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By: Benjamin Ryan
Published: Oct 31, 2024
Boston Children’s Hospital slashed the time slated for psychologists to assess and write a report on children seeking gender-transition treatment from 20 hours to under 3 hours, alarming experts.
The world-renowned Boston Children’s Hospital is being denounced by leading psychologists for drastically reducing the time it allocates for mental-health professionals to determine whether children identifying as transgender should receive gender-transition treatment. Shocked and dismayed by the hospital’s policy, these experts in pediatric-gender medicine have called the shortened assessment period woefully inadequate — considering the complexity of gender-related distress in minors and the fact that these medications are life-altering and, in the case of testosterone and estrogen, cause irreversible effects.
During the second half of the 2010s, leaders at the pediatric gender clinic at Boston Children’s first cut in half, and ultimately slashed by eightfold, the time they typically scheduled for in-house psychologists to assess gender-distressed children before determining whether they should be referred to endocrinologists to begin a treatment path that includes puberty blockers and cross-sex hormones.
By about 2018, the gender clinic’s assessment policy was to provide these minor-age patients only a one-hour appointment with a psychologist, plus one hour with that provider and their family. This is according to three staff psychologists and the clinic’s director.
“It’s shocking,” Laura Edwards-Leeper, a former Boston Children’s psychologist who helped found its gender clinic, told the Sun of the dramatic reduction in time allotted for such assessments.
This reported sea change in clinic policy came to light thanks to a lawsuit brought by a fired psychologist that is now being heard in Suffolk County Superior Court in Boston. Amy Tishelman, 68, has accused Boston Children’s Hospital of age- and gender-based discrimination and of retaliation. The hospital terminated her in 2021, alleging she violated a patient-privacy law; she had filed her initial discrimination suit against the institution the year prior.
Dr. Tishelman, who is widely recognized as a leader in pediatric gender medicine, on Thursday testified that when she began working for Boston Children’s gender clinic in 2013, administrators allotted her 20 hours, and sometimes longer, to assess whether a child should be referred for gender treatments; this included her time to write the report on the patient.
A few years into her tenure at the gender clinic, the hospital had cut that period to 10 hours, she said. Then, by early 2018, it had slashed the time again.
“I didn’t feel like that was doable at all,” Dr. Tishelman said from the stand. She denounced as “reckless” the clinic’s policy it adopted over six years ago of allotting just two hours of assessment-appointment time and a half hour for report writing.
Speaking to the complex calculus involved in considering whether gender-distressed adolescents should receive powerful medications to alter their puberty, Dr. Tishelman continued: “There’s a lot of things to think about in the long- and short-run. It’s not like taking an aspirin. It’s a big deal.”
That it has taken so many years for these specific policies at Boston Children’s to be laid bare lends weight, critics suggested to the Sun, to the persistent allegations that pediatric gender care, a controversial medical specialty, is lacking in transparency.
The associated political stakes are substantial. During the presidential campaign’s home stretch, President Tru.mp has relentlessly hammered Vice President Kamala Harris for her past support of taxpayer funded gender-transition treatments for prisoners, including detainees who are undocumented migrants. His campaign has funneled tens of millions of dollars into attack ads on this issue.
Dr. Tishelman alleged in court that her supervisor at Boston Children’s, Dr. Yee-Ming Chan, was threatened by her success and had long subjected her to sexist and ageist treatment. Dr. Chan, who denies these claims, is a pillar in the field of pediatric gender medicine in his own right. He is a co-principal investigator of an ongoing and multipronged $10 million National Institutes of Health–spon.sored research endeavor of the care transgender youth, including studies of the use of puberty blockers and cross-sex hormones to treat gender-related distress.
Republican members of Congress last week pledged to launch an investigation into the federal grant funding this study. They were inspired to do so after The New York Times reported that the research project’s leading investigator, Dr. Johanna Olson-Kennedy of Children’s Hospital Los Angeles, said that she had refrained, expressly for political reasons, from publishing the team’s study finding that puberty blockers were not tied to psychological benefits.
The Boston trial has also shone a harsh light on a substantial blind spot in pediatric gender medicine: the crucial question of how those who medically transition as minors fare as adults.
By stripping Dr. Tishelman of her right to see patients in the gender clinic in 2019, she and her attorney alleged in court, Boston Children’s compromised her vital research into the care of transgender children. By firing her outright two years later, she said, the hospital terminated, among other research, her effort to establish a comprehensive database of all the patients the gender clinic had ever seen and to follow up with those who had reached adulthood.
“We were the first clinic to see transgender kids in the United States, and we don’t know whatever happened to them and how they’re doing,” Dr. Tishelman testified about the hundreds of former patients who have aged out of the clinic’s care.
“It’s damning that an institution like that, which has all those esteemed affiliations with major universities, would put the kibosh on an area of research that’s so desperately needed and would have informed their administrative decisions had they allowed it,” Erica Anderson, a psychologist and former head of the U.S. division of the World Professional Association for Transgender Health, or WPATH, told the Sun.
Boston Children’s is most prominently affiliated with Harvard Medical School.
Dr. Anderson, who is transgender, said that the assessment-related testimony from multiple Boston Children’s employees in Dr. Tishelman’s trial — who gave no indication that the drastically shortened assessment time is anything but a long-standing clinic policy — suggested a “fall from grace” for the prestigious hospital. The institution, she said, has “capitulated to the medicalization of children in a way that is reckless.”
“When people like Amy Tishelman are forced to draw a line in the sand and say, ‘no,’ and institutions come down hard on someone like her, we’re in deep trouble in America,” Dr. Anderson said.
The gender clinic housed at Boston Children’s, called the Gender Multispecialty Service, or GeMS, is a pioneer and considered to be among the pre-eminent clinics of its kind in the United States. Consequently, the news that GeMS will approve children for gender-transition treatment at a pace multiple leading gender-medicine psychologists told the Sun was alarmingly hasty will likely deal a blow not only to the hospital’s reputation, but to this controversial and besieged medical field as a whole.
Opponents and skeptics of prescribing puberty blockers and cross-sex hormones to treat gender-related distress in minors frequently characterize the nation’s pediatric gender clinics as engaging in sloppy, rushed care. These critics, who include many Republican lawmakers as well as a few vocal insiders like Dr. Anderson, often assert that doctors routinely place vulnerable adolescents suffering from myriad mental health problems on powerful, life-altering drugs without engaging in proper due diligence.
Given the nation’s fractured health care system and a prevailing lack of routine patient-data collection in this field, as well as an evident reticence by gender-medicine researchers to publish unflattering research findings, comprehensive information about actual assessment practices at these clinics has remained fairly elusive.
The expositions that have emerged at Dr. Tishelman’s trial consequently shed crucial light onto the practices of a medical field that has become increasingly insular and secretive as it has faced mounting political and public scrutiny, lawsuits and, for Boston Children’s in particular, even threats of violence.
The hospital sustained waves of bomb threats in 2022 after the influential conservative social-media account LibsOfTikTok focused its criticism on the Boston gender clinic and others like it. The account, run by Chaya Raichik, circulated videos that Boston Children’s had published, and ultimately deleted, advertising its gender-transition services, including surgeries it indciated it would perform on minors.
Evidently concerned, at least in part, by the potential for further threats of violence, attorneys for Boston Children’s have sought to keep shielded from public view allegations about GeMS’s practices that were included in exhibits Dr. Tishelman submitted for her lawsuit. In an October 2023 filing successfully requesting that the judge overseeing the case seal portions of those exhibits the attorneys wrote:
“Public disclosure of these allegations will add fuel to an already highly charged public debate over the care of gender diverse youth and could cause serious, irreversible harm to the Hospital and the practitioners who Plaintiff now, for the first time, accuses of providing substandard care to this already at-risk population.” The attorneys further asserted: “GeMS practitioners provide individualized, safe, and affirmative care.”
