Man the failure to acknowledge drop-outs is SO terrible. You didn't even mention the biggest problem with it - why exactly would a not-depressed person who does not want blockers go to a gender clinic? This is BY FAR the biggest problem in my eyes. Like take the situation the authors seem to be describing, one where no amount of distress keeps you off blockers. In that situation you would logically expect anyone who wants blockers to end up on blockers, which just leaves the people who don't want blockers in the non-blocker group. If you are in the non-blocker group AND experiencing no distress the clinic is providing you literally zero services of value - it's not therapy because you don't need therapy it's not any medical intervention because no intervention is needed - so OF COURSE they dropped out!
I also think there’s hazard from doing this through a survey. It’s not like respondents can’t figure out what the right story is to tell. In a sample size this small you don’t need that many people saying “I probably want to show improvement over time with this so other people can get this thing that I believe is helpful” for it to skew your results.
I also think Jesse is conjuring up a far-fetched scenario for his non-GAH patient profile, i.e. "conservative family who wants their daughter to be more feminine". Is this really the type of patient that a gender clinic in Seattle would see? Color me skeptical.
Eh, given what Katie has said about her Trump-supporting neighbor, it sounds like there are still social conservatives within an hour or so of Seattle.
Loads of families like that come in. They love their kids, desperate for a solution. Social conservatives who trust experts... In this case, they come out Trumpier in the end when they cant square reality with what the experts are telling them. Some actually buy into it, though, at least for a while.
Unfortunately, hard sciences once again have a bit of a Galileo problem - their conclusions are required to align with the prevailing views of society's designated Moral Betters (the Church in Galileo's day, and the woke recently), which means often the research methodology is reverse-engineered to generate the desired/obligatory conclusions.
As another example, the American Academy of Pediatrics (AAP) recently deleted sections from its website regarding early childhood development and facial cues for learning, which conveniently coincided with progressives pushing mask mandates for children.
Progressives love to claim that their political views are informed by The Science, but in reality it's the opposite: The Science is predetermined by mandatory adherence to progressive talking points. This study looks like the double-blind equivalent of the Texas Sharpshooter Fallacy.
AAP also revised their language milestones by about 6 months- even though decades of research suggest that X number of words and sounds should be in a child's lexicon by particular ages, and failure to meet those milestones can indicate an issue.
There are (or I guess I should say were) entire publicly funded health initiatives geared toward driving home the importance of language acquisition at the infancy/toddler stage and how it impacts literacy in the longterm. In fact- it is THE main point Biden's administration was using to justify universal preschool in their spending bill.
Pedatrician's offices in blighted areas teach classes on why you should read books to your baby, and all of that just vanished due to COVID and have been replaced with, "It's FINE if your baby doesn't learn to talk until she's almost 3! Masks have NO DOWNSIDE!!"
It really is so disturbing how the AAP has lost its collective mind. My 8th grader is asthmatic and his school required masks during PE class. He pulled his mask down while wheezing and was told he couldn't do that or he'd be sent home. I looked up the AAP's guidance on asthma and mask-wearing/wheezing, and they suggested kids who couldn't tolerate masks take albuterol prior to mask-wearing. It was infuriating.
I would bet that a non-zero number of kids ended up in the emergency room due to masking/masking policies worsening their asthma. And yet, any time anyone suggested this, the response was that it was better than getting covid, especially for someone with asthma. Except asthma doesn't raise the risk of severe covid and kids are at nearly zero risk of severe Covid.
Regardless of whether masks have an effect on transmission, this insistence that masks have no downside, there are no medical contraindications for masks and anyone who says otherwise is a liar and general denial that humans have evolved to see faces makes the AAP less credible on anything else pediatrics-related.
I wasn't talking until I was over three years old, but my very first utterances were correct sentences. Grammar isn't optionl for me; 66 years later the singular they still gives me a headache.
A lot, like A LOT, of medical research is poorly done on the statistical side. The main critique I would have of this study is that the study design doesn’t seem to speak to the research question of interest (what is the effect of GAM on mental health?), and so they’ve tried to come around to it in a hacky way and not done a great job.
It’s common in studies of adolescent development to consider a flat trajectory a big success if the trajectory of a comparison group is going down, so I’m less concerned on that point. A lot of things get worse in adolescence and then recover.
I’m more concerned on selective attrition. It is absolutely not common to have 40% of your sample drop out within a year in a longitudinal study. It’s really hard to conclude anything with that kind of drop out.
I worked in a developmental biology lab in college and was kind of devastated to learn people aren’t really checking on each other like I had expected/been told since I was a kid.
AI could be very well deployed to serve as a filter for where we need to dive deeper on papers. Serving as a comprehensive first level reviewer, given the sheer volume of published work out there.
Google's 540B language model that was announced this week is incredibly impressive (deciphering jokes, inference chains). Don't think it would be too much of a leap to train an AI to be able to read methodology sections to ascertain statistical method being used and whether it's questionable given the research question at hand. Training set would probably be a collection of widely-considered high quality papers along with a reference table of statistical methods to generally-appropriate applications.
Not saying it's readily doable now, but could be a good automated way to attempt and flag what obviously needs greater scrutiny.
It's not about getting to your level necessarily, it's about being able to deploy it across millions of pages of articles to quickly bucket / assess where there may be misapplied methodologies, etc. - FOR FURTHER INVESTIGTION BY EXPERIENCED REVIEWERS
The fact that you couldn't get these questions answered by the corresponding author, but she was happy to go on Science Friday to talk all about the study is frustrating. It was a given that she wasn't going to get any in depth questioning there though. Science Friday is a well-produced show but it never disputes research claims. Science outlets, even the good ones, are essentially science fandom at this point. They promote science and scientists. I work in science PR and most outlets run our press releases as is. Some will even slap a new byline on it without changing the content of the release at all. It's that bad. There is obviously great science writing out there (this piece shows it) but for anything that's not just waxing poetic about the wonders of science, or being critical of an easy target ( oil companies and the sort) you need to go other places.
Makes you wonder how many other topics mainstream journalistic outlets are actually this blind about... Truly a scary thought. I want to be able to trust our important institutions, but too often, I can't.
I worry about how we are handling nuclear war risk, personally. Is MAD real? is it actually a reliable deterrant? I dunno, but Im not going to rely on Carl Sagan's 80's insistence that nukes would annihilate every thing on earth.
Do you think the "just re-write the press release" science writing is due to science journalists not having the time to do more through work, the journalists not having the kind of background to fully understand the work, the full paper being behind a paywall and the outlets not being willing to pay for the full paper, or something else? I have given up reading most reporting (aside from places like Nature and Science) on the subfields I've worked in because it's usually not very accurate.
