It’s just such an extreme, radical step to take. It’s bleeding obvious to me that the best and kindest way to handle gender dysphoria — for anyone, but especially kids — is to help them <become> comfortable in their body without resorting to cutting off major pieces of it.
“she wouldn’t force kids into a mental health exam before giving them insulin, so why would she make that a prerequisite for youth gender medicine?”
This is obnoxious from a supposed medical professional. The answer is obvious: because gender dysphoria is a mental illness, and type 1 diabetes isn’t.
Now before somebody runs off to Twitter cancel me, I understand why there are lots of social reasons why the average person would be uncomfortable with calling gender (or “chest”) dysphoria mental illness in casual conversation, and I don’t make a habit of running around calling trans people “mentally ill”. And I’m totally open to the idea that in at least some cases, the best treatment for gender dysphoria might be surgical transition.
But the reality is that by any definition that is remotely consistent, gender dysphoria is, medically speaking, a mental illness. And any medical professional needs to be cognizant of that and be willing to turn the best efforts of modern mental health care on the subject. To not do so is negligence.
“Trust the experts” only applies if the experts are willing to behave like experts, and that includes things like “doing the scientific method, not pantomiming it for activism”.
It is truly bizarre to see how willing the medical establishment has been to double- and triple-down on the idea that no one needs to worry about any of this because gender-affirming care is literally NEVER administered based on a misdiagnosis. Sure, the Rachel Levines and Jack Turbans of the world will admit (if pushed), giving teen girls double mastectomies as a treatment for anxiety and depression might not make sense if their anxiety and depression are coming from causes other than gender dysphoria. But don't worry! Clinicians are able, with 100% accuracy, to ALWAYS accurately detect when anxiety and depression are caused by true, persistent, gender dysphoria. And no clinic in these United States has ever, or will ever, perform a double mastectomy on this population without one of those perfectly accurate diagnoses (but don't you dare suggest mastectomies should be limited to those who've received significant counseling and diagnosis, you filthy gatekeeper).
It's just nuts. I'd wager that every person on this board has, personally, been the recipient of at least one medical diagnosis that, in retrospect, proved obviously incorrect. Medical diagnoses are really hard! The idea that we don't need to worry about mistakes in gender-affirming care because NO MISTAKES WILL EVER BE MADE is insane.
Can we get into a deep dive into the bombshell Reuters dropped, that the drug companies making puberty blockers are actively refusing to pursue FDA approval for use in trans youth?
Makes sense to me in a twisted, late capitalism way. Usually, FDA approval is sought because without it, doctors are reluctant to prescribe the drug, which limits sales. But since so many "affirming" doctors are willing to prescribe Lupron et al off-label, the manufacturers really have no financial incentive to roll the dice on an FDA-controlled risk/benefit study; their revenue numbers are doing just fine as-is.
My main question is: where does the malpractice buck stop? Is it the individual doctors who wrote the prescriptions, the clinics where they operated out of, or like Purdue pharmacy with Oxy, could detransitioners potentially sue the drug manufacturers themselves?
Just stepping away from the context and looking at the methodology here, it’s infuriating that they try to apply statistical (sorry, data science) techniques which only really make sense with continuous data, to bullshit measures which are flags or at best discrete values. That bollocks CDM could be improved, from a certain point of view, by using a single question “do you have breasts?” And taking the values zero and one. This would give 100% improvement after surgery with a completely sound statistical basis, but telling us nothing of any use.
I could understand this if the audience for the articles was the general public this is published in a scientific journal. Are those people really so statistically illiterate that they just let this go without a hint of worry?
I'd love to see an experiment where science reporters are given equally strong/weak data sets but on different topics. One set of data could be like the data in this article "proving" that top surgery for teens is helfpul. The other could be equally strong/weak data "proving" that a 6-month course of therapy in lieu of puberty blockers is helpful. What headlines would they write based on each of these data sets?
That CDM survey is too much. If it gets validated, then I REALLY will lose all faith in the medical establishment. (1) As Jesse and other commenters have pointed out, many would score high no matter what, and it's designed to get lower scores following mastectomy, no matter how one's feeling about it. (2) The questions are leading and will get higher scores due to the power of suggestion. Even an adolescent who isn't particularly self-conscious in a bikini will think: Oh, maybe I should be? (3) An adolescent or young woman coming in convinced they need to medically "transition" will know exactly how to answer the questions to get what they want. Granted, that is a danger with a lot of these types of self-scored subjective surveys, but it's particularly egregious in this case.
