This statement by @AAPPres of @AmerAcadPeds, in response to the interview with Hilary Cass in the NYT times, is so utterly dishonest. It implies that the AAP's position was articulated in response to state age restriction laws. 1/5 The AAP's policy position was published in 2018--well before age restriction laws were first introduced in the states (2020).



@AbigailShrier's Irreversible Damage, which brought the issue to public attention, also didn't come out until 2020. 2/5publications.aap.org/pediatrics/art…

NEW: UCSF's (@UCSF @UCSF_IHPS) Dr. Jack Turban (@jack_turban) claimed at @theDPUnion debate that the Cass-related systematic reviews found moderate quality evidence that puberty blockers improve mental health.

In a new article, I explain why this claim is false.

⬇️⬇️⬇️ 2/ First, Turban confuses quality of studies with quality of evidence. These are distinct concepts in evidence-based medicine, and any clinician opining on the evidence base of medical treatments should understand the difference.

UCSF's (@UCSF @UCSF_IHPS) Jack Turban (@jack_turban) claims that a new systematic review of the evidence for puberty blockers, published alongside the Cass Review (@thecassreview), finds “moderate quality evidence" for the use of these drugs in youth gender medicine.

⬇️⬇️⬇️ In an upcoming article, I explain how Turban confuses quality of studies with quality of evidence—two very different concepts in evidence-based medicine—and ignores the significance of the scoring tool the authors of the systematic reviews used. 2/

I just read the complaint filed by the ACLU of Ohio (@acluohio) asking a state court for temporary injunction against HB68, the new law that restricts “gender-affirming care" to adults only.

What a mess of a document.

⬇️⬇️⬇️ 1. ACLU can’t seem to decide if it’s alleging disparate treatment or disparate impact. These are different theories for why some law or policy may violate civil rights or constitutional provisions.

Andrea Long Chu's (@andrealongchu) March 11th cover story for @NYMag has sparked some thoughtful reflection in liberal journalism.

⬇️⬇️⬇️ Chu’s essay is worth reading. It makes the case for unrestricted minor access to hormones and surgeries, ignores everything we know about child and adolescent psychology, and openly states that humans have no obligation to come to terms with reality.

The Mary Bridge Children's Gender Health Clinic (@Mary_Bridge), which is part of MultiCare health system (@MultiCareHealth) in Tacoma, Washington, and site of whistleblower Tamara Pietzke, offers kids resources on binding and tucking. /1

⬇️⬇️⬇️ Tucking is the process by which boys push their testicles up into the inguinal canal, use their testicle-free scrotum to wrap their penis, and then secure their wrapped penis within their butt cheeks using methods like compression underwear or tape. /2

With the release of the WPATH Files, it's important to keep in mind that WPATH has been using mainstream medical associations like the Endocrine Society (@TheEndoSociety) to launder its pseudoscientific claims and promote experimental and harmful practices.

A thread. At least 6 of the 10 authors of the Endocrine Society’s 2017 Clinical Practice Guideline were/are WPATH members. That guideline is still in effect today.

In a new article for @CityJournal, MI's Joe Figliolia explains the problems with the "minority stress" hypothesis in the context of "gender-affirming care" and the mounting evidence against it. /1

city-journal.org/article/gender… The "minority stress" theory occupies a central role in the "gender-affirming" worldview and model of care. It is used to explain the extremely high rates of coexisting mental health and neurocognitive problems in trans-identified youth. /2

UCSF’s Jack Turban (@jack_turban) and Yale’s Meredithe McNamara recently criticized a new Finnish study that further weakens the “suicide prevention” narrative.

Their criticisms are wrong and hypocritical.

Here’s why. 🧵 To recall, the Finnish study found that suicide in gender clinic-referred (GR) youths <23 was uncommon (0.3%), and when the model adjusted for severe psychiatric comorbidities, there was no statistically significant difference in suicide rates between GR youth and controls. /2

1/ 🚨Some MultiCare UPDATES following Tamara Pietzke blowing the whistle in The Free Press and my follow-up report in City Journal. 2/ The Mary Bridge Children's Gender Health Clinic, which is owned and operated by MultiCare, has deleted a webpage where the clinic's social worker, Aytch Denaro (they/them), proudly reports: "Since joining Mary Bridge Children’s Gender Health Clinic in 2019, I have witnessed our referrals increase from less than five to more than 35 monthly."