A representative for Boston Children’s declined to answer questions from the Sun, saying the hospital could not comment on pending litigation.
In 2007, Boston Children’s became the first U.S. clinic to import a pediatric gender-transition treatment protocol pioneered by researchers in the Netherlands. The Dutch model, as it’s known, observed strict criteria that only prescribed puberty blockers and cross-sex hormones to minors who had consistent cross-sex identification from early childhood, supportive parents, and no major other psychiatric problems. The model also discouraged prepubescent social transitions.
According to a 2014 paper regarding 55 of the first Dutch youths to receive gender-transition treatment and surgeries under the protocol, their outcomes by young adulthood were generally favorable. The notable exception was one participant who died from complications from a vaginoplasty.
During the transformative decade since then, diagnoses of gender dysphoria — meaning distress stemming from a misalignment between a person’s biological sex and their gender identity — in young people have soared across the Western world. In response, scores of gender clinics nationwide have opened, following Boston Children’s lead.
Concurrently, the profile of the typical patient presenting at pediatric gender clinics has shifted profoundly from the makeup of the original Dutch cohort. Today’s gender-dysphoric minors are more likely to be natal females and to only express gender dysphoria after puberty’s onset. They also have a higher rate of other psychiatric conditions and autism.
In tandem, U.S. gender-medicine practitioners have become known worldwide for their particularly eager abandonment of the Dutch model’s guardrails. In their place, clinics such as Boston Children’s have adopted a philosophy known as gender-affirming care.
The gender-affirmative ethos has been propagated and popularized in particular by a policy statement published by the American Academy of Pediatrics in 2018. The statement encourages care providers to observe deference to a child’s self-perception of their gender and essentially let the child take much of the lead in their own care. The document is now the subject of a medical-malpractice lawsuit and a recent probing letter from Republican state attorneys general.
Recent analyses of national medical-claims data provide at least some sense of how common pediatric gender care has become. The nonprofit Do No Harm recently conservatively estimated that at least 14,000 U.S. minors received gender-transition medications, surgeries, or both between 2019 and 2023. And the Manhattan Institute estimated, also conservatively, that 5,300 to 6,300 minors—as young as 12 years old—received gender-transition mastectomies between 2017 and 2023.
Boston Children’s, Do Not Harm found, provided such services to at least 300 children, accounting for nearly half the cases that the analysis identified in Massachusetts.
According to GeMS’s website, the clinic has cared for more than 1,000 families. The site states: “We believe in a gender-affirmative model of care, which supports transgender and gender diverse youth in the gender in which they identify. This is a standard of care grounded in scientific evidence, demonstrating its benefits to the health and well-being of transgender and gender diverse youth.”
Recent systematic literature reviews—the gold standard of scientific evidence—have cast serious doubt on assertions that the evidence base behind pediatric gender-transition treatment is robust and reliable. These reviews have all found that such medical interventions are based on shaky and uncertain research findings.
The broad adoption of the gender-affirming care method and the concurrent surge in gender-transition treatment prescriptions have helped fuel a furious backlash among state-house Republicans. Since 2021, 26 states have passed laws banning pediatric gender-transition treatment; all but two of them ban transition surgeries for minors as well. In December, the Supreme Court will hear oral arguments over whether Tennessee’s treatment ban violates the Constitution.
Gary Click, a Republican state representative from Ohio, marshaled that state’s ban into law. In an email to the Sun, he responded to news from Dr. Tishelman’s trial, specifically that Boston Children’s assesses gender-dysphoric minors in just two hours of appointment time, by criticizing the pediatric gender-transition treatment advocates with whom he has clashed.
“While I consistently advocated for mental-health over medical interventions, I was frequently and falsely accused of denying psychological care,” Mr. Click said of such advocates. “I’ve since discovered they are usually guilty of what they accuse us of doing. Now it appears that they are in a rush to medicate children before they have a chance to heal emotionally and choose a normal life.”
Dr. Tishelman, who is an expert in child maltreatment and trauma, worked at Boston Children’s for nearly three decades. In 2013, she was appointed the director of clinical research at GeMS. Prior to her termination, she was a senior attending psychologist at the hospital and an assistant professor at Harvard Medical School.
In addition to her research duties, Dr. Tishelman spent a relatively small portion of her overall schedule conducting the psychological assessments of gender-dysphoric patients who were potential candidates for gender-transition treatment.
WPATH guidelines advise that gender clinics conduct a comprehensive assessment of such pediatric patients prior to prescribing them gender-transition drugs.
Today, Dr. Tishelman is a research associate professor in psychology at Boston College. Her 2021 amended legal complaint, filed after she was fired in March of that year, charts what it claims was a fraught relationship between her and the Boston Children’s pediatric endocrinologist Dr. Yee-Ming Chan. Her complaint states that Dr. Chan, who is over a decade her junior, became her supervisor at GeMS in 2014.
Dr. Chan repeatedly disputed in his testimony on Monday that he was indeed her official supervisor at the gender clinic.
The legal complaint alleges that Dr. Chan subjected Dr. Tishelman to “a ceaseless sexist and ageist campaign of denigrations, accusations and recriminations” that created a hostile work environment and was driven by his “professional jealousy.”
Dawn Solowey, an attorney for Boston Children’s of the law firm Seyfarth Shaw, asserted during her opening statement on Oct. 21 that Dr. Chan sought to foster a productive and copacetic working relationship with Dr. Tishelman. During his testimony, he denied Dr. Tishelman’s accusations of mistreatment.
Both Psychologist Kerry McGregor, who is now the associate director of GeMS, and Francie Mandel, a senior clinical social worker supervisor at the clinic, testified favorably about Dr. Chan’s character and professionalism and cast those qualities of Dr. Tishelman in a negative light.
There remain several days of additional testimony in the trial that might flesh out the details of all the contrasting accounts.
Dr. Tishelman testified that other GeMS employees reacted with jealousy to the news in late 2017 of her appointment by WPATH as the lead author of the revision to its guidelines on care for prepubescent children with gender dysphoria. However, many professionals throughout the national field congratulated her, she said.
Soon after the WPATH appointment, Dr. Tishelman testified, GeMS doubled her clinical work, demanding that she see far more gender dysphoric patients than her schedule permitted. Others testified that this shift was unrelated to the news regarding WPATH.
“When I started, there were 20 hours,” Dr. Tishelman said of the time allotted for patient assessments. “And now they were asking me to do them in two-and-a-half hours.”
The assessments, she said, were meant to address a litany of complex needs and concerns. The original 20 hours included the time for Dr. Tishelman to speak with a gender-distressed child and their family; conduct scoring of major mental-health and neurodivergence markers; assess for suicidality; and determine the family’s concerns about infertility, which is a major risk of pediatric gender-transition treatment. Additionally, she might secure permission to confer with the patient’s outside therapist or school counselor. The time allotted also factored in her effort to write a detailed report on whether the child was a proper gender-transition treatment candidate and what other types of support they might need.
“Kids can be confused about what they want to do,” she said on the stand. “It’s a collaborative process to try to work with kids and their families to try to figure out what’s best for them, knowing the benefits and risks—being informed about the choices.”
Dr. Tishelman testified that by early 2018, GeMS administrators eliminated from the assessments a screening measure for autism. She alleged that despite what she characterized as the degradation of the assessments’ quality by that time, GeMS would include in various reports about the clinic’s work that its staffers followed WPATH’s trans-care guidelines.
“Shortening evaluations” at GeMS “eventually became a big concern” among her research collaborators nationwide, Dr. Tishelman testified. “People would complain to me about my protocol from outside,” she said in reference to those national colleagues.
