One thing that sticks in my mind about this issue is the implicit blackmail. "Your kid will kill themselves if you don't do X!" is a jarring and terrifying framework for any parent to deal with, but I'm not aware of it existing anywhere in healthcare except in trans issues.
Consider for example if my teenager told me they'd kill themselves if they're not allowed to watch TV. MAYBE unlimited TV is the only way to ensure they don't carry out their threat, but if so this only reveals a deeply dysfunctional mindset that should be further investigated.
This inquiry seems to be completely missing from the trans discourse as far as I can tell. I find it genuinely alarming how little curiosity there is from the trans-affirming side as to *what* exactly causes someone to be feel dysphoria. The inquiry almost doesn't seem to matter, with the prognosis basically taking the form of "don't worry about why, just make sure they get cutting-edge plastic surgery and experimental hormonal treatments or else they'll kill themselves."
The current state of "gender affirming care" seems like a band-aid solution that papers over a much deeper problem, and I don't understand how we are helping trans people by turning a blind eye to the root cause of their suffering.
Jesse, this is such great work! As someone who can (barely) make sense of statistical data included in scientific papers, I know that it takes careful, detailed analysis to document the flaws. I admire your ability and commitment to doing so and applaud your perseverance. Thank you!!!
I remember Sam Harris once noting that deeply religious folks reject a lot of science because it runs counter to their beliefs, but that if (for example) a scientific finding supported the authenticity of the Shroud of Turin or Noah's Flood, the religionists would enthusiastically embrace those findings. Of course they would!
Confirmation bias is a powerful force and none of us is immune to it. We lefties want to believe that our views are right, so we uncritically accept any bases that support our priors and become suspicious only of those claims that challenge our views. This is basic human nature and to some extent is understandable on both ends of the political spectrum. The worrisome part is when it leads to potential harm.
As someone who published the first couple of peer reviewed papers for my PhD while still in med school I find the actions of pretty much everyone involved in this project remarkable. The principal author obviously has no idea how to interpret the data and that is just cool with everyone including the advisor? The student is obviously an activist but there are supposed to be checks and balances - I mean, this isn’t some ethnography about reading manga naked in the bath, it’s consequential stuff.
I have the feeling that these people won’t have the student’s back if this becomes an issue because they’re not protecting her (from herself) right now. Smdh.
Once again, the single (Singal?) biggest issue with the progressive movement is the way they're married to methods rather than goals. Share the same methods? ALLIES. Share the same goals? LITERALLY HITLER. We see this across the board, from trans kids to police violence (rest in power, David Shor).
I don't mean to elide the differences and disagreements between individual progressives, but the loudest voices seem to be shouting the same things. The ONLY way to improve policing is to abolish it. The ONLY way to improve economic equality is to abolish capitalism (and guillotine Jeff Bezos, apparently). The ONLY way to save "trans kids" is to give them access to drugs and/or surgery at any age.
Simple, one-size-fits-all solutions don't work in a complex and nuanced world, full stop.
There are kids with gender dysphoria, but there is NO DIAGNOSTIC for which of these kids may actually be "trans" (that is, with GD that persists into adulthood and which can only be relieved by radical cosmetic surgery). Which, Jesse, you know perfectly well from you own investigations and reviews.
So please, Jesse, PLEASE stop referring to "trans kids". THEY DO NOT EXIST. Talking as if they do only perpetuates the problem of highly inappropriate medical interventions.
Regarding the "we threw out the data at 12 months due to underresponse" excuse, I think they are trying to say that they see effects of PB/GAH even at 6 months. The problem is that this doesn't help their case, because, as they admit, they aren't actually following all the same kids over time. So by throwing out the 12 months, they just lose data ...
It seems that, int he final press release, they are simultaneously claiming "we can use fancy statistics to infer strong correlation even without the same kids" but also "the issue was just underresponse by the same kids we've been following after 12 months, but good thing more responed at 6 months." The two excuses are contradictory, though.
