As a Biological Psychologist and research scientist, I agree with your (detailed) analysis. However, in some sense it's beside the point (with which, I think, you probably agree). People see what they want to see in data, especially data that deal with fuzzy psychological concepts, or which can be spun to support an ideological agenda.
However, probably the most important issue, from my perspective, is the fact that you cannot simply manipulate anatomy and physiology to change a person into something they would like to be (or you would like them to be). Biology doesn't work like that. Further, we have known the deleterious effects of cross sex hormones and blockers for over half a century (ever since the drugs were first synthesized). It amazes me that people are now "debating" their effects. Except in the rarest of instances will traumatic hormonal manipulation help someone who is suffering from a psychological or psychosocial condition. I discussed some of that in "There is "Biological Evidence for Gender Identity..." but it’s not what you think."
Interestingly, much of the back-and-forth about "gender identity," its associated issues and their putative amelioration is driven by misconceptions about biological causation, biological malleability, and fundamental misunderstandings of neuroscience on both sides of the debate. In some ways, it's become like the debate over abortion:, misconceived by people on both sides of the issue, and subject to a perpetual attempt to win the argument by presenting progressively larger bodies of "facts".... with no one making a fair and honest assessment of their "opponents" point of view.
To be clear, I agree with your analysis. I'm just not sure if it's going to make much of a difference until people decide to more carefully — and objectively — consider the fundamental biological and psychological aspects of this issue. Everything is biology, after all.
there has not been much discussion of organizing and activating effects. De-feminizing and de-masculinizing effects of these hormones on the brain, and never any discussion as to whether we need to allow for estrogen-progesterone to continue to feminize an adolescent brain to its final product before we declare the person trans. I am writing here assuming there is a brain-biology basis to trans, which there may not be in most cases. Also, almost no discussion of the fact that it is a myth that trans brains are more like the sex they identify with than the sex they were born into. If anything, in the frontal lobes of FTMs, there is a "hyper-feminine" pattern--it's on the tail of the normal distribution for females that is on the side opposite of that which would converge with males.
I only ever seem to comment or tweet you when I want to disagree so first of all I have to state what great work you do and how much I appreciate it.
But with every write up like this that I read, I less understand your position on supporting hormones for *some* children as a better solution than, say, leeches.
Have you written about the positive research or the persuasive arguments that have led to this position? About which are the cases you can definitively make such a prescription for? If not, would you? Please.
There’s a glaring lack of evidence that this is good for ANY kids. There’s no physical/medical indication for these drugs so ... why?
At this point it seems more like Jesse is clinging to a “but maybe for some kids...” simply to maintain his distance from the conservatives and (for example) the truly unhinged content from Trump recently.
Sure I get it. No one wants to be lumped in with that guy. But if overnight there were NO “gender medicine” (I choke on that phrase!) for kids and teens in the US, that would be no doubt a net good for humankind.
Just because Trump is unhinged and unsavory doesn’t mean that he might not occasionally stumble on a true fact.
Stopped clocks, twice a day, and all that.
As a science writer, Jesse should notice that other countries are treating this as the experimental “treatment” that it is, meaning, until we have some evidence it works, Joe Schmo MD needs to stop prescribing this stuff and telling parents it’s evidence-based.
yes, and it was not Trump's solitary and independent genius that landed him on being "anti-Trans", it's him reading political tea leaves and seeing where he has an opening. Gender medicine certainly does more harm than good at this point.
Not Jesse, but I can answer why I still maintain that hormones for *some* children is a viable option.
First, we accept that transgender adults exist and, if we had a magic detector that could perfectly predict which kids will grow up to be transgender adults, it would be better to prevent those adults from going through the "wrong" puberty to prevent later surgeries. Supporting hormones for some kids comes down to how accurately we think we can match that hypothetical detector.
We don't have the data to suggest a causal relationship between youth CSH and better life outcomes. But we also don't have data to suggest a causal relationship between youth CSH and negative life outcomes.
We have some data that suggests, for a certain cohort, at least a correlation between CSH and better life outcomes. Therefore, for a strictly screened cohort (few to no other mental health issues, gender dysphoria that is severe, persistent, and early on-set), it's justifiable to administer CSH under a research setting to try to see if the causal relationship exists.
Once (if) it is established for the more certain cohort, it can be expanded to less certain cohorts.
I don’t accept that “transgender adults” exist in the magical gendered-soul sense that our culture seems to have adopted in the 21st century.
I accept that fully mature adults can undertake extreme cosmetic changes because they think it will make them “happier.” And kids can’t.
There is no evidence, zero, none, that there is such a thing as a person in a wrong body or a person with a brain-body mismatch.
There is evidence, across time and place and cultures, that some people are at the extreme ends of being gender-nonconforming: what we would call “masculine” women or “feminine” men.
There is evidence that various cultures have created niches for people who “didn’t fit in” to gendered norms, and those niches are different across cultures but in none of those cultures has there ever been a belief that the person is in the wrong body, or is really the opposite sex.
Those beliefs are purely our own cultural creations. And there’s no evidence supporting those beliefs. That’s why some people liken some of these gendered beliefs (“a girl brain in a boy’s body” and the like) to religious beliefs.
These are beliefs that many people have accepted on faith: there are no facts, data, evidence supporting such a belief -- nor even a clear explanation what it could possibly mean to have a female body part in a male body or vice versa, or “really” be the opposite sex “on the inside” in any more material way than “I simply really really wish it were true.”
Can you have a man’s elbow in a woman’s body? Why not?
When people incorrectly say that sex is on a spectrum (it’s not: we’re sexually dimorphic as a species and everyone is one of two sexes) what they mean is that gendered behavior and gendered expectations and stereotypes are on a spectrum: no one is such a caricature that they are Barbie or GI Joe, so we all lie along a spectrum in terms of how masculine or feminine we are -- and that’s perfectly natural and probably wired in.
Like any other spectrum, you will naturally have a few people on the extremes: masculine women who are still biologically women, and feminine men who are still biologically men.
So far so good.
How we get from there to “hormones and surgeries” for people who might sincerely wish they’d been born the other sex is purely a matter of cosmetics.
No male-born person can be made into a female person and vice versa. If people are really committed to living the role of the opposite sex, they can go pretty far in cosmetically simulating the other sex and “living as” the other sex.
While adults can make those decisions, kids can’t.
That ANY doctor prescribes hormones for cosmetic purposes or performs these surgeries for cosmetic purposes (really expensive profitable surgeries will high failure rates) is unethical in the extreme. But that would be a different conversation.
Does foregoing puberty prevent later surgeries? Transpeople who've been on blockers still often want bottom surgery, for example -- and this is /harder/ to do for them, since blockers arrest genital tissue development. For trans women, the surgery in that case is often more dangerous than it would otherwise have been (e.g. parts of the colon must be removed to create a vagina, whereas a fully developed penis can be "inverted"); for trans men, it's nigh impossible.
