you vet it six ways to breakfast. Regarding gender dysphoria, it is highly lamentable that ideology is trumping careful scientific inquiry wherever you look.
Leor Sapir has an excellent new piece in City Journal covering a new Texas bill to ban youth transition, and talks about his experience as an expert witness in support, as well as the contradictions expert witnesses testifying against fell into while trying to explain that the care they provide is “settled science”, etc.
Scroll down past "A. High risk of bias in the Dutch research" to "2. Bias in measurement of outcomes: The finding of “resolution of gender dysphoria” is invalid"
Basically, they have a male and female version, and I could administer the UGDS to a dysphoric youngster, then give them a fetching hat, tell them they totally look like the opposite sex now, and administer the opposite sex UGDS resulting in an impressive score improvement! It's bogus.
Also good to point out explicitly that the gender congruence measure is the only one of those four that doesn't seem like a tautology, hence maybe a not completely useless measure. Of course if you think you shouldn't have breasts and then get a double mastectomy, you'll think your body matches your thoughts of what your body should be!
I dunno. All of those image/congruence measures seem pretty useless because once you've done the work to look more like the gender you think you are, of course you'll feel less incogruent and probably less dysphoric. The really important measures would be of general mental well-being, and they never even claimed to be looking at those.
Well, isn’t mental well-being wrapped up in the diagnosis of gender dysphoria? That’s what made it exclusion in the results so telling--the one marker of mental health was GD, and they dropped it from the results.
Like, they scrapped the holistic evaluation in favor of smaller concrete things like whether no longer having breasts reduces chest dysphoria. Which, obviously. But whether that intervention alleviated the distress they feel being the sex they are--that went unaddressed, at least in the final results, while it was originally included in the patient materials as a key component of the study.
Basically, they started off looking to get info about whether it alleviates gender distress, but then omitted that factor in their results.
As Jesse has pointed out, it’s impossible to know *why* they omitted those results, but it’s hard not to wonder if they did so because there was no improvement in GD distress post-op.
In which case, again and again and again, what are we doing here?
My understanding is that gender dysphoria is the result of having a body that doesn't match your idea of who you are. So I would expect this to be alleviated by changing your body, whereas it could be that no physical changes will alleviate anxiety, depression, etc.
While there’s nothing about your understanding that seems out of step with how it’s discussed, I do think that the condition is more profound than the way you’ve rendered it. Like, it’s not necessarily the desire to be the opposite sex, but a deep and terrifying revulsion of what one is. I have had and still do have some GD as a 38 yo female. If I’d ever had the option to snap my fingers and literally and truly change sex, I’d have done it. But I was always aware of the limitations of transitioning--that I could never truly be a man, and short of that, I wasn’t gonna bother.
I worry that too many people believe that transitioning will make them feel like they really are the opposite sex, but then they realize that they still aren’t the target sex after transition, but also hope that the next (next, next) intervention will make them so.
I'd have to question the exception for the"hard" sciences, even the hardest, mathematics. A recent article in "National Review" describes a controversy in Canada about something called the "Discovery Mathematics" model of teaching math. Here's the link:
Here's the money quotes from the article of one of the proponents of the postmodernist approach to teaching kids math:
<<Laurie Rubel, an associate professor of mathematics education, explaining that proponents of “2 + 2 = 4” are grounded “in white, Western mathematics that marginalizes other possible values.”
<<Rubel argued that supporters of math’s political neutrality were oblivious to a deeper point: “It’s about truth: who holds the truth, who decides what is true, and how open we are as a society to multiple truths.”>>
Other possible values? Multiple truths? Are you kidding me!
Pray tell, what empirical observations have mathematicians made? How has empirical evidence contributed to the development and confirmation of hypotheses and theories in mathematics?
I’m not a scientist though I did train as one. My understanding of scientific paper writing is that one is supposed to include all results and why they do or do not support the hypothesis or talk about why they dropped one of the assessment tools.
ClinicalTrials.gov was intended to address this problem (somewhat) but the public is certainly unaware of it.
As long as the world of medical research is full of perverse incentives, we’re going to be in this mess. It’s not just gender medicine (although certainly this is important and the stakes are high when we talk about sterilizing children). It’s all of medicine.
The three biggest perverse incentives are:
(1) Scientists must “publish or perish.” Things like tenure and grant money ride on this. There is a perverse incentive to find significance in your data so you can publish it.
(2) If something is a potential huge new money maker (such as a new weight loss drug in an era when most Americans are overweight), there is a perverse incentive to find significance in your data (or find that the treatment is effective or doesn’t have bad outcomes or side effects) so that you can make a bunch of money.
(3) If some new “discovery” can create a sexy highly clickable headline, universities / drug companies / media will spin it that way.
In all of these cases (and more) if you have to remove some of the outcome variables to get what you want (statistical significance, tenure, grant money, a profitable new drug or surgery, an attention-grabbing headline) you’ll do it, clinicaltrials.gov be damned.
If you chop off girls’ breasts and they don’t benefit from it, it’s a lose-lose-lose: no one wants to publish negative results; no one profits from NOT chopping off girls’ breasts, and media doesn’t get an exciting headline when chopping off girls’ breasts turns out to be useless.
This last is the most debatable -- but in general, headlines where there’s nothing expensive to sell (like breast-removal surgery) are much less likely to make it into the public eye.
It’s not just “gender medicine” where this happens -- most drugs advertised on your TV are essentially useless -- but it is particularly sad and dangerous when applied to “gender medicine” which is not “life saving” and doesn’t lead to anyone’s happiness or authenticity. (Ask the governments of Finland or Sweden.)
These are extreme cosmetic procedures that also destroy the health of your body in many ways. There’s no win here except for the people selling this stuff.
One of the key issues is that that NIH will not hold the feet of bad actors and incompetent scientists to the fire. The current study by Olson-Kennedy is a good example. They were paid millions of dollars to conduct high-quality research. They are incompetent:
1) They lost 30% of cases in 2 years. This completely different from competent research, where 2-3% loss-to-follow-up is a firing offense.
