Astonishing work as always, Jesse. Thanks for linking to my account of Jack Turban talking out of both sides of his mouth about the worthiness of biopsychosocial assessments of kids with gender dysphoria: https://benryan.substack.com/p/dr-jack-turbans-quietly-radical-bible
In the most general sense, I would think anyone administering a new treatment to children, using drugs with side effects, on the assumption that it will help children more than hurt them, would have a nagging question: "what if I'm wrong?". And that would result in caution. But nope.
What is fascinating to me about Turban is that, like me, he is an effeminate gay man. So likely, he was a flamer as a child. And he has grown up and resolved his quote unquote dysphoria, to my knowledge.
I've noticed that the gender field has many practitioners like this...Gay men happily subjecting effeminate male children to these procedures that are more drastic and serious than most of what used to be conversion therapy. (Same goes for tomboy girls/lesbians.)
Consider, some history here. At one time, bone marrow transplants and whole body radiation were considered ‘treatments’ for cancer. A California insurance company refused to pay for these treatments on the ground that they were ‘experimental’. This was the basis for the Nelene Fox case (lawsuit). The insurance company was right and lost $140 million anyways. The ‘treatments’ didn’t work (for Nelene Fox and many others) and were subsequently abandoned.
The ‘treatments’ were very expensive and profoundly lucrative for the medical establishment. When it was shown that they didn’t work, they were abandoned. Trans surgery and hormones may be very lucrative for the medical establishment (they are). However, the real driver is ideology, not money. Trans ideology holds that people have a ‘right’ to trans medical treatment. The fact that these ‘treatments’ cost lots of money is irrelevant (to them). They don’t get the money anyway. They do provide the ideological justification.
So far, TRAs (Trans Rights Activists) have dominated the APA (American Psychological Association), The Endocrine Society, the American Academy of Pediatrics and many other groups. The bottom line is that Chase Strangio has far more power than the opponents of trans ‘medicine’. In Europe (Norway, Sweden, Finland, France, etc.), they have been far less successful. In the UK, the national government and political parties have turned against them. However, the situation in Scotland is more complex. Famously, JKR is a big critic. However, the SNP has promoted trans ideology without hesitation. Notoriously, Nicola Sturgeon was forced to resign because she wanted to send a male prisoner (a convicted rapist) to a women’s prison. The SNP has embraced ‘gender self-id’ allegedly, because the Greens insisted on it.
This fits the global (including American) pattern. Trans ideology is very much an elite idea. In the US, Harvard supports it. Ordinary Americans don’t. To paraphrase Lenin, “trans ideology is highest stage of identity politics”.
Also see: The long, sad history of the radical mastectomy, and how none of the surgeons wanted to conduct an RCT of this disfiguring surgery. Finally, after 10 years, they gathered enough surgery and found it was no more effective for breast cancer than a lumpectomy or mastectomy. (Read about both these historical narratives in The Emperor of All Maladies.)
How sad. How depressing. How predictable. The 'Emperor of All Maladies' was written by Siddhartha Mukherjee. He also wrote 'The Gene' which I recommend.
Don't forget that in addition to the validation of their ideological values and preferences, there are significant careers being built on this industry. Imagine leaving residency and starting your just-add-water-and-stir career in "gender-affirming" pediatrics or psychiatry or plastic surgery or endocrinology. You immediately move up the academic ladder, getting papers published just on the basis of which of your "peers" reviewed the manuscript. You get to teach and indoctrinate undergrads and residents within your first 5 years in practice. And, if you're like McNamara and Turban, you get $400 an hour to overinflate your qualifications and experience as a "gender expert". Seeing this all over academic medicine now.