In my opinion, it's almost 100% due to science journalists not having the time or institutional support (money and other reporting resources) to do the job right. Scientists will send you their papers for free. Press officers usually include it in press release materials. But it takes time to delve into papers, reach out to outside sources and other expertise, synthesize it all and then write something that's engaging and coherent. I think the science sections (not op eds about science) in legacy papers and magazines (ex. WaPo, NYT, Wall Street Journal) still do a pretty good job, even if they are playing it safe as far as coverage goes most of the time. It's the places that are primarily focused on science (SciAm, SciFri, Popsi, Discover, Gizmodo) that are really hollowed out. Luckily, I think it's pretty easy to spot the stuff that's 90% press release. (Top flag: All the quotes came from the release.) It's just exhausting to find the stuff that isn't like that.
Negative, this article had to get some intentional neglect. Nothing this bad is typically published. I dare you to find me a worse psych article in a journal with a higher impact factor. If you find one, a guarantee woke politics or subserving a useful political narrative.
Excellent article. As a layperson not well-versed in statistics, what stands out most to me is not even the difference in attrition rates between the two groups (which is a serious issue), but rather that they could have *6 people* left in one group at the end and still consider the study important. If you began with 6 people in the control group and had no dropouts, the study would be so small as to be practically useless. The fact that you began with 35 and ended with 6 makes it *worse* than useless, because of course the reasons for dropping out could be directly relevant to the question being investigated. Am I wrong?
Not wrong, on the nose correct. This is a very important aspect of probing the limitations of one's study. The level to which the population dwindled probably tells us something important about who left and who remained, something that's apparently not considered by the researchers.
Did anyone else hear a record scratch sound effect when they read “nonbinary youth who received gender affirming medical care"? This seems exponentially more troubling from a medical ethics standpoint than someone transitioning between sexes (which I think already has some medical ethics issues as Jesse has previously detailed), because being nonbinary (unlike transitioning) is literally nothing but -- and never can be anything more than -- a state of mind.
Yes, that's what I'm curious about because I can't recall ever seeing a reference to "gender affirming medical care" for nonbinary individuals before. Absent further explanation, it would appear to be as you said -- indefinite/perpetual use of puberty blockers -- which, first of all, would just keep someone prepubescent looking (including stunting their growth!), not make them physically "nonbinary," and, second of all, I can't believe that would be healthy over a protracted period since it would effectively be simulating hypopituitarism. I'd be curious to hear more from Jesse on this subject, as I would presume he's run across more discussion of this subject in his research.
What does non-binary even mean? Because I suspect many of the people who call themselves non-binary deny that there is even a binary. In essence, what is that "non" referring to?
(BTW, I understand that Judith Butler now considers herself non-binary, up from "queer", which I believe was what she once considered herself.)
I feel for people like your son who genuinely have dysphoria. Can’t be easy in this environment to be a reasonable person with all the hysteria going on.
I agree with you both that, unless "gender affirming medical care" for nonbinary individuals means something in addition to puberty blockers, it seems like this would just be keeping individuals prepubescent looking without actually making them "nonbinary" and that there would be some measurable health risks associated with doing that on a long term basis.
"In a more primitive stage of our evolution, we might have needed a neurologically based sex identity (just as we once needed a tail bone)"
I don't think this is something lost to antiquity. Every mammalian species is sexually dimorphic and requires sexual activity between the two sexes to procreate. I don't think it's much of a stretch to suggest that the hormones that lead to physical differences between the sexes would also translate to emotional and attitudinal differences as well.
The only part of the “just a social construct” discourse I don’t like is the “just.” If we were to trains neural net for billions of years abs it kept clustering things into two categories we wouldn’t quickly discard that information. On the other hand, it appears dysphoria occurs across cultures and histories. I think the new part is there are large enough populations to meaningfully network and create larger cultures.
They will blink stupidly and tell you that putting testosterone into a female body is no different from a man's testes secreting the stuff. Tell them that a male body expects it and a female's doesn't and they'll accuse you of "genocide."
This is the top shelf autism that I subscribe for. Well done. Going to have to sprinkle “variable dichotomization” into the mix next time I have to discuss data with someone.
the traditional 'gatekeeping' of science was publishing in a recognized peer-reviewed journal. this meant the study was pre-evaluated by a board of scientists who have pertinent backgrounds, and then the scientific community responded to the study by way of letters, specifically critiquing aspects of the scientific method rather than not liking the results and/or the author. checks & balances. and yet we have an offshoot of the AMA doing politics instead of scientific inquiry. In the olden days, the Journal would lose credibility (heck, they wouldn't have published it in the first place knowing it would damage credibility). I no longer recognize the field of science.
Cancel culture made peer review obsolete: those "peers" don't want to get canceled over objecting to questionable methodology that just so happens to align with progressive talking points.
Strictly guessing here, but it's more likely the editor who doesn't want to be canceled (= maybe fired). Journal editors have ultimate decision power. Even if a reviewer raised some objections, the authors would write back defending their methods, and the editor would decide. It's the editor's ass on the line for rejecting such an "important" paper.
Jesse that post is an act of courage as well as quite brilliant. Your analysis is incisive, it must’ve been tremendously hard work and you publish it at your own peril, you invite what will surely be a withering attack from the zealots.
Jesse’s type of inquiry keeps society out of trouble: deductive reasoning is our ONLY hope. Always and forever the bain of our existence, that is inductive reasoning; inductive reasoning is our most perfidy human intelligence and leads to that which we commemorate every November 11. Lest we forget - yes the sacrifice but more importantly the source, the stupidity of inductive reasoning, our great myopia, leading us inevitably and always to wanton destruction. The lesson of history: we don’t learn from history, we ALWAYS forget.
Bravo Jesse, you are a smart, courageous dude; as for your advisories, they bring darkness and violence. Standby.
I’m a subscriber and a fan and I think this was a good article, but I think it’s worth being precise about the dynamics here.
It would take genuine courage at this point for someone of good standing in institutions like the mainstream media or (really unfortunately) public health to write this sort of criticism. Jesse has to some extent already become persona non grata in these circles due to his past work, so the *marginal* courage required to publish something like this *for him* is not especially high.
In fact, Jesse has admitted before that his Substack incentives (were he to let them influence him) would drive him to post more trans/culture war articles (not sure but plausible to think this would count as that category).
This isn't culture war red meat, tho. It's far too detailed and technical for that. I think of culture war stories as bringing to light the "repent motherfucka" tambourine person, tales of cancellation, etc. But this is ... Jesse delving into actual science. Something we can't readily expect from scientists, unfortunately, in areas touched by the culture wars.
Delving into science and particularly into a field in which he has a much greater understanding than the average journalist. It’s hard to think of anyone else capable of and/or willing to doing this kind of breakdown.
