Woke doc refused to publish $10 million trans kids study that showed puberty blockers didn’t help mental health

Dr. Johanna Olson-Kennedy said she believes the study would be “weaponized” by critics of transgender care for kids, and that the research c

New York Post

A prominent doctor and trans rights advocate admitted she deliberately withheld publication of a $10 million taxpayer-funded study on the effect of puberty blockers on American children — after finding no evidence that they improve patients’ mental health.

Dr. Johanna Olson-Kennedy told the New York Times that she believes the study would be “weaponized” by critics of transgender care for kids, and that the research could one day be used in court to argue “we shouldn’t use blockers.”

Critics — including one of Olson-Kennedy’s fellow researchers on the study — said the decision flies in the face of research standards and deprives the public of “really important” science in a field where Americans remain firmly divided.

For the National Institutes of Health-funded study, researchers chose 95 kids — who had an average age of 11 — and gave them puberty-blocking drugs starting in 2015. The treatments are meant to delay the onset of bodily changes like the development of breasts or the deepening of the voice.

After following up with the youths for two years, the treatments did not improve the state of their mental health, which Olson-Kennedy chalked up to the kids being “in really good shape” both when they started and concluded the two-year treatment.

However, the Times points out that her rosy assessment contradicts earlier data recorded by the researchers which found around one-quarter of study participants “were depressed or suicidal” before receiving treatment.

The result also does not support the findings of a 2011 Dutch study, which is the primary scientific research cited by proponents of giving kids puberty blockers. That study of 70 kids found that children treated with puberty blockers reported better mental health and fewer behavioral and emotional problems.

Olson-Kennedy, the outlet points out, is one of the country’s leading advocates for providing gender-affirming care to adolescents, and regularly provides expert testimony in legal challenges to state bans on such procedures, which have taken root in more than 20 states.

When asked by the Times why the results have not been made public after nine years, she said, “I do not want our work to be weaponized,” adding, “It has to be exactly on point, clear and concise. And that takes time.”

She then flat-out admitted she was afraid the lack of mental health improvements borne out by the study could one day be used in court to argue “we shouldn’t use blockers.”

A Washington Post-KFF Trans in America survey found that 68% of US adults are against providing puberty blockers to trans-identifying youth ages 10 to 14, and 58% oppose hormone treatments for those ages 15 to 17.

Boston College clinical and research psychologist Amy Tishelman, who was one of the original researchers on the study, pointed out the obvious contradiction in withholding scientific evidence on the grounds that it doesn’t match an expected conclusion.

“I understand the fear about it being weaponized, but it’s really important to get the science out there,” she told the outlet.

“No change isn’t necessarily a negative finding — there could be a preventative aspect to it,” she said hopefully.

“We just don’t know without more investigation.”

Erica Anderson, a clinical psychologist and a transgender youth expert, told The Post she was “shocked” and “disturbed” about the decision to withhold publication of such vital research.

“We’re craving information about these medical treatments for gender-questioning youth. Dr. Olson-Kennedy has the largest grant that’s ever been awarded in the US on the subject and is sitting on data that would be helpful to know,” she said.

“It’s not her prerogative to decide based on the results that she will or won’t publish them.”

She also wasn’t buying Olson-Kennedy’s rationale for holding back the study’s findings based on fear of backlash.

“It’s contrary to the scientific method. You do research, and then you disclose what the results are,” she said. 

“You don’t change them, you don’t distort them, and you don’t reveal or not reveal them based on the reactions of others. You report as scientists what you’ve learned.”

In a 2020 progress report submitted to the NIH, Olson-Kennedy hypothesized that study participants would show “decreased symptoms of depression, anxiety, trauma symptoms, self-injury, and suicidality, and increased body esteem and quality of life over time.”

Olson-Kennedy appeared to attempt to muddy the waters in her interview with the Times when explaining how her hypothesis didn’t pan out, claiming participants had “good mental health on average.”

She made this assertion “several times” despite saying previously that 25% of the study’s young patients were suffering with various mental illness symptoms before treatments began.

When pressed by the outlet for an explanation for the seemingly contradictory findings, Olson-Kennedy attributed it to “data averages,” and said she was “still analyzing the full data set.”

In April, England’s National Health Service disallowed puberty blockers for children following a four-year review conducted by independent researcher Dr. Hilary Cass, who wrote in her report that “for most young people, a medical pathway will not be the best way to manage their gender-related distress.”

Last year, Dr. Riittakerttu Kaltiala, a leading Finnish expert on pediatric gender medicine, said in a newspaper interview that “four out of five” gender-questioning children will eventually grow out of it and accept their bodies even without medical intervention.

Olson-Kennedy did not respond to The Post’s request for comment.

U.S. Study on Puberty Blockers Goes Unpublished Because of Politics, …

archive.ph

The leader of the long-running study said that the drugs did not improve mental health in children with gender distress and that the finding might be weaponized by opponents of the care.

An influential doctor and advocate of adolescent gender treatments said she had not published a long-awaited study of puberty-blocking drugs because of the charged American political environment.

The doctor, Johanna Olson-Kennedy, began the study in 2015 as part of a broader, multimillion-dollar federal project on transgender youth. She and colleagues recruited 95 children from across the country and gave them puberty blockers, which stave off the permanent physical changes — like breasts or a deepening voice — that could exacerbate their gender distress, known as dysphoria.

The researchers followed the children for two years to see if the treatments improved their mental health. An older Dutch study had found that puberty blockers improved well-being, results that inspired clinics around the world to regularly prescribe the medications as part of what is now called gender-affirming care.

But the American trial did not find a similar trend, Dr. Olson-Kennedy said in a wide-ranging interview. Puberty blockers did not lead to mental health improvements, she said, most likely because the children were already doing well when the study began.

“They’re in really good shape when they come in, and they’re in really good shape after two years,” said Dr. Olson-Kennedy, who runs the country’s largest youth gender clinic at the Children’s Hospital of Los Angeles.

That conclusion seemed to contradict an earlier description of the group, in which Dr. Olson-Kennedy and her colleagues noted that one quarter of the adolescents were depressed or suicidal before treatment.

In the nine years since the study was funded by the National Institutes of Health, and as medical care for this small group of adolescents became a searing issue in American politics, Dr. Olson-Kennedy’s team has not published the data. Asked why, she said the findings might fuel the kind of political attacks that have led to bans of the youth gender treatments in more than 20 states, one of which will soon be considered by the Supreme Court.

“I do not want our work to be weaponized,” she said. “It has to be exactly on point, clear and concise. And that takes time.”

She said that she intends to publish the data, but that the team had also been delayed because the N.I.H. had cut some of the project’s funding. She attributed that cut, too, to politics, which the N.I.H. denied. (The broader project has received $9.7 million in government support to date.)

Dr. Olson-Kennedy is one of the country’s most vocal advocates of adolescent gender treatments and has served as an expert witness in many legal challenges to the state bans. She said she was concerned the study’s results could be used in court to argue that “we shouldn’t use blockers because it doesn’t impact them,” referring to transgender adolescents.

Other researchers, however, were alarmed by the idea of delaying results that would have immediate implications for families around the world.

“I understand the fear about it being weaponized, but it’s really important to get the science out there,” said Amy Tishelman, a clinical and research psychologist at Boston College who was one of the study’s original researchers.

Dr. Tishelman also noted that, even if the drugs did not lead to psychological improvements, they may have prevented some of the children from getting worse. “No change isn’t necessarily a negative finding — there could be a preventative aspect to it,” she said. “We just don’t know without more investigation.”

In the 1990s and 2000s, doctors in the Netherlands began studying a small group of children who had experienced intense gender dysphoria since early childhood. For most of these children, the negative feelings dissipated by puberty. For others, puberty made them feel worse.

For those who struggled, the researchers began prescribing puberty blockers, which had long been used to treat children whose puberty began unusually early. The Dutch scientists reasoned that by preventing the permanent changes of puberty, transgender adolescents would fare better psychologically and fit in more comfortably in society as adults.

In 2011, the researchers reported on the first 70 children who were treated with the so-called Dutch Protocol. The children were thoroughly assessed to make sure that they had persistent dysphoria and supportive parents and that they did not have serious psychiatric conditions that might interfere with treatment.

These patients showed some psychological improvements after puberty blockers: fewer depressive symptoms, as well as significant declines in behavioral and emotional problems. All the patients chose to continue their gender transitions by taking testosterone or estrogen.

The findings were highly influential even before they were published, and clinics around the world opened to treat transgender adolescents with puberty blockers and hormones.

