King’s College London on Friday announced that, after a period of reflection and regrouping amid outcry from all sides, the leaders of the much-debated, much-ballyhooed National Health Service clinical trial of puberty blockers for gender-distressed youths would continue largely as planned.

The study’s design has received just a few tweaks, most notably the addition of new minimum ages for participants: 11 years old for natal girls and age 12 for natal boys.

Otherwise, it’s full steam ahead for the £10 million, or $14 million, study.

But anyone who understands even the basic parameters of how pediatric gender medicine works—and what the central purpose of this medical field is—can see that this clinical trial, which if designed properly might have afforded the world some desperately needed insights into these controversial medical practices, is headed straight into the scientific abyss.

Multiple observational studies, including one conducted by the NHS itself and published in 2021 and another, long-delayed study out of the United States that finally emerged in preprint last year, have already found that minors who take puberty blockers to treat gender dysphoria or gender incongruence see essentially no change in major mental health metrics. Such disappointing conclusions stood in contrast to the more glowing findings of the foundational cohort study out of the Netherlands that was published in 2011 and helped spark global excitement and launch the pediatric gender medicine field worldwide.

The authors of the U.S. puberty-blocker study, led by Dr. Johanna Olson-Kennedy, formerly of Children’s Hospital Los Angeles, rationalized the lack of apparent benefit from taking puberty blockers by suggesting that the mental health of youths on these drugs would have worsened absent the medication.

That may very well be true, and such a premise points to the fact that these medications have only ever been meant to tee up treatment with cross-sex hormones. A coterie of pediatric gender medicine advocates, in fact, wrote an amicus brief for last year’s U.S. Supreme Court case over Tennessee’s ban of gender-transition treatments for minors in which they criticized Britain’s Cass Review for conceiving of blockers and hormones as anything but part and parcel of one another.

The fact is that almost all youth who take blockers for gender dysphoria go on to take hormones, according to multiple studies, including at the NHS. As British journalist Hannah Barnes wrote in her seminal investigation of the NHS’s doomed pediatric gender clinic, Time to Think, it is essentially unheard of in psychology to have any sort of test that has a close-to-perfect accuracy rate. In other words, gender-clinic providers haven’t simply succeeded brilliantly at selecting all the right kids to put on this treatment pathway, especially given how cursory, rushed or non-existent the assessment process can be at these clinics.

Considering all this, it is abundantly evident that gender-dysphoric adolescents have never conceived of the period they must spend on blockers as a “time to think” about their gender, as leaders in pediatric gender medicine long misled the public to believe (that is, before at least some of them conducted an about-face and started insisting, accurately, that blockers and hormones are simply part of a continuum). These youths quite clearly view the blockers as a waystation, a temporary burden they must satisfy on behalf of adult authority figures before they get what they actually want: hormones.

Given the planned NHS study, called PATHWAYS, has a randomized element—youths will be randomly assigned to go on blockers immediately or following a one-year delay—there was at least some hope that the study could have produced higher quality evidence than the critically flawed collection of studies that have been produced to date.

None of the past or ongoing studies of gender-transition treatment for youths have been randomized controlled trials. Instead, they are largely a messy and compromised collection of prospective cohort studies that for the most part have no comparison groups and typically have short follow-up times of 12 to 24 months. Or, in the case of Kristina Olson’s study out of Princeton, there is an ever-lengthening follow-up time, but the cohort is not at all representative of the typical youths presenting at a gender clinic these days, given the participants typically socially transitioned very young, by age six or seven.

So the whole world has turned its eyes Britain in hopes that, being an island nation that in 2024 passed a strict legislative ban of puberty blockers for minors outside of a clinical trial, the NHS might manage to recruit and retain a sizeable population of youths seeking gender-transition drugs. Denied other (legal) means of obtaining these drugs (hormones are blocked for those under 16 and are increasingly hard to get even for older minors in the UK), British youths might stay in the study even if they aren’t randomized to receive blockers immediately.

But if youths in PATHWAYS aren’t provided hormones after starting blockers, it is highly likely that all we will learn from this lengthy and expensive clinical trial—youths are set to receive blockers for up to two years and the study is slated to run for five-and-a-half years overall—is more of what we already know: that not much happens psychologically when these kids take blockers.

Furthermore, there isn’t much puberty actually to arrest among the youths who present at gender clinics these days. Recent research out of the United States, including one analysis of national insurance data and a comparable analysis focusing on Oregon, have suggested that only a fraction of the minors who receive gender-transition interventions actually take puberty blockers. And an even smaller minority start such treatment when they are young enough to be in puberty’s early stages.

The typical youth who presents at a gender clinic in the Western world these days, including in England, is a 14- to 16- year-old biological girl who only began exhibiting gender-related distress after puberty’s onset. PATHWAYS will only accept youths who are under age 16 when entering the study. So, given the age and sex breakdowns of youths upon their referrals to Britain’s since-shuttered gender clinic (see the chart below, from the 2024 Cass Review), that means that the bulk of the youths eligible for this new study will likely be 14- and 15-year-old natal girls.

Such youths are likely either in the final phase of puberty or are entirely finished with the developmental process. PATHWAYS, per its inclusion criteria, welcomes youths who are in any of the so-called Tanner stages of puberty, from Tanner 2 (the earliest phase) to Tanner 5 (meaning puberty is finished). So by the study authors’ own admission, they are perfectly willing to give puberty blockers to minors with no puberty to block.

Given that natal females have no physiological need to take blockers in advance of starting testosterone (for natal males, blockers can help suppress their natural testosterone production and thus supplement estrogen treatment), for these youths, starting blockers amounts to all risks with no clinical purpose.

Representatives for King’s College London, which is leading the trial on behalf of the NHS, did not respond to my brutally frank request for comment. Otherwise, in their press release announcing the slight revisions to the trial, they stated: “We will always welcome scrutiny of research involving children and young people because their health and safety is paramount. Our priority remains to safely, and robustly, investigate the benefits and risks of puberty suppression for young people with gender incongruence to improve the evidence base and inform NHS healthcare.”

The PATHWAYS study does have an important element in which some of the youths will receive a series of brain scans. This is perhaps the only part of the overall research endeavor that could yield vital results that could help inform worldwide care of gender-dysphoric youths. According to a 2024 review paper, scientific knowledge of the impacts of puberty blockers on the brain remains woefully thin. And there are concerns that the powerful drugs might have deleterious impacts on neurocognition.

Blockers are supposed to be the warm-up act to the main event, in which, at least in theory, people who identify as transgender spend a lifetime on cross-sex hormones—or, in the case of natal females in particular, they stay on testosterone long enough to permanently deepen the voice and prompt the permanent growth of facial and body hair.

Considering all this, why in heaven’s name isn’t the NHS planning to study cross-sex hormones in youths?

Is this study simply an expensive charade to kick the political can down the road?

I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net

After spending the better part of two months this past winter watching conference videos from the World Professional Association for Transgender Health, or WPATH, I concluded that the most mind-scrambling paradox in transgender medicine emerged from sessions concerning the care of Native Americans who identify as two-spirit.

First off, as I learned from one particular conference session, the full recording of which I’ve published above, the term “two-spirit” wasn’t even coined until the 1990s. One presenter in this session said that the term was cooked up to differentiate from traditional Western approaches to the sex binary the means by which Indigenous populations experienced identities that fall outside of the sex binary. So one can’t help but wonder if the very idea of being two-spirit was shoehorned into what became the contemporary Western LGBTQIA+ identity politics.

But more striking was this conference session’s baffling suggestion that, above all else, healthcare for two-spirit Native Americans needed to be decolonized, and yet in the process these patients ought to receive Western medicine’s approach to transgender identity: cross-sex hormones and gender-transition surgeries.

This glaring contradiction remained under the surface and unacknowledged throughout this session; the speakers never made any direct effort to square the circle.

Nevertheless, as they uttered streams of what I call publichealthspeak (word salad that says little of actual substance but accomplishes the central goal of signaling the virtue of the speaker) and made lots of references to the vital importance of honoring intersectionality, they left me pondering the following two questions:

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The use of gender-transition drugs among insured adolescents in Oregon soared between 2016 and 2023, charting a nearly 10-fold increase among biological girls and a 14-fold increase in natal boys. Across this period, about 1 in 100 insured youth ages 8 to 17 in the Pacific Northwest state were diagnosed with gender dysphoria, a psychiatric condition involving distress stemming from a conflict between an individual’s natal sex and their gender identity.