That's putting aside, of course, the other deleterious side effects of blocker + hormone use, such as anorgasmia, sterility, loss of bone density, etc.
You are assuming that a person -- a child, because it’s only children who can have their puberty blocked -- is this entity known as a “trans person.”
But there is no such thing.
Even doctors don’t have a diagnosis for “being trans.” There is only gender dysphoria. And a real (true, legit) diagnosis on gender dysphoria literally only means the person is very very unhappy at their natal sex and wish they were something else.
Gender dysphoria is a state of emotional unhappiness. It is not a physical, biological condition which requires medical treatments.
So ask yourself. For a very unhappy kid, do we let them make future major decisions about the cosmetic appearance of their body?
We don’t let children get tattooes, get married, or join the Navy, in part because children make really crap choices.
It makes no sense to impose a lifetime of medicalization on a child because he or she is unhappy about the type of body s/he has.
Forgive me, but I'm not really sure how you got from me telling someone that puberty blockers have deleterious side effects and don't "prevent surgeries" to me supporting kids going on puberty blockers.
True, 'swapping' puberty wouldn't prevent all later surgeries, but it would prevent some. Some effects of hormones, especially T, are not easily reversible. The deeper voice doesn't go away when you stop taking T. Going through the "correct" puberty prevents later top surgery as well.
Note that I'm talking about an ideal scenario where blockers (alone) wouldn't be necessary. The patient in question would be starting immediately on CSH. My understanding is that prevents anorgasmia. Sterility is a given, bone density can be monitored and accounted for.
Of course, this all assumes we have perfect knowledge of who is and isn't going to persist. With our current level of knowledge, I agree that the risk probably isn't worth it. But, I also think the risks don't so outweigh the possible benefits that it's not worth studying.
for MTF, not going through male puberty will lead to less facial feminization surgeries, and yes it is my understanding that the prevented puberty may lead the surgeon to use bowel in the construction of a neovagina due to lack of scrotal development. For females, the pausing of female puberty might help the growth plates not close, but it makes little difference for the face because faces are masculinized by T away from a childlike form that more resembles the adult female. I have suspected that female puberty increases the size of the eyes and makes the cheekbones more prominent, but that's not going to be too noticeable when you masculinize the face with T.
If you believe, as I do, that the whole concept of being transgender is based on regressive sex stereotypes, then it's very hard to accept that anyone—child or adult—needs any medical or physical transition in order to feel comfortable with the body he or she has. We should accept everyone as human beings with the right to dress, act, work, or play however they feel comfortable, and we should attach approximately zero significance to whether someone was born male or female (ETA: wrt looks, personality, clothing, etc.). "Gender incongruence" is a societal ill, not a medical condition.
As for kids, it's unwise to take how they feel at a given age as an indicator of how they will feel as an adult. At age 10, I (and many other women) would have done anything to avoid female puberty. Thank goodness changing my "gender" wasn't an option.
I agree that too many people conflate "gender" with "gender roles", and I think most people with self diagnosed gender dysphoria could be cured by not giving a fuck and doing what they want, regardless of societal expectations WRT their sex/gender.
That being said, I believe that there are people for whom there is a physical problem. Maybe, rather than gender incongruence, a better term would be sex incongruence. I don't know why transsexual fell out of favor, but it would seem to be a more accurate term.
And I agree that feelings at any given age are not a reliable predictor. Persistent feelings from a young age, however, seem to have at least some predictive usefulness. The issue is, of course, the present colors perception of the past. Unless this person has been in treatment from a young age, I don't know how much we can trust someone saying "oh, yeah, I've always felt like this."
i think they are looking for a solution as to why they have not fit in. The ADHD girls have a lot of problems with the social-emotional reciprocity of intense dyadic friendships and they often times are taken advantage of. "I suck at being a girl" leads to "maybe I'm not a girl", and hey... you give a bunch of testosterone to somebody, they get less depressed. (Maybe that's why men aren't diagnosed as often?) It's a terrible solution to a problem that wouldn't be that difficult if we protected and affirmed every child in ways other than their self-discovered gender identity.
Maybe we should have maximized accepting gender incongruence rather than brainwashing children into thinking they could impose their self-discovered gender identity upon the world, or that their self-discovered gender identity was Gospel truth the second it didn't match their biological reality.
I disagree with making a blanket statement that "it would be better to prevent those adults from going through the "wrong" puberty".
Jazz Jenning was the poster child for affirmation, hormones and surgery but as with most kids like this, has been dogged by problems. Weight gain, and mental health issues indirectly, but also as a direct result of stunting teenage development penis growth was hindered, so the inversion of the penis could not be performed in adulthood as there was not enough tissue.
The outcomes from needing to graft other body parts into a neo-phallus or a neo-vagina are worse than being able to invert fully grown organs.
Treatments remove any ability to orgasm too. Teenagers and young adults are being brought to menopause by hormones.
These problems at the very least undermine the benefits of feminised facial or vocal features. We treat them as secondary concerns as our primary focus is the visible and audible signifiers that someone is identifying as a sex. This is a mistake in my opinion.
I agree with you and Cass that where these experiments do occur, they should be strictly screened. And by independent parties, or by two groups who work on theories and proposals that act in opposition but use the same children and data and compromise with each other on the underlying methodology.
Is that what Jesse is referring to when he says he supports youth gender medicalisation in some cases? Only in terms of experimentation to determine once and for all the usefulness or not of treatment?
I would not be *as* opposed to children and parents being told they are taking part in experimental treatments. That they might get placebo drugs or no drugs rather than blockers/hormones, or they might get counselling that affirms their feelings or challenges them, but this in itself is an ethical minefield.
yeah, there are intersex kids where it might not be a bad idea, but how do you decide which ones? Of course, it would be evidence free living. CAH girls who are transitioned to boys early in life have more gender dysphoria than CAH girls raised as girls, so even in the clear-cut case of masculinized female babies with congenital adrenal hyperplasia, it is unclear if hormonal transition is typically a good idea.
there is none, and I have been yelled-at by my boss for pointing that out. In California, getting an ADHD diagnosis is very hard and the barriers Kaiser puts up are not evidence-based.
Regarding the redundant scale items (I'm a social psychology PhD) - There are different approaches to making scales. Sometimes what you want *is* to ask the same exact thing in slightly different words.
Every response has some error associated with it. By asking the same question multiple times and averaging together, you average away the error.
For instance, a commonly used measure of "extraversion" asks people whether they are "hard to get to know" and, separately, whether they "keep others at distance." By averaging these very similar items (and others) together you get a more accurate score.
[Very technical addendum: These items are specifically for the "negative keyed" sided of the "enthusiasm" aspect of extraversion. Other "aspects" will ask somewhat different questions -- but they, too, will do so in very similar ways within themselves. So the full measure of extraversion with all its "aspects" includes both clearly different items and items that resemble each other. For instance, the "assertiveness" aspect asks whether you "take charge," which is different from the "enthusiasm" items however you slice it.]