2) They promise to report on things that they fail to report on.
3) In Chen et al (2023), they modified 5% of the data values, which they state in the Methods section.
The study is terrible. And no one is enforcing currect good-practice standards.
Is there actually such a thing as a ‘science denier’? Or just people who’ve looked hard enough to realize that the same flaws Jesse finds in gender medicine are rampant in fields like Covid medicine too?
No, there really truly are science deniers. The evidence for evolution really is staggering, but there is a lot of motivated reasoning to to convince oneself otherwise.
I guess I'm curious about the term and how people use it.
I’ve met university educated scientists who make a living in sciences and truly believe that the scientific method is yielding evidence compatible with their belief in creationism. They remain employed, so are presumably competent scientists.
Many of histories greatest scientific innovators, like Galileo, were creationists.
If someone is a “science denier” does that mean they deny that the scientific method is a useful tool? Or does it mean that they deny particular findings that are widely agreed upon as current scientific “consensus”? What does the label actually claim about these people? Is it their relationship to science itself or to a presumed authority?
I agree with you that there are a lot of people incapable of sound scientific analysis who reject consensus conclusions due to motivated reasoning. But I see a lot of people one the consensus side of arguments who are every bit as scientifically illiterate as many “science deniers” and are often just as self-serving in their motivations for going *with* the grain. The accuracy of a person’s belief isn’t itself evidence that they arrived there by rational means.
And I see a lot of name calling used to avoid real analysis of data. That name calling comes from both sides, as it were - we shut down the likes of Jesse by calling him a transphobic bigot, and we shut down other folks with labels like science-denier and grandma-killer. And labels used as smears don’t differentiate between (to use your example) the creationists who think dinosaur bones were planted a few hundred years ago and the creationists who have a view of creationism that’s compatible with evolutionary theory.
I would certainly differentiate between a theistic evolutionist and someone who “thinks dinosaur bones were planted a few hundred years ago.” Young Earth Creationists are not worth being taken seriously, but there is nothing preventing a scientist from being a theist.
Edit: as for Galileo being a creationist: yes, and? So was Linnaeus, but he still admitted he could find no reason to not include humans among the apes but demurred out of fear of the ecclesiastics.
I agree. What I'm pointing to is that language like science-denier tilts towards rejecting and dismissing anybody who has beliefs different from the speaker's as long as the speaker believes their views are based in science. And unfortunately, as Jesse's book shows, we tend to seriously over-estimate how many of our presumptions are grounded in real evidence.
Thank you for demonstrating my point. Your comments in this thread come across like a troll, not a scientist. Anyone who's concerned that people aren't 'following the science' should take a look in the mirror and see if they are burnishing or demolishing the reputation of the scientific method. Sadly, you're doing the latter.
Accuses others of ignorance, doesn’t even get the name of the drug right. 🤷🏻♀️ Yes, there are some whackadoodles. There are also people doing extremely stringent research and uncovering high-quality evidence, just like Jesse does.
Make sure to see my Addendum -- some (not all) of this information was available on a government website, it turned out.
There's an additional serious transparency issue here ... Reporting the results of a study on ClinicalTrials.gov is supposed to be mandatory.
This law has been in effect for about 15 years. Yet it took FDA until 2021 to issue its very first Notice of Non-Compliance to a drug company (which merely hints at the possible imposition of penalties). In practice, researchers have been able to flout the law for years.
Failing to report your results when you have written them up for a medical journal is even more egregious. Especially when the journal article willfully conceals the Endpoint Switching that made the trial look more positive than it was. (And especially when the number of subjects is small and the data is relatively simple.) Failing to even post a link to that journal article as part of your ClinicalTrials.gov registration adds a particularly nasty twist.
A decent history of the toothless state of this reform measure here:
https://www.statnews.com/2018/01/17/time-levy-penalties-failing-report-clinical-trial-results/
This seems like a growing problem with gender affirming care. Assessing whether an intervention “works” can be thought of in two ways: did removing breasts make the patient feel better because they no longer have breasts, and therefor it “worked”? And then the question of whether the mastectomy worked in terms of reducing gender dysphoria and/or improving general mental health.
So often it seems like these studies say, It worked! But they only assess the first question, and then claim it answers the second question, as if the one obviously follows the other.
But does it?
Anecdotally we hear a lot about an incessant, almost Sisyphean quest to find the next thing that will assuage GD--first the blockers, then the hormones, then a suite of surgeries, always looking for the next one that will make them pass better or maybe make them feel that they are more “truly” the target sex.
I think the difference between question one and question two is profoundly important, and the latter is probably the one that matters the most: if an intervention doesn’t resolve dysphoria and/or improve the mental health of the patient, what’s the point?
It's hard to think of any other area of care where the "treatment" is to encourage a mentally ill person to overwrite reality with their fantasies. And then, as you note, it is not surprising that it becomes necessary to double down again and again, and castigate in ever harsher terms anyone who objects to forced participation in the farce. The whole thing just becomes continually more baroque and insane.
Well that’s the tension between the two sides within the activist movement--is it a condition to be treated, alleviating stress and discomfort? Or is it just a way of being with no clear boundaries and an issue of bodily autonomy, with some admittedly radical social changes.
I think many people are sympathetic to the idea of someone being in so much distress and the only way to alleviate that is to approximate looking like the target sex--so long as the boundary of reality remains in place, ie so long as the individual is cognizant if the fact that they are not, actually, the opposite sex in some meaningful circumstances.
It’s when TWAW is taken literally, when individuals insist they are just a different type of biological woman, etc, that things go off the rails.
No. I believe most men and women are not sympathetic to the idea of hundreds of thousands of grown men in this country parading about out in public disguised as women through their pronouns, dress, make up and/or cosmetic surgeries. This is a serious mental disorder that needs to be treated with psychotherapy not "affirmed" in any way by the majority. Because we've already seen the harm that comes when these "gender-bending" inmates take over the asylum.