1/ UPDATE: I've received email communications between Tamara Pietzke, the new whistleblower from the state of Washington, and her coworkers and supervisors at MuiltiCare. I will be making these emails public soon, but in the meantime, here's a snippet of what's inside them. 🧵 2/ On January 2, 2024, a month before Tamara went public, she sent an email to MultiCare's "gender-affirming care" specialist (who is also part of MC's DEI team) expressing her concerns about a young teen girl whose heartbreaking story was among those revealed in the Free Press article.

The 10 most popular NYT reader comments to the piece on detransitioners and the harms of "gender-affirming care" today: ⬇️⬇️⬇️ 1. "I predict we will look back on this period with the same disgust we feel about the overprescription of amphetamines like Adderall to every 8-year-old boy who couldn't sit still for an entire day. The most damage is often done by doctors and parents who are so well-meaning that they cease to think critically."

Pamela Paul's piece on detransitioners and "gender-affirming care" in the New York Times today is a welcome journalistic contribution to the ongoing debate on a thorny subject.

Paul gets many things right and one thing wrong.

Thread 🧵 Let's start with what Paul gets rights.

1. The recommendations of U.S. medical associations are out of sync with a growing number of countries and are not based on reliable evidence. These groups are not accountable for the harmful practices they are promoting.

Every time I recommend "The Myth of 'Reliable Research'" to medical professionals, they tell me it's a superb article, research at its finest.

They're not wrong.

A thread 🧵 The foundation for sex trait modification in minors ("gender-affirming care") is a Dutch study, published in two papers (2011 and 2014), and widely cited even today, even by transgender advocacy groups like WPATH, as the gold standard of research in this area.

🚨🚨 IMPORTANT 🚨🚨

The World Health Organization is convening a guideline development group (GDG) on gender medicine.

I rarely circulate or ask followers to sign petitions, but I’m making an exception because WHO’s actions are very troubling.

Thread. ⬇️ On December 18, WHO announced that it will be developing a guideline on “the health of trans and gender diverse people.” As the petition notes, there are three areas of concern here.

NEW: In a Letter to the Editor in Archives of Sexual Behavior (@ArchSexBehav), Lisa Littman (@LisaLittman1), Michael Biggs and I analyze a recent study by Jack Turban (@jack_turban) of @UCSF and colleagues related to #ROGD.

Thread 🧵 Turban et al.’s paper, “Age of Realization and Disclosure of Gender Identity Among Transgender Adults,” was published in the Journal of Adolescent Health last March.

jahonline.org/article/S1054-…

LEAKED 🚨🚨: The American Academy of Pediatrics (@AmerAcadPeds) is instructing its members to avoid using work emails when communicating about “AAP matters,” especially “sensitive topics,” due to concerns about “subpoenas” and “FOIA requests.” The directive from CEO Mark Del Monte (a lawyer) takes force on January 1, 2024, and applies “only to members who serve on committees councils, sections, task forces, editorial boards, [and] other advisory bodies.”

NEW: In an important Letter to the Editor, bioethicist Moti Gorin (@GorinMoti) criticizes a recent article by lawyer and transgender activist Alejandro Caraballo (@esqueer_), titled “The Anti-Transgender Medical Expert Industry,” published in @JLME_ASLME.

Thread 🧵 As state age restriction laws on “gender-affirming care” are fought over in the courts, a key question is who counts as an expert in pediatric gender medicine, and thus whose testimony should guide judges in their decisions.

NEW: The Patient-Centered Outcomes Research Institute, a 501(c)(1) organization created by Congress as part of the Affordable Care Act of 2010 and funded by taxpayers, is channeling a $7,000,000 grant to the Oregon Health & Science University to run a randomized trial of virtual peer-support groups for trans-identified males seeking vaginoplasty.

The STRIVE (Support for Transgender and Nonbinary Individuals Seeking Vaginoplasty) study will recruit 260 individuals at six hospitals who are seeking the procedure and assign them at random to two groups: one receiving only the standard pre-op consultation of the surgical team, and the other receiving “virtual group-based peer support intervention led by [post-op] trans peers” over 3 months.

PCORI cites “high demand” for vaginoplasty and lengthy wait times, which it says lead to various negative psychological outcomes. “The primary outcome to be measures [sic] at six months is coping self-efficacy, reported by patients, using a survey which assesses perceived ability to deal with stressors.” The planned total follow-up time is 3 years.

According to OHSU’s job listing for project lead, no qualifications are required other than “having experience with trans peer support and community-based research” and being “passionate and knowledgeable” about these issues.

OHSU is a leading institution for pathbreaking genital surgery and home of Dr. Blair Peters (aka “Queer Surgeon”), who has spoken of performing a la carte procedures such as “phallus preserving vaginoplasty.”