England’s youth gender clinic in 2011 tried to replicate the Dutch results with a study of 44 children. But at a conference five years later, the British researchers reported that puberty blockers had not changed volunteers’ well-being, including rates of self-harm. Those results were not made public until 2020, years after puberty blockers had become the standard treatment for children with gender dysphoria in England.

In 2020, Dr. Olson-Kennedy’s group described the initial psychological profile of the children enrolled in the U.S. study of puberty blockers, whose average age was 11. Before receiving the drugs, around one quarter of the group reported depression symptoms and significant anxiety, and one quarter reported ever having thoughts of suicide. Eight percent reported a past suicide attempt.

In a progress report submitted to the N.I.H. at that time, Dr. Olson-Kennedy outlined her hypothesis of how the children would fare after two years on puberty blockers: that they would show “decreased symptoms of depression, anxiety, trauma symptoms, self-injury, and suicidality, and increased body esteem and quality of life over time.”

That hypothesis does not seem to have borne out. “They have good mental health on average,” Dr. Olson-Kennedy said in the interview with The New York Times. “They’re not in any concerning ranges, either at the beginning or after two years.” She reiterated this idea several times.

When asked in follow-up emails to clarify how the children could have good initial mental health when her preliminary findings had showed one quarter of them struggling, Dr. Olson-Kennedy said that, in the interview, she was referring to data averages and that she was still analyzing the full data set.

Dr. Hilary Cass, a pediatrician who this year published an extensive review of youth gender services in England, said that the delays from the American and British research groups had led the public to believe that puberty blockers improved mental health, even though scant evidence backed up that conclusion.

“It’s really important we get results out there so we understand whether it’s helpful or not, and for whom,” Dr. Cass said.

Her report found weak evidence for puberty blockers and noted some risks, including lags in bone growth and fertility loss in some patients. It prompted the National Health Service in England to stop prescribing the drugs outside of a new clinical trial, following similar pullbacks in several other European countries.

An N.I.H. spokesman said that while the agency generally encourages the publication of data supported by its grants, researchers decide how and when to do so.

Dr. Olson-Kennedy’s collaborators have also not yet published data they collected on how puberty blockers affected the adolescents’ bone development.

But many other papers have been published from the wider N.I.H. project, including a 2023 study of older transgender and nonbinary adolescents who took estrogen or testosterone to aide their gender transition. After two years on hormones, the volunteers showed improvements in life and body satisfaction, and patients taking testosterone showed declines in depression and anxiety. (Two of the 315 patients died by suicide, a rate much higher than the general population.)

Dr. Olson-Kennedy noted that doctors’ clinical experience was often undervalued in discussions of research. She has prescribed puberty blockers and hormonal treatments to transgender children and adolescents for 17 years, she said, and has observed how profoundly beneficial they can be.

Although the N.I.H. studies are large, she said, “these are minuscule compared to the amount of people that we’ve taken care of.”

"I do not want our work to be weaponized."

Conclusions Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.

The Global Pediatric Medicine Field Has a Clear Habit Of Hiding—And Discouraging—Inconvenient Research Findings

What NYT reported about Johanna Olson-Kennedy sitting on her null findings on puberty blockers is but one such story in a field in which man

benryan.substack.com

The Cass Review Fact Check: It's Clear That Many People Never Bothered to Read The Report

A flood of false claims about England's Cass Review has coursed across social media and the press and among activists and academics. If only

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Activist-Blogger Erin Reed Can't Stop Telling Falsehoods About Gender Medicine

Even when fact checked, Erin Reed, who has a popular Substack and X account, has repeatedly made demonstrably false claims about England's C

benryan.substack.com

Controversial Gender Researchers Launch Long-Term Study of Gender Dysphoric Youth and Their Parents

Branded as gender heretics by the pediatric gender-medicine establishment and transgender-rights activists, Michael Bailey, Dr. Lisa Littman

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None of the reviewers identified any studies that I had missed that demonstrated safe and reversible impacts of puberty blockers on cognitive development, or presented any evidence contrary to my conclusions that the work just hasn’t been done. However, one suggested the evidence may be out there, it just hadn’t been published. They suggested that I trawl through non-peer reviewed conference presentations to look for unpublished studies that might tell a more positive story. The reviewer appeared to be under the naïve apprehension that studies proving that puberty blockers were safe and effective would have difficulty being published. The very low quality of studies in this field, and the positive spin on any results reported by gender clinicians suggest that this is unlikely to be the case. Another reviewer expressed concerns that publishing the conclusions from these studies risked stigmatising an already stigmatised group. A third suggested that I should focus on the positive things that puberty blockers could do, while a fourth suggested there was no point in publishing a review when there wasn’t enough literature to review. Another sought to diminish an entire field of neuroscience that has established puberty as a critical period of brain development as “my view”.

Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and

Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clini

sciencedirect.com

Conclusions Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.

The American Academy of Pediatrics (AAP) annual convention is an opportunity for pediatricians to network, exchange ideas and learn. Unfortunately, when it comes to youth gender medicine, misinformation was on the 2024 conference agenda. As a keynote speaker, the AAP chose U.S. Department of Health and Human Services Assistant Secretary for Health Rachel Levine, the highest-ranking transgender official in the Biden administration.

Levine’s invitation should cause concern to American families who want to know that the nation’s largest pediatrician group values evidence-based medicine. Levine has supported a misinformation campaign that has turned the U.S. into an international outlier in the use of the “gender-affirming” model of care, which recommends hormones and surgeries rather than psychotherapy as the first-line treatment for adolescent distress around puberty. 

Emails recently unsealed in a lawsuit revealed that in 2022, Levine pressured the World Association for Transgender Health to remove age minimums for gender surgeries from its “standards of care.”

Since 2017, a Manhattan Institute analysis of health insurance claims has shown, that more than 5,000 teenage girls had their breasts amputated as part of a “gender-affirming” procedure designed to help them achieve a male look. This includes 50 to 179 girls who were 12-and-a-half years old or younger at the time of surgery.  

These figures represent an undercount, as they do not include procedures performed at large health care systems like Kaiser Permanente (which is currently being sued by two young women who underwent “top surgery”). Yet these surgeries do not seem to pose a problem for those like Levine who believe the theory that “trans kids know who they are.”  

Levine’s invitation ought to also be a concern to AAP members who worry that homophobia and regressive sex stereotypes are a large component of what underlies “gender affirming” treatments. Incredibly, children who do not fit sex stereotypes and same-sex attracted adolescents are now given the idea they are “trans” and encouraged to perceive hormones and surgeries as a solution to the substantial difficulties that society imposes on gender non-conforming young people. It is unwise to promote this speculative narrative, since neither data nor logic supports the concept of a “trans child.”

What we need is open, respectful, and fact-based public dialogue regarding these issues. Unfortunately, that will not occur at the AAP’s primary peer-reviewed journal, Pediatrics. This formerly high-quality journal has been used to cheerlead for the “gender-affirming care” scheme rather than to provide a forum for rigorous scholarly debate. This distortion of science conveniently helps insulate the AAP from criticism and is a prime example of how ideological activism, even if well-meaning, destroys trust in medicine.   

Until recently, these large numbers of gender dysphoric teens would have been unheard of. I was in medicine for two decades without encountering a single trans-identified youth. Youth with other types of body-related distress were common, but only in the last decade did any substantial number claim they had been born in the wrong body and request hormones and surgeries to become their “authentic selves.”

What has occurred to cause young people so much distress with their biological sex? How did they come to believe so strongly in irreversible treatments with scant supporting evidence? 

Rather being humble and accurate about what we know and don’t know regarding how to approach these young people, those within AAP have condemned anyone who advocates for a cautious, evidence-based approach as “anti-trans.” They even attempted to have their conference moved out of Florida due to erroneous and self-aggrandizing perception that “hate” is why so many across the world recommend against these treatments.

Levine’s invitation to be keynote was not the only dubious milestone for the AAP this year. The AAP also promised to conduct a systematic review of the evidence for so-called “gender-affirming care” over 13 months ago. There is no indication that the review has begun.

Systematic reviews, the gold standard in medical evidence analysis, are the reason a growing number of countries now classify puberty blockers and cross-sex hormones as “an experimental practice” and impose restrictions on their use. The AAP has refused to answer questions from journalists on the matter and excluded voices urging caution from its convention.

AAP is now under investigation by state attorneys general and, along with the author of its 2018 policy statement on “gender-affirming care,” is a named defendant in a lawsuit by a young woman who says she suffered irreparable harm because of the APP’s fraudulent recommendations.