Dr. Tishelman specified that Dr. Robert Garofalo, a leading pediatrician at the gender clinic at Lurie Children’s Hospital in Chicago, expressed a concern to her at around this time regarding GeMS excluding from the assessments a measure of family acceptance and support of transgender patients. Along with Dr. Chan, Dr. Garofalo is a co-principal investigator on the long-running NIH-funded study of which Dr. Olson-Kennedy is the research lead.
“I would try to tell people that I was not in charge of the protocol,” Dr. Tishelman testified.
Dr. Garofalo responded to an email seeking comment by asserting that the Sun’s initial characterization of Dr. Tishelman’s testimony about him was incorrect. But after the Sun then clarified her words about him, he did not respond further.
Dr. Edwards-Leeper was a coauthor under Dr. Tishelman of the WPATH guidelines chapter revision on prepubescent children and also co wrote the accompanying adolescent chapter. Having left GeMS in 2011, Dr. Edwards-Leeper now practices in Ohio. She reported that she faced similar pressure to assess patients faster from an employer in the interim.
She refused.
“There was no possible way I could cut corners,” she said. Today, in private practice, she directly assesses gender-dysphoric adolescents and their parents for at least 10 hours and ultimately writes a 20- to 30-page report on them.
Dr. Edwards-Leeper, who was on the team that first imported the Dutch protocol to Boston Children’s, told the Sun that she only relatively recently learned that GeMS had progressively slashed its assessment time period during the late 2010s.
“When Amy first shared that with me, I was just in disbelief,” said Dr. Edwards-Leeper, expressing concern that the system of patient oversight she had helped establish at GeMS — one in which she said that, as Dr. Tishelman testified, psychologists spent about 20 hours on the assessment process all told and produced a 15- to 20-page report — had been compromised.
On Tuesday, Dr. McGregor testified that the clinic had allotted four hours of “face-to-face time” with patients for assessments when she started at GeMS in 2016 and ultimately cut this to two hours. The day prior, Dr. Jeremi Carswell, director of GeMS, also testified that the assessment appointment time had been cut from four hours to two hours.
“My understanding is that some were unhappy about it,” Dr. McGregor said about the time reduction, specifying Dr. Tishelman and GeMS psychologist Peter Hunt in particular. “I thought it was appropriate. But some people wished they’d had that time.”
Further asked by a Boston Children’s attorney about why the assessment time was reduced, Dr. McGregor said: “I think that four hours was too much time. If you ever try and get an adolescent to pay attention to you for four hours straight, it’s a little bit difficult. And also we were able to get all the information in much less time. So, in order to see our growing patient population, it made sense to make that time more efficient.”
Dr. McGregor, who said she spent about 15 to 45 minutes writing her assessment reports, with the aid of a template she created, continued: “And we also could always ask for more time if we needed to. So I’ve met for a second session with patients. It’s pretty rare, but I do it if I need it.”
Asked if two hours was typically sufficient to perform what the attorney called “a hormone-readiness assessment,” Dr. McGregor replied that it was. And asked for greater specifics about occasions when she said this was not sufficient time, she said, “Very rarely, but usually if someone has extreme social anxiety, they don’t want to talk, it takes a while to warm them up, maybe they’re on the autism spectrum, things like that, it might make sense to have a second session.”
Dr. Tishelman’s attorney, Patrick Hannon, of Hartley Michon Robb Hannon, asked Dr. McGregor about the videos that GeMS put out advertising their services. She referred to one in which she suggested that, as she recalled in her testimony, “a lot of parents share that some of their children seem to know seemingly from the womb as if they come out kind of knowing who they are,” meaning transgender.
“There’s no scientific research that would support the assertion that kids know whether they’re transgender as soon as they come out of the womb, right?” Mr. Hannon asked Dr. McGregor.
“I don’t know how we would do that scientific research, so no,” she replied.
It is evident that many of the nation’s pediatric gender clinics do engage in lengthy and circumspect assessments of gender-dysphoric minors seeking puberty blockers. But WPATH’s recommendation on this measure notwithstanding, it is also apparent that there is no uniformly upheld standard across this medical field and that assessment times and thoroughness vary dramatically.
Some American mental-health providers, for example, advertise that they will write a letter recommending a gender-dysphoric child for puberty blockers after only a single visit.
Dr. Edwards-Leeper has defended the value of robust assessments in the face of a burgeoning movement across the pediatric gender medicine field to question their utility.
The most comprehensive data set detailing assessment times comes not from America, but from Britain. A major analysis of pediatric gender medicine, called the Cass Review, that was published in April included information from an audit of discharge data regarding some 3,300 patients cared for by England’s pediatric gender clinic, known as GIDS.
The children from this cohort who were ultimately referred to endocrinology received the go-ahead after an average of just under seven assessment appointments. However, a substantial proportion of these children were referred after only three or four assessment appointments.
Anna Hutchison, a psychologist who worked for GIDS between 2013 and 2017, reflected on the prospect of being asked to assess a child and their family in only two appointments, as became the practice at GeMS in 2018. “What can you realistically achieve in that time?” Dr. Hutchinson said.
Dr. Hutchinson ultimately publicly protested policies at GIDS that she said resulted in incautious, unethical care. In an interview, she conjectured that the Boston clinic might have been under mounting demands similar to those that, across the Atlantic, caused the inadequately resourced GIDS to buckle. As the population of gender-dysphoric British children seeking care swelled, Dr. Hutchinson recalled, systemic pressure pushed her and her colleagues to spend less time assessing each child — even as the rate of other psychiatric conditions among the patients steadily increased.
“There are risks in changing what we do clinically based only on resources,” said Dr. Hutchinson. Referring to the increasing demand for services from increasingly troubled children, she said, “Because numbers are going up, complexity is going up, and the amount of time per patient her family goes down.”
“We essentially became an assessment and medication service,” she said of GIDS during her tenure.
Ms. Solowey, the attorney for Boston Children’s, suggested in court last week that GeMS also could not keep up with demand, saying that the clinic “had a really long waiting list.”
Ms. Mandel testified that the reduction, six years back, in appointment hours allotted for individual patient assessments at GeMS was driven not by clinical factors but by billing-related concerns.
As for insights into American practices, in October 2022, Reuters published an investigation of pediatric gender clinics in which it reported: “Seven of the clinics said that if they don’t see any red flags and the child and parents are in agreement, they are comfortable prescribing puberty blockers or hormones based on the first visit, depending on the age of the child.”
Nearly two dozen medical-malpractice lawsuits have been filed by detransitioners – people who medically transitioned and then regretted it, stopping treatment and reverting to identifying as their birth sex – against health and mental health providers over the past two years. Central to many of those suits are claims that minors or young adults suffering from multiple other psychiatric conditions were prescribed gender-transition treatment for dysphoria after only a cursory assessment that failed to meet the WPATH standard.
Jordan Campbell, a partner at Campbell Miller Payne, a Dallas firm that represents many of these plaintiffs, told the Sun: “Dr. Tishelman’s testimony squares with what we see and hear from every single one of our clients: a general sense to rush patients into life-altering medicalization with very little — frequently even less than two hours — assessment, if any.”
In Feb. 2023, Jamie Reed famously blew the whistle on her employer, The Washington University Transgender Center at St. Louis Children’s Hospital, where she had been a case manager. Ms. Reed has accused the since-shuttered clinic of shirking its responsibility to provide comprehensive aid to a population of vulnerable children with very complex needs. (An internal university investigation found the clinic followed “appropriate policies and procedures according to the accepted standards of care.”)
“I long suspected that the sloppy care Wash U. provided would be found across the country,” Ms. Reed told the Sun. During her time at the St. Louis clinic, she said, “I was often unable to refer patients to high-quality psychological assessment, and our clinicians were also limited to scheduling only two sessions to complete an assessment—matching Dr. Tishelman’s account.”