See also here:

In the past, vaginoplasty was done on a very small number of males, typically in their forties. Nowadays, the main patient demographic in adult gender clinics appear to be older adolescents (18-19) and young adults (20-25). Age for participation in the PCORI study is 18 and up.

Post-op complications are common in vaginoplasty (20-70%), though major complications requiring surgery are said to be less common. Vaginoplasty following pubertal suppression carries extra risk due to lack of penile tissue for inversion and resulting need to borrow colon tissue. The Dutch study had a patient who died as a result of a related complication (a fatality rate of almost 2%).

Some studies report high rates of satisfaction from genital surgery, though due to high rates of loss to follow-up these studies do not provide an accurate picture. The true rate of long-term satisfaction is unknown.

In 2018, a group of former patients wrote a letter of complaint to the gender surgery program at OHSU. They gave vivid examples of incompetence and iatrogenic harm, and emphasized that “too many people have come out of the program harmed without the financial or social means to do anything about it.”

One patient wrote: “Prior to surgery I had been expressing reservations to my therapist who wrote one of my letters, and was hesitating the day of surgery to begin. I was asked after being administered part of the anesthetic, before going under to sign consent papers. I believe I was coerced into this surgery by my doctors for whatever reason. I felt like as soon as it had been covered by insurance, I was rushed into it and not given proper informed consent.”

(I will try to attach the letter after posting the thread.)

I recently wrote about a lawsuit filed against Fenway Community Health Center in Boston by a gay man who was wrongly approved for genital surgery. What the plaintiff needed was help accepting himself as an effeminate gay man, not surgery to make him resemble a woman.



A key question for the scientific rigor of the proposed PCORI study is how coordinators will recruit support group leaders. Will they recruit only post-op people who are satisfied with their procedure and have no serious complications? Or will they also recruit people who are dissatisfied/have mixed feelings and/or who have challenging complications?

The Tavistock-trained psychiatrist Az Hakeem ran a support group comprised of “post-operative patients who were mainly depressed and a group of pre-operative patients who are mainly gender euphoric with exciting fantasies of what their life will become… The post-op patients were able to challenge the pre-op idealists with a more reality-based understanding of the limitations of what they were about to pursue and the regrets that they faced.”



At a recent gender medicine conference at Tampere University in Finland, Hakeem said that over 90% of vaginoplasty seeking adults decided not to go through with the procedure after hearing from post-op individuals with negative experiences. This was not a random sample, so findings should be taken with caution.

A truly randomized trial would not only allocate procedure seekers into peer-group and non-group cohorts. It would also assign participants in the peer-group arm to groups led by post-op trans people with diverse experiences. Even then, extrapolating generalizations would be difficult due to the individualized nature of this form of pre-op counseling. Regardless, lowering expectations about what surgery can realistically do and what its complications might be might be conducive to better mental health later on.

Will the taxpayer-funded PCORI grant be used to churn out yet more methodologically limited and biased research in support of a pre-approved narrative?

More fundamentally, why is this study being done at all? Patient support groups are now common practice in medicine. If the study’s outcome is that support groups help, that is already the hypothesis of the lead investigators. If it shows that it doesn’t do much, do we really expect these groups to vanish? Rare is the gender clinician-researcher who is genuinely interested in rigorously tested his/her hypotheses.

Another explanation for this study: it is a thinly veiled jobs-creation scheme for those seeking careers in trans medicine. PCORI should use its resources to address collective action problems in medical research--funding studies that are not politically popular or driven by financial (e.g., Pharma) interests.

This study seems like a waste of scarce resources. Why not put the money into a study of long-term health risks associated with adult transition? Risks are rarely studied in this context.

Link to PCORI announcement: 2018 letter to OSHU gender center from former patients (screenshots 1/3)

IMPORTANT 🚨🚨🚨: Finland's leading gender clinician and researcher, Dr. Riittakerttu Kaltiala of Tampere University Hospital, warns of a medical scandal in the U.S. and urges our medical societies to recommit themselves to science and safeguarding.

thefp.com/p/gender-affir… "Medical organizations are supposed to transcend politics in favor of upholding standards that protect patients. However, in the U.S. these groups—including the American Academy of Pediatrics—have been actively hostile to the message my colleagues and I are urging."

NEW: A new, must-watch Dutch documentary film examines the shaky foundations of the Dutch study and the rising doubts in Europe over pediatric sex trait modification for minors.

1/4 The documentary includes interviews with gender medicine pioneer Annelou de Vries and other key figures. It was produced for BNNVARA, "a merger of the progressive VARA and the youth-centered BNN" (Veerbeek et al., 2022) and part of the Dutch public broadcasting network.

2/4