In his book, “Blind Spots, When Medicine Gets It Wrong, and What It Means for Our Health,” Marty Makary reveals many examples of the harms of medical hubris and groupthink. One is the AAP’s reckless 2000 guidelines on peanut avoidance. Without supporting evidence, the AAP put its institutional credibility behind untested theories. When parents followed the AAP’s bad advice to avoid giving infants and young children peanuts, there was an increase in the number and severity of peanut allergies. The U.S. now leads the world in peanut allergies, which are almost unheard of in much of the world. 

The AAP quietly reversed this foolishness in 2017 but failed to learn from the episode. In 2018, it concocted its even more harmful and less evidence-based statement promoting gender-affirming care. The statement, written by a single physician with minimal clinical experience, has been thoroughly debunked and was rated unfit for use by a recent systematic review of guideline quality. The Cass Review, the most comprehensive review of youth gender medicine to date, found the AAP recommendations to be among the world’s worst.

Most embarrassing for AAP, in June, private emails unsealed as part of a lawsuit showed that even the discredited leadership at World Association for Transgender Health had said the AAP recommendations have “a very weak methodology, [and were] written by [a] few friends who think the same.” 

As a psychiatrist, I have seen firsthand how “gender-affirming” treatment approaches cause harm to vulnerable youth. Gender-affirming care is well-intended activism posing as medical treatment. It has torn families apart and eroded public trust in our medical system.

Contrary to the slogans, these treatments are not lifesaving. The AAP’s decision to invite Levine as keynote speaker and its continued lack of transparency regarding the evidence for its recommendations signal that the AAP continues to prioritize misguided advocacy over science.  

Kristopher Kaliebe is a psychiatrist and expert on youth gender medicine and professor in the Psychiatry Department at the University of South Florida.

At Least 14,000 U.S. Minors Have Received Gender-Transition Treatment or Surgeries In 5 Years, With Docs Billing $120 Million

The findings of a comprehensive analysis of insurance-claims data by the advocacy nonprofit Do No Harm.

realityslaststand.com

Medicalized gender transitions for minors were rapidly becoming more common in the United States until state bans of such medical interventions started to go into effect. Even in blue states where these medical practices remain legal, quite a few states saw a downturn in 2023, including in California and New York.

At least 14,000 minors underwent gender-transition treatment, surgeries, or both between 2019 and last year. This five-year tally is a conservative estimate, meaning that the true figure is likely higher, if not quite a bit higher. The figure is the product of a new analysis of national insurance-claims data that was released on Tuesday by Do No Harm.

This medical advocacy nonprofit is fervently opposed to minors accessing puberty blockers, cross-sex hormones, and gender-transition surgeries to treat gender dysphoria. Consequently, Do Not Harm’s word choice when describing these medical practices may strike some people as incendiary and even offensive.

“We feel very strongly that the science behind using these treatments in children is extraordinarily flawed and suggests that children are being harmed,” said the chair of Do No Harm’s board, Dr. Stanley Goldfarb, in a press briefing on Monday.

Do No Harm has published the findings of their medical-claims-data analysis in a comprehensive website—DoesMyHospitalTransitionKids.com—that allows users to investigate pediatric gender-transition and surgery data by state and by individual institutions within each state.

• 13,994 unique minors received gender-transition surgeries, treatment, or both.
• 5,747 minors received gender-transition surgeries.
• 8,579 minors received puberty blockers, cross-sex hormones, or both (the analysis did not disaggregate to show how many minors received each type of medication). Between them, these minors were written 62,682 prescriptions.
• Health care providers billed $119,791,202 for all these patients. The analysis did not reveal the dollar figure of how much these providers were actually reimbursed, mind you; that figure could be at least somewhat smaller.

The Williams Institute at UCLA estimates that 300,000 Americans age 13 to 17 identity as transgender. In April, the World Professional Association of Transgender Health (WPATH) argued that the majority of such minors would do best to undergo a medicalized gender transition. Consequently, from WPATH’s perspective, 14,000 minors receiving such a medical intervention over a five-year period is equivalent to only about 10 percent of the target population. However, on Tuesday, the Centers for Disease Control reported that 3.3 percent of high school students identified as transgender, compared with 1.4 percent according to the Williams Institute. It is difficult to discern whether this difference is a result of differences in survey methods, a rapid increase in youth trans identification, or both.

The math-minded among you may notice that there appears to be little overlap between the group that received surgeries and the group that received medication treatment, given that the sum of the two groups is 14,326; that is only 332 greater than the total number of minors who received either type of intervention. This defies logic, since presumably the vast majority of minors who undergo such surgeries are already taking cross-sex hormones.

This apparent lack of overlap between the two groups is a product of the analysis’ conservative methodology. The authors of the report only counted a cross-sex hormone prescription if it was written a maximum of 90 days following the entry into a patient’s medical file of a gender-dysphoria-related diagnosis code. Consequently, there may have been any number of cross-sex hormone prescriptions that the analysis did not include in its tally because too much time passed between the recording of a gender dysphoria-related diagnosis and the prescription of hormones.

“We have a very high level of confidence that what you are seeing here is directly related to sex-change treatments,” Michelle Havrilla, director of Do No Harm’s program to shield children from gender-transition treatment, said during Monday’s press briefing.

The Do No Harm analysis is also limited by the fact that its authors could not access medical-claims data regarding minor patients who either saw their care processed through internal Veterans Affairs claims, paid out of pocket, received charity care, or were cared for by Kaiser Permanente (which cares for a wide swath of patients across the West Coast in particular).

“What we’re really showing you today is a floor or a very conservative estimate of what’s happening throughout the country,” said Ms. Havrilla.

Do No Harm’s surgery figures are in the general ballpark of estimates put out by Leor Sapir of the Manhattan Institute in August. Dr. Sapir conducted a similar analysis of insurance-claims data and found that between 2017 and 2023, 5,288 to 6,294 minor natal girls underwent double mastectomies for gender dysphoria.

In an email to me regarding the Do Not Harm analysis, Dr. Sapir said: “The data on surgery align with our findings, though we looked at a broader range of years (2017-2023) and exclusively at mastectomy. In both cases, the analyses were deliberately based on conservative assumptions; with a field as contentious as this, it’s better to underestimate than to overestimate.”

“The practice of sex ‘change’ surgery in minors is not nearly as rare as its advocates have said,” Dr. Sapir told me. Indeed, the Do No Harm analysis re-affirms my previous reporting about how Harvard recently falsely claimed that gender-transition surgeries are rare among minors.

Dr. Sapir argued that at least for surgeries, the Do No Harm analysis has superseded an analysis conducted by the data analytics firm Komodo Health Inc. on behalf of Reuters, which was published in Oct. 2022. Komodo’s data for medication-based transition treatment was in the general ballpark of Do Not Harm’s. They found that between 2017 and 2021, 4,780 minors with gender dysphoria received puberty blockers and 14,726 received cross-sex hormones. But that analysis identified only 776 gender-transition surgeries.

Also, a study published in Sept. 2023 in the journal Cureus analyzed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database. From 2018 to 2021, it identified just 108 minors who received such surgeries. But it did identify a swift increase in the number of surgeries with each passing year, similar to the growth in all types of gender-transition interventions identified by Komodo.

Do No Harm assembled a list it derisively referred to as the “dirty dozen” of the “worst-offending children’s hospitals promoting sex change treatments for minors.”

Their criteria included:

• The number of gender-transition patients under age 18
• Whether the institution had a dedicated pediatric gender clinic that advertised gender-transition treatment
• Which treatments and procedures were offered (surgeries put a clinic higher on the list)
• The number of gender-transition treatment prescriptions written
• The dollar amount of related medical claims
• The promotion of gender-transition treatment within the community
• Activism and public support by an institution and its leaders of what Do No Harm referred to as “gender ideology”

The top dozen hospitals includes:

1. The Children’s Hospital of Philadelphia, with 122 minor patients receiving gender-transition treatment, 5 of whom received surgery. They submitted $230,784 in bills over the five-year period.
2. Connecticut Children’s Medical Center in Hartford
3. Children’s Minnesota in Minneapolis
4. Seattle Children’s
5. Children’s Hospital Los Angeles
6. Boston Children’s Hospital (which in 2007 set up the nation’s first pediatric gender clinic, importing a treatment model pioneered by Dutch researchers)
7. Rady Children’s Hospital in San Diego
8. Children’s National Medical Center in Washington, DC
9. UCSF Benoff Children’s Hospital Oakland
10. Children’s Hospital Colorado in Aurora
11. UPMC Children’s Hospital of Pittsburgh
12. Cincinnati Children’s Hospital Medical Center

For a rather famous—or, according to gender-medicine skeptics, infamous—example of how Boston Children’s has advertised gender-transition surgeries for minors, check out the video below. It was first published in Aug. 2022, but was later taken down amid a firestorm of criticism over the OB/GYN, Dr. Frances Grimstad, effervescently describing what she calls “gender-affirming hysterectomies” for minors with gender dysphoria. But the video is still available via the internet archive.