Attorneys for Boston Children’s have asserted in court that the hospital stripped Dr. Tishelman of permission to see GeMS patients in 2019 as a consequence of her chronic delinquency in turning in her patient reports; Ms. Mandel confirmed in her testimony that some reports were late. At that time five years ago, Dr. Tishelman testified, she had six delinquent reports.
The hospital claims that it fired Dr. Tishelman outright in 2021 for violating federal patient privacy laws by viewing, without authorization, records of hundreds of patients not under her care. The hospital alleged that she secretly accessed those files in 2019 in hopes of defending herself by identifying other delinquent psychologist colleagues.
Dr. Tishelman testified that the deadlines for her reports were deliberately unreasonable, given how GeMS administrators had burdened her with an excessive workload. She asserted that the clinic singled her out and “set me up to fail.”
Dr. Edwards-Leeper and Erica Anderson were among the dozens of major figures in pediatric gender medicine who signed a letter of protest to Boston Children’s over Dr. Tishelman’s firing.
In his opening statement, Mr. Hannon said that the patient-privacy-related infraction was a “tru.mped up” pretext for Dr. Tishelman’s termination. Dr. Tishelman ultimately testified that the GeMS patient population was considered communal among the staff psychologists and that it was common practice to discuss one another’s cases and review related medical records at staff meetings. Dr. Tishelman said that Dr. Chan knew in mid-2019 that she had recently reviewed other clinic psychologists’ reports and that he made no objection at the time.
Dr. Tishelman said Dr. Chan confirmed to her during that meeting that the other psychologist at GeMS she had identified as delinquent – Kerry McGregor –was making recommendations regarding gender-transition treatment for children despite omitting key information meant to be in the reports.
“You can’t really write the report without using all the information we’re gathering to put together to understand these people,” Dr. Tishelman testified. “Otherwise why would we even collect that information in the first place?”
Dr. McGregor testified that records indicated her reports were not actually delinquent. She said that at that time there were “some addended scores that I had not placed for the assessment report” – an oversight that she said she quickly rectified.
She further testified that she was alarmed when she learned in 2019 that Dr. Tishelman had accessed her patient records; the following year, she determined that this included files pertaining to over 200 children. Dr. McGregor recalled that Dr. Carswell relayed to her in mid-2019 that the legal department at Boston Children’s found there were some legitimate reasons for Dr. Tishelman to have accessed those records and that her having done so was not cause for concern.
Two years later, however, Dr. Tishelman was terminated from the clinic.
By: Chris Nesi
Published: Oct 23, 2024
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.
==
"It doesn't matter that I accidentally proved my pseudoscientific snake-oil doesn't work, I still want to sell it."
By: Azeen Ghorayshi
Published: Oct 23, 2024
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.”
==
This is fraud. When scientists - or, perhaps, people who simply "identify" as scientists - are given public money, they work for the public. They have no business hiding the results or trying to manipulate it to conform to their ideological commitments.
"I do not want our work to be weaponized."
What she's saying is that she doesn't want reality to be used against her ideology.
When the John Templeton Foundation, an unabashedly Xian organization, spon.sored "Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer" but found that prayer was worse than ineffective, they still published it as they had to.
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.
Reminder that this is the same woman who said of adolescent mastectomies that, "if you want breasts at a later point in your life, you can go get them."
By: Benjamin Ryan
Published: Oct 24, 2024
[ That’s a quote from a talk that pediatric gender medicine doctor Johanna Olson-Kennedy gave in which she was dismissing concerns about young people potentially regretting getting double mastectomies for a gender transition. ]
Some of the biggest names in the pediatric gender medicine field are part of an entrenched global trend in which they prioritize the transgender advocacy mission over honest and direct science. They hide inconvenient research findings. And they seek to prevent other researchers from even asking questions that might yield inconvenient answers. Supporting them is a cabal of activists and LGBTQ nonprofits standing at the ready to bully and cancel any scientists or journalists who might bring to light any of the more questionable aspects of pediatric gender medicine.
This pattern is not just limited to Children’s Hospital Los Angeles’ Dr. Johanna Olson-Kennedy. If you haven’t already heard, according to reporting in The New York Times, this major leader in the pediatric gender medicine field has been sitting on null findings from her National Institutes of Health–funded study of puberty blockers for gender dysphoric children because, she said, publishing them would prove politically inexpedient. (I wrote about an undercover video of her talking about mastectomies here.)
Where have we heard this story before?
Let’s take a trip across the pond to the British National Health Service’s now-shuttered pediatric gender clinic, GIDS. (I encourage you to read all about this troubled clinic in Hannah Barnes’ book Time to Think. Make sure to get the new 2024 U.S. paperback, which has a vital new epilogue.) After it was founded in 2011, GIDS’s leaders sought to recreate the findings of the original Dutch protocol that was first cultivated in the mid-1990s and that ultimately gave rise to the global pediatric gender-transition treatment movement during the 2000s and 2010s.
But the British team failed. They did not find a substantial benefit from providing puberty blockers to gender dysphoric children by following the Dutch protocol. So did these researchers alert the world to their troublesome findings? Did they send a word of caution to a field that by then was circumnavigating the globe, setting up what would soon be hundreds of pediatric gender-clinic outposts?
No, they kept their failure secret.
It wasn’t until Oxford sociologist Michael Biggs became suspicious and ultimately rooted out the truth that the GIDS clinicians finally owned up and published their failed study.
Also in England, the NHS’s Cass Review, which was published in April after a four-year effort to assess pediatric gender medicine at home and worldwide, sought to assess the long-term outcomes of the wider population of former GIDS patients. But the adult NHS gender clinics refused to share their de-identified data on those now-adult patients, providing only specious reasons for their refusal.
Now it seems as if the NHS will ultimately force them to do so. But for now, the world is poorer for not having that data. Because this entire field is compromised by a woeful lack of long-term data, in particular about the more recent cohorts of gender-dysphoric adolescents who have undergone gender-transition treatment, and whose profiles are vastly different from those kids who entered the original Dutch study.
After the Cass Review came out, activists went into overdrive to tell wild falsehoods about it, as I reported at the time. Hilary Cass, the pediatrician lead author of the report, was appalled, and told a reporter that those activists were harming children.
There are also plenty of examples of academics being discouraged from even asking research questions that might lead to an answer that would prove inconvenient for the pediatric gender medicine movement. Take, for example, the trio starting a long-term study to assess whether rapid-onset gender dysphoria is a true phenomenon. These three seasoned investigators have had to self-fund their research and are subject to persistent derision and scorn by trans activists for daring to ask difficult questions about this medical field and about the reasons for the recent surge in trans identification in natal girl adolescents in particular.
One of those three investigators, physician-researcher Dr. Lisa Littman, spoke to me for my article on The Trans Tipping Point in the New York Post. She said of the activists who attack her: “It’s as if their loyalty is to the transition interventions and not to the long-term health and well-being of transgender-identified young people.”
Here’s another example. When UCL neuropsychologist Sallie Baxendale sought to obtain peer review for her review paper about what scientists know—and don’t know—about the neuropsychiatric impacts of puberty blockers, here was what happened, according to what she wrote in Unherd:
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”.
Dr. Baxendale ultimately published her vital review paper, which concluded: “Critical questions remain unanswered regarding the nature, extent and permanence of any arrested development of cognitive function associated with puberty blockers. The impact of puberal suppression on measures of neuropsychological function is an urgent research priority.”
Meanwhile, the American Academy of Pediatrics has assured the public in its 2018 policy statement on the gender-affirming care method that puberty blockers are “reversible.” Twenty Republican attorneys general recently sent a stern, probing letter to the AAP, suggesting that that claim, which they assert is false, violates consumer protection laws. A lawsuit is likely imminent. The AAP is already being sued by a detransitioner over the statement. The original legal complaint lambasts the AAP for never responding to Canadian sex researcher James Cantor’s scathing fact check and critique he published of the policy statement in 2019.