Using redundant questions for error checking and frankly testing the respondent for consistency makes sense.
But you do need to make sure you aren’t “double counting” the redundant questions in the score - if you have 10 questions but 4 of them are really the same question, that one is going to have an outsize impact on the score unless you correct for it somehow.
Right, this is exactly how I interpreted Jesse's comments, especially since he mentioned the fact that the authors of the scale had *already* removed a question for being redundant.
Thanks for looking at this. In my own view, these studys are likely to have high participation bias. Why are the participants involved in the study? why do they want this care? have the participants and their families been told that most kids grow out of gender dysphoria without social transition and gender meds? have they been lied to regarding dysphoric youth suicide rates as is so common? have the participants and their familys been told about the long term downsides of gender meds? or that their child may have issues that arent related to gender at all, as many detransitioners report in retrospect. my apologies if this was covered. i assume the participants and their families are full believers of many of the common inaccurate gender biz catch phrases regarding this care. considering the celebratory and non critical ideation of gender care in many communities, participant feelings about this care is likely to be influenced by many factors other than the care itself.
also, i dont understand why a control group cant be used. in a previous study i read that a control group cant be used becuase not using these meds would put the control participants at risk. given these results it would seem they wouldnt be at any risk at all
The article doesn't fully address two big problems with the study:
1) The authors assume that avoiding medicalization would have led to worse outcomes. This assumption is particularly inappropriate given evidence that the majority of children who don't medicalize do desist; they come to accept their bodies. (In other words, the implications of there being no control group need to be articulated more clearly.)
2) The 2 year timeline is ridiculously short. There can be euphoria after taking action one fervently believes will help, especially as schools and peers lavish praise on a child for their "bold" "courageous" "authentic" living. As time goes on, as the problems underlying rejecting one's bodies remain unsolved, as the medical consequences of messing with one's previously-healthy body become more evident, and as a child matures....bad feelings can mount. There is evidence of depression and regret, and also suicide, happening after more time has passed. (See the big Swedish study, for example.)
I would also like to state for the record that the concept of a child having been born in the wrong body is as mystical and anti-science as it gets. And that it is an outrage that doctors mislead children into believing they can become the other sex...that the hormonal and surgical measures imposed on their previously healthy bodies will in any way enable them to have the body and experiences of someone of the opposite sex. Analyzing the obviously biased studies of the Gender faithful as if this were any other medical treatment evaluation, is a cop-out. How did it come to be that people fear they will be seen as unreasonable if they point out that the whole basis of any of this is madness?
"Gender affirmation" medicine is premised on everyone agreeing to the anti-science redefining of vital words like woman and man, rendering those words absolutely meaningless. Going along with that doesn't just subject kids to a medical scandal of horrific proportions. It also fuels other unacceptable consequences in our world: men in women's prison cells, lesbians chastised for insisting on same sex relationships, females and males alike losing the right to sex-based privacy, women losing female-only sports, the reification of vile sexist stereotypes, and more. I, for one, do NOT agree to that redefinition or to the forfeiture of rights that goes with it. Most people don't. Any discussion of pediatric "gender affirmation" medicine must acknowledge the definitional sleight-of-hand upon which it is based.
"I am opposed to the sorts of policies Trump is proposing — . . . to codify into federal policy a ban on even adults changing their legal sex."
Jesse, I color my hair, stay out of the sun, and follow a strict diet and exercise regimen that enables me to pass for a woman ten or more years younger than my chronological age of 70. My "authentic self" is not that of an old crone cashing her Social Security check, but that of a woman enjoying late middle age.
Should I insist that Medicare pays for my next facelift? Should I be able to change the birth date on my driver's license and birth certificate?
For years the medical establishment said we needed better research into how certain diseases affect women differently from men, that women needed to be better represented in clinical trials. Now it doesn't matter whether you're male or female, just whether you feel like a man or a woman.
Ditto for the pay gap and other possible ways that women are treated differently from men. These used to be major concerns for policy makers and researchers. Now discrimination on the basis of sex has been redefined to include gender identity, leaving no way to tell how something affects females as opposed to men who feel like women.
These do not seem like good directions for us to be going.
The transification movement is the revenge of the partriarchy. Women are being pushed aside by men who falsely claim to be women. It's men reasserting control over women.
Yes. It's being pushed by men. But it's a small subset of men, autogynephile billionaires and their "trans" activist minions, many of whom are brainwashed women.
Most men hate this nonsense just as much as the women they know. But everyone's afraid to speak up. People know that if they do speak up, they'll lose their job or their friends, or the custody of their children. So with each passing day,. they remain silent. And that's how the "trans" cancer grows and metastasizes through our entire society.
The time has come for all of us to put our foot down. To speak up. And excise this cancer once and for all.
it's an interesting back-door out of the patriarchy push-back for a very small group of men... often ones who have resented women, and want to gain control. The majority of men aren't down with this... this "patriarchy" you speak of often goes along with a lot of nonsense that emerges from somewhere outside of the patriarchy... perhaps just to get paid or impress chicks. "The Patriarchy" isn't behind this, but some resentful and envious men definitely are.
Yes. We are not headed in a good direction. And it's even worse than you think.
As Jennifer Bilek's 11th Hour Blog tells us, a small group of autogynephile (men who get off on pretending to be women) billionaires has plowed hundreds of millions of dollars into capturing all our most important institutions: hospitals, medical organizations, universities, schools, media, corporations, and the government. Ten million here. Fifty million there. It all adds up.
That's why formerly noble organizations like the ACLU, which was established to protect free speech, and Planned Parenthood, which was established to protect the reproductive health of women, now stand for the exact opposite of what they were created to do. The ACLU pushes for "trans" friendly laws and silences everyone who opposes them. Planned Parenthood is now the nation's leading supplier of wrong sex hormones to men and women, boys and girls. These organizations were once our saviors. Now they have morphed into the enemy. A cold blooded killer.
When we read publicly available information about and by these autogynephile billionaires, we see what they're really after. Yes. They're in it to fatten their bottom line from increased demand for expensive"transgender" drugs and surgeries. Every child who falls for the intensive "transgender" brainwashing adds half a million or more in lifetime payments to the medical industrial complex.
But the greed of the autogynephile billionaires goes far beyond money. As one of these billionaires, "Martine" (nee Martin) Rothblatt, has stated, "Transgender is the on-ramp to transhumanism." That's right, condition children to agree to chop off their healthy breasts or testicles and you can eventually get them to jettison their physical bodies and go live in the cloud as ones and zeros in a posthuman dystopia to end all dystopias. And then it's lights off for us all.
When we understand the future of biological humanity is at stake, we realize we can't fight these "transgender" madmen by using pronouns and being "nice." I only wish Jesse and Colin Wright would stop playing footsie with these guys and open his eyes to the danger.
>A tiny bit of political throat-clearing before we start: If you write critically about youth gender medicine, you will hear from a lot of people who are aghast that you could do so given the threats trans people in the United States (adults and children alike) face.