Many of the doctors at these top children’s hospitals, such as UCSF’s Dr. Jack Turban, may have established themselves as the face of the pediatric gender medicine field. But only about 10 percent of claims for pediatric gender-transition treatment and surgeries are coming from children’s hospitals, Do Not Harm found. The vast majority of care is provided by non-pediatric clinics or hospitals.

“There are lots of ideas that this is a rare event, lots of ideas that this is localized to just a few places,” Dr. Goldfarb said of pediatric gender-transition treatment at the Monday press briefing. “We thought it was really crucial that we develop an approach that allows you all, as representatives of the people, to be able to inform people in their local hospitals and locales exactly what’s happening.”

Accordingly, users of the Do Not Harm website can zoom in to individual states to analyze data on local health care practices and billing histories. For example, over the five-year period of the analysis, California health care providers treated at least 2024 minors with gender-transition treatments, billing nearly $29 million for 1359 surgeries and prescribing puberty blockers and cross-sex hormones to 725 children.

Zooming in a little closer, here is a segment of the roster of California care providers and their respective shares of the tally:

Here is share of those cases from Children’s Hospital Los Angeles:

Gender-transition treatment is a substantial source of revenue for a number of large hospitals. Keep in mind, however, that even if Mount Sinai brought in all $8.2 million they billed for such medial care over five years, this would only have amounted to 0.05 percent of the hospital system’s total revenues during that period, of about $17 billion.

The following figures suggest that there is a small club of individual doctors who billed in excess of $2 million over a five-year period for gender-transition treatment for minors. A single doctor at Boston Children’s billed in excess of $5 million.

Interestingly, even in states where gender-transition treatment and surgeries for minors has remained legal, there was a sharp downturn in prescriptions and operations in 2023 in some but not all states—including California, Colorado, Illinois, New York, Pennsylvania and Washington. Do No Harm told me this was not because the data from 2023 is incomplete.

My recent reporting suggests that it is possible that in the face of backlash against pediatric gender medicine and waves of bad publicity—including the publication of Britain’s Cass Review, the release of the WPATH Files and the unsealing of damaging documents about WPATH in the federal lawsuit in Alabama—physicians in this field have started to become more conservative in their prescribing practices. Also, it is possible that parents have become more reticent about consenting to such treatment in the face of waves of news that might lead them to question the related evidence base.

Also, in the wake of gender-affirming surgeon Dr. Blair Peters’ recent conversation on Instagram Live with the American Society of Plastic Surgeon’s president, many wondered how many minors Dr. Peters has operated on. Dr. Peters works at Oregon Health and Science University. OHSU Portland had at least 19 minor patients who received gender-transition surgeries over the past five years.

Benjamin Ryan is an independent journalist, specializing in science and health care coverage. He has contributed to The New York Times, The Guardian, NBC News and The New York Sun. Ryan has also written for the Washington Post, The Atlantic, The Nation, Thomson Reuters Foundation, New York, The Marshall Project, PBS, The Village Voice, The New York Observer, the New York Post, Money, Men’s Journal, City & State, Quartz, Out and The Advocate. 

Learn more about Ryan’s work on his website, follow him on X @benryanwriter, and subscribe to his Substack.

The BMA turns away from rejecting the Cass Report

The doctors’ union has voted to retain a neutral position on the issue.

New Statesman

The British Medical Association (BMA) has reversed its decision to call for a pause in implementing the recommendations of the Cass Review, the New Statesman can reveal. It follows intense criticism of the doctors’ union after this publication exposed its discussions regarding the rejection of the findings of Dr Hilary Cass’s independent review into gender identity services for children and young people.

Informed by seven new systematic evidence reviews, and more than a thousand conversations with trans young people, clinicians and others, Cass concluded in April that gender medicine was built on “shaky foundations” and “an area of remarkably weak evidence”. The reality, she wrote in her report, is that there is “no good evidence on the long-term outcomes of [hormonal] interventions to manage gender-related distress”.

Yet, on 16 July, the New Statesman revealed that a motion had been tabled by the BMA council – the executive body of the doctors’ union – which called for the BMA  to “lobby… to oppose the implementation of the recommendations made by the Cass Review”. It also described Cass’s recommendations as having been “driven by unexplained study protocol deviations, ambiguous eligibility criteria, and exclusion of trans-affirming evidence”. The motion had originally called for the BMA to “disavow” the Cass Review too, though this wording was changed to “publicly critique” when the vote took place the next day. Sources have confirmed since that 45 of the 69 voting members of the BMA’s council took part in those votes. Less than half of them – 21 – voted to oppose supporting the Cass Review (11 voted against; 13 abstained). By comparison, 29 members voted to critique it. 

In a press release that followed, the BMA also criticised the government’s ban on new prescriptions of puberty blockers to those aged under 18 (for the purpose of treating gender-related distress). NHS England had already confirmed in March that puberty blockers would no longer be prescribed on the NHS for the treatment of gender-related distress, because of a lack of evidence over their safety and clinical effectiveness. Instead, they would only be prescribed as part of clinical research. The ban meant that others could not continue prescribing routinely as well, and was judged lawful by the High Court in July. The Health Secretary, Wes Streeting, has extended the ban until the end of November, and to cover Northern Ireland

An open letter condemning the BMA’s stance followed, gaining more than 1,500 signatures, around 1,000 of which were from BMA members. The BMA was the only major medical group in the UK to consider rejecting Cass. Supportive statements have been issued by the Royal College of GPs, the Royal College of Psychiatrists, the Academy of Medical Royal Colleges and the Association of Clinical Psychologists. Many BMA members were dismayed, some resigning their membership in protest. Signatories to the letter accused the union of failing to follow an evidence-based approach to medicine. The letter, shown first to the New Statesman, criticised the process behind the BMA’s decision as “opaque and secretive” and said the motion did “not reflect the views of the wider membership, whose opinion you did not seek”.

After months of criticism and negative press coverage, it would seem the BMA has now listened. Earlier this week, the BMA’s council members voted to “retain a neutral position on the recommendations of the Cass Review… while a BMA task and finish group undertakes its own evaluation”.  

Dr David Strain, chair of the BMA’s board of science is leading the union’s “critique” of the Cass Review, which is still going ahead. “I have no preconceptions and have every intention to lead our evaluation from a position of neutrality,” he said. “As a geriatrician, I do not treat children and young people for gender dysphoria, and so the first phase of my review will be to listen to people with lived experience and a range of healthcare professionals working in this area.” Strain explained that his group would also review the actions taken in the name of the Cass Review. “I do not know, nor do I pre-empt, what we will conclude,” he added.

Some of those who were critical of the BMA’s earlier stance are relieved. Dr Louise Irvine, who organised the open letter condemning the original motion, told the New Statesman, “I welcome the BMA’s decision to reverse its opposition to the Cass Review and adopt a position of neutrality. Its previous position… has damaged the reputation of the union and its commitment to evidence-based medicine. I hope this change can help the BMA to earn it back.”

The BMA has previously said that it hopes to have completed its review by the end of the year.

The culture war is about to get a lot worse

The Tories deserved to lose, but the Labour landslide will keep the “woke” movement on life-support for another few years.

andrewdoyle.substack.com

“The intent of psychological intervention is not to change the person’s perception of who they are but to work with them to explore their concerns and experiences and help alleviate their distress, regardless of whether they pursue a medical pathway or not. It is harmful to equate this approach to conversion therapy as it may prevent young people from getting the emotional support they deserve.”

Progressives’ Drive for Equity Is Leading Them Astray on Medical Gender Transition for Minors | National Review

It’s understandable to want to help troubled kids. But the evidence simply isn’t there that unproven drugs and surgeries are what they need.

National Review

It’s understandable to want to help troubled kids. But the evidence simply isn’t there that unproven drugs and surgeries are what they need.

In our drive to eliminate health inequities, my fellow liberal Democrats and I are eager to help children who identify as transgender. This compassionate urge has led our state, Oregon, to fast-track Medicaid coverage of medical transition services for kids, including puberty-blockers, cross-sex hormones, and surgical removal of breasts and genitals. Yet I’m deeply concerned that in the push for equity, Oregon has ignored evidence, to the point of jeopardizing children’s health. I know from experience that my state can do better to ensure that kids get medically necessary care.