Also read the released court filings regarding WPATH for fun (shock value), SEGM has many of them at the bottom of this analysis (as well as descriptions above):
I do appreciate the work that goes into this series, but man I find myself pausing every few minutes and thinking “all this digital ink spilled, all the research time and money spent, on the question of whether to chemically and/or surgically alter the genitals and secondary sexual characteristics of mentally unwell children?” Big picture, this is just completely bananas. Because this all implies to me that somehow there is some threshold of evidence that would make this ok, but is there really? In that sense I am almost with the McNamara people, because it’s undoubtedly true we do things in medicine, and more so in pediatrics, in which we don’t have “good, long-term evidence” on the outcomes, including in areas that don’t represent immediate life-saving need like the examples Jesse cites of ventilation and fluid resuscitation. So to me the reason we shouldn’t offer these “treatments” (ugh) to kids is because it’s obviously gross and horrifying, full stop.
I think the same thing for the question of "can men be women and/or lesbians?" and "should men claiming to be women be allowed to access resources reserved for natal women?" We've spent so much money, time, ink, and energy on this in the last ten years. Women just have to keep fighting the same old battles all over again.
"Sometimes it feels as if there's this special cordoned-off Youth Gender Zone in which the usual standards of therapy and differential diagnosis don't apply." Exactly right. That's the crux of the problem.
"Some of the studies showing high rates of continuation and/or satisfaction come from the Dutch clinic."
Even the rate of continuation from the Dutch clinic isn't that high. In a retrospective study that included the cohort of the original "Dutch Protocol" youths, about 19% of the adults had discontinued identifying as the gender they affirmed with puberty blockers and cross-sex hormones. In other words, about 1 in 5 desisted.
Noteworthy in this same study’s findings is that a vast majority of medically transitioned subjects remain essentially same sex attracted post transition which of course is not made clear by the authors who defer to identifying the gender identity of subjects rather than their biological sex
Missing link, I think: "After I pointed out that there were actually significant changes between the two documents (you can see all of them here), " I think 'here' wants a hyperlink?
I think what bothers me most about this stuff is that none of these doctors have a good idea just what they are treating. They throw around the term "gender identity", but even Jack Turban can't provide a coherent definition of just what that means. That's like someone who can't tell me how blood is pumped also claiming to be an expert cardiologist. I'll get my heart surgery from another doctor, thanks.
No wonder they need to "flood the zone" with nonsense; it's the only way to cover up the nonsense they themselves have produced.
“several of the authors of this article work in gender clinics. They profit directly from providing blockers, hormones, or surgery to kids. Some of them get paid hundreds of dollars an hour as expert witnesses for the legal teams seeking to secure or regain access to youth gender medicine in states where it has been banned or is under threat. And here, in two sentences, they make not one, not two, but five statements that are absolutely unproven by normal research standards” FFS. These people aren’t doing science. They are defending their livelihoods and using science as a skin suit.
“With more research, the quality of evidence in many fields of medicine does not neccessarily [sic] improve, as the study designs needed to detect smaller and smaller effects become infeasible. Thus, many areas of medicine may have inherent, real-world upper limits on quality of evidence”
So what they’re implying—even if they don’t realize it—is that not only is the current evidence week, but strong evidence is likely to show only a very small effect? Aren’t they just kind of unwittingly admitting it doesn’t work?
Merely sharing.....Just saw these reader letters in NYTimes regarding the article Lydia Polgreen wrote a couple of weeks ago about the Cass report. Here is one...See if you can spot the errors (btw, not all are in this vein:
"Re “The Strange Report Fueling the War on Trans Kids,” by Lydia Polgreen (column, Aug. 18):
Thank you to Lydia Polgreen for this thoughtful, well-researched piece. She clearly identified the faulty and dangerous unspoken premise of the Cass report and much of the reporting on this topic: that being transgender is socially deviant and harmful, and we should do everything in our collective power to reserve gender-affirming care for those we deem virtuous enough to become “good” members of society.
She also pointed out critics’ double standards. Our medical system routinely provides — without controversy — the same gender-affirming medications to cisgender children and adolescents that it provides to trans children and adolescents. The issue is clearly not “concern for children” but the deep-rooted transphobia that this “concern” masks.