I find this attitude absolutely infuriating. Yes, noting that the evidence base isn't great might leave medical interventions vulnerable to fearmongering, lies and hysteric reactionary responses by bad faith actors. But you know what also leads to that? Attempts to suppress any criticism at all on patently absurd claims of 'harm' to trans people.
I'm in Australia and there's an upcoming vote on constitutional change to create an indigenous 'Voice' to the parliament - effectively an advisory body comprised of indigenous people, to raise issues with the government, guaranteed to exist into the future.
Because it's a constitutional change the actual wording is vague as to the composition of the entity, how it operates, etc etc., and people understandably are asking for detail. However, the government is ducking these questions, instead asking citizens to vote on the principle, and to trust that the parliament will set out the specific details later. Unsurprisingly, this doesn't wash with everybody, but the response has been to either imply that voters asking questions are doing so in bad faith, or ignorance (some activists have told questioning voters to read a 300 page report on the Voice that the government hasn't even endorsed as the model it wants), or that detail isn't something that is needed on a constitutional question.
The vote might succeed on principle alone, but I find it disturbing how many advocates of change reflexively believe that any questions being asked to derail the 'right thing to do'. Some people might be acting in bad faith, and there's a risk that the debate could be bogged down in insignificant minutiae, but even so, it shouldn't be that difficult to give the public a TL;DR and respond effectively to misconceptions. Frankly, the unwillingness to engage on anything but the 'principle' smacks of laziness and arrogance, and could sink the entire campaign.
They engage on "principle" because they know that the details, if revealed, would be unpalatable to too many people.
In the US, a similar issue is "reparations" for slavery. No proponents of reparations will ever deign to explain just exactly who will get them (do we follow the "one drop rule"?), how this will be adjudiciated (and by whom), if appeals to courts will be possible, etc, etc, etc, all details that would have to be worked out. But no one ever does, because they would be much more controversial than the principle.
My suspicion is that if too much detail is outlined, then voters will think that the Voice is too INEFFECTIVE a constitutional change, rather than too extreme. It's something a lot of indigenous people are behind, but fundamentally it's a non-binding advisory body that a government can choose to completely ignore if it wants - the government could also get the same result by literally just listening to the existing voices.
At best it might function as a first step towards larger reforms to improve indigenous wellbeing, at worst it's another impotent entity that has no meaningful impact on the country. Neither of which is a particularly inspiring message compared to the government just sticking with the 'principle of reconciliation' and acting like any comments that aren't enthusiastic agreement come out of a place of ignorance or hatred.
"Take items like “My outward appearance represented my gender identity” and “My physical appearance adequately expressed my gender identity.” For one thing, these items are so similar that I’m surprised they’re both on the scale — they seem truly redundant..."
Jesse, I'm surprised that you're surprised. Clearly you haven't been subjected to a lot of psychological questionnaires, which are rife with this kind of redundancy. Often these sets of questions are preceded by a statement like "Many of the questions may appear similar, but please answer them all." The two you cite don't appear as similar as some I've seen. There are subtle differences between "outward appearance" and "physical appearance" and not-so-subtle differences between "expressed" and "represented," not to mention that sneaky adverb "adequately."
There are good reasons to doubt the importance of this scale, but the redundancy is par for the course in psychological testing. I just did some quick searching to try to find out what the purpose of it might be, and I found a couple of sources that mention redundant questions as a way to weed out people who aren't paying attention or who aren't taking the questionnaire seriously (or robots perhaps). It seems unlikely that this was the case here though.
This is a fair critique! Probably my weakest point. I still think it stands as a matter of determining *changes* in someone's score on the scale, which I think we have no data on when it comes to the TCS.
yeah, a question that is asked multiple times can also slant the treatment effect towards the statistically significant if it is the most easy variable to positively change. It would be the same effect as weighting one item response more than another, which would be a totally valid thing to do, if we saw that this element of change was more heavily correlated with a positive, global clinical element. We don't have research that proves that in this case.
Thanks for taking the enormous amount of time to evaluate this “study.” It is discouraging that this will be used to justify pushing kids into gender transition. Don’t give up on this issue. We need same people to keep pushing back.
If we want to actually know whether these hormone treatments work, someone is going to need to bite the bullet and run a randomized trial. Randomize the participants to usual mental health treatment or usual mental health treatment with hormones. It's probably going to be controversial because there will be researchers who insist that it's unethical to randomize kids when we "already know" that the hormones work. Except that we don't have enough information to know if they work and medicine is littered with treatments that we were certain we knew worked but were abandoned when high quality evidence showed that they were either useless or caused more harm than good. There's a serious ethical problem with refusing to do high quality studies on a treatment that doesn't have good evidence one way or another.
Your post is wonderful, and nuanced, and the comments are germane. If I were a NEJM reviewer I'd have easily rejected the Chen et al article (and I'm pretty chickenshit).
It would have been enough for /me/ with a point you barely touched on -- the numbers of those in each category of the Beck's scale are in /all/ cases substantially lower after 24 months than at the inception of the study. The researchers are not following a consistent cohort! It's as though they have no clue that there are ways of handling cohort loss. What would the breakdowns be if we followed the group who completed the inventory in all cases? What is the breakdown of cases -- and what are the changes -- among the approximately one-third who are missing at the end?
It's magical thinking to conclude /anything/ based on such numbers. Yet the NEJM -- one of our flagship journals -- let it get past peer review, blustery conclusions and all.
One commenter said you're winning, Jesse. But you're not. We're not. One powerful institution after another falls. Enough.
The severe depression scores should be amended to include the suicides, which would make the before/after percent with severe depression almost the same.
Thank you, as always, for all this work. I sincerely hope that someone, somewhere is currently engaged in an extensive study of this, including controls with placebos, gender dysphoric kids who do not go the hormone route, and a comparison of mental health with kids that do not have gender dysphoria. I hope in 2-5 years we have the results of such a study that is rigorous, unbiased and has the interests of all children at heart.
That's not going to happen any time soon. Such a study would need funding, and the institutions that would fund it have all been captured by the transifiers. And the transifiers most definitely do not want such a study to be done.
OK, how come I paid for this Substack and I still have to pay for _Blocked and Reported_? Jesse Singal is worse than a Satanist, he is a Sam Smithonist.
the dog abuse did feel like an aside... it was really crazy. The description in that article is pretty similar to what I have seen in a medical center.
As a Biological Psychologist and research scientist, I agree with your (detailed) analysis. However, in some sense it's beside the point (with which, I think, you probably agree). People see what they want to see in data, especially data that deal with fuzzy psychological concepts, or which can be spun to support an ideological agenda.
However, probably the most important issue, from my perspective, is the fact that you cannot simply manipulate anatomy and physiology to change a person into something they would like to be (or you would like them to be). Biology doesn't work like that. Further, we have known the deleterious effects of cross sex hormones and blockers for over half a century (ever since the drugs were first synthesized). It amazes me that people are now "debating" their effects. Except in the rarest of instances will traumatic hormonal manipulation help someone who is suffering from a psychological or psychosocial condition. I discussed some of that in "There is "Biological Evidence for Gender Identity..." but it’s not what you think."