Oregon has long been a national and even international model for evidence-based medicine. I personally encountered my state’s strong commitment to medical science after my two young sons were diagnosed with autism in the late 2000s. At the time, few autism treatments were covered by insurance or Medicaid anywhere in America, so I worked with state leaders and a broader coalition to right that wrong. One key hurdle was Oregon’s Health Evidence Review Commission (HERC), which determines what treatments Medicaid covers and strongly influences the coverage of private health-insurance plans.

HERC held us to its customary high standards for quality of evidence. We organized testimony from some of the world’s leading experts on autism and submitted reams of peer-reviewed journal articles, all of which were rigorously scrutinized by HERC’s experts. We prevailed only after the U.S. Agency for Healthcare Research and Quality published a groundbreaking systematic review that supported the effectiveness of behavioral interventions for autistic children. In 2014, HERC approved Medicaid coverage of such treatments for children like mine. HERC’s wise focus on evidence steered patients and physicians away from risky and unproven interventions that were popular at the time, some of which, such as chelation therapy, reportedly killed autistic children. To this day, I’m grateful for the commission’s high standards.

Yet HERC hasn’t upheld the same standards for gender medicine. To its credit, the commission began looking at this issue in 2012, before gender dysphoria was on the social radar. At the time, based primarily on studies of adults over the age of 30, it concluded that there was “very poor evidence” of benefits of medical interventions for patients. Even so, HERC decided in 2014 to provide comprehensive Medicaid coverage for puberty-blockers, cross-sex hormones, and surgeries for anyone, including children, who identifies as transgender. In a strange departure from its own rules, HERC didn’t run these policies through its evidence-based-guidelines subcommittee. In my fight for autism coverage, that subcommittee was the most important part of the process.

I’m confident the commissioners were trying to help people in what was then a unique situation. At the time, in 2015, the state estimated that very few patients would choose medical transition: according to NPR, “at least 175” patients per year, of all ages. NPR quoted HERC’s medical expert as estimating that the combined total cost for this coverage would be “up to $200,000 — for the whole state.” Yet by 2019, more than 7,500 Oregonians were receiving such treatment, at a cost of over $20 million per year. Based on my analysis of state data, hundreds of children have received some combination of puberty-blockers, cross-sex hormones, and surgeries. None of these procedures have gone through clinical trials to demonstrate their safety and effectiveness, and in the case of hormones, children are receiving drugs that haven’t been approved for such use by the FDA.

Amid this exponential rise, HERC in 2023 commissioned a thorough review of the latest studies. The draft report, which I obtained via a freedom-of-information request, found that the evidence was still very limited. For youth, the investigators reported that they were unable to find any systematic reviews — the key evidence we had to provide for autism coverage — with “extractable data” showing benefits of transgender treatments for children. The report also noted that many lower-quality studies can’t be applied to patients who seek a rapid gender-affirming transition, which is typically the case with children. The report was essentially Oregon’s version of the Cass Report, which the United Kingdom released in April.

Yet Oregon’s report was never finalized, and HERC staff didn’t even present their draft to the body’s 13 commissioners. Instead, after the state passed a law requiring the coverage of “accepted standards of care” for transgender treatments, HERC quickly endorsed guidelines from an advocacy group — without any analysis of the contents. The guidelines are highly aggressive yet based on low-quality evidence. Today, preteen Oregonians can be put on powerful chemicals without FDA approval, before moving on to surgeries as adolescents. These interventions can irreversibly alter their bodies and leave them less likely or even unable to have children of their own later in life. The risks to their physical and mental health are high and, crucially, not justified by existing proof of benefit.

Equity cannot be achieved by ignoring evidence and stripping away consumer protections from historically underserved people. While I deeply sympathize with the goal of helping struggling kids, we can’t accept shortcutting medical ethics — and we didn’t accept it a decade ago, with autism coverage. The ethical path is for HERC to define “accepted standards of care” based on the best science. Medicine is supposed to follow the evidence because health and well-being hang in the balance. The stakes are especially high for children. If we truly want to be equitable, Oregon will stop undermining children’s right to evidence-based medical care.

Suppressing Dissent Against Transgender Ideology

The Justice Department tries to silence and imprison whistleblowers who expose the barbarism of transgender medicine.

City Journal

The fragile facade of transgender ideology has cracked over the past year. Whistleblowers from within the medical profession have emerged to provide damning evidence that doctors are performing procedures based on shoddy scientific evidence under the label of “gender-affirming care,” as outlined in the WPATH Files and the Cass Review. Former patients who received “gender-affirming” care as adolescents have now detransitioned and are suing the doctors who cut off their breasts and put them on hormones that permanently damaged their bodies. Businesses ranging from Target to NFL teams are scaling back or eliminating Pride-themed merchandise and promotions. The public, too, is increasingly turning against transgender ideology. The tide is shifting.

The Left has adopted a new approach in response: political persecution of those speaking out against trans dogma. Earlier this month, the Department of Justice indicted Eithan Haim, a surgeon at Texas Children’s Hospital (TCH) who exposed the hospital’s secret continued use of irreversible sex-change procedures on minors after having publicly stated that it had stopped. By indicting Haim, the DOJ is seeking to silence future whistleblowers and to signal its disregard for the mounting evidence that gender-affirming care is harmful, and often irreversible.

Haim had anonymously sent City Journal’s Christopher Rufo documents proving that doctors at TCH were still prescribing hormone replacement therapy drugs and implanting puberty blockers in minor-age patients more than a year after the hospital announced it had stopped its pediatric gender-affirming care program. A month after Rufo published his article in May 2023, federal agents from the Department of Health and Human Services knocked on Haim’s door to let him know that he was a “potential target” in an investigation of alleged violations of the Health Insurance Portability and Accountability Act (HIPAA). This week, an unsealed indictment revealed that the U.S. Attorney’s Office for the Southern District of Texas is charging Haim with four felony counts of violating HIPAA. A press release on the indictment alleges that Haim accessed patient information “under false pretenses and with intent to cause malicious harm to TCH.”

According to a letter written by Haim’s lawyers, Assistant U.S. Attorney Tina Ansari admitted that she hadn’t reviewed the purported evidence against Haim and was instead relying on what FBI agents told her. In the same discussion, Ansari insisted that the documents Haim sent to Rufo included children’s names, but nothing in the documents Rufo saw identified any individuals. All were redacted. The prosecutor then asked Haim to admit wrongdoing, telling him that he should apologize to the families of the children who received transgender medical interventions at TCH if he wanted her to help him avoid a felony prosecution. When this tactic failed, Ansari intimated that the families would sue if she didn’t bring criminal charges.

Roger Severino, vice president of domestic policy for the Heritage Foundation and a former HIPAA regulator at the Department of Health and Human Services, called Haim’s prosecution “outrageous.” As Severino notes, Haim blew the whistle in good faith in a state “where it’s illegal to do these experimental surgeries on minors.” (In September 2023, Texas attorney general Ken Paxton announced that SB 14, a new law banning gender-transition procedures for minors in Texas, had gone into effect.)

Ansari’s zeal to prosecute Haim is especially strange, given her lack of knowledge of HIPAA law, as noted in a letter from Haim’s lawyers. In the past, Ansari has prosecuted cases involving doctors who falsified patient-care documents to receive higher insurance payouts, a health-center owner who scammed Medicare out of millions based on fraudulent claims, and a pharmacist who submitted false claims to Tricare and other federal insurance programs while pocketing $22 million. Yet she moved to indict Haim in this case, despite his having no profit motive, and despite the Texas Attorney General’s Office declining to act on the case for six months.

Dan Epstein, vice president of America First Legal, a conservative public-interest law group, calls the Haim indictment an overreach of epic proportions. “The fact that Texas state attorneys decided not to bring action on this case says that there wasn’t much public concern over it,” Epstein said. “This is a policy matter, and as a prosecutor if you’re enforcing legal policy and statute, you have to exercise some level of discretion.”

Paragraph 19 of the indictment alleges that Haim’s disclosures to Rufo resulted in “financial loss” to TCH, and that Haim blew the whistle out of “malicious intent.” Haim, for his part, observes that he swore an oath to “do no harm” and believed he had a duty to disclose alleged TCH’s secret gender clinic to prevent further harm to children undergoing procedures for which there is a lack of long-term evidence of efficacy (or safety).

This week, Vanessa Sivadge, a former registered nurse at TCH, came forward as a second whistleblower, alleging not only that the hospital was running its gender clinic in secret but also that doctors were illegally billing Texas’s Medicaid program to pay for the transgender medical interventions. Sivadge had spoken with Rufo for an article last year as an anonymous whistleblower, denouncing TCH’s gender-affirming care treatments for minors. Shortly after she did that, two FBI agents knocked on her door and, according to Sivadge, told her that she was a “person of interest” in the investigation involving Haim. They threatened to “make her life difficult” if she tried to protect him.