What if we didn’t think of being trans as being deviant or broken? What if we saw it for what it is: an identity as old as human existence that is as worthy of respect and celebration as any other, especially amid this climate of fear? What if we focused less on creating unnecessary barriers to care and more on protecting the right to self-determination and access to health care that respects each person’s unique needs?
This letter perfectly captures the problem. Do you see this through the frame of medical treatment or identity? Treating this as a matter of identity makes it close to impossible to discuss the medical evidence in an impartial way, because raising concerns about the evidence is ipso facto an attack on identity.
The Cass report does not pathologize transgender people, from all that I have read.
In terms of the "same-gender affirming medications to cisgender children", the letter is talking about puberty blockers. I am pretty sure that the letter's writer is talking about precocious puberty....and there, the idea is that hormone levels are normalized. When used as a blocker, it abnormalizes hormone levels. This is elided again and again by activists.
Blockers for precocious puberty is also not intended to be 'gender affirming' in any meaningful sense. It's meant to treat an identifiable medical condition associated with potential lifelong physiological complications, not alleviate a mismatch between biological sex and 'gender identity.'
If a 'cis' person gets it too, then by golly it's gender affirming all the same! Gender affirming birth control, gender affirming lactation support, gender affirming boob jobs etc. Of course, this undermines the very logic behind deeming gender affirming care to be 'life saving' treatment, but making sense isn't their strong suit.
Astonishing work as always, Jesse. Thanks for linking to my account of Jack Turban talking out of both sides of his mouth about the worthiness of biopsychosocial assessments of kids with gender dysphoria: https://benryan.substack.com/p/dr-jack-turbans-quietly-radical-bible
In the most general sense, I would think anyone administering a new treatment to children, using drugs with side effects, on the assumption that it will help children more than hurt them, would have a nagging question: "what if I'm wrong?". And that would result in caution. But nope.
Thank you!
There is another also excellent review of Turban's book by Alex Byrne:
https://fairerdisputations.org/free-to-be-turban/
As far as Turban's giving patients "information" in assessments...his papers tend to be wrong, so what sort of information would that be?
And this. Exactly.
"For every minute McNamara and her colleagues spent writing this document, it probably takes five minutes to critique it."
Thank you for doing this!
What is fascinating to me about Turban is that, like me, he is an effeminate gay man. So likely, he was a flamer as a child. And he has grown up and resolved his quote unquote dysphoria, to my knowledge.
I've noticed that the gender field has many practitioners like this...Gay men happily subjecting effeminate male children to these procedures that are more drastic and serious than most of what used to be conversion therapy. (Same goes for tomboy girls/lesbians.)
Consider, some history here. At one time, bone marrow transplants and whole body radiation were considered ‘treatments’ for cancer. A California insurance company refused to pay for these treatments on the ground that they were ‘experimental’. This was the basis for the Nelene Fox case (lawsuit). The insurance company was right and lost $140 million anyways. The ‘treatments’ didn’t work (for Nelene Fox and many others) and were subsequently abandoned.
The ‘treatments’ were very expensive and profoundly lucrative for the medical establishment. When it was shown that they didn’t work, they were abandoned. Trans surgery and hormones may be very lucrative for the medical establishment (they are). However, the real driver is ideology, not money. Trans ideology holds that people have a ‘right’ to trans medical treatment. The fact that these ‘treatments’ cost lots of money is irrelevant (to them). They don’t get the money anyway. They do provide the ideological justification.
So far, TRAs (Trans Rights Activists) have dominated the APA (American Psychological Association), The Endocrine Society, the American Academy of Pediatrics and many other groups. The bottom line is that Chase Strangio has far more power than the opponents of trans ‘medicine’. In Europe (Norway, Sweden, Finland, France, etc.), they have been far less successful. In the UK, the national government and political parties have turned against them. However, the situation in Scotland is more complex. Famously, JKR is a big critic. However, the SNP has promoted trans ideology without hesitation. Notoriously, Nicola Sturgeon was forced to resign because she wanted to send a male prisoner (a convicted rapist) to a women’s prison. The SNP has embraced ‘gender self-id’ allegedly, because the Greens insisted on it.