Https://everythingisbiology.substack.com/p/there-is-biological-evidence-for
Interestingly, much of the back-and-forth about "gender identity," its associated issues and their putative amelioration is driven by misconceptions about biological causation, biological malleability, and fundamental misunderstandings of neuroscience on both sides of the debate. In some ways, it's become like the debate over abortion:, misconceived by people on both sides of the issue, and subject to a perpetual attempt to win the argument by presenting progressively larger bodies of "facts".... with no one making a fair and honest assessment of their "opponents" point of view.
To be clear, I agree with your analysis. I'm just not sure if it's going to make much of a difference until people decide to more carefully — and objectively — consider the fundamental biological and psychological aspects of this issue. Everything is biology, after all.
Thanks for a great read, Frederick
Frederick?
I was signing my comment.
If you put your name on the following line, instead of the same one, it would be much less confusing.
there has not been much discussion of organizing and activating effects. De-feminizing and de-masculinizing effects of these hormones on the brain, and never any discussion as to whether we need to allow for estrogen-progesterone to continue to feminize an adolescent brain to its final product before we declare the person trans. I am writing here assuming there is a brain-biology basis to trans, which there may not be in most cases. Also, almost no discussion of the fact that it is a myth that trans brains are more like the sex they identify with than the sex they were born into. If anything, in the frontal lobes of FTMs, there is a "hyper-feminine" pattern--it's on the tail of the normal distribution for females that is on the side opposite of that which would converge with males.
Hi Jesse,
I only ever seem to comment or tweet you when I want to disagree so first of all I have to state what great work you do and how much I appreciate it.
But with every write up like this that I read, I less understand your position on supporting hormones for *some* children as a better solution than, say, leeches.
Have you written about the positive research or the persuasive arguments that have led to this position? About which are the cases you can definitively make such a prescription for? If not, would you? Please.
Thanks again
I had the same question.
There’s a glaring lack of evidence that this is good for ANY kids. There’s no physical/medical indication for these drugs so ... why?
At this point it seems more like Jesse is clinging to a “but maybe for some kids...” simply to maintain his distance from the conservatives and (for example) the truly unhinged content from Trump recently.
Sure I get it. No one wants to be lumped in with that guy. But if overnight there were NO “gender medicine” (I choke on that phrase!) for kids and teens in the US, that would be no doubt a net good for humankind.
Just because Trump is unhinged and unsavory doesn’t mean that he might not occasionally stumble on a true fact.
Stopped clocks, twice a day, and all that.
As a science writer, Jesse should notice that other countries are treating this as the experimental “treatment” that it is, meaning, until we have some evidence it works, Joe Schmo MD needs to stop prescribing this stuff and telling parents it’s evidence-based.
yes, and it was not Trump's solitary and independent genius that landed him on being "anti-Trans", it's him reading political tea leaves and seeing where he has an opening. Gender medicine certainly does more harm than good at this point.
Not Jesse, but I can answer why I still maintain that hormones for *some* children is a viable option.
First, we accept that transgender adults exist and, if we had a magic detector that could perfectly predict which kids will grow up to be transgender adults, it would be better to prevent those adults from going through the "wrong" puberty to prevent later surgeries. Supporting hormones for some kids comes down to how accurately we think we can match that hypothetical detector.
We don't have the data to suggest a causal relationship between youth CSH and better life outcomes. But we also don't have data to suggest a causal relationship between youth CSH and negative life outcomes.
We have some data that suggests, for a certain cohort, at least a correlation between CSH and better life outcomes. Therefore, for a strictly screened cohort (few to no other mental health issues, gender dysphoria that is severe, persistent, and early on-set), it's justifiable to administer CSH under a research setting to try to see if the causal relationship exists.
Once (if) it is established for the more certain cohort, it can be expanded to less certain cohorts.
I don’t accept that “transgender adults” exist in the magical gendered-soul sense that our culture seems to have adopted in the 21st century.
I accept that fully mature adults can undertake extreme cosmetic changes because they think it will make them “happier.” And kids can’t.
There is no evidence, zero, none, that there is such a thing as a person in a wrong body or a person with a brain-body mismatch.
There is evidence, across time and place and cultures, that some people are at the extreme ends of being gender-nonconforming: what we would call “masculine” women or “feminine” men.
There is evidence that various cultures have created niches for people who “didn’t fit in” to gendered norms, and those niches are different across cultures but in none of those cultures has there ever been a belief that the person is in the wrong body, or is really the opposite sex.
Those beliefs are purely our own cultural creations. And there’s no evidence supporting those beliefs. That’s why some people liken some of these gendered beliefs (“a girl brain in a boy’s body” and the like) to religious beliefs.
These are beliefs that many people have accepted on faith: there are no facts, data, evidence supporting such a belief -- nor even a clear explanation what it could possibly mean to have a female body part in a male body or vice versa, or “really” be the opposite sex “on the inside” in any more material way than “I simply really really wish it were true.”
Can you have a man’s elbow in a woman’s body? Why not?
When people incorrectly say that sex is on a spectrum (it’s not: we’re sexually dimorphic as a species and everyone is one of two sexes) what they mean is that gendered behavior and gendered expectations and stereotypes are on a spectrum: no one is such a caricature that they are Barbie or GI Joe, so we all lie along a spectrum in terms of how masculine or feminine we are -- and that’s perfectly natural and probably wired in.
Like any other spectrum, you will naturally have a few people on the extremes: masculine women who are still biologically women, and feminine men who are still biologically men.
So far so good.
How we get from there to “hormones and surgeries” for people who might sincerely wish they’d been born the other sex is purely a matter of cosmetics.
No male-born person can be made into a female person and vice versa. If people are really committed to living the role of the opposite sex, they can go pretty far in cosmetically simulating the other sex and “living as” the other sex.
While adults can make those decisions, kids can’t.
That ANY doctor prescribes hormones for cosmetic purposes or performs these surgeries for cosmetic purposes (really expensive profitable surgeries will high failure rates) is unethical in the extreme. But that would be a different conversation.
Does foregoing puberty prevent later surgeries? Transpeople who've been on blockers still often want bottom surgery, for example -- and this is /harder/ to do for them, since blockers arrest genital tissue development. For trans women, the surgery in that case is often more dangerous than it would otherwise have been (e.g. parts of the colon must be removed to create a vagina, whereas a fully developed penis can be "inverted"); for trans men, it's nigh impossible.
That's putting aside, of course, the other deleterious side effects of blocker + hormone use, such as anorgasmia, sterility, loss of bone density, etc.
You are assuming that a person -- a child, because it’s only children who can have their puberty blocked -- is this entity known as a “trans person.”
But there is no such thing.