Do we know what the trend in puberty blockers is these days? I would imagine that if you were a parent of a trans girl you might look for some information and find the comments about how bad it is for natal boys to not go through puberty for their ability to be sexually mature later on and if you were the parent of a trans boy you would note that you can use interventions like continuous low does birth control to prevent menstruation and achieve a key component of blockers without the side effects. Additionally most of these trans boys become aware of their dysphoria after puberty has begun so why put them on blockers over birth control? Anyway just curious -- I think that it's very sad that a cohort of trans kids was subject to these powerful medications without a lot of evidence about the risk benefit ratio -- but it seems like this is one area where we can make progress in preventing harm without running afoul of the affirmation only mantra (especially now that Scandinavian countries are pulling back from blockers). Most parents willing to consider them are going to be pretty well educated and left leaning and cursory internet research should show that there are some real risks here.
Has anyone checked the AMA's code of ethics on this yet? In addition to misrepresenting treatment efficacy, the misrepresentation concerns a vulnerable population. (Ironically that may violate the code's language intended to promote equitable health care.)
Thanks Jesse for your lonely persistence. There is historical precedent for timely and open sharing of research data and methods, not just results, accelerating progress for the common good. At this point it's hard to believe that the authors of this study are withholding the data for any reason other than to obfuscate the weakness of their claims. Medicine would benefit from embracing a culture where any statistical argument in a publication must include links to the actual data and accompanying analysis scripts. Independently reproducible or it doesn't count.
I wonder--can you get someone from NYT to reach out for comment? After Bazelon's piece, it seems like maybe they're more open to exactly this sort of inquiry, dealing as it does with adolescent transition/care.
One thing that sticks in my mind about this issue is the implicit blackmail. "Your kid will kill themselves if you don't do X!" is a jarring and terrifying framework for any parent to deal with, but I'm not aware of it existing anywhere in healthcare except in trans issues.
Consider for example if my teenager told me they'd kill themselves if they're not allowed to watch TV. MAYBE unlimited TV is the only way to ensure they don't carry out their threat, but if so this only reveals a deeply dysfunctional mindset that should be further investigated.
This inquiry seems to be completely missing from the trans discourse as far as I can tell. I find it genuinely alarming how little curiosity there is from the trans-affirming side as to *what* exactly causes someone to be feel dysphoria. The inquiry almost doesn't seem to matter, with the prognosis basically taking the form of "don't worry about why, just make sure they get cutting-edge plastic surgery and experimental hormonal treatments or else they'll kill themselves."
The current state of "gender affirming care" seems like a band-aid solution that papers over a much deeper problem, and I don't understand how we are helping trans people by turning a blind eye to the root cause of their suffering.
I think Dolly put it well here: https://bprice.substack.com/p/lots-of-kids-have-real-and-diagnosable
Jesse, this is such great work! As someone who can (barely) make sense of statistical data included in scientific papers, I know that it takes careful, detailed analysis to document the flaws. I admire your ability and commitment to doing so and applaud your perseverance. Thank you!!!
I remember Sam Harris once noting that deeply religious folks reject a lot of science because it runs counter to their beliefs, but that if (for example) a scientific finding supported the authenticity of the Shroud of Turin or Noah's Flood, the religionists would enthusiastically embrace those findings. Of course they would!
Confirmation bias is a powerful force and none of us is immune to it. We lefties want to believe that our views are right, so we uncritically accept any bases that support our priors and become suspicious only of those claims that challenge our views. This is basic human nature and to some extent is understandable on both ends of the political spectrum. The worrisome part is when it leads to potential harm.
As someone who published the first couple of peer reviewed papers for my PhD while still in med school I find the actions of pretty much everyone involved in this project remarkable. The principal author obviously has no idea how to interpret the data and that is just cool with everyone including the advisor? The student is obviously an activist but there are supposed to be checks and balances - I mean, this isn’t some ethnography about reading manga naked in the bath, it’s consequential stuff.
I have the feeling that these people won’t have the student’s back if this becomes an issue because they’re not protecting her (from herself) right now. Smdh.
Once again, the single (Singal?) biggest issue with the progressive movement is the way they're married to methods rather than goals. Share the same methods? ALLIES. Share the same goals? LITERALLY HITLER. We see this across the board, from trans kids to police violence (rest in power, David Shor).