By age 17, about 1 in 240 insured natal girls were taking testosterone and about 1 in 630 natal boys were taking estrogen in Oregon. These figures are nearly three-fold higher for natal girls and nearly twice as high for natal boys as figures from a study published last year that analyzed national data on commercially insured youth from 2018 to 2022.

Oregon is among the most famously liberal states and is home to the notably progressive Oregon Health and Science University. Consequently, it is perhaps unsurprising that the state should have what appear to be disproportionately high rates of prescribing of gender-transition treatment to minors.

The new details about pediatric gender medicine in Oregon come from a study published in Research Connections on May 7. The study authors analyzed data on both publicly and commercially insured Oregon residents age 8 to 17 between 2016 and 2023. (They chose the age 8 for the lower end, because that is the earliest that puberty can begin and not be considered precocious puberty. ) The insurance database the authors relied upon covers about 80 percent of all insured Oregonians.

The investigators were keen to examine the rates of prescribing of puberty blockers and cross-sex hormones to treat pediatric gender dysphoria in a state that has a policy environment that is particularly supportive of pediatric gender medicine. Oregon’s Medicaid program started covering these treatments for minors in 2014. In 2023, the state passed a so-called shield law to protect youths’ access to gender-transition treatment.

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Out of 868,740 insured Oregonian youth in the data set, 0.98 percent were diagnosed with gender dysphoria, including 1.5 percent of natal girls and 0.5 percent of natal boys. This lopsided sex ratio is quite common across the Western world these days; whereas before the 2010s, the sex ratio of youth presenting at gender clinics was heavily slanted toward natal males. Few of the ardent supporters of pediatric gender medicine have expressed interest in thoroughly exploring the reasons for this dramatic flip in the sex ratio.

The new study’s authors noted that the gender dysphoria diagnosis rate in Oregon was lower than estimates of the population of youth identifying as transgender in the state, which range between 1.2 percent and 3.2 percent.

Of the group diagnosed with gender dysphoria in Oregon, 23 percent were ever prescribed gender-transition drugs, including 8 percent who received puberty blockers and 20 percent who received cross-sex hormones. Natal boys were much more likely to get puberty blockers (including 17 percent of those with gender dysphoria) compared with natal girls (including 5.5 percent). But their rates of cross-sex hormone prescriptions were similar, at 22 percent and 19 percent, respectively.

Youth with gender dysphoria had a higher rate of prescriptions of puberty blockers if they had commercial insurance, at 10 percent, compared with their publicly insured peers, at 7 percent. But the respective rates of cross-sex hormone prescriptions were about the same, at 20 percent and 19 percent.

Here are prescription patterns broken down by age and year and by type of insurance:

The median age at which youth were first diagnosed with gender dysphoria was 14 for both those with both commercial and public insurance. The median age at which youth received their first gender-transition treatment prescription was 15 for commercial insurance and 16 for public insurance. The median number of days between a gender dysphoria diagnosis and a first prescription of gender-transition treatment of any kind was 250 days for commercial insurance and 325 days for public insurance.

The earliest age at which any youth, natal boy or girl, received puberty blockers was 9. The earliest age at which any natal boy received estrogen was 10. And the earliest age at which any natal girl received testosterone was 12.

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Puberty blocker prescriptions were never particularly common in Oregon during the study period. They peaked at about age 14 for natal girls and at age 15 for natal boys—in both cases at a rate of about 75 prescriptions per 100,000 such youths, or 1 in 1,333 youths.

Cross-sex hormone prescriptions, on the other hand, began to inch up at age 13 for both natal sexes and then shot up dramatically through the mid-teen years for natal girls in particular. By age 17, about 414 in 100,000 natal girls were taking testosterone, or 1 in 242; while about 158 in 100,000 natal boys were on estrogen, or 1 in 632.

Note how similar the findings broken down by age from new study from Oregon (the first graph) are compared with the recent study looking at national data on commercially insured youth (the second graph). The rates of usage are much higher in Oregon, mind you. But the rates of increase of hormones and the overall pattern of the use of blockers broken down by age are very similar, lending confidence that these patterns represent a real-world phenomenon across the country, regardless of insurance type.

I recently reported in The New York Sun that from 2019 to 2023, Medicaid spent more than $100 million nationally on gender treatments and surgeries for minors. This was according to a recent government analysis. The particulars of the analysis suggested that a recent analysis by the nonprofit Do No Harm, which opposes pediatric gender medicine, finding that some 14,000 youths received gender-related treatments over a recent five-year period, was likely a considerable underestimate.

Across the eight-year study period in the Oregon study, the rate of testosterone prescriptions for all natal girls age 8 to 17 increased steadily from 28 per 100,000 girls in this age range in 2016 to 252 per 100,000 in 2023—a nine-fold increase. The rate of natal boys taking estrogen increased from 7 to 97 per 100,000 during this period—a 14-fold increase. The rate of increase for girls was particularly steep between 2022 and 2023.

Given this steady rate of increase in the use of gender-transition drugs over the study period, and given the fact that the prescription rates broken down by age represented an average over time, it is likely that by 2023, the rates of youth receiving cross-sex hormone prescriptions by age 17 was even higher than the 1 in 242 natal girls and 1 in 632 natal boys found in this paper. The study did not provide such granularity in its figures, however, including in the supplementary tables.

Over time, the proportion of youth diagnosed with gender dysphoria who received gender-transition drugs remained constant in Oregon, the study authors found. They suggested that this likely reflected “a combination of factors, including persistent structural and sys­temic barriers (e.g. access, insurance, provider availability, and consent requirements), variation in adolescents’ readiness for interventions, and the fact that not all [transgender] adolescents seek or require treatment.”

The interval between diagnosis and treatment, the study authors theorized, “may reflect a com­bination of factors, including guideline-concordant assessment, the variable timing of gender identity development, readiness for medical interventions, and, in some cases, barriers or delays in accessing care.”

Cross-sex hormone use, the authors wrote, “increased steadily across adolescence, reflecting guideline-recommended individualized initiation based on readiness and clinical judge­ment. These patterns reinforce that [gender-affirming care, or GAC] provision emphasizes ongoing assessment and individualized care rather than uniform uptake across adolescents.” I cannot see how they can know any of this based on simply looking at these data, however.

As for the reasons for higher use of gender-transition treatment among commercially-insured youth, the investigators wrote that “families with commercial insurance may, on average, have advantages in navigating complex care systems, reflecting differences in soci­oeconomic resources, caregiver advocacy capacity, geographic access, and provider availability. In contrast, publicly insured youth may encounter structural barriers—including limited avail­ability of trans-affirming providers, clinicians with less experience in GAC, transportation challenges, or financial constraints—that could limit access.”

The study is limited, in part, the authors wrote, by the fact that it does not cover uninsured youth and those insured by health plans that are not covered by the data set. This may limit the generalizability of the study findings, the authors stated.

I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net

Undergoing gender transition treatment did not appear to be associated with a long-term resolution of eating disorders among a population of Finnish youth, according to a new study.

The study calls into question previous scholarship that has suggested that prescribing cross-sex hormones to youths experiencing gender dysphoria will help treat eating disorders, such as anorexia or bulimia, among them.

The paper, which was published recently by the European Journal of Developmental Psychology, is one of a slew out of Finnish research team that over the past decade have collectively called into question the presumption that gender-transition interventions are widely beneficial to youths attending gender clinics.

One of the coauthors of the eating disorder paper, Dr. Riittakerttu Kaltiala, a psychiatrist at Tampere University in Finland, was tasked with founding one of the nation’s two youth gender clinics in 2011. After she observed that the patient population’s outcomes were not…

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The announcement prompted immediate outcry on social media from critics of pediatric gender medicine, given Dr. Johnson’s position as a leading Canadian provider of gender-transition interventions to minors at the McMaster gender clinic she directs.

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As an antidote, they frequently offered misinformation of their own, or at the very least made non-evidence-based claims.

This video of the conference session in question is the latest in an ongoing series I’m publishing of conference videos from WPATH and its US offshoot, USPATH, spanning 2021 to 2023. I covered the full scope of these videos as they applied to pediatric gender medicine in a recent article for Compact magazine. You can find the full roster of the videos I’ve published thus far here:

The title of the panel I’m focusing on in this Substack was: “When Science is Misused in law: How to Address the Biased Science that Underlies Legal Bans on Gender-Affirming Care for Youth.”