Unfortunately, these examples of politically motivated prosecutions aren’t new and will likely continue. Case in point: the U.S. Attorney’s Office for the District of Columbia has chosen to prosecute cases like that of 75-year-old Paulette Harlow, recently sentenced to two years in prison for a demonstration at an abortion clinic. Meantime, pro-Hamas demonstrators who violated D.C. law by covering their faces with masks and keffiyehs and defaced statues near the White House run free, and anti-Israel protesters who barricaded themselves in Columbia University’s Hamilton Hall have seen criminal charges against them dropped.

Texas Children’s Hospital is a flashpoint. Haim faces up to a decade in prison and a $250,000 fine. What happens next could discourage future whistleblowers in the health-care industry.

“When it comes to health care fraud, you prosecute those that are going to have a strong deterrent effect and where prosecutorial resources justified spending taxpayer dollars on the matter,” says Epstein. “And here, I think, this is a clear case of prosecutorial overreach.”

Research into trans medicine has been manipulated

Court documents offer a window into how this happens

The Economist

In April Hilary Cass, a British paediatrician, published her review of gender-identity services for children and young people, commissioned by NHS England. It cast doubt on the evidence base for youth gender medicine. This prompted the World Professional Association for Transgender Health (WPATH), the leading professional organisation for the doctors and practitioners who provide services to trans people, to release a blistering rejoinder. WPATH said that its own guidelines were sturdier, in part because they were “based on far more systematic reviews”.

Systematic reviews should evaluate the evidence for a given medical question in a careful, rigorous manner. Such efforts are particularly important at the moment, given the feverish state of the American debate on youth gender medicine, which is soon to culminate in a Supreme Court case challenging a ban in Tennessee. The case turns, in part, on questions of evidence and expert authority.

Court documents recently released as part of the discovery process in a case involving youth gender medicine in Alabama reveal that WPATH's claim was built on shaky foundations. The documents show that the organisation’s leaders interfered with the production of systematic reviews that it had commissioned from the Johns Hopkins University Evidence-Based Practice Centre (EPC) in 2018.

From early on in the contract negotiations, WPATH expressed a desire to control the results of the Hopkins team’s work. In December 2017, for example, Donna Kelly, an executive director at PATH, told Karen Robinson, the EPC's director, that the WPATH board felt the EPC researchers “cannot publish their findings independently”. A couple of weeks later, Ms Kelly emphasised that, “the [WPATH] board wants it to be clear that the data cannot be used without WPATH approval”.

Ms Robinson saw this as an attempt to exert undue influence over what was supposed to be an independent process. John Ioannidis of Stanford University, who co-authored guidelines for systematic reviews, says that if sponsors interfere or are allowed to veto results, this can lead to either biased summaries or suppression of unfavourable evidence. Ms Robinson sought to avoid such an outcome. “In general, my understanding is that the university will not sign off on a contract that allows a sponsor to stop an academic publication,” she wrote to Ms Kelly.

Months later, with the issue still apparently unresolved, Ms Robinson adopted a sterner tone. She noted in an email in March 2018 that, “Hopkins as an academic institution, and I as a faculty member therein, will not sign something that limits academic freedom in this manner,” nor “language that goes against current standards in systematic reviews and in guideline development”.

Eventually WPATH relented, and in May 2018 Ms Robinson signed a contract granting WPATH power to review and offer feedback on her team’s work, but not to meddle in any substantive way. After WPATH leaders saw two manuscripts submitted for review in July 2020, however, the parties’ disagreements flared up again. In August the WPATH executive committee wrote to Ms Robinson that WPATH had “many concerns” about these papers, and that it was implementing a new policy in which WPATH would have authority to influence the EPC team’s output—including the power to nip papers in the bud on the basis of their conclusions.

Ms Robinson protested that the new policy did not reflect the contract she had signed and violated basic principles of unfettered scientific inquiry she had emphasised repeatedly in her dealings with WPATH. The Hopkins team published only one paper after WPATH implemented its new policy: a 2021 meta-analysis on the effects of hormone therapy on transgender people. Among the recently released court documents is a WPATH checklist confirming that an individual from WPATH was involved “in the design, drafting of the article and final approval of [that] article”. (The article itself explicitly claims the opposite.) Now, more than six years after signing the agreement, the EPC team does not appear to have published anything else, despite having provided WPATH with the material for six systematic reviews, according to the documents.

No one at WPATH or Johns Hopkins has responded to multiple inquiries, so there are still gaps in this timeline. But an email in October 2020 from WPATH figures, including its incoming president at the time, Walter Bouman, to the working group on guidelines, made clear what sort of science WPATH did (and did not) want published. Research must be “thoroughly scrutinised and reviewed to ensure that publication does not negatively affect the provision of transgender health care in the broadest sense,” it stated. Mr Bouman and one other coauthor of that email have been named to a World Health Organisation advisory board tasked with developing best practices for transgender medicine.

Another document recently unsealed shows that Rachel Levine, a transwoman who is assistant secretary for health, succeeded in pressing WPATH to remove minimum ages for the treatment of children from its 2022 standards of care. Dr Levine’s office has not commented. Questions remain unanswered, but none of this helps WPATH’s claim to be an organisation that bases its recommendations on science. 

(011) PREVALENCE OF SEXUAL DYSFUNCTIONS AND HEALTHCARE NEEDS OF TRANSGENDER AND GENDER-DIVERSE PEOPLE: RESULTS FROM A REPRESENTATIVE CROSS-S

AbstractIntroduction. Sexual dysfunctions (SD) are a common issue for transgender-identified individuals and may persist despite access to g

OUP Academic

Introduction Sexual dysfunctions (SD) are a common issue for transgender-identified individuals and may persist despite access to gender-affirming care. Healthcare disparities experienced by transgender and gender-diverse people (TGDP) are often overlooked. Data on the prevalence of SD in TGDP from representative samples are rare, and little is known about the help-seeking behavior and healthcare needs regarding sexual problems in this subgroup compared to the needs of cisgender women (CW) and men (CM). Patient and Public Involvement can improve the quality and impact of research on under-researched topics.

Objective This study aims to investigate the prevalence of SD in TGDP in the German population and to compare sexual health and healthcare needs between TGDP and the groups of CW and CM.

Methods This cross-sectional study used data from an online survey with a sample representative of the German population in terms of gender, age, and federal state. ICD-11 criteria and FSDS-DAO were used to assess sexual health outcomes. Questionnaire items on gender, risk factors for SD, and healthcare needs were developed in collaboration with a culturally and gender-diverse group of eight external co-researchers and advisors following the patient and public involvement methodology. Outcomes were examined by gender group. Participants who reported identification with a gender different from their gender assigned at birth, a non-binary gender, a diagnosis related to gender incongruence, and/or variations of sex development were assigned to the TGDP group.

Results Data from N=4,023 participants (CW: n=1,985, CM: n=1,815, TGDP: n=223) were collected with a mean age of 49.0 years (SD = 16.5). The 6-month prevalence of sexual dysfunction (SD) according to ICD-11 criteria was considerably higher among TGDP (34.4%) compared to CW (16.3%) and CM (16.6%), as reflected in the FSDS-DAO scores of the TGDP subgroup (M = 21.1, SD = 15.3), CW (M = 11.1, SD = 12.4), and CM (M = 12.3, SD = 12.7). The demand for information regarding sexual problems among those experiencing SD was more frequently reported by TGDP (67.5%) than by CW (44.0%) and CM (47.3%), with an odds ratio of 4.3 for TGDP vs. cisgender. Across all gender groups, the most preferred source for information was online research, followed by peer networks (29.0%) and friends (26.5%) in the TGDP group, in contrast to healthcare providers and partners for CW and CM. The most desired dialogue partners among healthcare providers (HCP) were urologists and general practitioners in TGDP (26.4% and 23.9%) and CM (37.3% and 25.4%), and gynecologists (36.0%) and psychotherapists (11.5%) for CW. Among TGDP with SD, 49.9% had undergone therapy for sexual dysfunctions (in CW 10.2%, in CM 15.2%), with psychotherapy (36.0%) being the most frequently reported treatment. The TGDP group showed higher needs for information and help, identifying the lack of services considering individual needs related to culture, gender identity, physical illness, and mental health conditions as the primary barriers to care. Diversity sensitivity training for HCPs, drug developments, improved resources, and 'blended care' solutions that encompass both digital and physical procedures were identified as the most urgent developments to improve care for sexual dysfunctions.