OK, you are right, but you’re kind of raining on my parade, it made me very excited, so ya guilty as charged, exaggerated with effusive praise, but I enjoyed the enthusiasm, it is fun to get carried away.
Excessive praise is better than excessive negativity for sure! I thought it was worth responding to because the dynamics are important if you’re trying to counter arguments that cancel culture doesn’t exist. Like “how is <X person> canceled - X has a Substack with tons of subscribers!” In this case “canceled” might mean “this person has lost access to their position in established institutions for expressing an opinion that the majority of the country agrees with”
Just here to say how much I love Jesse’s SubStack commenters. I appreciate how nuanced their perspectives are, and how gracious they are to each other’s feedback. Prime example above.
Personae non gratae pay a high price in opportunity costs.
Were Jesse not on perennial shit lists, he would likely still be writing for The Atlantic and many other big-time publications in addition to TV spots.
You always pay a continuing price for being exiled to Corsica.
Freddie deBoer (from whose comments section I found this Substack, actually) writes fairly candidly about this topic. Like it or not, when you sell your writing, you're necessarily producing something that has to turn a profit. Hey, we all gotta eat. That being said, one of the reasons I follow people like Freddie and Jesse is precisely _because_ I'm interested in heterodox writing about our sociopolitical milieu, including the gender debate. He's incentivized to write certain things because people, like me, want to read those things (although I do appreciate when my favorite writers spill their guts about stuff they're passionate about, like Freddie's antique Marxism), and that's the entire reason why Substack works really well. I would probably leave if my various authors I support started writing about, I don't know, 17th-century French castles (actually, that would be rather interesting, but not 100% of the time).
Jesse, when you write "kids who SHOULD go on blockers and/or hormones", this implies that there is some definite methodology to determine which children should or should not receive GAM. What is this methodology?
It seems to me that such a methodology does not in fact exist. You own reviews of the available research (such as this one) demonstrate this.
Given that, outright banning of GAM for children seems to me to be wise public policy, and I support it.
I mean, the methodology exists, it's just extremely flawed. Affirmative care is the methodology, which more or less means doctors are required to rubberstamp any and all GAM requests.
As for whether a total child-GAM ban would throw the baby out with the bathwater, the argument for keeping child-GAM is that if someone is 100% guaranteed to get a sex change as an adult, it's medically much easier to start the process before puberty. It would also facilitate greater fairness in sports; Lia Thomas wouldn't have such a huge advantage if she'd transitioned before undergoing male puberty rather than after.
That said, Progressives like to THINK our current experts can accurately identify future transitioners at an early age, but the reality is they can't. Most kids with symptoms of youth gender dysphoria either outgrow it or grow up to be gay.
That's also why progressives want so badly to silence detransitioners, as they're the canary in the coal mine that current trans medicine is rife with false positives. It doesn't help that testosterone (aka steroids) tends to boost self-confidence, so adolescent girls are using it to self-medicate for depression and anxiety by identifying as trans, driving the rates of false positives up even further.
The other issue with trans medicine is it's currently repeating the same mistakes that gave us the opioid addiction crisis. Big Pharma is notorious for overpromising and underdelivering on the latest greatest Miracle Drug. For example, Oxycontin was heralded as the world's first non-addictive opioid painkiller. 20 years and countless overdoses later, that claim was clearly bullshit. Progressives have forgotten how to be skeptical of Big Pharma's constant overpromising, from "The covid vaccines will prevent you from infecting Grandma" to in the case of trans medicine "Puberty Blockers are completely reversible".
Because Progressives believe puberty blockers to be reversible, they think the occasional false positive in trans medicine is not that big of a deal, especially when they've convinced themselves that withholding said puberty blockers more or less guarantees the children in question will commit suicide.
Affirmative care is NOT a methodology for sorting out who SHOULD and SHOULD NOT receive blockers/hormones. Jesse stated that there are children who "SHOULD" receive blockers/hormones ("absolutely"), and (presumably) there are children who should not. What is Jesse's methodology for sorting gender dysphoric kids into these two groups (medically treat, medically don't treat)?
I have no idea, and I don't think Jesse does either.
Therefore I continue to support legal bans on GAM for children, as I believe the harm far far outweighs the good, and because the medical community has been completely captured by trans ideology and therefore is not making scientifically and medically sound decisions.
Sweden changed their rules recently to conform more to the "Dutch Protocol" and I believe a summary of it is that for children with persistent early dysphoria (that is, teenagers who have been dysphoric since childhood) that transition has very low "regret" rates and is highly justified.
Their more recent concerns are about adolescent onset dysphoria, and that it was better to do mental health therapy rather than hormones in these cases (at least, they were switching to limiting hormones etc to rare exceptions)
This is a summary for me from memory - but my PERSONAL takeaway was that blocking kids who have been dysphoric since early childhood from access to these medications is causing trans kids needless harm, but that sharply limiting teenagers who have only recently exhibited dysphoria symptoms from these same treatments was probably the right call.
So that's where I would currently lean on putting the line.
I would like to see the evidence that shows that "blocking kids who have been dysphoric since early childhood from access to these medications is causing trans kids needless harm". I would like to be sure that this conclusion is not based on godawfully bad statistical analysis, as so much of "trans" medicine is.
mmm.. Would you agree that if someone was 100% absolutely positively going to transition as an adult that they'd be better off if they got access to GAM as a teenager?
For "needless":
Now, even if you agree, that doesn't mean that you'd agree, for instance, that the result of having 98% of people go through GAM for whom it was correct and 2% end up having gotten drugs they shouldn't have gotten that was net positive. You might decide that was a net negative (and I don't know that you're wrong - it depends on the relative harms of course)
For the actual analysis, I encourage to you read Sweden's info for yourself.
"Would you agree that if someone was 100% absolutely positively going to transition as an adult that they'd be better off if they got access to GAM as a teenager?"
Yes. But the issue is what is the ACTUAL success rate of predicting adulthood transition on the basis of pre-puberty symptom presentation? It sure ain't 100%.
Also, it seems to me that it is essentially impossible to have good data on this. To collect it, you would need to have large numbers of pre-puberty gender dysphoric children, run the diagosis protocol, predict who will or will not transition as adults, and then DENY GAM to a large group who you predict will transition as adults, and then see what fraction actually do.
I very much doubt that this has ever been done, or ever will be done.
And so we are flying blind on GAM even for gender dysphoria even in early childhood.
Still, I will look at the Swedish report to see if they did better than this.
I think this “late onset dysphoria” is a fad. Everything about it is wrong. The absence of childhood symptoms, the gender distribution, the clamoring for attention.
All the pre-fad GD men I knew were quiet about their condition.