The panel was moderated by Anne L. Alstott, a professor at Yale Law School and included:

• Jennifer Levi, the director of the transgender rights program at GLAD, the LGBTQ legal advocacy group

• Dr. Christy Olezeski, an associate professor of psychiatry and the director of the Yale Pediatric Gender Program (she was on the program but wasn’t in attendance)

• Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale (who presented Dr. Olezeski’s slides and her own presentation)

• Dr. Nathalie Szilagyi, an instructor at the Yale Child Study Center

Dr. McNamara in particular has established herself as one of the leading voices straddling medicine and policy in the effort to protect minors’ access to gender-transition treatments. In recent years, she has often served as a paid expert witness in legal settings defending the medical field—a practice that is highly lucrative for witnesses on either side of this dispute.

Ms. Alstott and Dr. McNamara are the cofounders of The Integrity Project, which acts as a kind of rapid-response hub in the face of legal and scientific threats to pediatric gender medicine. The project is most known for putting out a white paper criticizing Britain’s Cass Review of this field.

has subjected that particular white paper to a withering three-part critique in which he said that it was guilty of spreading reams of misinformation.

The Manhattan Institute’s Leor Sapir published a scathing account of what he characterized as Dr. McNamara’s misrepresentation of her clinical experience. In an August 2024 article in City Journal, Dr. Sapir analyzed a deposition that Dr. McNamara gave in the federal lawsuit over Alabama’s ban of gender-transition interventions for minors. Most notably, Dr. Sapir focused on Dr. McNamara’s admission that she did not provide gender-affirming care herself; and since 2021, she had only ever referred two minors to a pediatric gender clinic.

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This admission is remarkable, given that Dr. McNamara has often suggested she is a hands-on expert in pediatric gender medicine. And indeed, in the 2022 WPATH panel, she suggested she was one.

What amazed me about this conference panel was how seldom the speakers rebutted misinformation with substantive information of their own. Oftentimes they simply sweepingly declared something untrue and expected the audience to take it on faith that this was an accurate assertion. This was not an unreasonable presumption, given how WPATH conference-goers almost never challenged the ideas of presenters—at least in the well over 100 videos that I watched during my reporting for Compact.

The 2022 legal panel was based on a certain bedrock of confidence among the speakers that their methods of combatting what they asserted was misinformation would help their movement prevail in the face of major, mounting political attacks on pediatric gender medicine. And while hindsight is 20/20, it is now clear that they were being wholly naive about just how aggressive—and ultimately successful—their opponents would be in this fight.

Little did they know that they were waging a fast-losing battle.

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Jennifer Levi

Ms. Levi expressed her dismay over what she characterized as “a coordinated, nationwide strategy to roll back protections” for the transgender community. This included attacks on pediatric gender medicine; school-related legislation that governed, for example, what could be addressed regarding LGBTQ issues in the classroom; and restrictions on cross-sex sports participation.

Regarding sports-related laws, Ms. Levi said, “The only tiny sliver of light here is that where these laws are challenged, courts have seen the bans for the bias that they reflect.”

In the coming weeks, the nation will see the culmination of that fight when the Supreme Court issues its ruling about the constitutionality of sex-based restrictions on sports participation and whether such restrictions square with Title IX. Legal experts expect the transgender plaintiffs will likely lose.

Speaking to laws banning pediatric gender-transition interventions, Ms. Levi said, “Proponents of these discriminatory laws and defenders of these discriminatory laws are actually abusing and misusing research to distort the truth and the underlying facts about transgender young people and the well-established medical care that many young people need.”

It is safe to say that Ms. Levi’s next assertion is contradicted by multiple systematic literature reviews of this medical field, which have found the evidence backing gender-transition interventions for minors wanting and uncertain. Journalist reported in BMJ in 2023, for one, that gender-transition treatment cannot be considered evidence based.

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This video is the latest in the series I’m publishing of 2021 to 2023 USPATH and WPATH conference videos. To see the full set, go to this master list:

Dr. Rosenthal is a professor of pediatrics at the University of California, San Francisco and the co-founder and medical director of the multidisciplinary UCSF Child and Adolescent Gender Center. Dr. Olson-Kennedy is a pediatrician and until the clinic was shuttered last year under pressure from the Trump administration, directed the pediatric gender clinic at Children’s Hospital Los Angeles. She now does similar work for a private clinic in Pasadena.

Dr. Olson-Kennedy is the lead investigator on the long-running study of medical interventions to treat gender dysphoria among youth, the Trans Youth Care Study, that has received some $10 million in National Institutes of Health funds to date. Dr. Rosenthal is one of the co-principal investigators on the study. The study is particularly controversial because of reporting by The New York Times in 2024 that Dr. Olson-Kennedy had refrained from publishing results of their research about puberty blockers for political reasons. (Dr. Olson-Kennedy has said her interview with the Times was mischaracterized.)

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This 2021 USPATH video is particularly notable because it includes Dr. Olson-Kennedy going into the weeds about the first year of follow-up of 316 youth after they started cross-sex hormones. At the time, she was more optimistic about how publishing her data would sway the political debate about pediatric gender medicine. But as a 2023 conference video demonstrates, by then her perspective had darkened, and she came to the conclusion that it was more politically expedient to be very cautious about publishing. As I reported in Compact magazine:

In 2021, Olson-Kennedy reported that her team had amassed a trove of data from the federally backed study. Facing rising political scrutiny, she suggested sunlight was the best disinfectant. “We want to prioritize publishing this information because it needs to get out into the general public while there is this ongoing attack on transgender youth and transgender youth care,” she said. By the 2023 conference, she reported her team had up to seven years of follow-up data and were working on “several more manuscripts.” But now they were wary about publishing.

“I asked our person at the NIH if there was a prize for the grant that got the most FOIA requests, and she said, ‘No, but even if there was, you would still be behind Covid and fluoride,’” Olson-Kennedy said, to laughter. Describing her team’s painstaking efforts to avoid providing fodder for a backlash, Olson-Kennedy said, “Every single manuscript is absolutely impeccable with what it is, what it is stating, the results that are being reported. We’re thinking about how things can be taken out of context and misused and potentially come back and damage us.”

Following Dr. Rosenthal and Dr. Olson-Kennedy’s USPATH 2021 presentations, she engaged in a detailed dialogue with Dr. Joshua Safer. Dr. Safer is a professor of endocrinology at Mount Sinai in New York, where he is the executive director of the transgender program. He was a leader in the revision of WPATH’s transgender-care guidelines, the Standards of Care, Version 8, or SoC 8, which were published to much fanfare (and controversy) in September 2022.

Introducing the plenary, Dr. Safer said it would address how “we navigate our evidence-based approaches in an environment where sometimes the conversations we have are distorted for political gain.”

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Dr. Rosenthal

The first to present, Dr. Rosenthal reported that the prevalence of trans identification in adolescents and young adults was about 0.7 percent. (This figure would only soar in the subsequent couple of years—to about 3 percent. Although data recently analyzed by psychologist has suggested this figure has since retreated again.)

Dr. Rosenthal posed the question of what drove the “marked increase” in referrals to youth gender clinics in recent years. He pointed to Dutch research concluding it was driven by reduced stigma towards trans identities. He did not explicitly suggest that there was a cultural component to this increase. He further noted the recent inversion of the sex ratio—youth presenting at clinics used to be largely natal boys and now they are largely natal females—but did not offer a reason for this dramatic shift.

Instead, he spoke more generally about the notion that “gender identity is not simply a psychosocial construct, but very likely reflects a complex interplay of biological factors as well as environmental and cultural factors.” He did not broach this subject, he said, to “develop a litmus test of being transgender, and certainly not to identify something to be fixed to prevent gender diversity.” Rather, he said, he hoped “this can lead to destigmatization, which can then lead to increased acceptance and decrease health disparities for people of diverse gender identities.”

The SoC 8, which greatly loosened guardrails around pediatric gender-transition treatment, was not out yet. So Dr. Rosenthal referred instead to the most recent Endocrine Society guidelines, which he noted, said that cross-sex hormones could be prescribed to youth who have “sufficient mental capacity to give informed consent, which most adolescents have by age 16 years.” But the guidelines, he said, did allow for commencing hormones at younger ages in select cases.