Even doctors don’t have a diagnosis for “being trans.” There is only gender dysphoria. And a real (true, legit) diagnosis on gender dysphoria literally only means the person is very very unhappy at their natal sex and wish they were something else.
Gender dysphoria is a state of emotional unhappiness. It is not a physical, biological condition which requires medical treatments.
So ask yourself. For a very unhappy kid, do we let them make future major decisions about the cosmetic appearance of their body?
We don’t let children get tattooes, get married, or join the Navy, in part because children make really crap choices.
It makes no sense to impose a lifetime of medicalization on a child because he or she is unhappy about the type of body s/he has.
Forgive me, but I'm not really sure how you got from me telling someone that puberty blockers have deleterious side effects and don't "prevent surgeries" to me supporting kids going on puberty blockers.
"Does foregoing puberty prevent later surgeries?"
True, 'swapping' puberty wouldn't prevent all later surgeries, but it would prevent some. Some effects of hormones, especially T, are not easily reversible. The deeper voice doesn't go away when you stop taking T. Going through the "correct" puberty prevents later top surgery as well.
Note that I'm talking about an ideal scenario where blockers (alone) wouldn't be necessary. The patient in question would be starting immediately on CSH. My understanding is that prevents anorgasmia. Sterility is a given, bone density can be monitored and accounted for.
Of course, this all assumes we have perfect knowledge of who is and isn't going to persist. With our current level of knowledge, I agree that the risk probably isn't worth it. But, I also think the risks don't so outweigh the possible benefits that it's not worth studying.
for MTF, not going through male puberty will lead to less facial feminization surgeries, and yes it is my understanding that the prevented puberty may lead the surgeon to use bowel in the construction of a neovagina due to lack of scrotal development. For females, the pausing of female puberty might help the growth plates not close, but it makes little difference for the face because faces are masculinized by T away from a childlike form that more resembles the adult female. I have suspected that female puberty increases the size of the eyes and makes the cheekbones more prominent, but that's not going to be too noticeable when you masculinize the face with T.
If you believe, as I do, that the whole concept of being transgender is based on regressive sex stereotypes, then it's very hard to accept that anyone—child or adult—needs any medical or physical transition in order to feel comfortable with the body he or she has. We should accept everyone as human beings with the right to dress, act, work, or play however they feel comfortable, and we should attach approximately zero significance to whether someone was born male or female (ETA: wrt looks, personality, clothing, etc.). "Gender incongruence" is a societal ill, not a medical condition.
As for kids, it's unwise to take how they feel at a given age as an indicator of how they will feel as an adult. At age 10, I (and many other women) would have done anything to avoid female puberty. Thank goodness changing my "gender" wasn't an option.
I agree that too many people conflate "gender" with "gender roles", and I think most people with self diagnosed gender dysphoria could be cured by not giving a fuck and doing what they want, regardless of societal expectations WRT their sex/gender.
That being said, I believe that there are people for whom there is a physical problem. Maybe, rather than gender incongruence, a better term would be sex incongruence. I don't know why transsexual fell out of favor, but it would seem to be a more accurate term.
And I agree that feelings at any given age are not a reliable predictor. Persistent feelings from a young age, however, seem to have at least some predictive usefulness. The issue is, of course, the present colors perception of the past. Unless this person has been in treatment from a young age, I don't know how much we can trust someone saying "oh, yeah, I've always felt like this."
i think they are looking for a solution as to why they have not fit in. The ADHD girls have a lot of problems with the social-emotional reciprocity of intense dyadic friendships and they often times are taken advantage of. "I suck at being a girl" leads to "maybe I'm not a girl", and hey... you give a bunch of testosterone to somebody, they get less depressed. (Maybe that's why men aren't diagnosed as often?) It's a terrible solution to a problem that wouldn't be that difficult if we protected and affirmed every child in ways other than their self-discovered gender identity.
Maybe we should have maximized accepting gender incongruence rather than brainwashing children into thinking they could impose their self-discovered gender identity upon the world, or that their self-discovered gender identity was Gospel truth the second it didn't match their biological reality.
I disagree with making a blanket statement that "it would be better to prevent those adults from going through the "wrong" puberty".
Jazz Jenning was the poster child for affirmation, hormones and surgery but as with most kids like this, has been dogged by problems. Weight gain, and mental health issues indirectly, but also as a direct result of stunting teenage development penis growth was hindered, so the inversion of the penis could not be performed in adulthood as there was not enough tissue.
The outcomes from needing to graft other body parts into a neo-phallus or a neo-vagina are worse than being able to invert fully grown organs.
Treatments remove any ability to orgasm too. Teenagers and young adults are being brought to menopause by hormones.
These problems at the very least undermine the benefits of feminised facial or vocal features. We treat them as secondary concerns as our primary focus is the visible and audible signifiers that someone is identifying as a sex. This is a mistake in my opinion.
I agree with you and Cass that where these experiments do occur, they should be strictly screened. And by independent parties, or by two groups who work on theories and proposals that act in opposition but use the same children and data and compromise with each other on the underlying methodology.
Is that what Jesse is referring to when he says he supports youth gender medicalisation in some cases? Only in terms of experimentation to determine once and for all the usefulness or not of treatment?
I would not be *as* opposed to children and parents being told they are taking part in experimental treatments. That they might get placebo drugs or no drugs rather than blockers/hormones, or they might get counselling that affirms their feelings or challenges them, but this in itself is an ethical minefield.
yeah, there are intersex kids where it might not be a bad idea, but how do you decide which ones? Of course, it would be evidence free living. CAH girls who are transitioned to boys early in life have more gender dysphoria than CAH girls raised as girls, so even in the clear-cut case of masculinized female babies with congenital adrenal hyperplasia, it is unclear if hormonal transition is typically a good idea.
there is none, and I have been yelled-at by my boss for pointing that out. In California, getting an ADHD diagnosis is very hard and the barriers Kaiser puts up are not evidence-based.
Regarding the redundant scale items (I'm a social psychology PhD) - There are different approaches to making scales. Sometimes what you want *is* to ask the same exact thing in slightly different words.
Every response has some error associated with it. By asking the same question multiple times and averaging together, you average away the error.
For instance, a commonly used measure of "extraversion" asks people whether they are "hard to get to know" and, separately, whether they "keep others at distance." By averaging these very similar items (and others) together you get a more accurate score.
[Very technical addendum: These items are specifically for the "negative keyed" sided of the "enthusiasm" aspect of extraversion. Other "aspects" will ask somewhat different questions -- but they, too, will do so in very similar ways within themselves. So the full measure of extraversion with all its "aspects" includes both clearly different items and items that resemble each other. For instance, the "assertiveness" aspect asks whether you "take charge," which is different from the "enthusiasm" items however you slice it.]
Where does removal for covariance come in? Do only remove at high covariance for unintentional similarities then?
Using redundant questions for error checking and frankly testing the respondent for consistency makes sense.
But you do need to make sure you aren’t “double counting” the redundant questions in the score - if you have 10 questions but 4 of them are really the same question, that one is going to have an outsize impact on the score unless you correct for it somehow.