I don't think Jesse has or knows a methodology, he's just pointing out quite effectively that the medical community is not doing honest non idealogical research on this topic.
Maybe I'm splitting hairs, but I think affirmative care is a methodology. A godfuckingawful methodology, but a methodology nonetheless. It basically works on an opt-in basis; the kids who ask for GAM get GAM, and the kids who don't, don't.
I agree that Jesse seems to have rejected affirmative care without proposing an alternative methodology in its place.
Yes, this is my complaint with Jesse: he ends this piece by blasting Republcians for wanting to ban GAM for kids, but does not (it seems to me) have an actual reason for opposing such a ban.
This is one of my ongoing nits with Jesse, who I really enjoy reading - he seems to frequently feel the need to trumpet his lefty bona fides in ways that often seem a bit ham-fisted
Well, there's a difference between not having a reason and not having a better alternative.
The reason is that a blanket ban on child GAM could potentially be an overcorrection that harms legitimately trans kids.
However, until we can reliably tell the difference between lifetime gender dysphoria and temporary "it's just a phase" gender dysphoria, a temporary moratorium on child GAM does seem prudent to me as well.
We can't reliably tell the difference, and the prospects for ever being able to do so are very dim. Just think through the experimental protocol that would be needed for such a verification (I've outlined it in another comment).
Isnt Jesse always advocating for better screening and counseling prior to medical interventions? Isn’t that the piece that’s largely been dropped from GAM in the States?
Yes, but I think the question is what exactly does that screening process look like? How do you know if a 12 year old with Gender Dysphoria will still have GD in 10 years, or if it will wear off?
I see what you’re asking. It just seems to me that Jesse has always held up the Dutch protocol—which worked with a different population than the current cohort, and which screened much more carefully for patients—as the gold standard, even if that standard still has flaws.
"The other issue with trans medicine is it's currently repeating the same mistakes that gave us the opioid addiction crisis. Big Pharma is notorious for overpromising and underdelivering on the latest greatest Miracle Drug. For example, Oxycontin was heralded as the world's first non-addictive opioid painkiller. 20 years and countless overdoses later, that claim was clearly bullshit."
Well said! There are zero children who should go on these medications that we do not know all of the long term effects of. Zero. In fact, I think you shouldn't be able to until your reasoning skills are fully developed, at around 25. Young people are impulsive, emotional, unreasonable, and at times even irrational.
Side effects that we know from puberty blockers is infertility. They cannot properly reason the consequences of thia to consent to it. According to the American College of Obstetricians and Gynecologists, “Approximately 14% of sterilized women request information about sterilization reversal,...Those aged 18–24 years at the time of sterilization are nearly four times more likely to seek reversal information and nearly eight times more likely to undergo a reversal procedure than women who are sterilized at 30 years or older.” It appears that even young adults have a hard time understanding the full ramifications of sterilization, much less minors.
Other side effects are cognitive decline, loss of bone density, possible testicular cancer, etc. And these are just what is known at this time. There is no empirical evidence demonstrating that a pre-
pubescent child who is permitted to transition gender role but then desists can simply and harmlessly transi-
tion back to the natal gender.
Another issue is boys who go on them. They stop the growth of his penis and will then have a micro penis if they decide to keep the organ. If they decide to remove it, there won't be enough skin for the surgery. It will be a more difficult surgery than it already was and they will have to use other parts of the body, such as the colon. Their new package will always smell like a colon.
Then there are the problems with giving them wrong sex hormones. Firstly, great for big pharma, this will make them lifelong medical patients.
Estrogen introduced in male brain leads to high glutamate levels, reduction of the size of the brain, and increase in the size of ventricles. Long term, these studies are revealing that estrogen in males leads to reduction in grey matter and vastly increases the risk of Alzheimer’s Disease and psychopathology. These are serious brain changes with extremely serious long term side effects.
In a longitudinal study of over a decade of persons on hormonal or surgical “transition” treatment on data from the entire population with no drop-outs, mental health did not improve with such treatments. So, not only are the risks high, and the brain impacts severe, there is no evidence that they even help the patient with their original issue.
Lastly, since no clinician can accurately predict the future gender identity of any particular child, efforts to encourage public early childhood cross-gender roles may be experienced as hurtful and possibly even traumatic by children who
do not persist into adolescence and adulthood.
I think there will be reckoning in the future for what these people are doing to these kids. And they're just grooming it into them now so I don't think it will be pretty when that time comes.
Oxycontin was marketed as "addiction-proof" the same way puberty blockers are marketed as "reversible". False advertising is an issue in general, but a much more serious issue in the medical field.
You're being extremely generous, Jesse. At every stage - evidence gathering, processing, reporting and socialisation, the paper's authors have at best failed to live up to standards, if not outright rigged the result.
And the lack of critical assessment by "science journalists" is approaching a fraud on the public - we all know a study with the opposite finding would have been picked over forensically, if not ignored. The "showtime" afforded to this is absolutely a function of its partisan usefulness.
This is exactly what I love from you Jesse, thanks for this great piece.
It would not shock you to learn that I think the methodology of science is it's most important aspect, and that papers like this (and so many others) that seem conclusion driven drives me wild.
I wish we could get to the stage where all studies of this sort could only be interpreted through pre-registration that includes the statistical models that are used to draw conclusions.
Damn, THIS is what I'm paying for.
Thanks, Jesse, for doing the work that researchers and reviewers obviously aren't willing to do.
I bet you're often feeling like you're fighting against windmills, but you're doing stellar and really important work.
That's how it's done - not by mindlessly accusing everyone you disagree with of being a "groomer".
Man the failure to acknowledge drop-outs is SO terrible. You didn't even mention the biggest problem with it - why exactly would a not-depressed person who does not want blockers go to a gender clinic? This is BY FAR the biggest problem in my eyes. Like take the situation the authors seem to be describing, one where no amount of distress keeps you off blockers. In that situation you would logically expect anyone who wants blockers to end up on blockers, which just leaves the people who don't want blockers in the non-blocker group. If you are in the non-blocker group AND experiencing no distress the clinic is providing you literally zero services of value - it's not therapy because you don't need therapy it's not any medical intervention because no intervention is needed - so OF COURSE they dropped out!
"So weird how everyone stopped going to the mechanic when their car problems stopped."
I also think there’s hazard from doing this through a survey. It’s not like respondents can’t figure out what the right story is to tell. In a sample size this small you don’t need that many people saying “I probably want to show improvement over time with this so other people can get this thing that I believe is helpful” for it to skew your results.
It also means we are making this decision based on the ultimate observation of *SIX* kids. You get a 17% bump from just one of them.
I also think Jesse is conjuring up a far-fetched scenario for his non-GAH patient profile, i.e. "conservative family who wants their daughter to be more feminine". Is this really the type of patient that a gender clinic in Seattle would see? Color me skeptical.