Wow. That’s harsh.
Nancy Robertson
7 min ago
·edited just now
No. It's simply reality. You can fool some of the people some of the time. And all of the people all of the time. But you can't fool all of the people all of the time. And people are catching on to the "transgender" con game.
I'll tell you what "harsh" is. What's harsh is sending men who were convicted of rape and with intact penises into a women's prison where they can beat, rape, and impregnate women prisoners with impunity.
What's "harsh" is sending four year olds into a drag queen story hour at the public library and filling their heads with "transgender" lies.
What's "harsh" is assaulting Riley Gaines for stating the obvious. Men do not belong in women's sports.
I don't think there should be any place in medicine for this "social justice" kind of trratment.
Gender dysphoria is a disorder, even if it has replaced "gender identity disorder" at the demand of "trans" activists. Just as in Body Integrity Identity Disorder, BIID, where people want healthy limbs amputated, this is a psychological malady and the real treatment is to treat the psychology, not slice off healthy body parts.
And that's the real dysphorics; the other 99.9% of "trans" who are not even dysphoric should not be coddled at all but should go directly into psychological treatment with the intent of having them get another hobby, and getting them off social media.
The last time surgery was used for a psychiatric disorder was lobotomy, which is now regarded as unethical. Why anyone regards "gender affirmation" as ethical is beyond sane commprehension.
Yes, I agree.
“To most people, trans is a sort of "super-gay", drag is just what gays really want to do, and transvestism is all the same, both the male prostitutes seeking to deceive customers and the straight men who get a thrill out of secretly wearing an item of women's clothing.”
This is fascinating; if asked, I would not have known to assert these things. It’s hard for me to know what “most” people think; my experiences are pretty far out of the mainstream, I suppose. Not sure on that, but seems true.
Being transgendered is not being “super gay.” The LGB part of the acronym is about sexual orientation--whether sexual attraction is experienced toward same or opposite sexes. One of my kid’s experiments measured eye movement toward pictures; the hypothesis being tested is that gaze will move toward and stay longer on content that fits orientation.
Fetishes are different than orientation; I don’t know much about them. Maybe wearing women’s clothing is classed as a fetish. I would think so.
It’s definitely not true that “drag is just what gays really want to do.” Most gay people that I’ve met, including lesbians, want to live their lives and find people that love and accept them. There is also a whole subculture for sexual hookups; some of this is unhealthy, for sure. And, of course, gay people want many things, just like the rest of us, like good jobs and being competent. Pete Buttegieg is a good example of a gay guy who has internalized most of the values of middle America; he has chosen to “be gay” in ways that are (somewhat) acceptable to the mainstream. If you look like them, talk like them, and behave like them, perhaps you belong with them. Because gays have historically been misunderstood and stigmatized, they’ve created subcultures that are more important to many of them for their own wellbeing than trying to fit into the dominant culture. Some of that involves acting out; my son wore a purple bathrobe to school after being beat up for finding a jock attractive and being outed by a female “friend” that he confided in. He also tried that goth crap for a while. It was hard.
The "effeminate gay man" was an enclave identity that is rapidly fading out. Go to a gym and probably 40% of the men there are gay. When I came out in 1974 my gay-acting period was a few weeks and then I went back to my old self, threw out the flowery shirts and platform shoes. It ain't me, babe.
While gay people have made disproportionate contributions to society, gay culture really didn't contribute anything. It was toxic and cruel and the quicker it fades out, the better.
Of course men, with penises, who were convicted of rape should not be sent into a women’s prison. I completely agree.
Drag queen story hour ... we’ll have to agree to disagree here. I could “converse” about it with you, but that would require that both of us were interested in having a conversation.
I saw posts that claimed someone assaulted Riley. I hope that she pressed charges.
What I can't understand is the support for drag from the radical gender ideologues and, apparently, most feminists, at least their organized public voices. Can't they see what's in front of their nose, that drag - the extreme gowns, the frightening make-up, the preposterous wigs - is mockery of femininity? The humor of drag, such as it is, comes from the irony that it's really a man under all that getup. It may be associated with gay men, but that's not necessarily so; Dame Edna Everage (Barry Humphries) is as straight as they come.) I suppose the vast majority of the public, those who don't have a direct interest in the issues, don't really understand or care about them. To most people, trans is a sort of "super-gay", drag is just what gays really want to do, and transvestism is all the same, both the male prostitutes seeking to deceive customers and the straight men who get a thrill out of secretly wearing an item of women's clothing. Lately, I've come to suspect the trans ideologues, especially those who aren't trans themselves, are deliberately conflating all these groups to advance their own agenda, the postmodernist project of destroying the very idea of truth.
John - I think you make some very important points. My work investigated deradicalization. I don’t know much about political activism, although I’m learning now that I have time to get involved; there, I’m focused on election reform.
I was just thinking about what makes drag funny, e.g., in Tootsie, is that “it’s really a man.” Maybe that is evolving. Maybe now it’s more like wearing Star Trek outfits or whatever other costumes make people happy. I’m actually more offended by young girls being made up like sexualized, adult women than I am of older people wearing drag as entertainment. I’d rather not see bare asses on the street, so I’d be fine with limits. But I was just at the Eno Festival and women there wearing a thong was fine as long as she’s cisgender and straight seems unfair.
but ultimately I don’t care about all that, because it’s in the category of live and let live for me. What I’m interested in are mostly these two questions: 1) Why are people suffering and what can be done to help them? and 2) What potential harms might be done and how do we prevent harm?
You're so right about young girls. The worst I've seen was once at the Halloween party given for the kids by the day Care operated by my Y. One little girl, I'd guess about five, was costumed presumably by her mother as a street hooker complete with black miniskirt, fishnet hose, and platform heels. I thought CPS should have gotten a call.