Personally, I don’t think the claim that puberty blockers are reversible is definitively false, given what science is able to tell us at this time. But on the flip side, we also know that it is not definitely true either. As Dr. Baxendale’s paper demonstrates, there remain too many substantive and unanswered questions about how using drugs that throw vital human development processes out of synch might impact a young person, possibly for the rest of their lives.
The AAP announced in August 2023 that it was going to conduct a systematic literature review of the evidence behind pediatric gender medicine—and then never said another word about it. The authors of such reviews are expected to publish their methodology in advance, and the there is no sign that the AAP has done so.
Then there’s the World Professional Association for Transgender Health, or WPATH, which as the Alabama attorney general’s subpoenas have revealed and Jesse Singal reported for The Economist in June, suppressed systematic literature reviews about this field that it commissioned from Johns Hopkins. And after a Biden Health official and the AAP strong armed WPATH into removing the age restrictions on gender-transition treatment and surgeries in the update to its trans-care guidelines in 2022, WPATH president Dr. Marci Bowers coordinated for the leadership to lie about why they had done so. All of this is detailed in scathing, unsparing detail in the Alabama AG’s amicus brief to the Supreme Court, which argues that the court should uphold Tennessee’s law banning pediatric gender-transition treatment.
And in the wake of today’s news about Dr. Olson-Kennedy, we have an example of yet another front in this battle over pediatric medicine: the sheer denial and deflection coming from transgender activist Ari Drennen of Media Matters and the LGBTQ “media watchdog” GLAAD. As you can see from the tweet below, all they could do in the face of such a damning report was deflect.
This makes me wonder: What exactly is GLAAD’s endgame? This is the same nonprofit that had the temerity to condescend to the New York Times last year and falsely claim that the “science is settled” on pediatric medicine with their protest truck they drove around the Times building in Midtown Manhattan.
The science is, of course, not settled. No science is. It is always evolving, in particular in this tempestuous and troubled field of pediatric gender medicine. And there are many people in this wider movement who are seeking to suppress the full, ever-changing truth from coming to light.
At the center of this story is a burgeoning population of very troubled children. They are owed the best science possible. They are owed the truth, whatever that might be.
==
I previously posted about Olsen-Kennedy's tone-deaf endorsement of medical mutilation.
Imagine a medical study of a cancer treatment that was found to be ineffective, which was then covered up. Why would a report about that coverup need to quote people who had had cancer? These fanatics think we're stupid.
People wonder why the trust in our institutions is so low. It's because they keep producing this kind of fraud, which isn't science any more than Intelligent Design is science.
When the devoutly Christian John Templeton Foundation funded a study on intercessory prayer, they were forced to publish it, even though it found that it was ineffective. Or worse.
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.
These genderists are doing religious proselytization.
By: Kristopher Kaliebe
Published: Oct 10, 2024
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.
By: Benjamin Ryan
Published: Oct 10, 2024
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.
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.
[ Sapir added these caveats: “2023 data are incomplete, making it premature to conclude that a dip occurred that year, relative to previous years. Second, even the liberal estimates are an undercount, as the data are limited by two constraints: the procedures had to be covered by insurance, and patients had to have a preexisting diagnosis of 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.
[ Komodo Health Inc.'s findings for Reuters in 2022 ]
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 top dozen hospitals includes:
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.
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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.
By: Void If Removed
Published: Oct 6, 2024
In May 2024, The Southern Poverty Law Centre (SPLC) added the Society for Evidence Based Gender Medicine (SEGM) and Genspect to its list of hate groups.
Unsealed evidence in the US court case Boe vs Marshall (dealing with access to paediatric transition) earlier this year contained snippets of internal WPATH emails revealing their concern over academic critics like SEGM:
I think we need a more detailed defense that we can use that can respond to academic critics and that can be used in the many court cases that will be coming up. […] we know that some of the studies we have cited in support of our recommendations will be torn about by organizations such as the Society for Evidence Based Gender Medicine.
SPLC are representing the plaintiffs in this case, so at the same time as they are waging a legal campaign which relies on WPATH’s evidence, they are also formally designating groups who WPATH privately fear will tear apart that evidence as “hate groups”. Rather than being impartial and evidence-based designations these labels are little more than reputational attacks as part of an ongoing legal strategy in the highly polarised political landscape in the US.
The more US-based lobbyists can publicly discredit SEGM, the more suspicion can be cast on anyone with any connection to them, any evidence they produce, and now on the findings of the Cass Review. The fact is that the Cass Review’s damning assessment of the evidence for the efficacy and safety of puberty blockers fatally undermines legal cases based on arguing the opposite. The Cass Review is already being cited by their Republican opponents, so in the absence of any actual response grounded in evidence, SPLC’s huge resources are turned to an international smear campaign - one that is exemplified by their CAPTAIN report, which as I’ve previously discussed is built on an echo chamber of activist groupthink and conspiracist logic.
SPLC’s attacks on SEGM serve as a foundation for critical commentary directed against the Cass Review. Since the release of that report - and the later “hate group” designation that it led to - links between SEGM and the Cass Review have been played up in media reports, and by activists like Erin Reed in an effort to undermine public reception of Cass’ findings:
Most recently, members of the newly designated hate group, Society for Evidence-Based Gender Medicine, helped advise the Cass Review in the United Kingdom,
This week, Reed brought further focus on the NHS, complaining that several clinicians connected to the Cass Review will be speaking at the 2024 SEGM conference in Athens.
Three times in this piece Reed draws attention to SEGM’s “shared funding streams” with the far right:
Notably, SEGM’s funding streams include the same groups that fund the Heritage Foundation, the Alliance Defending Freedom, and the Family Research Council, far-right organizations capitalizing on Christian nationalism.
The source for this is SPLC’s CAPTAIN report, where the basis of this allegation is that in 2020 and 2021 SEGM received donations from four large charitable foundations - American Online Giving Foundation, Fidelity Investments, Vanguard, and the Edward Charles Foundation - which have also either a) received money from bad actors or b) donated money to bad actors:
a large part of SEGM’s funding in 2020 came through a $100,000 donation from the Edward Charles Foundation … Analyses of additional financial records from 2021 reveal that SEGM’s total revenue nearly quadrupled from the previous year to nearly $800,000, and that funding appears to have come primarily from donor advised funds. The largest contribution, which came from Fidelity Investments Charitable Gift Fund, totals over $350,000. Notably, Fidelity and Vanguard Charitable Endowment Program (which also donated to SEGM in 2021) have a history of directing money to anti-LGBTQ+ groups, such as the Alliance Defending Freedom and the Family Research Council. … [In 2020] In addition to Heritage Foundation, that year, the Charles Koch Institute contributed […] $1.3 million to the Edward Charles Foundation (which funded SEGM that year).
So, taking the Edward Charles Foundation as an example, SPLC cannot outright say something like “SEGM are funded by the Koch Institute” - because there is no evidence of that. All they can say is that in the same tax year as the Edward Charles Foundation received $1.3 million from Koch, the Edward Charles Foundation gave $100k to SEGM. That’s all - and all they do is present these numbers near each other, and thereby strongly imply a financial connection between the Heritage Foundation and SEGM, without actually saying so - which then, in the hands of activists like Reed becomes definitive. There’s nothing here but insinuation - and seemingly false, since according to this Undark report, it was an individual donor who gave money via the Edward Charles Foundation, who simply wishes to remain anonymous:
The donor, a 68-year-old woman from California who asked to remain anonymous because she feared harassment, described herself as a non-religious feminist who had supported Barack Obama and Hillary Clinton.