Have they done that here?
Right, this is exactly how I interpreted Jesse's comments, especially since he mentioned the fact that the authors of the scale had *already* removed a question for being redundant.
Thanks for looking at this. In my own view, these studys are likely to have high participation bias. Why are the participants involved in the study? why do they want this care? have the participants and their families been told that most kids grow out of gender dysphoria without social transition and gender meds? have they been lied to regarding dysphoric youth suicide rates as is so common? have the participants and their familys been told about the long term downsides of gender meds? or that their child may have issues that arent related to gender at all, as many detransitioners report in retrospect. my apologies if this was covered. i assume the participants and their families are full believers of many of the common inaccurate gender biz catch phrases regarding this care. considering the celebratory and non critical ideation of gender care in many communities, participant feelings about this care is likely to be influenced by many factors other than the care itself.
also, i dont understand why a control group cant be used. in a previous study i read that a control group cant be used becuase not using these meds would put the control participants at risk. given these results it would seem they wouldnt be at any risk at all
The article doesn't fully address two big problems with the study:
1) The authors assume that avoiding medicalization would have led to worse outcomes. This assumption is particularly inappropriate given evidence that the majority of children who don't medicalize do desist; they come to accept their bodies. (In other words, the implications of there being no control group need to be articulated more clearly.)
2) The 2 year timeline is ridiculously short. There can be euphoria after taking action one fervently believes will help, especially as schools and peers lavish praise on a child for their "bold" "courageous" "authentic" living. As time goes on, as the problems underlying rejecting one's bodies remain unsolved, as the medical consequences of messing with one's previously-healthy body become more evident, and as a child matures....bad feelings can mount. There is evidence of depression and regret, and also suicide, happening after more time has passed. (See the big Swedish study, for example.)
I would also like to state for the record that the concept of a child having been born in the wrong body is as mystical and anti-science as it gets. And that it is an outrage that doctors mislead children into believing they can become the other sex...that the hormonal and surgical measures imposed on their previously healthy bodies will in any way enable them to have the body and experiences of someone of the opposite sex. Analyzing the obviously biased studies of the Gender faithful as if this were any other medical treatment evaluation, is a cop-out. How did it come to be that people fear they will be seen as unreasonable if they point out that the whole basis of any of this is madness?
"Gender affirmation" medicine is premised on everyone agreeing to the anti-science redefining of vital words like woman and man, rendering those words absolutely meaningless. Going along with that doesn't just subject kids to a medical scandal of horrific proportions. It also fuels other unacceptable consequences in our world: men in women's prison cells, lesbians chastised for insisting on same sex relationships, females and males alike losing the right to sex-based privacy, women losing female-only sports, the reification of vile sexist stereotypes, and more. I, for one, do NOT agree to that redefinition or to the forfeiture of rights that goes with it. Most people don't. Any discussion of pediatric "gender affirmation" medicine must acknowledge the definitional sleight-of-hand upon which it is based.
"I am opposed to the sorts of policies Trump is proposing — . . . to codify into federal policy a ban on even adults changing their legal sex."
Jesse, I color my hair, stay out of the sun, and follow a strict diet and exercise regimen that enables me to pass for a woman ten or more years younger than my chronological age of 70. My "authentic self" is not that of an old crone cashing her Social Security check, but that of a woman enjoying late middle age.
Should I insist that Medicare pays for my next facelift? Should I be able to change the birth date on my driver's license and birth certificate?
If you don't think so? Why not?
Of course adults should be banned from changing their legal sex! Sex cannot be changed, any more than age can be changed.
Duh.
Darn it! And here I was, hoping for that free facelift.
For years the medical establishment said we needed better research into how certain diseases affect women differently from men, that women needed to be better represented in clinical trials. Now it doesn't matter whether you're male or female, just whether you feel like a man or a woman.
Ditto for the pay gap and other possible ways that women are treated differently from men. These used to be major concerns for policy makers and researchers. Now discrimination on the basis of sex has been redefined to include gender identity, leaving no way to tell how something affects females as opposed to men who feel like women.
These do not seem like good directions for us to be going.
The transification movement is the revenge of the partriarchy. Women are being pushed aside by men who falsely claim to be women. It's men reasserting control over women.
Yes. It's being pushed by men. But it's a small subset of men, autogynephile billionaires and their "trans" activist minions, many of whom are brainwashed women.
Most men hate this nonsense just as much as the women they know. But everyone's afraid to speak up. People know that if they do speak up, they'll lose their job or their friends, or the custody of their children. So with each passing day,. they remain silent. And that's how the "trans" cancer grows and metastasizes through our entire society.
The time has come for all of us to put our foot down. To speak up. And excise this cancer once and for all.
it's an interesting back-door out of the patriarchy push-back for a very small group of men... often ones who have resented women, and want to gain control. The majority of men aren't down with this... this "patriarchy" you speak of often goes along with a lot of nonsense that emerges from somewhere outside of the patriarchy... perhaps just to get paid or impress chicks. "The Patriarchy" isn't behind this, but some resentful and envious men definitely are.
Yes. We are not headed in a good direction. And it's even worse than you think.
As Jennifer Bilek's 11th Hour Blog tells us, a small group of autogynephile (men who get off on pretending to be women) billionaires has plowed hundreds of millions of dollars into capturing all our most important institutions: hospitals, medical organizations, universities, schools, media, corporations, and the government. Ten million here. Fifty million there. It all adds up.
That's why formerly noble organizations like the ACLU, which was established to protect free speech, and Planned Parenthood, which was established to protect the reproductive health of women, now stand for the exact opposite of what they were created to do. The ACLU pushes for "trans" friendly laws and silences everyone who opposes them. Planned Parenthood is now the nation's leading supplier of wrong sex hormones to men and women, boys and girls. These organizations were once our saviors. Now they have morphed into the enemy. A cold blooded killer.
When we read publicly available information about and by these autogynephile billionaires, we see what they're really after. Yes. They're in it to fatten their bottom line from increased demand for expensive"transgender" drugs and surgeries. Every child who falls for the intensive "transgender" brainwashing adds half a million or more in lifetime payments to the medical industrial complex.
But the greed of the autogynephile billionaires goes far beyond money. As one of these billionaires, "Martine" (nee Martin) Rothblatt, has stated, "Transgender is the on-ramp to transhumanism." That's right, condition children to agree to chop off their healthy breasts or testicles and you can eventually get them to jettison their physical bodies and go live in the cloud as ones and zeros in a posthuman dystopia to end all dystopias. And then it's lights off for us all.
When we understand the future of biological humanity is at stake, we realize we can't fight these "transgender" madmen by using pronouns and being "nice." I only wish Jesse and Colin Wright would stop playing footsie with these guys and open his eyes to the danger.
https://www.the11thhourblog.com/
https://www.amazon.com/gp/product/B0054SCPKQ/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1&pldnSite=1
>A tiny bit of political throat-clearing before we start: If you write critically about youth gender medicine, you will hear from a lot of people who are aghast that you could do so given the threats trans people in the United States (adults and children alike) face.