As for the humor, what's most vivid for me is the memory of the one time I went with some buddies to the show at the famous My Oh My club in New Orleans. The jokes and the musical numbers (parodies of pop songs) were mostly R rated innuendo not out of place at a conventional strip show but made even more funny by the irony. Almost 60 years later, i still remember one song, "A Hard Man is Good to Find". (Hope this doesn't get me barred!)
Most transvestites are heterosexual, and always have been.
I'd distinguish drag - entertainers, certainly not necessarily gay, e.g., "Dame Edna Everage" or Milton Berle - from transvestism - men who get a sexual thrill out of wearing women's apparel usually privately or even concealed such as panties under a business suit. Then, I've heard of gay male prostitutes who dress as women at least ostensibly to deceive customers. I do wonder whether customers are actually deceived or the costume allows the customer to maintain his self esteem by pretending to himself the transaction is not what it actually is. The human capacity for self deception is truly astonishing.
Honestly, I have no idea what most feminists are doing these days. I became a feminist in the Bay Area of California between 1968-1983, when I had my first baby, a little gay boy. There were lots of unintended consequences from the sexual freedom movement, of which my father was a part. I suffered as a result. I’ve learned a lot. Post-traumatic growth is something I’ve studied and experienced personally.
Darg queens who read stories are clowns. Their impersonations are not serious, if anything they are making fun of women in a good-natured way that is not going to warp any kids. Republican rage about this is as stupid as everything else Republican.
Only Republicans care about making fun of women?
I’m so tired of commenter looking for fights.
Fuck off.
It’s not accurate to assume that transgendered people are mentally ill. Any more than it was accurate to assume that being homosexual is a mental illness.
Gender dysphoria is in the DSM, and if it was not a disorder it would not require expensive treatment. Unless you are using the new expanded definition whereby everyone who is nonconforming to traditional gender roles is "transgender."
On your second point, that some people appear to be moving toward an understanding that “everyone who is nonconforming/gender atypical is ‘transgender’.” I absolutely do NOT agree with that. My father was a bisexual male who occasionally wore a dress or went naked to make a statement about his atypicality or to raise $$ for AIDS awareness or STD treatments, or whatever. He did not have a dress fetish. Fetishes are another sexual “disorder” that gets attention sometimes. A clear, shared understanding of what constitutes a “disorder” might be helpful. In general, with the DSM, classifying something as a disorder means that you’ve met a bunch of the clinical criteria. So, you can have post traumatic stress ... but you don’t have PTSD until the dis-ease renders you functionally incapable in some way, on a chronic basis. I believe.
Any boy who picks up a doll.
Any girl who doesn't.
Straight to the operating table.
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My PhD is in human development and although I am a positive psychologist, not a clinician--who extensively studies pathologies and how to treat them--I do know quite a bit about the DSM and mental illness/health in general, and specifically as it pertains to trauma.
Dysphoria is a condition that is experienced along a spectrum, as many are. Higher levels of dysphoria, or discomfort, warrant more “invasive” treatments, i.e., those that have significant side effects or involve surgery are more invasive than talk therapy, obviously.
There are two human sexes and only two sexes, male and female. An adult human male is a man. An adult human female is a woman.
Sex is determined at the moment of conception, and it is immutable.
There are vanishingly few people who are intersex. They do exist.
Those people are all either male and female. They are most definitely not "transgender."
By the way, "doc." the fact that you have a PhD, doesn't earn you any points around here since it is widely known that the universities have all been captured by woke, and specifically "transgender" ideology.
Intersex is an ensemble of developmental defects.
They are not sexes, nor does their existence challenge any notion of sexes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808814/
https://journals.sagepub.com/doi/10.1177/2158244017745577
“ Problems in research beyond variable terminology include variable population estimates. Research has generally estimated that 1.7% to 4% of people go on to actually have intersex variations (Carroll, 2005; Fausto-Sterling, 1993; OII Australia, 2012b). Given that many elements of sex (chromosomes, genes, hormones) are not apparent without testing, current estimates of the incidence and types of intersex variations seen in humans may be conservative.”
Does this apply to body dysmorphia around weight? Should I have liposuction or take Ozempic because, despite being thin since I was 18, I invariably feel fat and see a chubby teenager in the mirror instead of a lithe 40-year-old woman?
Parsing out “dysphoria” and understanding what that is, how it works, and what alleviates it is something that some researchers want to explore.
Research happens because people want to invest the time, energy, and resources $$$ to do it.
>Anecdotally we hear a lot about an incessant, almost Sisyphean quest to find the next thing that will assuage GD--first the blockers, then the hormones, then a suite of surgeries, always looking for the next one that will make them pass better or maybe make them feel that they are more “truly” the target sex.
I'd argue that they've tried all these options, found they haven't really worked that well, and are now trying to engineer society to uncritically accept their gender in the vain hope that THIS will alleviate whatever emotional pain they feel.
This won't work - by annihilating the concept of sex entirely and replacing it with some radically individualistic, unknowable, soul-like concept of gender, they're eliminating any common reference point they might have with other people around gender.
I don't know what's more disturbing - that next to no people in this space have thought these consequences through. Or that they have, and they actually WANT to make our entire society miserable so that we all feel as adrift and isolated as they apparently feel.
I agree. We do see people talking/complaining about not being able to trust if others “really see me as” the sex they want to be, even when all the pronouns are respected and exceptions are made etc etc.
Some of these stories are almost heartbreaking. They have been led to believe they’ll be and be believed as the other sex only to have reality slam them.
I suspect nothing will ever be enough to assuage GD because at the end of the day, as Nancy Robertson pointed out, sex is immutable. Putting wings on a dog won't make it a bird. The whole thing feels like a farce, and a cruel one at that, fed by a tempest of mental illness, anger, empathy (however misguided), and greed.... HG Wells's Island of Doctor Moreau.