However, in the case of American Online Giving Foundation, Fidelity Investments and Vanguard the accusation of “shared funding streams” becomes quite staggering hypocrisy. These are huge foundations, collectively worth $21 billion annually, that make thousands and thousands of donations every year, not only to dubious organisations like Alliance Defending Freedom or Family Research Council, but also to SPLC themselves.
And while those much smaller donations to SEGM appear to be one-offs, SPLC have received similar amounts in preceding and subsequent years. Over the past three years, SPLC have received $22 million from these three foundations alone. If receiving grants from these foundations constitutes “shared funding streams” with the far right, as Erin Reed describes it, then the same is true many, many times over of SPLC.
The origin of these claims of "shared funding” go back to the highly conspiracist posts of Health Liberation Now, the activist co-authors of the CAPTAIN report, who cite themselves for these claims in the report itself. Originally they had SEGM in their sights, so I doubt they checked whether their conspiracist logic would apply to SPLC - but in December 2023, when SPLC gave their official stamp to this “research” - and the ensuing “hate group” designation - did they not realise they were implicating themselves?
There’s two possibilities. Either SPLC did not verify this information, in spite of their near-limitless financial resources, in which case why should anybody take anything they say seriously given this level of incompetence? Alternatively, they do know that these allegations of shared funding streams are far more applicable to themselves, in which case this is pure deceit on their part.
There are millions sloshing about in opaque funds, with wealthy US philanthropists funnelling money to pet causes or exploiting tax breaks, and SPLC is one of the fattest pigs at the trough, with three-quarters of a billion dollars in reserve, which they are now using to baselessly smear the reputations of clinicians in the UK in service of an ideological legal agenda in the US.
I think that anyone seeking to understand and address the misinformation and disinformation currently being spread about the Cass Review need to take a long look at the incredibly well-financed activists in the US who have been successfully traducing tiny organisations and blameless individuals, with no serious opposition, for years. As with feminist targets before, these attacks don’t stop at the door of SEGM - they spread, by relentless guilt-by-association, to contaminate absolutely everyone who touches them, or anyone connected to them. Unchecked claims like this are toxic to public discourse, spreading and gaining traction with zero corrective force, creating an unwarranted chilling effect around their targets. Bystanders are quick to believe there is no smoke without fire, and UK clinicians cannot realistically defend their reputations from this sort of partisan dreck from the US. Blandly wondering why the Cass Review has been “largely ignored” in the US misses the point - it is not merely being ignored, it is actively being undermined.
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SPLC hasn't been trustworthy in decades.
By: Leor Sapir, Mungeri Lal
Published: Sep 19, 2024
The Department of Health and Human Services’ documented failures to hold gender medicine to scientific standards have happened under both Republican and Democratic administrations.
In 2015, the Centers for Medicare & Medicaid Services (CMS) accepted a formal request to initiate a national coverage analysis for “gender-reassignment surgery.” When making these coverage determinations, CMS is legally obligated to evaluate relevant clinical evidence and answer the question: Is the evidence sufficient to conclude that the application of the item or service under study will improve health outcomes for Medicare patients? In June 2016, CMS released its 109-page analysis, which it made open for public comment. The agency published its final decision memo two months later. The differences between the two documents were revealing—and disturbing.
At first sight, the summaries of both memos seemed similar. Each mentioned that the CMS was not issuing a national coverage determination on “gender-reassignment surgery” for Medicare beneficiaries with gender dysphoria. Such determinations, the CMS said, would continue to be made by local contractors on a case-by-case basis. On closer examination, however, the final document included substantial changes. These were not corrections. They amounted to a systematic effort to scrub any reference to the evidence of the harms associated with these surgeries.
The agency’s shifting analysis of gender surgery is glaring enough. But it is just one of several examples, between 2016 and the present day, of how key figures and agencies within the U.S. Department of Health and Human Services have misled the American public about the evidence for “gender-affirming care.”
Start with the tale of two memos. To conduct a proper analysis of the clinical evidence, CMS identified a large number of publications related to “gender-reassignment surgery.” As CMS explained:
Studies with robust study designs and larger, defined patient populations assessed with objective endpoints or validated test instruments were given greater weight than small, pilot studies. Reduced consideration was given to studies that were underpowered for the assessment of differences or changes known to be clinically important. Studies with fewer than 30 patients were reviewed and delineated, but excluded from the major analytic framework. Oral presentations, unpublished white papers, and case reports were excluded. Publications in languages other than English were excluded.
Thirty-three publications, ranging from 1979 to 2015, were eventually identified and included. Twenty-four of these studies were conducted in Europe, compared with just six from the United States—not surprising, considering that European nations have historically kept better track of such medical interventions. Patients in the studies were typically in their twenties and thirties. CMS also consulted the guidelines and recommendations of medical groups, including the American Psychological Association, the Endocrine Society, and the U.S. Institute of Medicine. The agency considered evidence from any listed clinical trials at the time and solicited public comments.
All of this is to say that CMS’s analysis was rigorous. It went through the 33 studies, explaining their methodology, results, strengths, and weaknesses. The analyses were more detailed than those found in some of the systematic reviews carried out in the medical literature, which have space limitations. The individual studies varied widely in their rigor and reporting.
Though the results of these studies were somewhat inconsistent, CMS found that the best studies all pointed to negative outcomes.
The proposed analysis—the first memo that CMS released—identified one particular study from Sweden as “the most comprehensive study with functional endpoints of the 33 studies reviewed” and devoted considerable space to discussing it. What differentiated the Swedish study from the others? Unlike most other studies that relied on clinic samples (a convenient choice for researchers but one that introduces the risk of bias) for a limited amount of time (thereby missing long-term consequences), the Swedish study tracked all patients who had undergone “gender-reassignment surgery” over a 30-year interval and compared them with 6,480 matched controls from the general Swedish population.
The proposed memo explained why it considered this particular study comprehensive. The data came from a compulsory national database. The study followed all patients nationally across all clinics for over 30 years. It used the same, consistent criteria for everyone permitted to undergo surgery, allowing an accurate comparison across patients. It captured objective outcomes, namely mortality and regret (narrowly defined as a recorded request for surgical reversal), as endpoints. And it included a full record of all suicide and suicide attempts in the clinical data in the Swedish National Patient Register.
The Swedish study presented an alarming picture of life after “gender-reassignment surgery.” To appreciate why, consider two additional features. First, the study used “highly vetted patients”—only those who passed a battery of physiological and psychological tests were eligible to undergo the surgery. Second, surgeries were conducted only “at select centers with integrated care . . . in which there is sequential evaluation of patients for progressively more invasive interventions.” Thus, individuals who received these surgeries seemed comparatively better adjusted at baseline and were well positioned to enjoy all-around care following their procedures.
Yet even after receiving “gender-reassignment surgery,” transsexuals in the Swedish study were 19.1 times more likely to die by suicide than were members of the control group. The authors adjusted for psychiatric history, among other things. According to CMS, the study could not isolate the impact of “reassignment surgery,” but it did find that “[r]eassignment surgery does not return patients to a normal level of morbidity risk and that the morbidity risk is significant even in highly vetted patients in a structured care system.” In addition, the divergence in survival rates from the rest of the Swedish population did not become apparent until at least ten years, an interval much longer than the follow-up period of other studies. The survival rates at the 20-year follow-up were: female controls 97 percent, male controls 94 percent, “female-to-male” patients 88 percent, and “male-to-female” patients 82 percent.
The ultimate CMS report systematically downplayed these findings.