I find this attitude absolutely infuriating. Yes, noting that the evidence base isn't great might leave medical interventions vulnerable to fearmongering, lies and hysteric reactionary responses by bad faith actors. But you know what also leads to that? Attempts to suppress any criticism at all on patently absurd claims of 'harm' to trans people.
I'm in Australia and there's an upcoming vote on constitutional change to create an indigenous 'Voice' to the parliament - effectively an advisory body comprised of indigenous people, to raise issues with the government, guaranteed to exist into the future.
Because it's a constitutional change the actual wording is vague as to the composition of the entity, how it operates, etc etc., and people understandably are asking for detail. However, the government is ducking these questions, instead asking citizens to vote on the principle, and to trust that the parliament will set out the specific details later. Unsurprisingly, this doesn't wash with everybody, but the response has been to either imply that voters asking questions are doing so in bad faith, or ignorance (some activists have told questioning voters to read a 300 page report on the Voice that the government hasn't even endorsed as the model it wants), or that detail isn't something that is needed on a constitutional question.
The vote might succeed on principle alone, but I find it disturbing how many advocates of change reflexively believe that any questions being asked to derail the 'right thing to do'. Some people might be acting in bad faith, and there's a risk that the debate could be bogged down in insignificant minutiae, but even so, it shouldn't be that difficult to give the public a TL;DR and respond effectively to misconceptions. Frankly, the unwillingness to engage on anything but the 'principle' smacks of laziness and arrogance, and could sink the entire campaign.
They engage on "principle" because they know that the details, if revealed, would be unpalatable to too many people.
In the US, a similar issue is "reparations" for slavery. No proponents of reparations will ever deign to explain just exactly who will get them (do we follow the "one drop rule"?), how this will be adjudiciated (and by whom), if appeals to courts will be possible, etc, etc, etc, all details that would have to be worked out. But no one ever does, because they would be much more controversial than the principle.
My suspicion is that if too much detail is outlined, then voters will think that the Voice is too INEFFECTIVE a constitutional change, rather than too extreme. It's something a lot of indigenous people are behind, but fundamentally it's a non-binding advisory body that a government can choose to completely ignore if it wants - the government could also get the same result by literally just listening to the existing voices.
At best it might function as a first step towards larger reforms to improve indigenous wellbeing, at worst it's another impotent entity that has no meaningful impact on the country. Neither of which is a particularly inspiring message compared to the government just sticking with the 'principle of reconciliation' and acting like any comments that aren't enthusiastic agreement come out of a place of ignorance or hatred.
"Take items like “My outward appearance represented my gender identity” and “My physical appearance adequately expressed my gender identity.” For one thing, these items are so similar that I’m surprised they’re both on the scale — they seem truly redundant..."
Jesse, I'm surprised that you're surprised. Clearly you haven't been subjected to a lot of psychological questionnaires, which are rife with this kind of redundancy. Often these sets of questions are preceded by a statement like "Many of the questions may appear similar, but please answer them all." The two you cite don't appear as similar as some I've seen. There are subtle differences between "outward appearance" and "physical appearance" and not-so-subtle differences between "expressed" and "represented," not to mention that sneaky adverb "adequately."
There are good reasons to doubt the importance of this scale, but the redundancy is par for the course in psychological testing. I just did some quick searching to try to find out what the purpose of it might be, and I found a couple of sources that mention redundant questions as a way to weed out people who aren't paying attention or who aren't taking the questionnaire seriously (or robots perhaps). It seems unlikely that this was the case here though.
Ah, I see that someone already commented on the possible reasons for redundancy. Perhaps I should delete my comment as redundant...
This is a fair critique! Probably my weakest point. I still think it stands as a matter of determining *changes* in someone's score on the scale, which I think we have no data on when it comes to the TCS.
yeah, a question that is asked multiple times can also slant the treatment effect towards the statistically significant if it is the most easy variable to positively change. It would be the same effect as weighting one item response more than another, which would be a totally valid thing to do, if we saw that this element of change was more heavily correlated with a positive, global clinical element. We don't have research that proves that in this case.
no need to delete, you've made the point clearly
Thanks for taking the enormous amount of time to evaluate this “study.” It is discouraging that this will be used to justify pushing kids into gender transition. Don’t give up on this issue. We need same people to keep pushing back.
If we want to actually know whether these hormone treatments work, someone is going to need to bite the bullet and run a randomized trial. Randomize the participants to usual mental health treatment or usual mental health treatment with hormones. It's probably going to be controversial because there will be researchers who insist that it's unethical to randomize kids when we "already know" that the hormones work. Except that we don't have enough information to know if they work and medicine is littered with treatments that we were certain we knew worked but were abandoned when high quality evidence showed that they were either useless or caused more harm than good. There's a serious ethical problem with refusing to do high quality studies on a treatment that doesn't have good evidence one way or another.
Your post is wonderful, and nuanced, and the comments are germane. If I were a NEJM reviewer I'd have easily rejected the Chen et al article (and I'm pretty chickenshit).
It would have been enough for /me/ with a point you barely touched on -- the numbers of those in each category of the Beck's scale are in /all/ cases substantially lower after 24 months than at the inception of the study. The researchers are not following a consistent cohort! It's as though they have no clue that there are ways of handling cohort loss. What would the breakdowns be if we followed the group who completed the inventory in all cases? What is the breakdown of cases -- and what are the changes -- among the approximately one-third who are missing at the end?
It's magical thinking to conclude /anything/ based on such numbers. Yet the NEJM -- one of our flagship journals -- let it get past peer review, blustery conclusions and all.
One commenter said you're winning, Jesse. But you're not. We're not. One powerful institution after another falls. Enough.
The severe depression scores should be amended to include the suicides, which would make the before/after percent with severe depression almost the same.
Thank you, as always, for all this work. I sincerely hope that someone, somewhere is currently engaged in an extensive study of this, including controls with placebos, gender dysphoric kids who do not go the hormone route, and a comparison of mental health with kids that do not have gender dysphoria. I hope in 2-5 years we have the results of such a study that is rigorous, unbiased and has the interests of all children at heart.
That's not going to happen any time soon. Such a study would need funding, and the institutions that would fund it have all been captured by the transifiers. And the transifiers most definitely do not want such a study to be done.
I was way off in my estimate on how often you would reference Testosterone; I didn't realize how widespread the issues with this study were.
I wish more of your expert references were willing to be on the record, but I don't blame them for wanting to keep their names out of this debate.
I hope they release all of their data for further review. I'm sure it would be illuminating.
OK, how come I paid for this Substack and I still have to pay for _Blocked and Reported_? Jesse Singal is worse than a Satanist, he is a Sam Smithonist.
the dog abuse did feel like an aside... it was really crazy. The description in that article is pretty similar to what I have seen in a medical center.