The authors of the SoC 8, acting under pressure from a Biden administration health official, the American Academy of Pediatrics, and the Trevor Project, would remove the age limits on pediatric gender-transition interventions in the guidelines. They kept secret that they did not make this change based on scientific research, but under duress. Child psychiatrist Dr. Scott Leibowitz, the lead author of the adolescent chapter in the SoC 8, then got up in WPATH’s 2022 conference and made a number of false claims about the reason for the removal of the age limits, as I reported in a previous Substack.

Dr. Rosenthal then went into specifics about the Trans Youth Study.

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For an eloquent and eyebrow-raising account of this and several other nonbinary-focused conference videos included in the videos I obtained, I also direct you to Leor Sapir’s December article in The Free Press. He wrote:

One of the biggest revelations from the recordings is how these clinicians acknowledge performing unproven, seemingly experimental treatments—only it appears there is often no protocol being followed, no formal research being conducted, and no ethics-board approval being sought. These practitioners say their goal is to fulfill the “embodiment” desires of their patients, whatever these may be, and doing this may require “deviat[ing] from guidelines.”

The conference video I’m documenting in this Substack includes a particularly astonishing admission by one care provider that made it into Dr. Sapir’s headline. The provider said, “We’re all just winging it” where medical interventions for nonbinary patients are concerned.

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To see all the previous WPATH conference videos I’ve published, see:

Despite a paucity of research to guide gender interventions for nonbinary patients, the WPATH presenters in the 2022 nonbinary session insisted that this fast-growing population had a genuine medical need for all manner of experimental hormonal treatments and body-modification surgeries, sometimes effecting bodies that do not appear in nature. And the audience members who came up to the mic made it clear that they generally wanted guardrails stripped down to facilitate access to meet the swelling patient demand.

(Psychologist , note, has recently presented data in her Substack suggesting that nonbinary identification has sharply declined in adolescents and young adults in the years since this conference. This has added fodder to the argument that such an identity is largely shaped by shifts in culture and not by fixed biological forces.)

As Dr. Sapir wrote, there was a heavy emphasis on treatment “goals” in this and other conference presentations about nonbinary-related treatment. Such a service-minded orientation took over this field because, as the presenters acknowledged, there is sometimes no established precedent for the medical interventions this population seeks. This is all a part of a larger postmodern, deconstructionist project to “move away from the binary” in the gender-care field. Such an academic project has merged with a departure from traditional medical paternalism, in which the doctor was seen as an infallible demigod, and toward more patient-led care with minimal guardrails around what any individual person might seek from a white-coated professional bearing a medical license and a prescription pad or a scalpel.

The 2022 presentation opened with words from Dr. Joz Motmans, who is the director of the Centre for Sexology and Gender at Ghent University Hospital in Belgium. Dr. Motmans was one of a slew of coauthors of the new nonbinary chapter in WPATH’s Standards of Care, Version 8. The SoC 8, as it’s known, is the trans-care guideline update that was published to much fanfare in September 2022, days before this particular conference.

As was often the case in the WPATH conference videos I reviewed, Dr. Motmans apologized for a lack of racial diversity in the leadership. (I made particular note of this brand of self-flagellation in a recent essay I published in UnHerd.) He alluded to the fact that the coauthors of the SoC 8 nonbinary chapter were all white. “We do miss some diversity in the authorships,” he said. “But I think that’s the case in most of the chapters.”

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Dr. Motmans said that doctors should observe a particularly open mind when caring for nonbinary patients, saying: “It’s very important that health care professionals recognize a need of an individual to access gender-affirming medical procedures and that you cannot predict that need based on someone’s gender role, expression, or identity,” He continued: “So it’s important that health professionals provide information about existing medical procedures and options that might help alleviate gender dysphoria or incongruence and increase body satisfaction without making assumptions about which treatment options may best fit.”

Next, Dr. Walter Bouman, a transgender care specialist at the Nottingham Centre for Transgender Health in the United Kingdom, took to the lectern. Along with Dr. Motmans, he led the WPATH working group on nonbinary genders.

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I have an article out in The New York Sun today in which I break the news that transgender activist and Substacker succeeded in her campaign to undo the accreditation of a series of continuing medical education, or CME, courses that cast doubt on pediatric gender medicine. In the fall, the reporting in Ms. Reed’s Substack about these courses, which were created by the Society for Evidence Based Gender Medicine, or SEGM, and accredited by Washington State University, or WSU, fueled an activist outcry.

Behind the scenes, the Accreditation Council for Continuing Medical Education, or ACCME, which regulates the nation’s CME courses, launched an investigation. As I report for The Sun, the investigation was based on the only inquiry the ACCME received to have come in before the organization compelled WSU to take down the SEGM CME course series; WSU took the courses down an hour after Ms. Reed ran her first story on the matter. And I further report that the wording of that inquiry was nearly identical to portions of an email that Ms. Reed’s staff reporter, , sent to a WSU spokesperson inquiring about the university’s accreditation of the SEGM course series. Baum made a particular point of the Southern Poverty Law Center, or SPLC, having designated SEGM a hate group, a dubious designation that I’ve covered before.

In the end, the ACCME voided WSU’s accreditation of the SEGM course series and the university decided not to object.

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This Substack of mine serves as an appendix to my article in The Sun, which I encourage you to read. Below, I will include screenshots of the numerous internal documents I obtained and that informed my reporting, including:

• S. Baum’s communications with WSU

• Internal WSU deliberations on how to respond publicly to the imbroglio

• Emails from a WSU LGBTQ group expressing dismay over the university’s work with SEGM

• An email to that LGBTQ group from a City University of New York graduate student and trans activist

• The assessments of the SEGM course series written by anonymous reviewers who the ACCME recruited for its investigation

• Letters between WSU and the ACCME.

Below is the October 23 email from Ms. Reed’s staffer, S. Baum, to WSU spokesperson Pam Scott that began the imbroglio. Take note of the following wording, which will come up again later on when I detail the complaint that gave rise to the investigation by the ACCME:

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Camille Kiefel, the prominent detransitioner who sued a pair of Portland, Oregon, area mental health providers who each referred her for a gender-transition mastectomy following a single appointment, has reached a settlement with the defendants.

The malpractice lawsuit, in which Ms. Kiefel, 36, sought $3.5 million, had been set to enter what would have been a historic jury trial in the Circuit Court in Multnomah County, Oregon, in January. But the parties entered a confidential settlement just days before the trial was slated to begin.

The existence of the settlement has not previously been reported.

The lawsuit’s defendants included the two authors of the referral letters for surgery that Ms. Kiefel obtained in 2020: Amy Ruff, a licensed clinical social worker and her employer, Brave Space; and Mara Burmeister, a licensed professional counselor and her employer, Quest Center for Integrative Health. The suit alleged malpractice, intentional infliction of emotional distress and fraudulent misrepresentation.

A July 2025 amended complaint filed with the court alleged that Ms. Ruff and Ms. Burmeister effectively rubber stamped Ms. Kiefel’s request for a referral letter, in each case following a single telehealth appointment lasting under an hour. The lawsuit alleged that each of these mental-health professionals failed to adhere to their employers’ training for providing such a letter, which the suit suggested already set quite a low bar and was in conflict with the care guidelines set by a major transgender-medicine organization.

Ms. Kiefel underwent a mastectomy in August 2020, at age 30. At the time, she identified as nonbinary, but has since reverted to identifying as a woman. The legal complaint detailed a lengthy history of serious mental-health problems on Ms. Kiefel’s part dating back to childhood, which ultimately rendered her unable to maintain employment and put her on long-term disability. Her litany of diagnoses included generalized anxiety disorder, major depressive disorder, post-traumatic stress disorder, ADHD and other-specified personality disorder with mixed borderline and dependent features.

Amid the raging national political fight over the care of minors with gender dysphoria, Ms. Kiefel’s case raises complicated questions about who is ultimately responsible if an adult undergoes gender-transition treatment or surgery and ultimately comes to conclude that the intervention was harmful, in particular if they have serious mental health problems.

According to her website, Ms. Kiefel “once believed a non-binary double mastectomy would finally provide relief where 20 years of talk therapy with conventional modalities hadn’t; she lives with physical health issues from the surgery.”