Every time I read one of these pieces of yours, Jesse, I get almost paralyzed by disbelief.
I’m so glad you’re doing this work—and I’m so happy to contribute every month so that you can—but it is just *bananas* that each and every study is so flawed it basically never should’ve passed review let alone get touted in MSM articles as proving “lifesaving care”!
The correlation between chest dysphoria and anxiety/depression seems like it wouldn't necessarily be relevant to this study even if it was strong. The correlation is at a single point in time, they haven't presented any evidence that decreasing one effects the other. Also those r values are pitiful. Even assuming the relationship WAS causal those r values implied that 'chest dysphoria' explains 1-4% of the anxiety/depression differences. A double mastectomy is a pretty radical intervention for that kind of response...
So what happens when some troubled individuals decide they'd be happier without thumbs? Or toes? Or vision in both eyes? Will a cottage medical industry in elective amputation spring up? Will universities put out skewed studies affirming the benefits self-mutilation? Will schools declare that information on students considering radical destructive surgery be concealed from parents?
This is madness.
There's an old short story by Ray Bradbury titled "The Watchful Poker Chip of H Matisse" about this very thing...a man who incrementally cuts off pieces of himself and replaces them with inanimate objects to make himself more "interesting." It was written as satire. And we are rapidly getting there.
I really enjoy your articles (and your book) that go beyond headlines to look deeper into research papers and analyze whether the papers actually prove what the press releases or articles say they prove.
It’s just such an extreme, radical step to take. It’s bleeding obvious to me that the best and kindest way to handle gender dysphoria — for anyone, but especially kids — is to help them <become> comfortable in their body without resorting to cutting off major pieces of it.
“she wouldn’t force kids into a mental health exam before giving them insulin, so why would she make that a prerequisite for youth gender medicine?”
This is obnoxious from a supposed medical professional. The answer is obvious: because gender dysphoria is a mental illness, and type 1 diabetes isn’t.
Now before somebody runs off to Twitter cancel me, I understand why there are lots of social reasons why the average person would be uncomfortable with calling gender (or “chest”) dysphoria mental illness in casual conversation, and I don’t make a habit of running around calling trans people “mentally ill”. And I’m totally open to the idea that in at least some cases, the best treatment for gender dysphoria might be surgical transition.
But the reality is that by any definition that is remotely consistent, gender dysphoria is, medically speaking, a mental illness. And any medical professional needs to be cognizant of that and be willing to turn the best efforts of modern mental health care on the subject. To not do so is negligence.
“Trust the experts” only applies if the experts are willing to behave like experts, and that includes things like “doing the scientific method, not pantomiming it for activism”.
Why has “top surgery” replaced “double mastectomy”? Purely for its euphemistic quality? If so, why are we going along with this?
It is truly bizarre to see how willing the medical establishment has been to double- and triple-down on the idea that no one needs to worry about any of this because gender-affirming care is literally NEVER administered based on a misdiagnosis. Sure, the Rachel Levines and Jack Turbans of the world will admit (if pushed), giving teen girls double mastectomies as a treatment for anxiety and depression might not make sense if their anxiety and depression are coming from causes other than gender dysphoria. But don't worry! Clinicians are able, with 100% accuracy, to ALWAYS accurately detect when anxiety and depression are caused by true, persistent, gender dysphoria. And no clinic in these United States has ever, or will ever, perform a double mastectomy on this population without one of those perfectly accurate diagnoses (but don't you dare suggest mastectomies should be limited to those who've received significant counseling and diagnosis, you filthy gatekeeper).
It's just nuts. I'd wager that every person on this board has, personally, been the recipient of at least one medical diagnosis that, in retrospect, proved obviously incorrect. Medical diagnoses are really hard! The idea that we don't need to worry about mistakes in gender-affirming care because NO MISTAKES WILL EVER BE MADE is insane.