CMS’s two memos differed in multiple ways. First, and less suspiciously, the final memo contained a large section noting and responding to public comments. This was to be expected, though the comments were interesting. One group of commenters “suggested that CMS should recommend the WPATH Standards of Care (WPATH) as the controlling guideline for” gender surgery. Also in the final memo, in a section titled “Evidence Summary and Analysis,” CMS notes that several commenters “disagreed with our summary of the clinical evidence and analysis” in the NCA of the proposed memo and that some of them felt that “the overall tone of the review was not neutral and seemed biased or flawed.” The CMS team disagreed with this contention, insisting that “the summary and analysis of the clinical evidence are objective” and that, “As with previous [national coverage analyses], our review of the evidence was rigorous and methodical.”
Despite these pronouncements, however, CMS made substantial changes to the final memo regarding the analysis of clinical evidence. Both the proposed and final memos include a section called “Knowledge Gaps” that discusses the limitations of the current evidence in the literature.
This section was much larger in the first memo. And it included a crucial observation: “The results were inconsistent, but negative in the best studies, i.e., those that reduced confounding by testing patients prior to and after surgery and which used psychometric tests with some established validation in other large populations” (emphasis added). That entire sentence was struck from the final memo.
Also gone were large swathes of text that covered the Swedish paper, described in the proposed memo as “the most comprehensive study with functional endpoints of the 33 studies reviewed.” The final memo never explained why the Swedish study had been considered so comprehensive.
Similarly missing was the entire section on “Mortality and Regret as Endpoints.” In the proposed memo, that section had argued that death and regret (measured by surgical reversal) represented more “objective” measuring sticks than did psychometric measures. Gone, too, were statements from the Swedish study that “[r]eassignment surgery does not return patients to a normal level of morbidity risk,” and that this risk “is significant even in highly vetted patients in a structured care system.”
The final memo made subtler changes, too. A sentence that appeared in the proposed memo reappears in the final memo, but in modified form. “Much of the available research has been conducted in highly vetted patients at select care programs integrating psychotherapy, endocrinology, and various surgical disciplines and operating under European medical management and regulatory structures.” The struck reference to Europe and its regulatory structures—or even the seemingly innocuous fact that most of the studies emanate from Europe—apparently had to go. Readers familiar with the general European trend of restricting “gender-affirming care” can draw their own inferences.
Gone, finally, from the final memo is a discussion under patient care about the necessary surgical expertise and care settings for the administration of these procedures. “The surgical expertise and care setting(s) required to improve health outcomes in adults with gender dysphoria remain(s) uncertain. The selection of a particular surgeon could become an important variable if subjective outcomes depend on functional surgical results. . . . Many of these procedures involve complicated gynecologic, urologic surgical techniques accompanied by significant risk. . . . Most of the studies for reassignment surgery have been conducted in northern Europe at select centers with integrated care (psychological, psychiatric, endocrinologic, and surgical) in which there is sequential evaluation of patients for progressively more invasive interventions.” (Emphasis added.) This omission likely occurred because the recommendation amounted, de facto, to a barrier to access—at the time of writing, very few surgeons were qualified to carry out these procedures in North America—and observed that such procedures are highly complex and risky.
It’s hard to avoid the conclusion that, in its final memo, CMS tried its best to paint a rosy picture of “gender-reassignment surgery.” It did so by misleading the public—not only mischaracterizing the state of the evidence but also, it seems, leaving out details about what these procedures actually involve and what risks they pose.
It wasn’t the last time that HHS would provide cover for dubious conduct in the gender-medicine field. On April 5, 2019, a group of clinicians wrote a letter to Jerry Menikoff, then the director of the Office for Human Research Protections at HHS, alerting him to ethical concerns regarding an ongoing NIH-funded study on the use of “gender-affirming” cross-sex hormones in children as young as age eight. The study’s principal investigator, Johanna Olson-Kennedy, is one of the most prominent figures in the world of youth gender medicine and is known for (among other things) devising dubious research to cement the practice of double mastectomy in teenage girls.
The authors of the letter to Menikoff emphasized several critical problems in Olson-Kennedy’s study, including the lack of a control group, the extremely young age of eligibility (much lower than 16, which is what European countries were recommending at the time), the dangerously high doses participants were being given, the risks of long-term harms including infertility, and the lack of informed consent.
The clinicians did not hear back from Menikoff, but they did receive a response from Diana Bianchi, director of NIH’s National Institute of Child Health and Human Development, who dismissed their concerns. According to Bianchi, the participants in the study “sought and obtained the hormonal therapies independent of the [study’s] protocol. Therefore, termination of the protocol would not end the treatments; rather it would only end the compilation of data needed to advance scientific understanding of the risks and likely outcomes of those treatments.” In other words, according to NIH, there was no ethical problem with Olson-Kennedy and her colleagues conducting an uncontrolled experiment on vulnerable young teens because they were not technically conducting an experiment; they were merely observing the effects of an already proceeding medical intervention.
Bianchi’s assumption that the researchers intended to “compil[e]. . . data needed to advance scientific understanding of the risks and likely outcomes of those treatments” turned out to be overly optimistic. When the researchers—who thus far have received over $9 million for this study from the taxpayer-funded NIH—published the first round of their findings in the New England Journal of Medicine in 2023, their study contained serious methodological problems. The results were far from impressive and mischaracterized by the authors, who also seemed unconcerned that two of their 315 adolescent participants had committed suicide after commencing hormones.
In July 2020, the Agency for Healthcare Research and Quality (AHRQ), an entity within HHS responsible for conducting systematic reviews of evidence, received a request for just such a review from the American Academy of Family Physicians (AAFP) on “Treatments for Gender Dysphoria in Transgender Youth.” Unfortunately, the agency wound up shirking its duty to provide a major medical association with accurate information about this dubious practice.
To ensure “gender-affirming care” was not already being studied systematically, AHRQ searched a database in which researchers register their protocols. On doing so, it apparently learned that researchers at Johns Hopkins University were already conducting several reviews on behalf of WPATH. (Court documents would eventually reveal that WPATH manipulated those evidence reviews.) In any case, WPATH had commissioned the reviews from Hopkins as part of a process to revise its “Standards of Care,” a document that has received wide deference from doctors, clinics, insurance carriers, state and federal health authorities, lawyers, and journalists.
Shortly after receiving the request from the association of family-medicine doctors, AHRQ reached out to the Hopkins team to inquire about whether they were examining outcomes for minors. The lead Hopkins researcher wrote back that they had “found little to no evidence” about the use of medical gender transition in “children and adolescents,” but that they were “having issues” with their “sponsor [WPATH] trying to restrict our ability to publish.”
Six months later, on January 8, 2021, AHRQ released a memo explaining why it would not conduct a systematic review of youth gender transition. “[W]e found protocols for two systematic reviews that address[] portions of the [AAFP] nomination,” the agency explained, “and an insufficient number of primary studies exist to address the remainder of the nomination.” One of the two protocols the agency cited was the WPATH review itself. The second “protocol” AHRQ cited was not a systematic review protocol at all but a single study on double mastectomy performed on “transmasculine youth” at “one pediatric center.” The study was published in the International Journal of Transgenderism, the official journal of WPATH.
In other words, a branch of HHS dedicated to evaluating empirical evidence told a major medical association of family practitioners that a review was underway—despite having learned six months earlier that the sponsor of that review was actively trying to prevent its publication.
That AHRQ listed these WPATH-affiliated “protocols” as a reason not to conduct a systematic review is suspicious. It is especially so considering that, in the decision memo, AHRQ noted, “There is a lack of current evidence-based guidance for the 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 there are some existing guidelines and standards of care, most are derived from expert opinion or have not been updated recently.” Why, then, credit WPATH’s attempts to make the record show otherwise?
The agency’s decision also seemed to be at odds with its own criteria for when to do a systematic review. In an appendix to its decision, the agency explained that a systematic review is appropriate when, among other things, there is no “recent high-quality systematic review . . . on this topic” and when “clinical benefits and potential harms” from some intervention are in question. The family-practitioner association mentioned some of those harms—including cancer and cardiovascular disease—in its letter; in its exchange with Hopkins, AHRQ had asked if the university’s team was planning to look at these risks. “I don’t think any of the planned manuscripts would be an overlap [with the AAFP questions],” the Hopkins lead author replied.
