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.
"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."
This is why I think there should be a careful distinction in discussions between the question of the medical condition of being transgender and what I would characterize as the ideology of "transgenderism" (which "cis" people are entirely capable of being part of), but in practice the latter has somehow completely subsumed the former in a way that would be pretty incredible on its own, yet it's gone even further and somehow subdues mainstream institutions into subverting or forgoing all conventional medical, scientific, legal, and even philosophical interrogation of the phenomenon.
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.
What's striking to me is that none of the authors are established researchers, they're all junior. That tells me nobody who knew what they were doing was willing to put their name on it.
I've also published in peer-reviewed scientific journals and this bothered me as well. Part of the advisor's job is to teach the student to properly analyze data and make sure that their students are doing good science. Sometimes, part of an advisor's job is to tell their students that their data aren't publishable, that they've made a mistake or the design of the experiment doesn't pass muster. That did not happen here. It's bad for everyone. Everyone with their name on that paper now has their name attached to terrible quality science.
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.
Complete tangent but it is very funny to talk about David Shor being canceled when the New York Times just published a whole article about how cool and smart and fuckable he is. We should all be so lucky to get as canceled as him lol
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.
Sorry, but listen to the podcast For Crying Out Loud. One of the hosts has a genetically female child who has insisted since age 2 that she is a male. He started social transition at age 10 and is now on blockers. The podcast has been talking about this for years. It is not a "see how progressive I am" issue. There are trans-kids. ROGD is a whole different issue
Please, for the sake of balance, listen to the first episode of Gender, A Wider Lens. Stella O'Malley, one of the hosts, had a history similar to the child you describe. She insisted she was male as a small child and for years, insistently, persistently and consistently. She desisted with puberty. This child you describe has been put on blockers, so we will never know if that would have happened for them. Gender dysphoric children have been studied, and in the past, a super-majority desisted with puberty. Most turned out to be gay. Children don't have the vocabulary to explain why they feel different from other children, it's not surprising some use a simple formulation (I *am* a boy/girl) to express how they feel. It doesn't mean you have to sacrifice their fertility and sexual function. You can let them do all the things without telling them that wearing a dress makes you a girl, or having short hair and climbing trees makes you a boy. Transition is a difficult path, with many long term consequences and side effects. Taking that path is an adult decision.
The child, once identifying as male, found profound relief and lifting of depression. I am with you on Gender, A Wider Lens. Their Pioneer series was very interesting. I would add a caveat, that like all shows, not every episode is strong. Some can be more polemic than enlightening. On the whole, though, it's an important resource..
Sorry, no. The kid clearly has parents who are facilitating and encouraging belief in being "trans". No child can possibly understand what it means to have puberty blocked, with all the attendant medical issues, including possible permanent sterility and permanent loss of sexual function.
This "medical" treatment of children is a crime against humanity, and will one day be recognized as such.
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.
I know a lot of affirming left-leaning parents. They’re all well-educated and otherwise intelligent, critical thinkers, but they have their culture war goggles on so tight that they do not believe any evidence to the contrary when it comes to medical treatment for dysphoric children. (Side note, we really need to stop calling dysphoric kids trans kids. Not all people who have had sex dysphoria remain dysphoric, especially children. Many people who have dealt with it, self included, don’t end up transitioning. We just kind of grew out of it. Calling them trans kids assumes an outcome that used to be the least likely one.)
I read one substack attributing progressives' childlike trust in "the experts" as partially driven by widespread antidepressant use.
If the same medical establishment peddling SSRIs and Covid boosters to progressive wine moms say Lupron is "safe and reversible", then those wine moms won't even think to do any independent research (in fact they would describe "doing your own internet research" as something only MAGA deplorables would do).
"SSRI users are docile, emotionally warm, asexual, and plump (weight gain is a near-universal side effect of SSRIs). The predictable result of a culture whose elite drug of choice is SSRIs is that people with significant institutional power will tend to be credulous (if highly-educated), chubby, happy people who don’t question authority."
As someone in this demographic that does not reflect my experience but I was asking because I am curious. As the parent of a trans young adult people ask me for advice a lot and I always tell them that the risks of blockers are significant and kind of scary and that was before the changes in practice in Europe.
Progressivism by definition is a deference to authority. "If only the right people were in charge" and we must "do something " are very alluring concepts in spite of 100 years of evidence to the contrary.
Back in the 60s they were the "fight the system" people. It was only once they acquired institutional power that suddenly they learned to stop worrying and love the system.
I'd argue based on a failing memory that 60's radicals never used the word "progressive". In fact, identifying as Progressive seems like a 21st century thing. Although the movement has been around since the early 20th century, the word "Liberal" took such a beating in the 80's and 90's that the identity of Progressive became popularized.
Anyhow, every Progressive I know is deeply wedded to deference to authority. And I doubt it's because they're all perpetually medicated.
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
"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."
This is why I think there should be a careful distinction in discussions between the question of the medical condition of being transgender and what I would characterize as the ideology of "transgenderism" (which "cis" people are entirely capable of being part of), but in practice the latter has somehow completely subsumed the former in a way that would be pretty incredible on its own, yet it's gone even further and somehow subdues mainstream institutions into subverting or forgoing all conventional medical, scientific, legal, and even philosophical interrogation of the phenomenon.