This is an issue throughout medical science: the use of surrogate endpoints in research. Say you want to test if a drug lowers the risk of heart disease: heart disease takes a long time to form, so a study testing for prevalence of heart disease will be a very expensive (and long-term) study. But cholesterol levels are correlated with heart disease! Instead of doing an (expensive, long) study on how the drug interacts with heart disease, you can do a (cheaper, shorter) study on how the drug interacts with cholesterol, and then extrapolate that a drug that lowers cholesterol levels will also lower incidence of heart disease (in reality: it's complicated. Lowering cholesterol prevents future heart attacks in specific cohorts, but accomplishes nothing for the majority, and also will miss the people with regular cholesterol who have heart attacks anyway).
It's amazing how much of what I read about "gender affirming care" seems so tenuous and premised on quicksand. BTW, part of the reason I became fascinated with "gender affirming care" was that euphemism itself.......Why must there be affirmation? And specifically, What is it that is being affirmed?
It's odd to me that something that could start off as 6 or 7 year old boy liking fashion or dolls could eventually lead to procedures as invasive as orchiectomies or penectomies.
I share your curiosity about affirmation. As best I can understand, there is a sense among everyone from doctors to families to advocates that for whatever reason, this population is *so* fragile that any recognition of reality is earth shattering.
It’s my opinion that tactic will backfire both with every individual and with the population at large, and I’m not sure why this population is to be treated with kid gloves compared to any other difficult condition--say, dwarfism or being physically disabled, neither of which we go out of the way to avoid acknowledging in all cases.
Insulating people in a bubble of supportive unreality can’t ever work, except maybe for patients with dementia.
Yes, and the Utrecht Gender Dysphoria Scale specifically seems pretty useless as a measure as well.
Here's the FTM version (for starred items, agreement indicates less dysphoria, obviously):
1. I prefer to behave like a boy/man.
2. Every time someone treats me like a girl/woman I feel hurt.
3. I love to live as a girl/woman.*
4. I continuously want to be treated like a boy/man.*
5. A boy’s/man’s life is more attractive for me than a girl’s/woman’s life.
6. I feel unhappy because I have to behave like a girl/woman.
7. Living as a girl is something positive for me.*
8. I enjoy seeing my naked body in the mirror.*
9. I like to behave sexually as a girl/woman.*
10. I hate menstruating because it makes me feel like a girl/woman.
11. I hate having breasts.
12. I wish I had been born as a boy/man.
I understand that it's fishy as hell that this variable disappeared from the study, possibly because the results didn't look good. But I also don't know why this scale would produce data that looked good for mastectomy, *even if mastectomy does reduce gender dysphoria.*
Which items on this scale would you expect to change as a result of a gender-affirming double mastectomy, assuming this intervention is helpful? #8, sure. #11 has the same problem as the Chest Dysphoria Measure. #12, arguably — maybe now you like your body enough that you no longer wish that?
But most of these are things that, to the best of my understanding, affirming practitioners not only wouldn't expect to change, but would not WANT to change. No affirming treatment is intended to make an FTM start saying "I love to live as a girl."
So while I understand why the authors would want to discard this scale as a variable — I DON'T understand why they wanted to use it in the first place. It is obviously not measuring what they want it to measure.
(The same is true of the Dutch studies where they administered the opposite-sex version of this scale at followup. They claim the resulting low scores show that GD was "alleviated," but it doesn't follow. Wouldn't you expect an MTF to have a low score on the FTM dysphoria scale both before and after transition?)
Jesse writes, "Either science takes these kids’ lives and treatment decisions seriously, or it doesn’t. Disappearing a key variable without any explanation why could not be a clearer signal that at root, this was not a serious effort to understand the effects of these surgeries."
Exactly, but I'd go further: Attempting to use the UGDS to evaluate the effect of affirming treatments on gender dysphoria is *in itself* a signal of an unserious effort to understand the effects of these treatments.
(Source for the scale: https://research.vumc.nl/ws/portalfiles/portal/354253/hoofdstuk+03.pdf )
I question the very first impulses that must have inspired "gender affirming medicine". I just can't get inside the head of the first person to think "Maybe cross sex hormones will help this person!" or "Maybe this type of surgery will help this person!" They both seem to fail a basic smell test.
Did those people know anything about human evolution? (Apparently not!)
It's also part of the difference between Evidence-Based Medicine and Science-Based Medicine (although the blog named after the latter has sadly fallen). Not just does an RCT support a given intervention, but does the intervention even make sense in the first place, in a worldview based on science?
You continue to give these researchers the benefit of the doubt. Why? All the obfuscation, misrepresentation & non responsiveness points at this point one way & that way is not in support of the evidence they were sure they would find.
Are we really to believe that if they had better (or any) data showing “affirmative care” be it puberty blockers, opposite sex hormones or surgeries was net beneficial to kids that they wouldn’t be screaming it from the rooftops?
Are we really to believe that “affirmative care” providers just don’t have the data required to answer these questions?
Or are we to surmise that they have a very good idea of what the data will say & would prefer not to think too much about it because it could put their not just livelihoods but that which gives their lives meaning (in their own conceptions) at risk?
I won’t mention the potential impacts on these researchers’, clinicians’ & activists’ future employment prospects & community standing if the data turns out to show “affirmative care” on net 𝘩𝘢𝘳𝘮𝘴 the majority of its recipients.
Every time you discuss how weak and/or misrepresented pro-“affirmative care” studies are you go to pains to stress that “yes, it absolutely helps some people”.
Can you explain in what way the fact that there exist some people for which a poorly at best evidenced medical intervention produces some benefit supports using that intervention indiscriminately in any patient that presents with any of a very broad range of symptoms?
It sounds to me that what you are really saying is that the fact that these studies don’t show that “affirmative care” 𝘩𝘢𝘳𝘮𝘴 patients that the weakly quantified benefits justifies the provision of said care.