Eh, given what Katie has said about her Trump-supporting neighbor, it sounds like there are still social conservatives within an hour or so of Seattle.
A lot of people move to Seattle from eastern Washington and they are very conservative.
Loads of families like that come in. They love their kids, desperate for a solution. Social conservatives who trust experts... In this case, they come out Trumpier in the end when they cant square reality with what the experts are telling them. Some actually buy into it, though, at least for a while.
Unfortunately, hard sciences once again have a bit of a Galileo problem - their conclusions are required to align with the prevailing views of society's designated Moral Betters (the Church in Galileo's day, and the woke recently), which means often the research methodology is reverse-engineered to generate the desired/obligatory conclusions.
As another example, the American Academy of Pediatrics (AAP) recently deleted sections from its website regarding early childhood development and facial cues for learning, which conveniently coincided with progressives pushing mask mandates for children.
Progressives love to claim that their political views are informed by The Science, but in reality it's the opposite: The Science is predetermined by mandatory adherence to progressive talking points. This study looks like the double-blind equivalent of the Texas Sharpshooter Fallacy.
AAP also revised their language milestones by about 6 months- even though decades of research suggest that X number of words and sounds should be in a child's lexicon by particular ages, and failure to meet those milestones can indicate an issue.
There are (or I guess I should say were) entire publicly funded health initiatives geared toward driving home the importance of language acquisition at the infancy/toddler stage and how it impacts literacy in the longterm. In fact- it is THE main point Biden's administration was using to justify universal preschool in their spending bill.
Pedatrician's offices in blighted areas teach classes on why you should read books to your baby, and all of that just vanished due to COVID and have been replaced with, "It's FINE if your baby doesn't learn to talk until she's almost 3! Masks have NO DOWNSIDE!!"
The AAP is garbage. JAMA is garbage.
It really is so disturbing how the AAP has lost its collective mind. My 8th grader is asthmatic and his school required masks during PE class. He pulled his mask down while wheezing and was told he couldn't do that or he'd be sent home. I looked up the AAP's guidance on asthma and mask-wearing/wheezing, and they suggested kids who couldn't tolerate masks take albuterol prior to mask-wearing. It was infuriating.
I would bet that a non-zero number of kids ended up in the emergency room due to masking/masking policies worsening their asthma. And yet, any time anyone suggested this, the response was that it was better than getting covid, especially for someone with asthma. Except asthma doesn't raise the risk of severe covid and kids are at nearly zero risk of severe Covid.
Regardless of whether masks have an effect on transmission, this insistence that masks have no downside, there are no medical contraindications for masks and anyone who says otherwise is a liar and general denial that humans have evolved to see faces makes the AAP less credible on anything else pediatrics-related.
Oof, do you have a link? Overuse of albuterol isn't so great for the heart.
I think sometime this summer? He was still required to wear a mask until the end of May; I must have looked for guidance prior to that.
"In this house, we believe in science. Just ask our 9-year old who is still struggling to read Pat the Bunny".
I wasn't talking until I was over three years old, but my very first utterances were correct sentences. Grammar isn't optionl for me; 66 years later the singular they still gives me a headache.
A lot, like A LOT, of medical research is poorly done on the statistical side. The main critique I would have of this study is that the study design doesn’t seem to speak to the research question of interest (what is the effect of GAM on mental health?), and so they’ve tried to come around to it in a hacky way and not done a great job.
It’s common in studies of adolescent development to consider a flat trajectory a big success if the trajectory of a comparison group is going down, so I’m less concerned on that point. A lot of things get worse in adolescence and then recover.
I’m more concerned on selective attrition. It is absolutely not common to have 40% of your sample drop out within a year in a longitudinal study. It’s really hard to conclude anything with that kind of drop out.
I worked in a developmental biology lab in college and was kind of devastated to learn people aren’t really checking on each other like I had expected/been told since I was a kid.
AI could be very well deployed to serve as a filter for where we need to dive deeper on papers. Serving as a comprehensive first level reviewer, given the sheer volume of published work out there.
I’m not sure what you’d use as the training set there but am open to ideas. Peer review, as currently deployed, seems to be kinda shitty to be honest.
Google's 540B language model that was announced this week is incredibly impressive (deciphering jokes, inference chains). Don't think it would be too much of a leap to train an AI to be able to read methodology sections to ascertain statistical method being used and whether it's questionable given the research question at hand. Training set would probably be a collection of widely-considered high quality papers along with a reference table of statistical methods to generally-appropriate applications.
Not saying it's readily doable now, but could be a good automated way to attempt and flag what obviously needs greater scrutiny.
I am an article reviewer for several journals, I cant imagine a machine getting to my level
It's not about getting to your level necessarily, it's about being able to deploy it across millions of pages of articles to quickly bucket / assess where there may be misapplied methodologies, etc. - FOR FURTHER INVESTIGTION BY EXPERIENCED REVIEWERS
The fact that you couldn't get these questions answered by the corresponding author, but she was happy to go on Science Friday to talk all about the study is frustrating. It was a given that she wasn't going to get any in depth questioning there though. Science Friday is a well-produced show but it never disputes research claims. Science outlets, even the good ones, are essentially science fandom at this point. They promote science and scientists. I work in science PR and most outlets run our press releases as is. Some will even slap a new byline on it without changing the content of the release at all. It's that bad. There is obviously great science writing out there (this piece shows it) but for anything that's not just waxing poetic about the wonders of science, or being critical of an easy target ( oil companies and the sort) you need to go other places.
Makes you wonder how many other topics mainstream journalistic outlets are actually this blind about... Truly a scary thought. I want to be able to trust our important institutions, but too often, I can't.
Yes! What are MY blind spots? Things I believe in because I think the science is there but it isn't really? We need better science journalism.
I worry about how we are handling nuclear war risk, personally. Is MAD real? is it actually a reliable deterrant? I dunno, but Im not going to rely on Carl Sagan's 80's insistence that nukes would annihilate every thing on earth.
Do you think the "just re-write the press release" science writing is due to science journalists not having the time to do more through work, the journalists not having the kind of background to fully understand the work, the full paper being behind a paywall and the outlets not being willing to pay for the full paper, or something else? I have given up reading most reporting (aside from places like Nature and Science) on the subfields I've worked in because it's usually not very accurate.