Months after the exchange between AHRQ and the Hopkins team, Rachel Levine—the Biden administration’s transgender assistant secretary for health at HHS, who advocates “gender-affirming” interventions in minors—pressured WPATH to eliminate age minimums for medical procedures, including surgeries, in its soon-to-be-released updated standards of care (known as SOC-8). WPATH complied, issuing a correction several days after publication and doing away with age minimums. After news of Levine’s role in shaping SOC-8 broke, the Biden White House half-heartedly walked back its support for gender surgeries for kids. Levine, who is a pediatrician, is currently scheduled to be a keynote speaker in the American Academy of Pediatrics’ upcoming national conference in Orlando, Florida.
Around the same time that Levine was meddling in WPATH’s guideline development process, the Food and Drug Administration, itself an HHS agency, released a warning about brain tumor–like symptoms that can result in vision loss associated with use of puberty blockers. The conservative group America First Legal promptly served the FDA with a Freedom of Information Act request for FDA communications regarding the off-label use of puberty blockers in transgender procedures.
The request returned correspondence between Reuters journalists, who were working on a series of articles about youth gender medicine, and FDA officials. “I saw mention of a 2017 FDA safety review of these drugs related to CPP [central precocious puberty],” the journalist wrote. “There are questions about bone health, brain development and fertility. Did anything come out of that? Has FDA done anything in relation to their off-label use for gender dysphoria in children?”
The official who received the email from Reuters forwarded it to colleagues for help. An official whose email signature designates her as “Clinical Team Leader” for the “Division of General Endocrinology” wrote back to her colleague:
Most of these patients had CPP but a handful were transgender kids using the drugs off label. We found no effect on bone (after factoring in catch-up growth), including no increase in fracture risk. We did find increased risk of depression and suicidality, as well as increased seizure risk and we issued [safety labeling changes] to the entire class for these [Adverse Events] (added to [Warnings and Precautions] in 2017). . . . Regarding use of GnRH agonists in the transgender population, no company [that produces puberty blockers] has come in for this indication to date. DUOG [Division of Urology, Obstetrics, and Gynecology] has done a patient listening session with trans kids and separately with trans adults, which I participated in, and there is definitely a need for these drugs to be approved for gender transition, as they are typically not covered by insurance and are expensive out of pocket. It was my understanding that DUOG would take these applications if and when any do come in.
These four examples (and there are likely more) tell a grim story. Key figures and departments within HHS have repeatedly failed to live up to the agency’s mission to improve “the health, safety, and well-being of America.” These failures may have been intentional. They may have been the result of incompetence. They may have reflected unwarranted trust in researchers presumed to be concerned with scientific evidence above political agendas. Or they may reflect standard bureaucratic pathologies, from excessive red tape to deficiencies in intra-agency communication and coordination. Whatever the reason, the outcome is clear: HHS has misled the public about gender medicine under Democratic and Republican administrations alike.
By: Hannah Barnes
Published: Sep 27, 2024
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.
By: Paul Terdal
Published: Jul 2, 2024
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.
[ Via: https://archive.today/WcL66 ]
By: Madeleine Rowley
Published: Jun 25, 2024
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.”
This is what a slow retreat looks like.
At least they're admitting it's a form of medically assisted self-harm.
By: Jesse Singal
Published: Jun 27, 2024
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.
[ Via: https://archive.today/wJCI7 ]
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So, there are 6 completed reviews sitting somewhere, that WPATH knows shows undesirable (to them) results. And they know it. And despite - or perhaps, because of - that, they wrote the insane SOC8 anyway. And then, at the behest of Rachel Levine, went back and took out the age limits, making it even more insane.
This isn't how science works, it's how a cult works.
When John Templeton Foundation commissioned a study on the efficacy of intercessory prayer, a study which unsurprisingly found that it's completely ineffective, it was forced to publish the negative results.
So, even the religious are more ethical than gender ideologues when it comes to science. This is outright scientific corruption.
By: Margaret McCartney, GP, Glasgow
Published: May 30, 2024
Publication of the Cass review in April 2024 was a seminal moment in contemporary medicine. Hilary Cass, a consultant paediatrician, was commissioned by NHS England to report independently on “the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence.” The background was an increase in referrals—of mainly “birth registered females in early teenage years”—to gender identity clinics from 2014 at an “exponential rate.”
The conclusions of the Cass review should not be surprising to anyone who has watched the promotion of medical interventions as necessary or curative in young people with gender dysphoria. As Cass states, there is a “lack of evidence” on the long term impact of hormonal prescriptions in young people, for example. Work now begins on how to design better, more evidence based, holistic services. The conclusion that services “must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors” is astonishing, in that it needed to be said. We need, says the report “a different approach to healthcare, more closely aligned with usual NHS clinical practice.” In other words, this suggests that the approach the NHS has taken with respect to gender dysphoria has been at odds with the usual, evidence based approach taken elsewhere. This should be deeply discomfiting. As the dust settles, and we reflect on the report’s conclusions, we should ask why this has happened.
There are multiple potential explanations. One is alluded to clearly by Cass: “the toxicity of the debate is exceptional,” she writes. Indeed. I know many senior medics who were concerned about the lack of evidence for interventions, but felt their reputation and job would be under threat if they spoke up. Anonymous personal attacks online is one thing; personal abuse from senior medics for raising clinical concerns is quite another. When considered in the context of whistleblowing more broadly, medicine clearly has an ongoing problem.
But when it comes to large, well funded, professional medical organisations, there is even less excuse. The job of medical institutions is in large part to remember the mistakes of history. These organisations should respond with care, consider evidence, uncertainty, and the recurrent tendency of well meaning medicine to do harm with good intentions. Popularity should be resisted over the need for evidence and caution. This requires strong leadership. Shutting down, or trying to shut down debate about serious clinical uncertainties—as has happened—is unacceptable.
This has not been helped by the multiple lobby groups, welcomed by many institutions to influence their policy making in this area. The same rules that we would normally use to guard relationships with any other pressure group—be it promoters of disease “awareness campaigns” or party politicians looking for support—seem to have dissolved against social pressure to achieve a compliance badge on a website.
The other explanation for what has happened that I think pertinent is this. Doctors, quite rightly, have been afraid to make the same mistakes as medicine did when homosexuality was treated as an illness in the 1950s. Then, electric shocks, desensitisation, hormones, and psychotherapy were attempted to be used to “treat” homosexuality—shamefully. What medicine did then was to intervene—ineffectively and harmfully—in something that was not a disease and should not have come under a medical purview. As Cass states, for most young people experiencing gender dysphoria, it is temporary; it is often associated with neurodiversity; it mainly resolves over time, and medical intervention does not benefit the majority. There is a comparison, but it is in favour of medicine backing off from prescriptions and surgery, and understanding why a phenomenon might be happening, why it is being seen in a medical context, and what is the best and least harmful way to respond to such expressed and profound distress.
I urge major medical institutions to treat the Cass review as a significant event, and consider what they have contributed, both negative and positive, to the damning conclusions. Was speaking up in their organisation possible, and welcomed? Did people raising concerns have fair hearings, or were they attacked or dismissed? Did the organisation enable rational debate, or instead attempt to shut it down? Did the organisation acknowledge uncertainty and the potential for harm in current practice? I don’t expect any of that to be easy. But without understanding what has happened, we will only be ready to make the same mistakes again, just in a different set of circumstances.
By: Benjamin Ryan
Published: Jun , 2024
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.
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Having all of this corruption, coverups, ideological capture, and violation of medical ethics on the legal record heralds the coming end of WPATH.