If the treatment in question was for Alzheimer’s or terminal cancer I would agree. But that is not what we are talking about. There is nothing 𝘱𝘩𝘺𝘴𝘪𝘤𝘢𝘭𝘭𝘺 wrong with gender dysphoric kids and, as you have related previously, the suicide stats are bullshit.
Even if they were not bullshit, in what other instance is suicidality treated with 𝘱𝘩𝘺𝘴𝘪𝘤𝘢𝘭 interventions (other than physically sequestering a patient somewhere so that they cannot physically harm themselves)?
The onus is 𝘯𝘰𝘵 on providers of a novel treatment to show patients are 𝘯𝘰𝘵 harmed, but to show that the a treatment’s is net beneficial taking into account all associated 𝘳𝘪𝘴𝘬𝘴.
To Jesse's credit he is saying this makes them, this research, this field, and science in general lose it's credibility when researchers operate this way.
I disagree with your summary of Jesse’s views, but your frustration with the medical professionals is righteous and shared.
For so many years, the evidence that this treatment helped could be found in the Dutch studies. Obviously there’s new scrutiny with that study, and as you say, it’s not like it was ever intended to be used the way it is in the US and elsewhere.
To the extent that Jesse carved out a caveat for some individuals, it always seems he has the Dutch protocol in mind.
Okay, I'm not giving you legal advice, but just as a point of information, most FOIA processes contain an appeal process to get a 3rd party set of eyes on the request without requiring a lawyer or filing a lawsuit. As a point of interest, Illinois has a public access counselor (https://foiapac.ilag.gov/) who handles such things and may be able to assist you.
This is not legal advice, I am not representing you, or providing legal services to you.
Thank you for representing me and providing legal services to me!
He's a very funny man, who is not represented by me.
This is permanent surgery removing healthy tissue. Glad the subjects are happy 3 months later. Their breasts are gone forever! How will they feel in 5 or 10 years?
I'm confident that all of these researchers will unanimously agree that there's no need to conduct long term studies to check the subject's wellbeing. And they'll give detailed justifications for this too - we're not allowed to see them though, and they're conveniently exempt from FOI if you try to find them.
Just listen and believe in the infallible science, as interpreted by the equally Infallible researchers... /s
I have a friend whose grand daughter had puberty blockers, hormone treatment and breast removal before the age of 15. When I asked how she/he was doing, I was told she/he had never been happier. Well, I said, so that must have worked. Maybe my friend said. Or it could be all the antidepressents and and antianxiety meds she/he has been taking for years.
This "affirming" nonsense - do shrinks affirm a patient who persistently and insistently "identifies" as Jesus? - is clearly a fad among the medical and related professionals, and I know such fads exist. About five years ago, in my 70s, I was diagnosed with skin cancer on my nose (a basal cell carcinoma, not exceptionally dangerous). About a year later, there was a squamous cell carcinoma on my cheek. Now when I was about 15, I had pretty bad acne that the dermatologist my folks sent me to attempted to treat with X-ray exposure. (It produced no detectable improvement.) I asked my current dermatologist whether that x-ray "treatment" was a widely accepted treatment at the time, about 1960. He said, "Oh yes. It was very popular at that time. Unfortunately, we later found out it was worse than useless." I bit my tongue rather than yell, "I could have told you that! And I was just a 15 year old high school sophomore!" So did it lead to the current situation? "It almost certainly was the cause of your problems." So when I learn of surgeons amputating healthy body parts and endocrinologists prescribing off-label use of the drugs approved by FDA for palliative treatment of metastatic prostate cancer, especially during the unbelievably complex changes in a child's body in puberty and adolescence, I can only shake my head and think, "You fools, you blind fools!"
Around 1949 my mother received a blast of X-rays for an ear infection. Nobody knew back then that ionizing radiation was carcinogenic. Decades later she came down with myelomonocytic leukemia, a rare cancer, and died at the age of 62.
That's awful, Chris. I keep thinking all those smart guys would have figured out the dangers of radiation seeing the delayed consequences of radiation from the atomic bombs used in Japan if not from the American troops used in the atomic tests. Yet it was not until some time in the early '50's that the fluoroscopic devices, used by consumers without supervision, were removed from shoe stores.
For my father it was asbestos. Mesothelioma. Forty year onset.
"If researchers aren’t transparent about their methods and won’t answer basic questions about those methods, they are not entitled to our trust."
+1000000
"Science is Real" was an epic failure of a slogan because it was implicitly "STFU and OBEY". It was not about transparency. It was not about the quest for knowledge. It paid no respect to the limitations of the scientific method to determine "truth".
It was just STFU. It was gross. It was stating that the narrative is reality. It was, by any definition, anti-science.
I’m starting to hold all claims in scientific papers equal to “a raven told me in my dreams.”
This is really bad from an ethical perspective. Investigators have an ethical obligation to publish the evidence that they said they would collect. Withholding data that might change the results means that patients will be making decisions based on incomplete and inaccurate information. If investigators only publish the scales that have a benefit and leave the scales that show no effect or a negative effect in their desk drawer, patients might choose a treatment that is ineffective or dangerous over one that actually works. That puts patients in danger.
This problem isn't confined to gender-affirming care. There's a long-standing problem with oncology trials not reporting all of the secondary endpoints. It's also been a big problem in reporting on psychiatric drugs for children and adolescents. It's socially more acceptable to talk about missing endpoints in oncology trials because oncology isn't politicized the way gender-affirming care is and many of those oncology trials are for expensive drugs made by large pharmaceutical companies while people providing gender affirming care mean well.
One other thing I would point out is that careerism may play a role. Scientists want to publish their work in the highest impact journal they can get. Thanks to politics, journal editors would probably be less likely to publish a paper that found mixed results than one that just reported the positive ones. And the paper might be published with an accompanying editorial that says the study isn't very good. Something similar happened to the DANMASK study. The study was powered to find a 50% reduction in SARS-COV2 infections in people wearing surgical mask and found a 20% reduction that wasn't statistically significant. It took a surprisingly long time to publish it and the journal accompanied it with an editorial that went on about its flaws and could have left the reader with the impression that the study should be ignored -- not a surprise when public health officials were claiming that universal masking could bring the pandemic under control or that masks were more effective than vaccines. Journal editors are subject to the same social pressures as everyone else.
