If, as you yourself acknowledge, the concerns are real, why do you assume that the lawmakers who are promoting these laws are motivated by straight up bigotry and maliciousness?

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I agree it's concerning if, say, you have someone aged 11-13 who abruptly starts having gender issues for a few months and dominant progressive attitudes (and possibly "cis privilege" guilt) pressure the parents to shop around for a clinic that will fast track hormone replacement. The main problem is that gender clinics in many areas are a "wild west" of inconsistent philosophies and practices, so the solution is effective regulation and professional guidelines rather than panic-oriented bills supported by conservative politicians.

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Yeah I have first hand experience on how easy it is to just get psychiatrists to give you what you want. It is shockingly easy to get a psychiatrist to write benzo scripts or adderall scripts if you have half a brain and know the right things to say. And Im not talking some shady pill mills you hear about from an addict but legit respectable psychiatrists.

When I first got diagnosed with ADD I filled out a long questionnaire that scored you. The "correct" answers are obvious so you just pick them but dont go so over the top it seems suspicious. I turned in my questionare he diagnosed me with ADD and 5 minutes later i'm walking out with a script for a schedule II drug (Adderall) in my pocket. With benzos basically same deal only dont even need the questionnaire. Just google Generalized Anxiety Disorder and tell a sympathetic story that moves with it. Tell them you're already taking an SSRI and it's not helping. If they name a couple other things tell them you tried them in the past and they didn't work. Eventually they'll offer the benzos typically.

Some are probably just in it for the money but many overwork themselves seeing a new patient every 15 minutes. The client seems sympathetic and seems to understand the pros and the cons so they don't want to say no. There are doctors who are much more cautious but you just don't see them again. Chances are the next one you see will give you what you want.

All this is to say so vehemently agree no kid should be put on medical transition just because one doctor thought it was the right thing. This should involve multiple psychologists including ones who arent wedded to trans advocacy. And the process should take MUCH longer than a visit or two.

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Thanks for another interesting piece.

I'd apply the Santa Claus test. If a kid who believes their sex is wrong also believes in Santa Claus one may indeed question their maturity in making big decisions. And the belief that puberty blockers' effects are completely reversible is by no means shared by all doctors and others. And these concerns are not limited to Conservatives. I need hardly remind you, Jesse, that you youself have often been labelled “Transphobic” for asking basic and reasonable questions about Trans orthodoxy.

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The more complicated the scientific, philosophical, ethical, and medical issues around a given subject, the more leery a responsible politician should be of pushing legislation. Obviously that's not going to happen because we've largely dis-incentivized politicians from behaving in a responsible way.

Great analysis, regardless of one's position on trans issues it should be a no-brainer for everyone to agree that the state should not insert itself between physician and patient.

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Isn’t your idea of a competent clinician Dr Erica Anderson? The one who talks about “so-called TERFS,” “wanting to throttle Rand Paul,” and puberty blockers “hitting a pause button” as if they are reversible? After listening to that softball of an interview, the draconian laws in Arkansas and NC look pretty good. If that’s the best of clinicians, I’d hate to see the quacks

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Jesse, do you still believe these treatments are "reversible", knowing what we now know?

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Since this post is roughly three years old, and you just pointed to it in today's post about the AMA, I'm wondering if you still stand by what you wrote at the time.

"Cruz is deeply confused about this subject — a 7-year-old is unlikely to be going on hormone blockers any time soon…"

The SoC8 suggest starting blockers for girls around ages 8-13, but they're not big on age limits, as you know.

"…the general trajectory usually starts with social transition (which has no medical component). Then, puberty blockers around the onset of puberty. Then, perhaps a couple years later, if the kid decides s/he really does want to go through with a ‘cross-sex’ puberty … they can begin cross-sex hormones. Alternatively, they can stop the blockers and their natal puberty will soon kick in."

As Cass states, social transition is a psycho-social intervention. It's not a benign action. There is good reason to believe it concretizes a gender identity, so I don't think it deserves just a hand-wave because it's not "medical." As for the "couple of years later," they're only recommending blockers for a year — two at most — because of possibly permanent harm to bone development (among other increased risks), and pretty much every kid that gets on blockers quickly pushes to start hormones, since what little evidence we have shows that they largely do nothing in terms of relieving dysphoria or improving mental health issues. And really, what do we know about that "'cross-sex' puberty"? Despite the scare quotes, this suggests that there is such a thing. No one knows to what degree what passes for a cross-sex puberty aligns with a sex-aligned puberty.

The hypothetical about the 11 year old "competently diagnosed with severe gender dysphoria" (LOL) who starts blockers but is stuck on them because hormones are outlawed in his state isn't a thing. Any state banning hormones is also banning blockers. And honestly, if they're going to ban one over the other, it's much more likely they'll ban blockers, since the potential for permanent neurodevelopmental harm is in many ways a greater concern (not to downplay any of the irreversible side-effects of hormones). As for the trauma of having to undergo a sex-aligned puberty, there's data that show this is not unlikely to resolve gender dysphoria, although obviously the cohort was different.

You included this quote from Dr. Daniel Metzger: "And there’s also the simple issue of forcing a kid to wait for very important medical care." Is it, though? Is it "very important medical care," given the abject lack of any real assessment and the inflation of suicidality, not to mention the lack of an evidence base for said care?

And here's a really great quote from Erica Anderson you included: "The professional societies are motivated to offer guidelines based upon the best available science and revise them based upon emerging science and best practices." You still believe this enough to let this go unchallenged in your post? The quote that follows from Laura Edwards-Leeper trots out the suicide risk threat. Are you fine letting that stand?

You have shown that we cannot rely on the professional medical organizations to be honest about gender transition treatment outcomes. We have more than enough evidence of the shoddy care young people are getting at gender clinics. We have systematic reviews showing that treating kids with blockers and hormones does not result in anything but maybe meager improvements if any (plus, you know, the suicide thing). In the face of this evidence, the AMA is not taking a cautious, "conservative," measured approach. They're doubling down. I'm a parent in this. I see more parents joining the support groups every week, watching their kid spiral down and away. California Dems are pushing legislation that is inching toward making affirmation a requirement. How do you not see the necessity for using legislation to place reasonable limitations on the medicalization of children, given that we limit other medical procedures for minors, not to mention other general safeguarding that's been put in place around tobacco, alcohol, pot, etc.? What exactly do you propose we do aside from watch as our kids and families get destroyed?

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