“Gender affirming treatments are experimental, risky and distributed inconsistently,” Ms. Kiefel stated on her web site. “Before we consider invasive surgeries, we must first look at all low-risk alternative treatments that address the physical health of the individual.”

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Ms. Kiefel also sued the plastic surgeon who performed her mastectomy, Dr. Tina Jenq, and her employer, Oregon Cosmetic and Reconstructive Clinic. That case was dismissed due to the statute of limitation running out. Ms. Kiefel and her attorneys did not pursue it further.

In recent years, adult transgender care in particular has increasingly moved toward what is known as an informed-consent model, in which there are minimal barriers for patients to cross when seeking gender-transition treatment or surgeries. Ms. Kiefel’s legal complaint asserted that both Brave Space and Quest had established systems that facilitated patients’ desires for such medical interventions with a relatively minimal amount of so-called gatekeeping.

In the emerging field of detransition litigation, Ms. Kiefel’s settlement marks the first of its kind, given she and the defendants entered into the agreement at the 11^th hour before a jury trial. At least two other such lawsuits have been dismissed pursuant to a settlement, but without having scheduled a trial.

The lawsuit called into question whether such a minimal-gatekeeping care model might leave care providers exposed to legal liability, especially given the recent surge of transgender identification among adolescent and young-adult biological girls and women in particular. This population has a high rate of psychiatric comorbidities and autism, which may complicate any process of assessing them for gender-transition interventions. There is considerable conflict within the transgender-care community over whether even severe mental-health conditions serve as a contraindication for such interventions.

The Oregon trial had been slated to begin only days following the launch of the three-week trial in White Plains, New York, in which Fox Varian, 22, became the first detransitioner to bring a malpractice lawsuit before a jury. Ms. Varian sued her Westchester County-area psychologist and plastic surgeon over the gender-transition mastectomy she underwent at age 16. She was awarded $2 million by the jury on January 31. (I was the sole reporter to attend the entire trial.)

My appearance on CBS News to discuss the Varian case:

Had Ms. Kiefel’s case gone before a jury, it would have been the first trial in which a detransitioner had sued their care providers over a gender-transition intervention they received as an adult.

In stark contrast to Ms. Varian, who has tightly guarded her privacy regarding her lawsuit, Ms. Kiefel has maintained a public profile as a detransitioner. She is among a small group of such individuals who have testified in state legislatures arguing for greater institutional support for detransitioners or on behalf of restrictions on pediatric gender medicine. The most common such advocate is Chloe Cole, who has sued Kaiser Permanente in California over the gender-transition treatment and surgery she received during her adolescence. Ms. Cole’s trial is slated for next year, and, given her high profile, should provoke a media bonanza.

In a joint statement, two of Ms. Kiefel’s attorneys, Josh Payne, of Campbell Miller Payne, and Zac Hostetter, of the Oregon-based Hostetter Law Group, told me: “We are proud to have represented Camille Kiefel in her pursuit of justice. It was our privilege to fight for her, and we are pleased the parties were able to resolve the matter shortly before the trial was set to begin. We are not at liberty to disclose the terms of the settlement as they are confidential.”

Attorneys for the defendants did not return my request for comment.

There are 27 known detransitioner lawsuits that have been filed in the United States since 2022, a figure that includes both those who underwent gender-transition interventions as minors and those who did so as adults (the oldest I have documented was 32 at the time of the intervention). A number of these cases have run into obstacles related to statutes of limitation, including the lawsuit against prominent pediatric gender medicine physician Dr. Johanna Olson-Kennedy. The plaintiff’s attorneys in that case have filed an appeal.

Isabelle Ayala in 2023 sued Dr. Jason Rafferty, a Brown University pediatrician who wrote the American Academy of Pediatrics’ influential—and highly contested—2018 policy statement on the gender-affirming care method, over the testosterone treatment she received as a minor. Ms. Ayala also sued the AAP itself. Her case has been dismissed pursuant to a settlement.

Ms. Ayala is represented by Campbell Miller Payne, a Dallas firm established for the sole purpose of representing detransitioners. The firm’s leadership has recently undergone major changes. Founding partner Jordan Campbell left in 2025 to lead a unit Department of Justice devoted to targeting the field of pediatric gender medicine. And another founding partner, Ron Miller, died of cancer earlier this year at age 38. Mr. Payne is the sole remaining founding partner.

A representative for the firm declined to comment on Ms. Ayala’s case.

The other known lawsuit to be dismissed pursuant to a settlement was waged by Christopher Miller, who in 2024 sued Identity Hormones in Arizona over estrogen treatment he received as an adult. Mr. Miller’s attorney did not return a request for comment.

Erin Friday, a California attorney and outspoken activist campaigning against all forms of medicalized gender transitions, told me in a statement that she hoped that Ms. Kiefel’s settlement, however confidential the terms, might send a chilling effect across the field of transgender medicine.

“For some medical providers, moral arguments and lack of efficacy of the treatments is sufficiently compelling, but for others it is only the fear of malpractice suits that will stop them,” Ms. Friday said.

Adam Deutsch, a partner at Fiedler Deutsch in White Plains and Ms. Varian’s attorney, told me that since his victory in her case, he thought that care providers and insurance carriers “are taking a harder look at the exposure these detransitioner cases present.” The Varian case, he said, “showed these claims can carry real litigation and reputational risk, which makes pretrial settlement a more attractive option. In my view, as more of these cases are filed and better understood, we’re likely to see more of them resolve before trial.”

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Ms. Kiefel’s case

Ms. Kiefel’s 2025 legal complaint characterized her as severely burdened by a constellation of mental-health conditions that left her in a poor position to decide upon whether to undergo surgery to remove her breasts, even well into adulthood. The complaint further suggests that gender dysphoria—the mental health diagnosis that doctors typically require to provide gender-transition interventions—did not play a major role in her mental health struggles during the years leading up to the surgery.

According to the complaint, the borderline features of her personality disorder included an “unstable sense of self, impulsivity, recurrent suicidal gestures, affective instability due to reactivity in mood, and chronic feelings of emptiness.” The complaint further asserted: “Kiefel’s dependent features include difficulty making decisions, the need for others to assume responsibility for major areas of life, and difficulty initiating projects.”

Brave Space and Quest, the complaint suggested, had engineered the transgender-care assessment process such that patients with complex psychological profiles were at risk of falling through the cracks, given how much these organizations favored lowering guardrails over protecting patients from medical interventions that might not be in their best interest.

Both Brave Space and Quest, the complaint alleged, sought to “eliminate barriers” for patients seeking gender-transition surgeries.

The complaint alleged that Ms. Ruff’s employer, Brave Space, “eliminated safety barriers for transgender individuals seeking ‘gender-affirming’ surgeries, such as the requirements of a valid mental health diagnosis and a valid mental health assessment before such surgeries.”

Ms. Burmeister, the complaint alleged, “wholly failed to provide Kiefel an adequate mental health assessment before filling in blanks on a form letter to a plastic surgeon so that Kiefel could receive ‘gender affirming’ surgery.”

Ms. Kiefel adopted a nonbinary identity in 2015, when she was in her mid-twenties. She was ultimately diagnosed with gender dysphoria by a therapist.

Three years later, she underwent a major depressive episode and, according to her legal complaint, “became unable to work or drive, went on short-term disability, and applied” for medical leave from her job. She ultimately went on long-term disability due to her mental-health struggles.

She underwent mental-health treatment from various providers from the fall of 2018 to the spring of 2020. During that period, she was not diagnosed with gender dysphoria, per her legal complaint.

In April 2020, she told her primary care provider, Dr. Ewen Harrison, of the Providence Medical Group in Clackamas, Oregon, that she thought she needed a breast reduction. Dr. Harrison, who did not diagnose Ms. Kiefel with gender dysphoria at the time, wrote in his notes that she identified as nonbinary and that she did “not require masculinizing surgery, but would be comfortable with reduction only, no surgery to nipples or areolae.”

Dr. Harrison then referred Ms. Kiefel to Dr. Jenq. One of Ms. Kiefel’s mental health providers, meanwhile, referred her to Brave Space to obtain a referral letter for gender-transition surgery.

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The referrals

In an August 2025 deposition, Ms. Kiefel stated that she thought the purpose of the assessment with the mental-health providers was to determine “whether or not I was truly nonbinary.”