In my opinion, it's almost 100% due to science journalists not having the time or institutional support (money and other reporting resources) to do the job right. Scientists will send you their papers for free. Press officers usually include it in press release materials. But it takes time to delve into papers, reach out to outside sources and other expertise, synthesize it all and then write something that's engaging and coherent. I think the science sections (not op eds about science) in legacy papers and magazines (ex. WaPo, NYT, Wall Street Journal) still do a pretty good job, even if they are playing it safe as far as coverage goes most of the time. It's the places that are primarily focused on science (SciAm, SciFri, Popsi, Discover, Gizmodo) that are really hollowed out. Luckily, I think it's pretty easy to spot the stuff that's 90% press release. (Top flag: All the quotes came from the release.) It's just exhausting to find the stuff that isn't like that.
Negative, this article had to get some intentional neglect. Nothing this bad is typically published. I dare you to find me a worse psych article in a journal with a higher impact factor. If you find one, a guarantee woke politics or subserving a useful political narrative.
Excellent article. As a layperson not well-versed in statistics, what stands out most to me is not even the difference in attrition rates between the two groups (which is a serious issue), but rather that they could have *6 people* left in one group at the end and still consider the study important. If you began with 6 people in the control group and had no dropouts, the study would be so small as to be practically useless. The fact that you began with 35 and ended with 6 makes it *worse* than useless, because of course the reasons for dropping out could be directly relevant to the question being investigated. Am I wrong?
Not wrong, on the nose correct. This is a very important aspect of probing the limitations of one's study. The level to which the population dwindled probably tells us something important about who left and who remained, something that's apparently not considered by the researchers.
Did anyone else hear a record scratch sound effect when they read “nonbinary youth who received gender affirming medical care"? This seems exponentially more troubling from a medical ethics standpoint than someone transitioning between sexes (which I think already has some medical ethics issues as Jesse has previously detailed), because being nonbinary (unlike transitioning) is literally nothing but -- and never can be anything more than -- a state of mind.
What care do they actually receive? Is the idea to keep them on puberty blockers indefinitely?
Yes, that's what I'm curious about because I can't recall ever seeing a reference to "gender affirming medical care" for nonbinary individuals before. Absent further explanation, it would appear to be as you said -- indefinite/perpetual use of puberty blockers -- which, first of all, would just keep someone prepubescent looking (including stunting their growth!), not make them physically "nonbinary," and, second of all, I can't believe that would be healthy over a protracted period since it would effectively be simulating hypopituitarism. I'd be curious to hear more from Jesse on this subject, as I would presume he's run across more discussion of this subject in his research.
Gender dysphoria is real, even if at the moment there are tons of frivolous self-reports.
“Non-binary” has no psychiatric foundation. The very idea of intermediate gender is just silly.
What does non-binary even mean? Because I suspect many of the people who call themselves non-binary deny that there is even a binary. In essence, what is that "non" referring to?
(BTW, I understand that Judith Butler now considers herself non-binary, up from "queer", which I believe was what she once considered herself.)
Nonbinary is fake. GID is real but extremely rare; nonbinary has no psychiatric foundation whatsoever.
I feel for people like your son who genuinely have dysphoria. Can’t be easy in this environment to be a reasonable person with all the hysteria going on.
I agree with you both that, unless "gender affirming medical care" for nonbinary individuals means something in addition to puberty blockers, it seems like this would just be keeping individuals prepubescent looking without actually making them "nonbinary" and that there would be some measurable health risks associated with doing that on a long term basis.
The "nonbinary" are the "they/them" people.
‘They/them’ is a hand wave towards a very vague category.
"In a more primitive stage of our evolution, we might have needed a neurologically based sex identity (just as we once needed a tail bone)"
I don't think this is something lost to antiquity. Every mammalian species is sexually dimorphic and requires sexual activity between the two sexes to procreate. I don't think it's much of a stretch to suggest that the hormones that lead to physical differences between the sexes would also translate to emotional and attitudinal differences as well.
The only part of the “just a social construct” discourse I don’t like is the “just.” If we were to trains neural net for billions of years abs it kept clustering things into two categories we wouldn’t quickly discard that information. On the other hand, it appears dysphoria occurs across cultures and histories. I think the new part is there are large enough populations to meaningfully network and create larger cultures.
Yeah, this is looking more transhumanistic than gender affirming.
Hi Penny, you may want to check out this BBC podcast:
https://twitter.com/JohnMcM1/status/1509926533149990923
They will blink stupidly and tell you that putting testosterone into a female body is no different from a man's testes secreting the stuff. Tell them that a male body expects it and a female's doesn't and they'll accuse you of "genocide."
This is the gold standard for rigorous, non-ideological, science-based journalism. Why oh why can't we have more of this?
Obviously the non-GAM dropouts in this study all killed themselves, Jesse.
This is the top shelf autism that I subscribe for. Well done. Going to have to sprinkle “variable dichotomization” into the mix next time I have to discuss data with someone.
the traditional 'gatekeeping' of science was publishing in a recognized peer-reviewed journal. this meant the study was pre-evaluated by a board of scientists who have pertinent backgrounds, and then the scientific community responded to the study by way of letters, specifically critiquing aspects of the scientific method rather than not liking the results and/or the author. checks & balances. and yet we have an offshoot of the AMA doing politics instead of scientific inquiry. In the olden days, the Journal would lose credibility (heck, they wouldn't have published it in the first place knowing it would damage credibility). I no longer recognize the field of science.
Cancel culture made peer review obsolete: those "peers" don't want to get canceled over objecting to questionable methodology that just so happens to align with progressive talking points.
Strictly guessing here, but it's more likely the editor who doesn't want to be canceled (= maybe fired). Journal editors have ultimate decision power. Even if a reviewer raised some objections, the authors would write back defending their methods, and the editor would decide. It's the editor's ass on the line for rejecting such an "important" paper.
Jesse that post is an act of courage as well as quite brilliant. Your analysis is incisive, it must’ve been tremendously hard work and you publish it at your own peril, you invite what will surely be a withering attack from the zealots.
Jesse’s type of inquiry keeps society out of trouble: deductive reasoning is our ONLY hope. Always and forever the bain of our existence, that is inductive reasoning; inductive reasoning is our most perfidy human intelligence and leads to that which we commemorate every November 11. Lest we forget - yes the sacrifice but more importantly the source, the stupidity of inductive reasoning, our great myopia, leading us inevitably and always to wanton destruction. The lesson of history: we don’t learn from history, we ALWAYS forget.
Bravo Jesse, you are a smart, courageous dude; as for your advisories, they bring darkness and violence. Standby.
I’m a subscriber and a fan and I think this was a good article, but I think it’s worth being precise about the dynamics here.
It would take genuine courage at this point for someone of good standing in institutions like the mainstream media or (really unfortunately) public health to write this sort of criticism. Jesse has to some extent already become persona non grata in these circles due to his past work, so the *marginal* courage required to publish something like this *for him* is not especially high.