Can we get into a deep dive into the bombshell Reuters dropped, that the drug companies making puberty blockers are actively refusing to pursue FDA approval for use in trans youth?
https://www.dailywire.com/news/puberty-blocking-drug-companies-refuse-to-conduct-safety-trials
Makes sense to me in a twisted, late capitalism way. Usually, FDA approval is sought because without it, doctors are reluctant to prescribe the drug, which limits sales. But since so many "affirming" doctors are willing to prescribe Lupron et al off-label, the manufacturers really have no financial incentive to roll the dice on an FDA-controlled risk/benefit study; their revenue numbers are doing just fine as-is.
My main question is: where does the malpractice buck stop? Is it the individual doctors who wrote the prescriptions, the clinics where they operated out of, or like Purdue pharmacy with Oxy, could detransitioners potentially sue the drug manufacturers themselves?
My daughter would’ve scored very high on that absurd chest survey at age 14 and it had absolutely nothing to do with any dysphoria or trans nonsense.
It had everything to do with drawing boys’ attention and getting through normal adolescence with a disproportionately large bust size.
What a freaking insane world. No wonder other countries are showing this lunacy to their populations and asking, “do you want this done to your kids?”
Just stepping away from the context and looking at the methodology here, it’s infuriating that they try to apply statistical (sorry, data science) techniques which only really make sense with continuous data, to bullshit measures which are flags or at best discrete values. That bollocks CDM could be improved, from a certain point of view, by using a single question “do you have breasts?” And taking the values zero and one. This would give 100% improvement after surgery with a completely sound statistical basis, but telling us nothing of any use.
I could understand this if the audience for the articles was the general public this is published in a scientific journal. Are those people really so statistically illiterate that they just let this go without a hint of worry?
gonna need a BARpod deep dive or a novel-length Singal-minded article on the new Jon Stewart episode on pediatric gender affirming care https://twitter.com/theproblem/status/1578052464334589952
I'd love to see an experiment where science reporters are given equally strong/weak data sets but on different topics. One set of data could be like the data in this article "proving" that top surgery for teens is helfpul. The other could be equally strong/weak data "proving" that a 6-month course of therapy in lieu of puberty blockers is helpful. What headlines would they write based on each of these data sets?
I work for a hospital system and we give minors mastectomies every month. I’ve seen two 14 year olds get them.
That CDM survey is too much. If it gets validated, then I REALLY will lose all faith in the medical establishment. (1) As Jesse and other commenters have pointed out, many would score high no matter what, and it's designed to get lower scores following mastectomy, no matter how one's feeling about it. (2) The questions are leading and will get higher scores due to the power of suggestion. Even an adolescent who isn't particularly self-conscious in a bikini will think: Oh, maybe I should be? (3) An adolescent or young woman coming in convinced they need to medically "transition" will know exactly how to answer the questions to get what they want. Granted, that is a danger with a lot of these types of self-scored subjective surveys, but it's particularly egregious in this case.
Every time I read one of these pieces of yours, Jesse, I get almost paralyzed by disbelief.
I’m so glad you’re doing this work—and I’m so happy to contribute every month so that you can—but it is just *bananas* that each and every study is so flawed it basically never should’ve passed review let alone get touted in MSM articles as proving “lifesaving care”!
The correlation between chest dysphoria and anxiety/depression seems like it wouldn't necessarily be relevant to this study even if it was strong. The correlation is at a single point in time, they haven't presented any evidence that decreasing one effects the other. Also those r values are pitiful. Even assuming the relationship WAS causal those r values implied that 'chest dysphoria' explains 1-4% of the anxiety/depression differences. A double mastectomy is a pretty radical intervention for that kind of response...
Also 13!?
So what happens when some troubled individuals decide they'd be happier without thumbs? Or toes? Or vision in both eyes? Will a cottage medical industry in elective amputation spring up? Will universities put out skewed studies affirming the benefits self-mutilation? Will schools declare that information on students considering radical destructive surgery be concealed from parents?
This is madness.
There's an old short story by Ray Bradbury titled "The Watchful Poker Chip of H Matisse" about this very thing...a man who incrementally cuts off pieces of himself and replaces them with inanimate objects to make himself more "interesting." It was written as satire. And we are rapidly getting there.
I really enjoy your articles (and your book) that go beyond headlines to look deeper into research papers and analyze whether the papers actually prove what the press releases or articles say they prove.
Stuart also has a great Substack if anyone is interested: https://stuartritchie.substack.com