This fits the global (including American) pattern. Trans ideology is very much an elite idea. In the US, Harvard supports it. Ordinary Americans don’t. To paraphrase Lenin, “trans ideology is highest stage of identity politics”.
Also see: The long, sad history of the radical mastectomy, and how none of the surgeons wanted to conduct an RCT of this disfiguring surgery. Finally, after 10 years, they gathered enough surgery and found it was no more effective for breast cancer than a lumpectomy or mastectomy. (Read about both these historical narratives in The Emperor of All Maladies.)
How sad. How depressing. How predictable. The 'Emperor of All Maladies' was written by Siddhartha Mukherjee. He also wrote 'The Gene' which I recommend.
Don't forget that in addition to the validation of their ideological values and preferences, there are significant careers being built on this industry. Imagine leaving residency and starting your just-add-water-and-stir career in "gender-affirming" pediatrics or psychiatry or plastic surgery or endocrinology. You immediately move up the academic ladder, getting papers published just on the basis of which of your "peers" reviewed the manuscript. You get to teach and indoctrinate undergrads and residents within your first 5 years in practice. And, if you're like McNamara and Turban, you get $400 an hour to overinflate your qualifications and experience as a "gender expert". Seeing this all over academic medicine now.
I highly recommend reading McNamara's deposition. Linked here by Leor Sapir.
https://www.city-journal.org/article/the-deposition-of-meredithe-mcnamara
Also read the released court filings regarding WPATH for fun (shock value), SEGM has many of them at the bottom of this analysis (as well as descriptions above):
https://segm.org/wpath-evidence-manipulation-risks-discrediting-WHO-transgender-guidelines
I do appreciate the work that goes into this series, but man I find myself pausing every few minutes and thinking “all this digital ink spilled, all the research time and money spent, on the question of whether to chemically and/or surgically alter the genitals and secondary sexual characteristics of mentally unwell children?” Big picture, this is just completely bananas. Because this all implies to me that somehow there is some threshold of evidence that would make this ok, but is there really? In that sense I am almost with the McNamara people, because it’s undoubtedly true we do things in medicine, and more so in pediatrics, in which we don’t have “good, long-term evidence” on the outcomes, including in areas that don’t represent immediate life-saving need like the examples Jesse cites of ventilation and fluid resuscitation. So to me the reason we shouldn’t offer these “treatments” (ugh) to kids is because it’s obviously gross and horrifying, full stop.
I think the same thing for the question of "can men be women and/or lesbians?" and "should men claiming to be women be allowed to access resources reserved for natal women?" We've spent so much money, time, ink, and energy on this in the last ten years. Women just have to keep fighting the same old battles all over again.
"Sometimes it feels as if there's this special cordoned-off Youth Gender Zone in which the usual standards of therapy and differential diagnosis don't apply." Exactly right. That's the crux of the problem.
You just need to get rid of the "sometimes."
"Some of the studies showing high rates of continuation and/or satisfaction come from the Dutch clinic."
Even the rate of continuation from the Dutch clinic isn't that high. In a retrospective study that included the cohort of the original "Dutch Protocol" youths, about 19% of the adults had discontinued identifying as the gender they affirmed with puberty blockers and cross-sex hormones. In other words, about 1 in 5 desisted.
https://doi.org/10.1093/jsxmed/qdad062.088
Noteworthy in this same study’s findings is that a vast majority of medically transitioned subjects remain essentially same sex attracted post transition which of course is not made clear by the authors who defer to identifying the gender identity of subjects rather than their biological sex
Missing link, I think: "After I pointed out that there were actually significant changes between the two documents (you can see all of them here), " I think 'here' wants a hyperlink?
Yep, sorry -- fixing
Thanks again Jesse.
Fantastic!