In fact, Jesse has admitted before that his Substack incentives (were he to let them influence him) would drive him to post more trans/culture war articles (not sure but plausible to think this would count as that category).
This isn't culture war red meat, tho. It's far too detailed and technical for that. I think of culture war stories as bringing to light the "repent motherfucka" tambourine person, tales of cancellation, etc. But this is ... Jesse delving into actual science. Something we can't readily expect from scientists, unfortunately, in areas touched by the culture wars.
Delving into science and particularly into a field in which he has a much greater understanding than the average journalist. It’s hard to think of anyone else capable of and/or willing to doing this kind of breakdown.
OK, you are right, but you’re kind of raining on my parade, it made me very excited, so ya guilty as charged, exaggerated with effusive praise, but I enjoyed the enthusiasm, it is fun to get carried away.
Excessive praise is better than excessive negativity for sure! I thought it was worth responding to because the dynamics are important if you’re trying to counter arguments that cancel culture doesn’t exist. Like “how is <X person> canceled - X has a Substack with tons of subscribers!” In this case “canceled” might mean “this person has lost access to their position in established institutions for expressing an opinion that the majority of the country agrees with”
Yes that’s a practical description of the phenomenon, pushed to the fringes.
Just here to say how much I love Jesse’s SubStack commenters. I appreciate how nuanced their perspectives are, and how gracious they are to each other’s feedback. Prime example above.
Personae non gratae pay a high price in opportunity costs.
Were Jesse not on perennial shit lists, he would likely still be writing for The Atlantic and many other big-time publications in addition to TV spots.
You always pay a continuing price for being exiled to Corsica.
Freddie deBoer (from whose comments section I found this Substack, actually) writes fairly candidly about this topic. Like it or not, when you sell your writing, you're necessarily producing something that has to turn a profit. Hey, we all gotta eat. That being said, one of the reasons I follow people like Freddie and Jesse is precisely _because_ I'm interested in heterodox writing about our sociopolitical milieu, including the gender debate. He's incentivized to write certain things because people, like me, want to read those things (although I do appreciate when my favorite writers spill their guts about stuff they're passionate about, like Freddie's antique Marxism), and that's the entire reason why Substack works really well. I would probably leave if my various authors I support started writing about, I don't know, 17th-century French castles (actually, that would be rather interesting, but not 100% of the time).
Jesse, when you write "kids who SHOULD go on blockers and/or hormones", this implies that there is some definite methodology to determine which children should or should not receive GAM. What is this methodology?
It seems to me that such a methodology does not in fact exist. You own reviews of the available research (such as this one) demonstrate this.
Given that, outright banning of GAM for children seems to me to be wise public policy, and I support it.
And FWIW, I am a 66-year-old lifelong Democrat.
I mean, the methodology exists, it's just extremely flawed. Affirmative care is the methodology, which more or less means doctors are required to rubberstamp any and all GAM requests.
As for whether a total child-GAM ban would throw the baby out with the bathwater, the argument for keeping child-GAM is that if someone is 100% guaranteed to get a sex change as an adult, it's medically much easier to start the process before puberty. It would also facilitate greater fairness in sports; Lia Thomas wouldn't have such a huge advantage if she'd transitioned before undergoing male puberty rather than after.
That said, Progressives like to THINK our current experts can accurately identify future transitioners at an early age, but the reality is they can't. Most kids with symptoms of youth gender dysphoria either outgrow it or grow up to be gay.
That's also why progressives want so badly to silence detransitioners, as they're the canary in the coal mine that current trans medicine is rife with false positives. It doesn't help that testosterone (aka steroids) tends to boost self-confidence, so adolescent girls are using it to self-medicate for depression and anxiety by identifying as trans, driving the rates of false positives up even further.
The other issue with trans medicine is it's currently repeating the same mistakes that gave us the opioid addiction crisis. Big Pharma is notorious for overpromising and underdelivering on the latest greatest Miracle Drug. For example, Oxycontin was heralded as the world's first non-addictive opioid painkiller. 20 years and countless overdoses later, that claim was clearly bullshit. Progressives have forgotten how to be skeptical of Big Pharma's constant overpromising, from "The covid vaccines will prevent you from infecting Grandma" to in the case of trans medicine "Puberty Blockers are completely reversible".
Because Progressives believe puberty blockers to be reversible, they think the occasional false positive in trans medicine is not that big of a deal, especially when they've convinced themselves that withholding said puberty blockers more or less guarantees the children in question will commit suicide.
Affirmative care is NOT a methodology for sorting out who SHOULD and SHOULD NOT receive blockers/hormones. Jesse stated that there are children who "SHOULD" receive blockers/hormones ("absolutely"), and (presumably) there are children who should not. What is Jesse's methodology for sorting gender dysphoric kids into these two groups (medically treat, medically don't treat)?
I have no idea, and I don't think Jesse does either.
Therefore I continue to support legal bans on GAM for children, as I believe the harm far far outweighs the good, and because the medical community has been completely captured by trans ideology and therefore is not making scientifically and medically sound decisions.
Sweden changed their rules recently to conform more to the "Dutch Protocol" and I believe a summary of it is that for children with persistent early dysphoria (that is, teenagers who have been dysphoric since childhood) that transition has very low "regret" rates and is highly justified.
Their more recent concerns are about adolescent onset dysphoria, and that it was better to do mental health therapy rather than hormones in these cases (at least, they were switching to limiting hormones etc to rare exceptions)
This is a summary for me from memory - but my PERSONAL takeaway was that blocking kids who have been dysphoric since early childhood from access to these medications is causing trans kids needless harm, but that sharply limiting teenagers who have only recently exhibited dysphoria symptoms from these same treatments was probably the right call.
So that's where I would currently lean on putting the line.
I would like to see the evidence that shows that "blocking kids who have been dysphoric since early childhood from access to these medications is causing trans kids needless harm". I would like to be sure that this conclusion is not based on godawfully bad statistical analysis, as so much of "trans" medicine is.
Is your concern "needless" or "harm"?
For "harm":
mmm.. Would you agree that if someone was 100% absolutely positively going to transition as an adult that they'd be better off if they got access to GAM as a teenager?
For "needless":
Now, even if you agree, that doesn't mean that you'd agree, for instance, that the result of having 98% of people go through GAM for whom it was correct and 2% end up having gotten drugs they shouldn't have gotten that was net positive. You might decide that was a net negative (and I don't know that you're wrong - it depends on the relative harms of course)
For the actual analysis, I encourage to you read Sweden's info for yourself.
Here is a link:
https://genderreport.ca/the-swedish-u-turn-on-gender-transitioning/#:~:text=Sweden%20National%20Board%20of%20Health%20and%20Welfare%20Update&text=%E2%80%9CThe%20diagnosis%20of%20gender%20dysphoria,at%20birth%20has%20increased%20most.