Is there any doubt careerism plays a huge role in this issue? Try to imagine a non tenured academic submitting a paper for publication that contradicts what she knows is the prevailing opinion of the tenure committee. Or a PhD candidate proposing a research project that he believes is likely to cast doubt on his advisor's firmly held theory. It ain't gonna happen. Careerism may not contribute to the fad, but it must help smooth the path for its advance.
"Wouldn't you want to know if this didn't help the people you care about?"
"Opposing treatment is phobia"
I don't think the activists entertain that they could be wrong, and they seem to be running the institutions (not literally, but sometimes also literally).
I am duly exasperated. Maybe pro bono legal aid will be forthcoming to pursue a lawsuit. To purloin and repurpose the WaPo's slogan, science dies in darkness. It really says something that so many researchers are not close to transparent in their practices. They often treat data and methodologies as proprietary.
Our country is rife with silly liberals running around saying, "trust the science." Well no, don't trust the science until you vet it six ways to breakfast. Regarding gender dysphoria, it is highly lamentable that ideology is trumping careful scientific inquiry wherever you look.
Leor Sapir has an excellent new piece in City Journal covering a new Texas bill to ban youth transition, and talks about his experience as an expert witness in support, as well as the contradictions expert witnesses testifying against fell into while trying to explain that the care they provide is “settled science”, etc.
https://www.city-journal.org/article/making-the-case-for-the-other-side
Sapir documents numerous lies told (presumably under oath) by these "experts" to the Texas legislature.
Nullus in verbia.
We point out the deep flaws in the UGDS (and the "Dutch Studies" in general) in this article:
https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2150346
Scroll down past "A. High risk of bias in the Dutch research" to "2. Bias in measurement of outcomes: The finding of “resolution of gender dysphoria” is invalid"
Basically, they have a male and female version, and I could administer the UGDS to a dysphoric youngster, then give them a fetching hat, tell them they totally look like the opposite sex now, and administer the opposite sex UGDS resulting in an impressive score improvement! It's bogus.
I'm beginning to think it's all bogus.
Winston: "do you think the resistance is real?"
Julia: "none of it's real"
Also good to point out explicitly that the gender congruence measure is the only one of those four that doesn't seem like a tautology, hence maybe a not completely useless measure. Of course if you think you shouldn't have breasts and then get a double mastectomy, you'll think your body matches your thoughts of what your body should be!
I dunno. All of those image/congruence measures seem pretty useless because once you've done the work to look more like the gender you think you are, of course you'll feel less incogruent and probably less dysphoric. The really important measures would be of general mental well-being, and they never even claimed to be looking at those.
Well, isn’t mental well-being wrapped up in the diagnosis of gender dysphoria? That’s what made it exclusion in the results so telling--the one marker of mental health was GD, and they dropped it from the results.
Like, they scrapped the holistic evaluation in favor of smaller concrete things like whether no longer having breasts reduces chest dysphoria. Which, obviously. But whether that intervention alleviated the distress they feel being the sex they are--that went unaddressed, at least in the final results, while it was originally included in the patient materials as a key component of the study.
Basically, they started off looking to get info about whether it alleviates gender distress, but then omitted that factor in their results.
As Jesse has pointed out, it’s impossible to know *why* they omitted those results, but it’s hard not to wonder if they did so because there was no improvement in GD distress post-op.
In which case, again and again and again, what are we doing here?
My understanding is that gender dysphoria is the result of having a body that doesn't match your idea of who you are. So I would expect this to be alleviated by changing your body, whereas it could be that no physical changes will alleviate anxiety, depression, etc.
While there’s nothing about your understanding that seems out of step with how it’s discussed, I do think that the condition is more profound than the way you’ve rendered it. Like, it’s not necessarily the desire to be the opposite sex, but a deep and terrifying revulsion of what one is. I have had and still do have some GD as a 38 yo female. If I’d ever had the option to snap my fingers and literally and truly change sex, I’d have done it. But I was always aware of the limitations of transitioning--that I could never truly be a man, and short of that, I wasn’t gonna bother.
I worry that too many people believe that transitioning will make them feel like they really are the opposite sex, but then they realize that they still aren’t the target sex after transition, but also hope that the next (next, next) intervention will make them so.
I feel like science is dying before my eyes (or, at least, the "non-hard" fields). This is all immensely discouraging.
I'd have to question the exception for the"hard" sciences, even the hardest, mathematics. A recent article in "National Review" describes a controversy in Canada about something called the "Discovery Mathematics" model of teaching math. Here's the link:
https://www.nationalreview.com/news/22white-supremacy-how-woke-ideologues-corrupted-canadas-math-curriculum/
Here's the money quotes from the article of one of the proponents of the postmodernist approach to teaching kids math:
<<Laurie Rubel, an associate professor of mathematics education, explaining that proponents of “2 + 2 = 4” are grounded “in white, Western mathematics that marginalizes other possible values.”
<<Rubel argued that supporters of math’s political neutrality were oblivious to a deeper point: “It’s about truth: who holds the truth, who decides what is true, and how open we are as a society to multiple truths.”>>
Other possible values? Multiple truths? Are you kidding me!
Those appear to be math teachers (not actual mathematicians). Also, mathematics is not a science, hard or soft.
Mathematics absolutely is a science. It follows the scientific method; hypothesis, experiment, rejection or promotion to theory.
It's economics that is not a science; its failed hypotheses remain esteemed, and continue to be taught.
Pray tell, what empirical observations have mathematicians made? How has empirical evidence contributed to the development and confirmation of hypotheses and theories in mathematics?
https://plato.stanford.edu/entries/philosophy-mathematics/index.html
I’m not a scientist though I did train as one. My understanding of scientific paper writing is that one is supposed to include all results and why they do or do not support the hypothesis or talk about why they dropped one of the assessment tools.