Conclusions The results indicate the alarming extent of the burden of SD for TGDP. Furthermore, the findings emphasize the importance of tailored interventions that acknowledge and address the diverse needs of TGDP.

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@benryanwriter: NEWS: Alabama Attorney General submits motion for summary judgment in District Court case over ban on pediatric gender-trans

threadreaderapp.com

NEWS: Alabama Attorney General submits motion for summary judgment in District Court case over ban on pediatric gender-transition treatment.

The document offers a scathing @WPATH's credibility, based on subpoenaed documents, dismissing it as an "activist interest group." 🧵

This summarizes the Alabama Attorney General's assessment of @WPATH, based on a trove of subpoenaed internal communications that have been unsealed this week, plus more yet to be unsealed: "In short, neither the Court nor Alabama need treat WPATH as anything other than the activist interest group it has shown itself to be. The Constitution allows States to reject WPATH’s model of “care” and protect vulnerable minors from life-altering transitioning “treatments.” The Court should grant Defendants summary judgment."

The AL AG's motion for summary judgment borrows liberally from the UK Cass Review to portray the scientific literature on gender-transition treatment as weak and unreliable. It also relies on the words of @WPATH's president, Dr. Marci Bowers: "Asked whether 'reasonable people could conclude that there is not enough evidence to support the safety or clinical effectiveness of puberty blockers,' Bowers replied: 'There’s not enough high level evidence. Yes, you can – you can – you can say that.'”

The AL AG also points to Dr. Eli Coleman, the chair of @WPATH's Standards of Care 8 trans-care guidelines, when arguing that a 12-year-old cannot assent to gender-transition treatment that may make them infertile: “at their age – they would not know what they want."

The Alabama AG posits what has become a highly contested argument that most gender dysphoric young children will desist and stop identifying as transgender during adolescence.

The Alabama Attorney General argues in its motion for summary judgment in District Court regarding suit over the state's pediatric gender-transition ban: “Minors, and often their parents, are unable to comprehend and fully appreciate the risk and life implications, including permanent sterility, that result from the use of puberty blockers, cross-sex hormones, and surgical procedures." Thus, “the decision to pursue a course of hormonal and surgical interventions to address a discordance between the individual’s sex and sense of identity should not be presented to or determined for minors who are incapable of comprehending the negative implications and life-course difficulties attending to these interventions.”

The plaintiffs suing Alabama over its ban of pediatric gender-transition treatment rely on guidelines by @WPATH and the Endocrine Society. The AL Attorney General points to the Cass Review to characterize them as "unreliable and methodologically unrigorous."

The Alabama AG again refers to the Cass Review when characterizing what Cass called "circularity" in the WPATH and Endocrine Society's pediatric gender-transition treatment guidelines, but which the AG refers to as laundering.

The Alabama AG argues that the major medical associations that back the gender-affirming care model for children do not, in fact, explicitly endorse @WPATH or the Endocrine Society's treatment guidelines per se. 

When @WPATH's Dr. Eli Coleman couldn't get the @AmerMedicalAssn to back WPATH's Standards of Care 8 guidelines for trans care, he emailed his colleagues in a fury and said the AMA is run by “white cisgender heterosexual hillbillies from nowhere."

The Alabama AG criticizes @WPATH for not seeking to prevent intellectual conflicts of interest from biasing its Standards of Care 8, meaning the guidelines were made by those "professionally engaged in performing, researching, or advocating for the practices under review."

Activists have made much of the fact that Hilary Cass was appointed by the NHS to conduct a review of pediatric care for gender dysphoric children despite no experience with such patients. But that is why she was chosen, because she lacked that intellectual conflict of interest. 

WPATH, the AL AG asserts, leaned into intellectual conflicts of interest when crafting the SoC8. Its president, Dr Marci Bowers, says she made more than $1 million from such surgeries last year and said it was "absolutely...important for someone to be an advocate" for gender-transition treatment to sit on the guideline committee.

Despite the fact that the head of WPATH's Standards of Care 8 trans treatment guidelines, Dr. Eli Coleman, said that most of those who contributed to them had financial and/or nonfinancial conflicts of interest, WPATH denied this in public.

Despite asserting that they were creating the Standards of Care 8 according to evidence-based medicine principles, WPATH did not do so. Dr. Eli Coleman, who headed the effort, said, "we were not able to be as systematic as we could have been (e.g. we did not use GRADE explicitly)

WPATH admitted using the term "recommend," which per the principles of evidence-based medicine is reserved for treatments backed by strong evidence with few downsides and a high degree of acceptance among providers and patients, to describe treatments with low-quality evidence.

The systematic literature reviews that @WPATH commissioned from Johns Hopkins and that it subsequently largely buried found "little to no evidence about children and adolescents" with respect to gender-transition treatment. HHS acknowledged this in Sept 2020.

WPATH denied Johns Hopkins the requisite independence for conducting and publishing the systematic literature reviews on trans care that the organization commissioned.

Social justice lawyers told @WPATH that evidence-based reviews of the science behind gender transition treatment for children would put the organization "in an untenable position in terms of affecting policy or winning lawsuits."

WPATH, the Alabama AG alleges, were "explicit in their desire to tailor SOC-8 to ensure cover-age for practically any 'embodiment goal' a patient has by labelling it 'medically necessary.' That label was given to a staggeringly broad list of treatments, seemingly without regard to the evidence base."

Biden Admin health official Rachel Levine put political pressure on WPATH to remove the age restrictions for gender-transition treatments in the Standards of Care 8.

After the @AmerAcadPeds threatened to withhold support for the SoC8 and to come out against it if @WPATH didn't remove the age limits on gender-transition treatment, WPATH relented and then fabricated a story for the public about why they did so.

WPATH's Dr. Eli Coleman said trans health care is "not only under attack by politicians, but by:” (1) “academics and scientists who are naturally skeptical,” (2) “parents of youth who are caught in the middle of this controversy,” (3) “increasing number of regret cases” who “blame clinicians for allowing them[] to transition,” and (4) “continuing pres-sure in health care to provide evidence-based care.”

Erica Anderson, former USPATH head, told me how she locked horns with her WPATH colleagues after telling @AbigailShrier that some care of gender dysphoric kids was "sloppy." Anderson wanted more openness with journalists, USPATH wanted a moratorium on talking to the press. Anderson lost that battle.

One author of the SoC8 adolescent chapter said: "My fear is that if WPATH continues to muzzle clinicians and relay the message to the public that they have no right to know about the debate, WPATH will become the bad guy and not the trusted source."

In public, WPATH denies that social contagion may contribute to gender dysphoria in minors and that rapid-onset gender dysphoria may be a real phenomenon, but in private they are more circumspect, the Alabama Attorney General asserts.

The Scandal Goes All the Way to the White House—But It’s Deeper than Levine

What the New York Times left out of their recent reporting.

realityslaststand.com

WPATH leadership went to great lengths to suppress systematic reviews (SR) commissioned from Johns Hopkins because the reviews’ conclusions did not support the WPATH plans to recommend wide access to hormones and surgeries for all those who desired them. The evidence suppression was achieved via a 2-prong strategy. First, WPATH forced JHU to withdraw the manuscripts that were already submitted for publication as they did not meet the desired conclusions. Next, WPATH instituted a new policy whereby WPATH would have to approve all future publications by JHU.

WPATH developed an approval checklist, which required that the authors must have the “intention to use the Data for the benefit of advancing transgender health in a positive manner,” the content approval must involve SOC8 chapter leads, and the review must include “at least one member of the transgender community in the design, drafting of the article, and the final approval of the article.”

Two levels of WPATH approval were required before JHU could submit a publication: first, the proposal which includes the conclusion had to be approved; and then, the actual manuscript draft, with WPATH retaining the rights to alter content.

Only the reviews passing both levels of approval could be submitted by JHU for publication—and they had to carry a specific disclaimer that “the authors are solely responsible for the content of the manuscript, and the manuscript does not necessarily reflect the view of WPATH in the publication.”

There is a lack of current evidence-based guidance for care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation. While these are some existing guidelines and standards of care,2, 5-6 most are derived from expert opinion or have not been updated recently so a comprehensive evidence review is currently not available.

The EPC Program will not develop a new systematic review because we found protocols for two systematic reviews that addresses portions of the nomination, and an insufficient number of primary studies exist to address the remainder of the nomination.

Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show

Newly released emails from an influential group issuing transgender medical guidelines indicate that U.S. health officials lobbied to remove

nytimes.com

Newly released emails from an influential group issuing transgender medical guidelines indicate that U.S. health officials lobbied to remove age minimums for surgery in minors because of concerns over political fallout.