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.
Everyone likes science as long as it's in their side. But it's science as a rhetorical tool, not a truth seeking one.
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.
I won't have you disparaging my PHD in Bathtime Manga Studies... take it back.
What's striking to me is that none of the authors are established researchers, they're all junior. That tells me nobody who knew what they were doing was willing to put their name on it.
I've also published in peer-reviewed scientific journals and this bothered me as well. Part of the advisor's job is to teach the student to properly analyze data and make sure that their students are doing good science. Sometimes, part of an advisor's job is to tell their students that their data aren't publishable, that they've made a mistake or the design of the experiment doesn't pass muster. That did not happen here. It's bad for everyone. Everyone with their name on that paper now has their name attached to terrible quality science.
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.
Complete tangent but it is very funny to talk about David Shor being canceled when the New York Times just published a whole article about how cool and smart and fuckable he is. We should all be so lucky to get as canceled as him lol
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.
Sorry, but listen to the podcast For Crying Out Loud. One of the hosts has a genetically female child who has insisted since age 2 that she is a male. He started social transition at age 10 and is now on blockers. The podcast has been talking about this for years. It is not a "see how progressive I am" issue. There are trans-kids. ROGD is a whole different issue
Please, for the sake of balance, listen to the first episode of Gender, A Wider Lens. Stella O'Malley, one of the hosts, had a history similar to the child you describe. She insisted she was male as a small child and for years, insistently, persistently and consistently. She desisted with puberty. This child you describe has been put on blockers, so we will never know if that would have happened for them. Gender dysphoric children have been studied, and in the past, a super-majority desisted with puberty. Most turned out to be gay. Children don't have the vocabulary to explain why they feel different from other children, it's not surprising some use a simple formulation (I *am* a boy/girl) to express how they feel. It doesn't mean you have to sacrifice their fertility and sexual function. You can let them do all the things without telling them that wearing a dress makes you a girl, or having short hair and climbing trees makes you a boy. Transition is a difficult path, with many long term consequences and side effects. Taking that path is an adult decision.
The child, once identifying as male, found profound relief and lifting of depression. I am with you on Gender, A Wider Lens. Their Pioneer series was very interesting. I would add a caveat, that like all shows, not every episode is strong. Some can be more polemic than enlightening. On the whole, though, it's an important resource..
Sorry, no. The kid clearly has parents who are facilitating and encouraging belief in being "trans". No child can possibly understand what it means to have puberty blocked, with all the attendant medical issues, including possible permanent sterility and permanent loss of sexual function.
This "medical" treatment of children is a crime against humanity, and will one day be recognized as such.
Jesse has firmly stated that he believes that "radical cosmetic surgery" can be appropriate for a minor. It just should have a high bar.
If Jesse has stated that, then he is wrong. "Radical cosmetic surgery" on children is a crime against humanity.
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.
I know a lot of affirming left-leaning parents. They’re all well-educated and otherwise intelligent, critical thinkers, but they have their culture war goggles on so tight that they do not believe any evidence to the contrary when it comes to medical treatment for dysphoric children. (Side note, we really need to stop calling dysphoric kids trans kids. Not all people who have had sex dysphoria remain dysphoric, especially children. Many people who have dealt with it, self included, don’t end up transitioning. We just kind of grew out of it. Calling them trans kids assumes an outcome that used to be the least likely one.)
I read one substack attributing progressives' childlike trust in "the experts" as partially driven by widespread antidepressant use.
If the same medical establishment peddling SSRIs and Covid boosters to progressive wine moms say Lupron is "safe and reversible", then those wine moms won't even think to do any independent research (in fact they would describe "doing your own internet research" as something only MAGA deplorables would do).
"SSRI users are docile, emotionally warm, asexual, and plump (weight gain is a near-universal side effect of SSRIs). The predictable result of a culture whose elite drug of choice is SSRIs is that people with significant institutional power will tend to be credulous (if highly-educated), chubby, happy people who don’t question authority."
https://wonderlandrules.substack.com/p/a-touch-of-the-tism-part-iv
As someone in this demographic that does not reflect my experience but I was asking because I am curious. As the parent of a trans young adult people ask me for advice a lot and I always tell them that the risks of blockers are significant and kind of scary and that was before the changes in practice in Europe.
Progressivism by definition is a deference to authority. "If only the right people were in charge" and we must "do something " are very alluring concepts in spite of 100 years of evidence to the contrary.
Back in the 60s they were the "fight the system" people. It was only once they acquired institutional power that suddenly they learned to stop worrying and love the system.
I'd argue based on a failing memory that 60's radicals never used the word "progressive". In fact, identifying as Progressive seems like a 21st century thing. Although the movement has been around since the early 20th century, the word "Liberal" took such a beating in the 80's and 90's that the identity of Progressive became popularized.
Anyhow, every Progressive I know is deeply wedded to deference to authority. And I doubt it's because they're all perpetually medicated.
Well, don't forget the Progressives of the late 1890s and early 20th century.
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.