I don't mean to elide the differences and disagreements between individual progressives, but the loudest voices seem to be shouting the same things. The ONLY way to improve policing is to abolish it. The ONLY way to improve economic equality is to abolish capitalism (and guillotine Jeff Bezos, apparently). The ONLY way to save "trans kids" is to give them access to drugs and/or surgery at any age.
Simple, one-size-fits-all solutions don't work in a complex and nuanced world, full stop.
Thank you, Jesse! I really admire your pursuit of the truth and the tenacity you show in going after it.
Repeat after me:
There is no such thing as a "trans kid"!
There is no such thing as a "trans kid"!
There is no such thing as a "trans kid"!
There are kids with gender dysphoria, but there is NO DIAGNOSTIC for which of these kids may actually be "trans" (that is, with GD that persists into adulthood and which can only be relieved by radical cosmetic surgery). Which, Jesse, you know perfectly well from you own investigations and reviews.
So please, Jesse, PLEASE stop referring to "trans kids". THEY DO NOT EXIST. Talking as if they do only perpetuates the problem of highly inappropriate medical interventions.
It is shocking how this insidious idea has wormed its way into our culture. The evidence is available for the destructive effects of puberty blockers ( see: https://thelesbianpost.substack.com/p/our-report-on-puberty-suppression) and the stories of detransitioners are starting to be heard: https://pitt.substack.com/p/please-watch-the-detransition-diaries/comments . Thank you for your voice in this ongoing debate about reality!
My first suicide attempt was at age ten.
Why would a ten year old try to kill herself? Not a single shrink bothered to ask that very simple question.
I’ve never had a scintilla of respect for shrinks and this trans lunacy is ensuring I never will.
Regarding the "we threw out the data at 12 months due to underresponse" excuse, I think they are trying to say that they see effects of PB/GAH even at 6 months. The problem is that this doesn't help their case, because, as they admit, they aren't actually following all the same kids over time. So by throwing out the 12 months, they just lose data ...
It seems that, int he final press release, they are simultaneously claiming "we can use fancy statistics to infer strong correlation even without the same kids" but also "the issue was just underresponse by the same kids we've been following after 12 months, but good thing more responed at 6 months." The two excuses are contradictory, though.
Jesse, Aren't their grounds for suit here somewhere? This just seems too egregious to leave as a whine-o-gram in Substack.
Do we know what the trend in puberty blockers is these days? I would imagine that if you were a parent of a trans girl you might look for some information and find the comments about how bad it is for natal boys to not go through puberty for their ability to be sexually mature later on and if you were the parent of a trans boy you would note that you can use interventions like continuous low does birth control to prevent menstruation and achieve a key component of blockers without the side effects. Additionally most of these trans boys become aware of their dysphoria after puberty has begun so why put them on blockers over birth control? Anyway just curious -- I think that it's very sad that a cohort of trans kids was subject to these powerful medications without a lot of evidence about the risk benefit ratio -- but it seems like this is one area where we can make progress in preventing harm without running afoul of the affirmation only mantra (especially now that Scandinavian countries are pulling back from blockers). Most parents willing to consider them are going to be pretty well educated and left leaning and cursory internet research should show that there are some real risks here.
Has anyone checked the AMA's code of ethics on this yet? In addition to misrepresenting treatment efficacy, the misrepresentation concerns a vulnerable population. (Ironically that may violate the code's language intended to promote equitable health care.)
Thanks for banging this drum. It's surreal all the shit you get and we're lucky you're willing to keep putting up with it.
Thanks Jesse for your lonely persistence. There is historical precedent for timely and open sharing of research data and methods, not just results, accelerating progress for the common good. At this point it's hard to believe that the authors of this study are withholding the data for any reason other than to obfuscate the weakness of their claims. Medicine would benefit from embracing a culture where any statistical argument in a publication must include links to the actual data and accompanying analysis scripts. Independently reproducible or it doesn't count.
I wonder--can you get someone from NYT to reach out for comment? After Bazelon's piece, it seems like maybe they're more open to exactly this sort of inquiry, dealing as it does with adolescent transition/care.