Ms. Ruff and Ms. Burmeister seem to have been trained, on the contrary, as facilitators of gender-transition interventions, not as gender-identity auditors.

Ms. Kiefel’s legal complaint suggested that the providers did not properly obtain her informed consent for the operation. The complaint alleged that neither Ms. Ruff nor Ms. Burmeister “assessed Kiefel’s knowledge regarding the impacts of surgery would have on parenting, the potential for revision [surgery and] the possibility of regrets or later detransitioning.” Nor did they discuss with her “other, non-surgical ways to manage gender dysphoria.” Nor did they address how the surgery might impact sexual intimacy.

Ms. Ruff’s Zoom session with Ms. Kiefel, held May 13, 2020, lasted less than an hour. Ms. Ruff wrote the referral letter for the mastectomy to Dr. Jenq that same day. The letter, referring to Ms. Kiefel with gender-neutral pronouns, stated that “they do not identify with either gender and thus are not interested in transition.”

At that point, Ms. Kiefel was still on disability. Nevertheless, Ms. Ruff’s mental-health examination put her “within normal limits” for all related categories. Ms. Ruff’s referral letter, according to the legal complaint, did not include any diagnostic assessments for Ms. Kiefel and how those mental health conditions might have adversely impacted her capacity to provide informed consent for the surgery. The complaint alleged that Ms. Ruff falsely asserted in the letter that Ms. Kiefel’s mental-health conditions were “successfully managed.”

The World Professional Association for Transgender Care, or WPATH, publishes widely observed transgender care guidelines known as the Standards of Care. Even after these guidelines have been considerably liberalized in recent years, some in the trans-care community who favor greater bodily autonomy for transgender people still find them overly restrictive.

This appeared to include Brave Space and Ruff.

Ms. Kiefel’s legal complaint alleged that “Brave Space and Ruff purport to follow” WPATH’s Standards of Care. “In reality,” the complaint countered, “Brave Space and Ruff rejected the WPATH standards of care, and maintained that the WPATH standards of care create barriers for individuals seeking gender-affirming care.”

The complaint continued: “Brave Space and Ruff believe the transgender community should actively participate in developing clinical practice guidelines and standards of care for transgender individuals, that transgender individuals are the experts and that they should self-determine what medical therapies and surgeries are right for them.”

The lawsuit suggested that such a liberal philosophy was ill-suited for a patient with needs as complex as Ms. Kiefel.

Soon after obtaining the letter from Ms. Ruff, which cleared her as essentially mentally stable, Ms. Kiefel told another mental-health provider that she had “chronic thoughts of death” and that she “might be taking on to [sic] much right now,” per the legal complaint.

After Dr. Jenq’s office told Ms. Kiefel that she needed a second referral letter for the mastectomy, she attended a Zoom session with Ms. Burmeister on July 1, 2020. During that approximately 40-minute session, the legal complaint asserted, Ms. Kiefel described her struggles with her mental health conditions “and disclosed that her treatments of those conditions had not been successful.”

Nevertheless, Ms. Burmeister wrote the referral letter for surgery the following day. According to the legal complaint, the letter violated Quest’s own policies in myriad ways. These included Ms. Burmeister’s omission of “any documentation to support a DSM 5 diagnosis that was the medically appropriate reason for services in question.” Nor did Ms. Burmeister “adequately address Kiefel’s mental health conditions.” She also falsely referred to Ms. Kiefel as male (she identified as nonbinary at the time), characterized her mental-health symptoms as mild, and wrote that her “only instance of suicidal ideation was a couple of months ago.”

The complaint faulted Ms. Burmeister for not obtaining or reviewing Ms. Kiefel’s medical or mental health treatment records or consulting with her other care providers. (This was a key sticking point in the Varian case. Ms. Varian’s psychologist never sought the notes from another mental-health-care provider with whom the girl was more candid about her ambivalence over her gender identity.) Nor did Ms. Burmeister alert Dr. Jenq that she had not engaged in such due diligence, which the legal complaint asserted was in violation of Quest’s policies.

On July 21, 2020, Dr. Harrison noted that Ms. Kiefel was experiencing increasing symptoms of depression, anxiety and insomnia, and, per the legal complaint, that she “had poor self-care at home, and inability to drive as she felt too unstable to keep appointments.”

Ms. Kiefel underwent the mastectomy, including the removal and repositioning of her nipples, on August 27, 2020.

According to the complaint, Ms. Kiefel has since suffered from feelings of “betrayal by and mistrust in health professionals,” as well as “humiliation, distress and anxiety” over losing her breasts. This includes “deep feelings of regret over unnecessarily and permanently losing her choice ever to breastfeed a child, and fears and anxiety over finding a life partner sexually and romantically attracted to a woman without breasts.”

I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net

Note: After the April 26, 2026, panel, I obtained some video of protests and disruptions as well as audio of the moderator introducing the panel. I dropped those at the end of this article. I also updated the article to show a response from the Pediatric Endocrine Society on April 27.

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In 2024, a federal judge unsealed a raft of internal emails from the World Professional Association for Transgender Health, or WPATH, that shone light on this tightly held secret. The following year, that judge further unsealed hundreds of WPATH conference videos, which I ultimately obtained and covered in a recent feature article for Compact magazine.

One of those videos, which I have published in full above, provides remarkable documentation of what transpired when a coauthor of the new adolescent chapter of WPATH’s guidelines, child psychiatrist Dr. Scott Leibowitz, presented the chapter to his colleagues at the organization’s September 2022 conference. During his presentation, Dr. Leibowitz made a series of claims about the removal of the age limits that the internal emails would later reveal to be false.

In this Substack, which is the sixth in an ongoing series I am publishing about the WPATH conference videos I obtained, I zero in on Dr. Leibowitz’s statements and measure them against the email documentation. You’ll see individual clips paired with screen shots of internal WPATH emails.

As you will see, these documents make clear that Dr. Leibowitz was uttering falsehoods in his presentation. The documents also raise important questions about what Dr. Leibowitz knew at that moment about what the truth actually was.

To see the other conference videos I have published thus far, visit and bookmark this page, where I will keep publishing links to each new installment:

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WPATH’s big secret: Why they really removed the age limits

All these revelations about WPATH stem from a federal lawsuit over Alabama’s ban of gender-transition treatments for minors. The state’s attorney general wound up subpoenaing WPATH’s records. In June 2024, the judge overseeing the case unsealed the internal emails.

The emails demonstrated that a Biden health official, Admiral Rachel Levine, had pressured WPATH to remove the age limits from the draft of the 2022 revision to its trans-care guidelines, called The Standards of Care, Version 8, or SoC 8. Dr. Levine was explicitly motivated in this pressure campaign by political considerations, the emails showed. WPATH leaders resisted, but they ultimately caved to pressure after the American Academy of Pediatrics threatened to come out against the SoC 8 if they didn’t remove the age limits. WPATH leaders subsequently developed a cover story to tell inquiring journalists: that they had removed the age limits because they favored “individualized” care for young people.

As I reported for Compact:

When the guidelines were published online on September 15, 2022, the age limits remained. But WPATH took the document down that same day. When it was republished hours later, the age limits had vanished.

Four days later, Leibowitz, who then ran the gender clinic at Nationwide Children’s Hospital in Columbus, Ohio, presented the new adolescent chapter to the WPATH conference. Acknowledging the “risks associated” with “including or not including age minimums,” he enumerated various criteria he said should take precedence, such as a child’s maturity and ability to provide informed consent. He added that “currently the final document landed on protecting the criteria,” because “ages were serving as a distracter from those important criteria, and that would not have allowed for adolescents to access the care that they need.”

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Here is where Dr. Leibowitz enumerated the criteria that should take precedence:

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Earlier this month, Finnish researchers published an analysis of national health records that found that the use of specialty psychiatric care, which they considered a proxy for serious mental health problems, surged among youth who underwent gender-transition interventions.

The study provoked a round of protestations and recriminations from advocates of pediatric gender medicine.