ClinicalTrials.gov was intended to address this problem (somewhat) but the public is certainly unaware of it.
As long as the world of medical research is full of perverse incentives, we’re going to be in this mess. It’s not just gender medicine (although certainly this is important and the stakes are high when we talk about sterilizing children). It’s all of medicine.
The three biggest perverse incentives are:
(1) Scientists must “publish or perish.” Things like tenure and grant money ride on this. There is a perverse incentive to find significance in your data so you can publish it.
(2) If something is a potential huge new money maker (such as a new weight loss drug in an era when most Americans are overweight), there is a perverse incentive to find significance in your data (or find that the treatment is effective or doesn’t have bad outcomes or side effects) so that you can make a bunch of money.
(3) If some new “discovery” can create a sexy highly clickable headline, universities / drug companies / media will spin it that way.
In all of these cases (and more) if you have to remove some of the outcome variables to get what you want (statistical significance, tenure, grant money, a profitable new drug or surgery, an attention-grabbing headline) you’ll do it, clinicaltrials.gov be damned.
If you chop off girls’ breasts and they don’t benefit from it, it’s a lose-lose-lose: no one wants to publish negative results; no one profits from NOT chopping off girls’ breasts, and media doesn’t get an exciting headline when chopping off girls’ breasts turns out to be useless.
This last is the most debatable -- but in general, headlines where there’s nothing expensive to sell (like breast-removal surgery) are much less likely to make it into the public eye.
It’s not just “gender medicine” where this happens -- most drugs advertised on your TV are essentially useless -- but it is particularly sad and dangerous when applied to “gender medicine” which is not “life saving” and doesn’t lead to anyone’s happiness or authenticity. (Ask the governments of Finland or Sweden.)
These are extreme cosmetic procedures that also destroy the health of your body in many ways. There’s no win here except for the people selling this stuff.
One of the key issues is that that NIH will not hold the feet of bad actors and incompetent scientists to the fire. The current study by Olson-Kennedy is a good example. They were paid millions of dollars to conduct high-quality research. They are incompetent:
1) They lost 30% of cases in 2 years. This completely different from competent research, where 2-3% loss-to-follow-up is a firing offense.
2) They promise to report on things that they fail to report on.
3) In Chen et al (2023), they modified 5% of the data values, which they state in the Methods section.
The study is terrible. And no one is enforcing currect good-practice standards.
Right. There is no money in “let’s see if they grow out of it” or many other healthy things and behaviors.
I get thoroughly irritated by “science deniers” and certainly do not want to join that team. This shit fucks with my head.
Is there actually such a thing as a ‘science denier’? Or just people who’ve looked hard enough to realize that the same flaws Jesse finds in gender medicine are rampant in fields like Covid medicine too?
No, there really truly are science deniers. The evidence for evolution really is staggering, but there is a lot of motivated reasoning to to convince oneself otherwise.
I guess I'm curious about the term and how people use it.
I’ve met university educated scientists who make a living in sciences and truly believe that the scientific method is yielding evidence compatible with their belief in creationism. They remain employed, so are presumably competent scientists.
Many of histories greatest scientific innovators, like Galileo, were creationists.
If someone is a “science denier” does that mean they deny that the scientific method is a useful tool? Or does it mean that they deny particular findings that are widely agreed upon as current scientific “consensus”? What does the label actually claim about these people? Is it their relationship to science itself or to a presumed authority?
I agree with you that there are a lot of people incapable of sound scientific analysis who reject consensus conclusions due to motivated reasoning. But I see a lot of people one the consensus side of arguments who are every bit as scientifically illiterate as many “science deniers” and are often just as self-serving in their motivations for going *with* the grain. The accuracy of a person’s belief isn’t itself evidence that they arrived there by rational means.
And I see a lot of name calling used to avoid real analysis of data. That name calling comes from both sides, as it were - we shut down the likes of Jesse by calling him a transphobic bigot, and we shut down other folks with labels like science-denier and grandma-killer. And labels used as smears don’t differentiate between (to use your example) the creationists who think dinosaur bones were planted a few hundred years ago and the creationists who have a view of creationism that’s compatible with evolutionary theory.
So I don’t see it as a very helpful phrase.
I would certainly differentiate between a theistic evolutionist and someone who “thinks dinosaur bones were planted a few hundred years ago.” Young Earth Creationists are not worth being taken seriously, but there is nothing preventing a scientist from being a theist.
Edit: as for Galileo being a creationist: yes, and? So was Linnaeus, but he still admitted he could find no reason to not include humans among the apes but demurred out of fear of the ecclesiastics.
I agree. What I'm pointing to is that language like science-denier tilts towards rejecting and dismissing anybody who has beliefs different from the speaker's as long as the speaker believes their views are based in science. And unfortunately, as Jesse's book shows, we tend to seriously over-estimate how many of our presumptions are grounded in real evidence.
Since I am a statistician, who analyzed medical and research data for 40 years, I feel confident in saying that you are full of complete crap.
Thank you for demonstrating my point. Your comments in this thread come across like a troll, not a scientist. Anyone who's concerned that people aren't 'following the science' should take a look in the mirror and see if they are burnishing or demolishing the reputation of the scientific method. Sadly, you're doing the latter.
This is about "gender-affirming care". It is not about COVID, which has a bunch of complete lunatics who are science-deniers commenting.
Thank you for your evidence-based interjection 👍
COVID wackadoodles are a whole 'nother can of worms. Or is that hydrochlorozine? Most of them are ignorant about science, statistics, and evidence.
Accuses others of ignorance, doesn’t even get the name of the drug right. 🤷🏻♀️ Yes, there are some whackadoodles. There are also people doing extremely stringent research and uncovering high-quality evidence, just like Jesse does.