Health officials in the Biden administration pressed an international group of medical experts to remove age limits for adolescent surgeries from guidelines for care of transgender minors, according to newly unsealed court documents.

Age minimums, officials feared, could fuel growing political opposition to such treatments.

Email excerpts from members of the World Professional Association for Transgender Health recount how staff for Adm. Rachel Levine, assistant secretary for health at the Department of Health and Human Services and herself a transgender woman, urged them to drop the proposed limits from the group’s guidelines and apparently succeeded.

If and when teenagers should be allowed to undergo transgender treatments and surgeries has become a raging debate within the political world. Opponents say teenagers are too young to make such decisions, but supporters including an array of medical experts posit that young people with gender dysphoria face depression and worsening distress if their issues go unaddressed.

In the United States, setting age limits was controversial from the start.

The draft guidelines, released in late 2021, recommended lowering the age minimums to 14 for hormonal treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries, and 17 for genital surgeries or hysterectomies.

The proposed age limits were eliminated in the final guidelines outlining standards of care, spurring concerns within the international group and with outside experts as to why the age proposals had vanished.

The email excerpts released this week shed light on possible reasons for those guideline changes, and highlight Admiral Levine’s role as a top point person on transgender issues in the Biden administration. The excerpts are legal filings in a federal lawsuit challenging Alabama’s ban on gender-affirming care.

One excerpt from an unnamed member of the WPATH guideline development group recalled a conversation with Sarah Boateng, then serving as Admiral Levine’s chief of staff: “She is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out.”

Another email stated that Admiral Levine “was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them.”

The excerpts were filed by James Cantor, a psychologist and longstanding critic of gender treatments for minors, who used them as evidence that the international advisory group, referred to as WPATH, was making decisions based on politics, not science, in developing the guidelines.

The emails were part of a report he submitted in support of Alabama’s ban on transgender medical care for minors. No emails from Admiral Levine’s staff were released. Plaintiffs are seeking to bar Dr. Cantor from giving testimony in the case, claiming that he lacks expertise and that his opinions are irrelevant.

Admiral Levine and the Department of Health and Human Services did not respond to requests for comment, citing pending litigation.

Dr. Cantor said he filed the report to expose the contents of the group’s internal emails obtained by subpoena in the case, most of which remain under seal because of a protective order. “What’s being told to the public is totally different from WPATH’s discussions in private,” he said.

Dr. Marci Bowers, a gynecologic and reconstructive surgeon and the president of WPATH, rejected that claim. “It wasn’t political, the politics were already evident,” said Dr. Bowers. “WPATH doesn’t look at politics when making a decision.”

In other emails released this week, some WPATH members voiced their disagreement with the proposed changes. “If our concern is with legislation (which I don’t think it should be — we should be basing this on science and expert consensus if we’re being ethical) wouldn’t including the ages be helpful?” one member wrote. “I need someone to explain to me how taking out the ages will help in the fight against the conservative anti-trans agenda.”

The international expert group ultimately removed the age minimums in its eighth edition of the standards of care, released in September 2022. The guidelines reflected the first update in a decade and were the first version of the standards to include a dedicated chapter on medical treatment of transgender adolescents.

The field of gender transition care for adolescents is relatively new and evidence on long-term outcomes is scarce. Most transgender adolescents who receive medical interventions in the United States are prescribed puberty blocking drugs or hormones, not surgeries.

But as the number of young people seeking such treatments has soared, prominent clinicians worldwide have disagreed on issues such as the ideal timing and criteria for the medical interventions. Several countries in Europe, including Sweden and Britain, have recently placed new restrictions on gender medications for adolescents after reviews of the scientific evidence. In those countries’ health systems, surgeries are only available to patients 18 and older.

The email documents were released by the U.S. District Court for the Middle District of Alabama, in a challenge to the Alabama ban brought by civil rights groups including the National Center for Lesbian Rights and the Southern Poverty Law Center on behalf of five transgender adolescents and their families.

Transgender rights groups have turned to the courts to block laws, like Alabama’s, that have been approved in more than 20 Republican-controlled states since 2021, but the courts have been split in their rulings.

On Monday, the Supreme Court announced that it would hear a challenge to Tennessee’s ban on youth gender medicine, which makes it a felony for doctors to provide any gender-related treatment to minors, including puberty blockers, hormones and surgeries. The petition, filed by the Department of Justice, cited the WPATH guidelines among its primary “evidence-based practice guidelines for the treatment of gender dysphoria.”

Additional emails cited in the new court filings suggest that the American Academy of Pediatrics also warned WPATH that it would not endorse the group’s recommendations if the guidelines set the new age minimums.

In a statement on Tuesday, Mark Del Monte, chief executive of the American Academy of Pediatrics, pointed out that the medical group, which represents 67,000 U.S. pediatricians, had not endorsed the international guidelines because it already had its own in place.

He said the academy had sought to change the age limits in the guidelines because the group’s policies did not recommend restrictions based on age for surgeries.

Last summer, the pediatrics academy reaffirmed its own guidelines, issued in 2018, but said that it was commissioning an external review of the evidence for the first time.

The numbers for all gender-related medical interventions for adolescents have been steadily rising as more young people seek such care. A Reuters analysis of insurance data estimated that 4,200 American adolescents started estrogen or testosterone therapy in 2021, more than double the number from four years earlier. Surgeries are more rare, and the vast majority are mastectomies. or top surgeries. In 2021, Reuters estimated that 282 teenagers underwent top surgery that was paid for by insurance.

Gender-related surgeries for minors have been a focal point for some politicians. Gov. Ron DeSantis, Republican of Florida, has argued that surgeons should be sued for “disfiguring” children. In Texas, where parents of transgender children have been investigated for child abuse, Gov. Greg Abbott, a Republican, has called genital surgeries in adolescents “genital mutilation.”

The final WPATH guidelines state that distress about breast development in particular has been associated in transgender teenagers with higher rates of depression, anxiety and distress.

“While the long-term effects of gender-affirming treatments initiated in adolescence are not fully known, the potential negative health consequences of delaying treatment should also be considered,” the guidelines state.

“Gender-affirming surgery is valued highly by those who need these services — lifesaving in many cases,” Dr. Bowers said.

Unsealed Court Documents Show That Admiral Rachel Levine Pressured WPATH To Remove Age Guidelines From The Latest Standards Of Care

A head-on collision between science and politics

jessesingal.substack.com

I have just spoken to Admiral Levine today, who—as always is extremely supportive of the SOC 8, but also very eager for its release—so to ensure integration in the US health policies of the Biden government. So, let’s crack on with the job!!! 

I am meeting with Rachel Levine and her team next week, as the US Department of Health is very keen to bring the trans health agenda forward.

The failure of WPATH to be ready with SOC 8 is proving a barrier to optimal policy progress and she [Dr. Levine] was eager to learn when SOC 8 might be published. 

[T]his should be taken as a charge from the United States government to do what is required to complete the project immediately. 

Sarah Boateng, who is Adm. Levine’s chief of staff [said the] biggest concern is the section below in the Adolescent Chapter that lists specific minimum ages for treatment, she is confident, based on the rhetoric she is hearing in DC, and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out and perhaps an adjunct document could be created that is published or distributed in a way that is less visible than the SOC8, is the way to go. 

The issue of ages and treatment has been quite controversial (mainly for surgery) and it has come up again. We sent the document to Admiral Levine. . . She like [sic] the SOC-8 very much but she was very concerned that having ages (mainly for surgery) will affect access to health care for trans youth and maybe adults too. Apparently the situation in the USA is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them. We have the WPATH executive committee in this meeting and we explained to her that we could not just remove them at this stage. 

[W]e heard your [Dr. Levine’s] comments regarding the minimal age criteria for transgender healthcare adolescents; the potential negative outcome of these minimal ages as recommendations in the US [. . . ] Consequently, we have changes to the SOC 8 in this respect. Given that the recommendations for minimal ages for the various gender affirming medical and surgical intervention are consensus-based, we could not remove them from the document. Therefore, we have made changes as to how the minimal ages are presented in the documents. [Note: “your” may well refer to an aide of Levine’s rather than the Secretary herself, though it’s unclear.] 

I don’t see how we can simply remove something that important from the document—without going through a Delphi—at this final stage of the game [. . . ] I realize that those in favor of the bans are going to go right to the age criteria and ignore the fact that we actually strengthened the strictness of the criteria to help clinicians better discern appropriate surgical candidates from those who are inappropriate [. . . ] It’s all about messaging and marketing.