Prominent transgender activist and Substacker slapped one of her trademark “Fact check: false” red banners on the study, falsely asserting that its authors had claimed that gender care for youths doesn’t improve mental health outcomes. In a subtle but important distinction, the study authors did not use such causal language; they actually wrote that their analysis “does not support the suggested improvement in mental health af…

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I published an article in The Free Press yesterday that peels the lid off the American Medical Association and reveals what that led the organization’s board president to claim, without evidence, that the The New York Times had misquoted its statement endorsing limits on youth gender surgeries. I revealed that the AMA’s CEO contradicted the board president in an employee town hall, asserting that the board had signed off on the statement (while deferring any responsibility for it). This new Substack serves as a complement and appendix to my Free Press article, which I encourage you to read. It includes a lot of extra details about the surrounding politics that appear to have given rise to the imbroglio at the AMA.

This Substack is free to read. At the end of it, behind the paywall, I will provide for you the two key pieces of internal documentation on which I based my reporting for The Free Press:

1. The official transcript from a February 10 AMA town hall at which the CEO, Dr. John Whyte, and the director of communications, Josh Zembik, each addressed the media’s reporting of the AMA’s position on youth gender surgeries.

2. Comprehensive records from the message board of the AMA’s LGBTQ+ affinity group, on which numerous members expressed their upset that the AMA had gone against policy by at least generally advising against gender surgeries for minors.

I previously wrote about this story in a Substack that diagrammed how all the media outlets that quoted the AMA on the matter published some portion of the five-sentence statement from Mr. Zembik that the Times asserted in a March 27 statement that it received from the communications director in February.

The AMA Faces Political Peril

All of the drama started after the American Society of Plastic Surgeons on February 3 announced in a policy statement that it was recommending its members not provide gender-transition surgeries to patients under age 19. This prompted the AMA to tell The National Review and The New York Times, among other outlets, that it agreed with the ASPS and that such surgeries should “generally” be deferred to adulthood.

The resulting internal chaos at the AMA comes at a politically perilous time for the medical behemoth. Lawmakers in Washington have threatened to unravel the AMA’s monopoly over medical billing codes that generate well over $100 million in annual royalties for the organization. Multiple individuals who have held top positions at AMA expressed concern to me that Dr. Whyte, who became CEO last year, seems keen on appeasing President Trump by aligning with the administration’s conservative overhaul of major institutions. Trump has been vocal about his disdain for pediatric gender medicine, and gender clinics at multiple major children’s hospitals have closed after the administration has threatened to cut off access to federal funding.

The AMA did not respond to multiple requests for comment.

In January, the Centers for Medicare and Medicaid Services director Dr. Mehmet Oz held what the Times reported was a “tense meeting” with the leaders of top medical associations to discuss the field of pediatric gender medicine. In attendance were Dr. Aizuss and Dr. Whyte. Two of the AMA leaders I spoke with told me that Dr. Oz has previously spoken of his and Dr. Whyte’s long-standing relationship. I contacted the U.S. Department of Health and Human Services, which confirmed the relationship. At the January meeting, ASPS leadership made evident that they were preparing to publicly oppose gender surgeries for minors.

The AMA board then set to work drafting a response should media outlets ask them about the ASPS’s position, according to the March 26 board newsletter penned by Aizuss in which he accused the Times of misquoting the organization.

On February 3, the ASPS published its policy statement opposing youth gender surgeries. In its coverage of the development, the Times ran a statement from the AMA: “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.” The National Review, and multiple other publications, published parts of the broader AMA statement.

According to two of the AMA leaders I spoke with, board members were immediately upset that the statement given to the Times did not reflect the statement the board had crafted. In particular, the board did not intend to say that it sided with the ASPS. It’s not clear what the exact wording of the intended statement actually was.

This set off a period of confusion and debate among AMA membership over whether the news outlets had misquoted Mr. Zembik.

The day the Times story ran, Dr. Andrew Norton, a pediatrician at the University of Wisconsin, wrote on the LGBTQ+ group’s message board that “it appears whoever spoke” to the press about the AMA’s position on youth gender surgeries “did not follow policy.” He referenced a 2024 AMA policy document that stated that “medical and surgical treatments for gender dysphoria” are “medically necessary” and that made no suggestion of age limitations.

Some of the group’s members expressed concern that politics had been broadly guiding AMA decision-making, and conveyed a wider loss of trust in the organization’s leadership.

Dr. Frank Dowling, a psychiatrist at Stony Brook School of Medicine expressed suspicion that at “least some in the AMA are working” on “an agenda and against our clear policies.”

“The fact that section leaders do not have answers, have no paper trail on this announcement, and we have no policy or report to back it,” Dr. Scott Chaiet, an otolaryngologist at the University of Wisconsin-Madison, wrote, “is very telling of our organization today.”

Dr. Kavita Arora, an OB/GYN at the UNC School of Medicine, voiced concerns about the AMA’s apparent political leanings. “Over the past several months, I have become increasingly uneasy about a number of significant decisions that appear to have been made at the management level rather than originating from, or bering directly directed by” the board, she said. She lamented “the reduction of state-level advocacy on women’s health, the scaling back of DEI initiatives, the discontinuation of the AMA Journal of Ethics, and most recently, decisions related to pediatric gender-affirming care.”

According to comments on the message board and my conversations with AMA leaders, the board initially decided not to seek a correction to the February 4 Times article, believing doing so would only feed the news cycle and worsen the public-relations fiasco. Better to do nothing, they thought, and hope the story would die down. It did not. The Times referred to the statement in an editorial by , “Medical Associations Trusted Belief Over Science on Youth Gender Care,” on February 24 and again in the March 16 article on the Oz meeting.

The board’s inaction infuriated Dr. Frances Grimstad, a gynecologist at Boston Children’s Hospital, who gained notoriety in 2022 for a widely circulated video, since deleted, of her enthusiastically promoting gender-transition hysterectomies. (Amid uproar over the video, Boston Children’s asserted that it did not provide such surgeries to minors. The hospital also treats young adults.) On February 11, she wrote on the message board: “Choosing to be silent is the board being complicit in allowing the statement to stand as AMA’s voice, suggesting they support it, which is a smack in the face.”

Dr. Grimstad went on to say that “the policies and procedures that typically safeguard an org from being at the ideological whim of one person are being ignored, similar to our federal admin.” She asked if the organization was “just becoming the trumpian AMA,” guided by “rogue leadership?”

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I wrote for The Free Press:

To complicate matters further, a video The Free Press reviewed from a February 10 AMA town hall showed the organization’s CEO, Dr. John Whyte, insisting that the board had, in fact, signed off on the published statement about youth gender surgeries.

At the gathering, which was limited to AMA employees, Whyte said that the AMA had publicly sided with the ASPS on youth gender surgery because this “was a position that the board of trustees voted on.” He continued: “Consistent with what the board felt was existing policy is that it generally should be delayed until adulthood.” He deferred responsibility, saying, “I’m not a member of the board.” The AMA did not reply to multiple requests for comment.

Mr. Zembik did not challenge Whyte’s characterization during the town hall. But he did say at the gathering that the statement “wasn’t a position change. This was a clarification in case we were asked.”

And yet there is no evident documentation of the AMA having ever issued a public statement regarding age limits for gender surgeries.

I wrote for The Free Press:

On March 26, nearly two months after the original Times article ran, the AMA’s board chair, Dr. David Aizuss, published a newsletter in which he declared that the newspaper had published an incorrect statement whose “phrasing did not come from the AMA.”

“During our Board discussion, we were clear that we were not changing AMA policy,” he wrote. Aizuss said the AMA had written to The New York Times and “requested a correction on their part to reflect the actual language the AMA used.”

But the following day, the Times communications department defended its reporting in a press release, which included the full five-sentence remark that AMA’s communication’s director, Josh Zembik, provided the paper. The Times also wrote that it “received no requests to correct, clarify or update our articles from the A.M.A.”

After reading the Times’ statement, Dr. Paula Amato, an OB/GYN at Oregon Health & Science University, who is part of the LGBTQ+ group, told me: “The AMA statement is inconsistent with current AMA policy.”

I wrote for The Free Press:

Once it appeared clear that The New York Times had, indeed, not misquoted the AMA spokesperson, members of the LGBTQ+ group trained their ire on the AMA’s leadership.

Dr. Sophia Spadafore, an emergency medicine attending physician at Mount Sinai in New York, wrote on the LGBTQ+ message board, “That fact that our board may have been lied to about such a huge issue (whether the misstatement was intentional or not I don’t know) needs to have real consequences.”