"Would you agree that if someone was 100% absolutely positively going to transition as an adult that they'd be better off if they got access to GAM as a teenager?"
Yes. But the issue is what is the ACTUAL success rate of predicting adulthood transition on the basis of pre-puberty symptom presentation? It sure ain't 100%.
Also, it seems to me that it is essentially impossible to have good data on this. To collect it, you would need to have large numbers of pre-puberty gender dysphoric children, run the diagosis protocol, predict who will or will not transition as adults, and then DENY GAM to a large group who you predict will transition as adults, and then see what fraction actually do.
I very much doubt that this has ever been done, or ever will be done.
And so we are flying blind on GAM even for gender dysphoria even in early childhood.
Still, I will look at the Swedish report to see if they did better than this.
I think this “late onset dysphoria” is a fad. Everything about it is wrong. The absence of childhood symptoms, the gender distribution, the clamoring for attention.
All the pre-fad GD men I knew were quiet about their condition.
I don't think Jesse has or knows a methodology, he's just pointing out quite effectively that the medical community is not doing honest non idealogical research on this topic.
Maybe I'm splitting hairs, but I think affirmative care is a methodology. A godfuckingawful methodology, but a methodology nonetheless. It basically works on an opt-in basis; the kids who ask for GAM get GAM, and the kids who don't, don't.
I agree that Jesse seems to have rejected affirmative care without proposing an alternative methodology in its place.
Yes, this is my complaint with Jesse: he ends this piece by blasting Republcians for wanting to ban GAM for kids, but does not (it seems to me) have an actual reason for opposing such a ban.
This is one of my ongoing nits with Jesse, who I really enjoy reading - he seems to frequently feel the need to trumpet his lefty bona fides in ways that often seem a bit ham-fisted
Well, there's a difference between not having a reason and not having a better alternative.
The reason is that a blanket ban on child GAM could potentially be an overcorrection that harms legitimately trans kids.
However, until we can reliably tell the difference between lifetime gender dysphoria and temporary "it's just a phase" gender dysphoria, a temporary moratorium on child GAM does seem prudent to me as well.
We can't reliably tell the difference, and the prospects for ever being able to do so are very dim. Just think through the experimental protocol that would be needed for such a verification (I've outlined it in another comment).
I vote for return to responsible criteria: strict diagnosis, a year of living as the opposite gender, no medical treatment before 18.
Isnt Jesse always advocating for better screening and counseling prior to medical interventions? Isn’t that the piece that’s largely been dropped from GAM in the States?
Yes, but I think the question is what exactly does that screening process look like? How do you know if a 12 year old with Gender Dysphoria will still have GD in 10 years, or if it will wear off?
I see what you’re asking. It just seems to me that Jesse has always held up the Dutch protocol—which worked with a different population than the current cohort, and which screened much more carefully for patients—as the gold standard, even if that standard still has flaws.
"The other issue with trans medicine is it's currently repeating the same mistakes that gave us the opioid addiction crisis. Big Pharma is notorious for overpromising and underdelivering on the latest greatest Miracle Drug. For example, Oxycontin was heralded as the world's first non-addictive opioid painkiller. 20 years and countless overdoses later, that claim was clearly bullshit."
PREACH
Well said! There are zero children who should go on these medications that we do not know all of the long term effects of. Zero. In fact, I think you shouldn't be able to until your reasoning skills are fully developed, at around 25. Young people are impulsive, emotional, unreasonable, and at times even irrational.
Side effects that we know from puberty blockers is infertility. They cannot properly reason the consequences of thia to consent to it. According to the American College of Obstetricians and Gynecologists, “Approximately 14% of sterilized women request information about sterilization reversal,...Those aged 18–24 years at the time of sterilization are nearly four times more likely to seek reversal information and nearly eight times more likely to undergo a reversal procedure than women who are sterilized at 30 years or older.” It appears that even young adults have a hard time understanding the full ramifications of sterilization, much less minors.
Other side effects are cognitive decline, loss of bone density, possible testicular cancer, etc. And these are just what is known at this time. There is no empirical evidence demonstrating that a pre-
pubescent child who is permitted to transition gender role but then desists can simply and harmlessly transi-
tion back to the natal gender.
Another issue is boys who go on them. They stop the growth of his penis and will then have a micro penis if they decide to keep the organ. If they decide to remove it, there won't be enough skin for the surgery. It will be a more difficult surgery than it already was and they will have to use other parts of the body, such as the colon. Their new package will always smell like a colon.
Then there are the problems with giving them wrong sex hormones. Firstly, great for big pharma, this will make them lifelong medical patients.
Estrogen introduced in male brain leads to high glutamate levels, reduction of the size of the brain, and increase in the size of ventricles. Long term, these studies are revealing that estrogen in males leads to reduction in grey matter and vastly increases the risk of Alzheimer’s Disease and psychopathology. These are serious brain changes with extremely serious long term side effects.
In a longitudinal study of over a decade of persons on hormonal or surgical “transition” treatment on data from the entire population with no drop-outs, mental health did not improve with such treatments. So, not only are the risks high, and the brain impacts severe, there is no evidence that they even help the patient with their original issue.
Lastly, since no clinician can accurately predict the future gender identity of any particular child, efforts to encourage public early childhood cross-gender roles may be experienced as hurtful and possibly even traumatic by children who
do not persist into adolescence and adulthood.
I think there will be reckoning in the future for what these people are doing to these kids. And they're just grooming it into them now so I don't think it will be pretty when that time comes.
I also believe there will be a reckoning coming. You simply cannot experiment on this many children and have it not come back to bite you in the ass.
It will be opioid epidemic 2.0.
Oxycontin was marketed as "addiction-proof" the same way puberty blockers are marketed as "reversible". False advertising is an issue in general, but a much more serious issue in the medical field.
👏🏻👏🏻
Experimentation = sterilization
Exactly
You're being extremely generous, Jesse. At every stage - evidence gathering, processing, reporting and socialisation, the paper's authors have at best failed to live up to standards, if not outright rigged the result.
And the lack of critical assessment by "science journalists" is approaching a fraud on the public - we all know a study with the opposite finding would have been picked over forensically, if not ignored. The "showtime" afforded to this is absolutely a function of its partisan usefulness.
This is exactly what I love from you Jesse, thanks for this great piece.
It would not shock you to learn that I think the methodology of science is it's most important aspect, and that papers like this (and so many others) that seem conclusion driven drives me wild.
I wish we could get to the stage where all studies of this sort could only be interpreted through pre-registration that includes the statistical models that are used to draw conclusions.
I need to bump up my contribution for this Substack. Thanks for putting in the hard work like this, Jesse. Someone has to do it.