I think what bothers me most about this stuff is that none of these doctors have a good idea just what they are treating. They throw around the term "gender identity", but even Jack Turban can't provide a coherent definition of just what that means. That's like someone who can't tell me how blood is pumped also claiming to be an expert cardiologist. I'll get my heart surgery from another doctor, thanks.
No wonder they need to "flood the zone" with nonsense; it's the only way to cover up the nonsense they themselves have produced.
“several of the authors of this article work in gender clinics. They profit directly from providing blockers, hormones, or surgery to kids. Some of them get paid hundreds of dollars an hour as expert witnesses for the legal teams seeking to secure or regain access to youth gender medicine in states where it has been banned or is under threat. And here, in two sentences, they make not one, not two, but five statements that are absolutely unproven by normal research standards” FFS. These people aren’t doing science. They are defending their livelihoods and using science as a skin suit.
“With more research, the quality of evidence in many fields of medicine does not neccessarily [sic] improve, as the study designs needed to detect smaller and smaller effects become infeasible. Thus, many areas of medicine may have inherent, real-world upper limits on quality of evidence”
So what they’re implying—even if they don’t realize it—is that not only is the current evidence week, but strong evidence is likely to show only a very small effect? Aren’t they just kind of unwittingly admitting it doesn’t work?
Damn those oncologists gatekeeping patients away from the laetrile they *know* will cure their cancer!
Thank you for this.
Impressive work, Jesse. Extremely detailed and thorough. I’m looking forward to part 3 as well as your book on this topic!
Merely sharing.....Just saw these reader letters in NYTimes regarding the article Lydia Polgreen wrote a couple of weeks ago about the Cass report. Here is one...See if you can spot the errors (btw, not all are in this vein:
"Re “The Strange Report Fueling the War on Trans Kids,” by Lydia Polgreen (column, Aug. 18):
Thank you to Lydia Polgreen for this thoughtful, well-researched piece. She clearly identified the faulty and dangerous unspoken premise of the Cass report and much of the reporting on this topic: that being transgender is socially deviant and harmful, and we should do everything in our collective power to reserve gender-affirming care for those we deem virtuous enough to become “good” members of society.
She also pointed out critics’ double standards. Our medical system routinely provides — without controversy — the same gender-affirming medications to cisgender children and adolescents that it provides to trans children and adolescents. The issue is clearly not “concern for children” but the deep-rooted transphobia that this “concern” masks.
What if we didn’t think of being trans as being deviant or broken? What if we saw it for what it is: an identity as old as human existence that is as worthy of respect and celebration as any other, especially amid this climate of fear? What if we focused less on creating unnecessary barriers to care and more on protecting the right to self-determination and access to health care that respects each person’s unique needs?
Libby Hartle-Tyrrell
Brooklyn"
https://www.nytimes.com/2024/09/01/opinion/transgender-cass-report.html
This letter perfectly captures the problem. Do you see this through the frame of medical treatment or identity? Treating this as a matter of identity makes it close to impossible to discuss the medical evidence in an impartial way, because raising concerns about the evidence is ipso facto an attack on identity.
The Cass report does not pathologize transgender people, from all that I have read.
In terms of the "same-gender affirming medications to cisgender children", the letter is talking about puberty blockers. I am pretty sure that the letter's writer is talking about precocious puberty....and there, the idea is that hormone levels are normalized. When used as a blocker, it abnormalizes hormone levels. This is elided again and again by activists.
Blockers for precocious puberty is also not intended to be 'gender affirming' in any meaningful sense. It's meant to treat an identifiable medical condition associated with potential lifelong physiological complications, not alleviate a mismatch between biological sex and 'gender identity.'
If a 'cis' person gets it too, then by golly it's gender affirming all the same! Gender affirming birth control, gender affirming lactation support, gender affirming boob jobs etc. Of course, this undermines the very logic behind deeming gender affirming care to be 'life saving' treatment, but making sense isn't their strong suit.