I wrote for The Free Press:

On March 29, Aizuss wrote on the group’s message board that he had addressed the matter “with senior management” and would be discussing it further at the April board meeting. He said that “there continues to be a discrepancy between what the New York Times states they were told and what our communications people say they said.” He added: “If our spokesperson said that the AMA agrees with the ASPS, that was a clear error and was not authorized by the board. He unfortunately does not recall if he used those words.”

Dr. Aizuss said that the “board gave very specific guidance” to the communications team. He made it evident that he believed that the AMA spokesperson had conveyed the statement to the Times verbally and had no recording of the conversation.

And yet a representative for the Times told me that the statement from Mr. Zembik came in over email. The author of the National Review piece, Haley Strack, also told me that she received the statement from the AMA in writing. A journalist at another publication, who asked for anonymity because they were not cleared to speak on the matter, said they received the full statement from Mr. Zembik digitally; I reviewed a copy of the message from Mr. Zembik.

Dr. Grimstad pointed the finger squarely at the AMA, on March 29 writing on the message board: “In this moment where the credibility of American medicine is being questioned at every turn, for the AMA to add to the national distrust by suggesting NYT has no editorial standards and, when facts come to light, it was the AMA that was the source of misinformation…a massive deal.”

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Fact checking a misleading article in The Advocate

(Feel free to scroll past this if you just want to look at the source materials, including the AMA town hall transcript and the detailed records from the LGBTQ+ group’s message board.)

One member of the AMA’s LGBTQ+ group is Alex Sheldon, executive director of GLMA: Health Professionals Advancing LGBTQ+ Equality. Sheldon, who uses gender-neutral pronouns, gave an interview to The Advocate for an article that ran April 1: “Doctors’ group says American Medical Association didn’t retreat on gender-affirming care for minors.”

The article sought to do two things that it never acknowledged are in direct conflict with one another:

1. Deny that the AMA released a statement about youth gender surgery that ran contrary to what the board prepared for the press

2. And yet credulously insist that the organization had not, in fact, publicly changed its policy on the matter in the statement Mr. Zembik provided.

Both of these things cannot be true at the same time. For starters, as I have made clear, there is no evidence that the AMA had ever taken a stance on age limits for gender surgeries. And the statement Mr. Zembik provided did agree with the ASPS on generally deferring surgeries until adulthood. Furthermore, multiple AMA members have made evident that the statement published by the Times did represent a change in policy.

The Advocate stated the following regarding what the Times had reported about the AMA’s stance on youth gender surgeries:

In an interview with The Advocate, Alex Sheldon…said the controversy reflects misinterpretation rather than any substantive shift in medical guidance.

“We knew right away that any shift in policy that was being reported was a grave exaggeration,” Sheldon said, pointing to GLMA’s role within the AMA’s House of Delegates, where it has a voting seat and direct visibility into policymaking.

…

Sheldon argued that the nuance was lost in translation and then amplified.

“In this case, the New York Times relied on a quote that was itself sourced from another outlet,” they said, describing an “echo effect” that distorted the AMA’s underlying policy framework.

Being a member of the AMA’s LGBTQ+ group, Sheldon had access to its message board, where he was an active participant (as you can see in the screenshots below). There, the group had emotionally-charged, in-depth discussions about how the gender-surgery-related statement that the press reported was not what the board had prepared and represented a change in poicy. And yet, despite recent developments that were discussed on the message board, Sheldon still tried to pin the blame on the Times.

It is always possible that Sheldon did not check the message board to see Dr. Aizuss post on March 29 the very strong suggestion that the Times was not at fault, that the problem was internal. And then there was Dr. Grimstad making abundantly clear that the AMA was the culprit.

Dr. Aizuss’ complete quote on the message board was:

“I’ve had a number of calls yesterday with senior management regarding the statements to the New York Times. I will be discussing this further with the Board at our April meeting. At this point, there continues to be a discrepancy between what the New York Times states they were told and what our communications people say they said. Unfortunately, there is no tape recording to my knowledge, and it is difficult to verify exactly what was stated by our spokespeople compared to what the New York Times says they were told. Regardless, there will be further discussion of this entire matter. As you can imagine, I am deeply disappointed by the information that was provided to me. the board gave very specific guidance to enterprise communications, and specifically what was to be utilized in responding to press inquiries, as I have said to all the groups that I met with it now appears that there may have been some deviation.

“If he use [sic] those words, it was just in regards to the fact that we stated gender, affirming surgery in minors should be generally deferred to adulthood, which is similar to what was stated by the ASPS. However we do not agree under any circumstances with the ASPS 9 page statement. If our spokesperson said that the AMA agrees with the ASPS, that was a clear error and was not authorized by the board. He unfortunately does not recall if he use those words.

“As I noted, I will continue to follow up with senior management, both our CEO and Josh are out for the next week. I will be in Chicago the following week for meetings some of which will be addressing this issue as well as the following week for the board meeting.”

Sheldon claimed to be providing The Advocate with a “clarification” on the matter. (Incidentally, this is the same word that Mr. Zembik used to characterize what he told the press when addressing the issue at the town hall. That word also showed up in reporting by NPR on February 8 and STAT News on February 10. Coincidence?) And yet Sheldon was, knowingly or not, clouding over the internal confusion and upset at the AMA over how Mr. Zembik gave the Times a statement that did indeed represent a major change in policy.

All this raises the question of why Sheldon felt the need to make these claims to The Advocate at this particular moment in time. And did the AMA put Sheldon up to it, or did Sheldon go rogue?

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The internal AMA documents I obtained:

Just below are screenshots from the official transcript of the February 10 AMA town hall, which was limited to AMA employees and took place one week after the ASPS released its policy document on youth gender surgeries and the AMA provided its response to that document to media outlets.

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At the 2023 conference of the World Professional Association for Transgender Health’s U.S. branch, USPATH, a top communication firm schooled attendees on how to combat misinformation in the media about pediatric gender medicine. Except, as is often the case in the intellectual battle over this controversial medical field, the PR mavens offered a cocktail of misinformation as an antidote.

The video is one of hundreds I obtained of WPATH and USPATH conferences spanning 2021 to 2023. I covered the videos applying to pediatric gender medicine for a feature article in Compact magazine earlier this month. Over the coming weeks and months, I will be publishing the most notable videos in my Substack. To see the full set of them (this is the fifth), visit this landing page, which I will update regularly:

As I wrote for Compact:

[USPATH president Dr.] Maddie Deutsch by 2023 flipped about speaking to the media. But by then WPATH was no longer merely defending the science. It had advanced to an active training mode, politically and rhetorically, and was coaching members to observe its rigidly prescribed terms. “The work that we do is important. It’s life-saving,” Deutsch said at the 2023 conference. “And because this charge does bring great responsibility, we have to be evidence-based. We have to be measured—measured in our approach, measured in dealing with the press, measured in dealing with conflict.”

Deutsch announced that WPATH had brought in experts from the prominent communications firm BerlinRosen to advise attendees on messaging.

The PR training was hosted by two representatives from BerlinRosen: Laura Brandon, who at the time was a senior vice president, and Kara Watkins-Chow, then an account supervisor at the agency.

Most notably, Ms. Watkins-Chow asserted that “the body of evidence” backing pediatric gender medicine “is strong.” This is categorically false, according to a slew of systematic literature reviews that started emerging in the late 2010s. Even Dr. Deutsch acknowledged at the 2022 WPATH conference that the supporting evidence was of low quality according to such reviews; although she was keen to emphasize that this did not mean “there was sloppy science.”

As was fairly typical across the WPATH conference videos I reviewed, the BerlinRosen reps barely made any explicit reference to minors, children or adolescents during their presentation. Instead, they just spoke more generally of “care” and did not often make age-based distinctions.

Ms. Watkins-Chow dismissed the idea that pediatric gender medicine was an “anomaly that’s completely different from all other health care.” This assertion ignores the fact that in no other branch of pediatrics do doctors change the appearance of the body to treat a psychiatric disorder. This field represents a three-way bridge between endocrinology, plastic surgery and psychiatry that is without parallel.

The BerlinRosen rep went into detail about how to vet—and potentially shun—a reporter, including by scanning the journalist’s previous reporting and social-media presence. “If you see that they’ve covered other nuanced health care or social issues in a way that kind of sends up red flags for you, that’s always a sign you can disengage,” she said. Ghosting was always an option, she said: “It’s fine to sort of pretend you didn’t get the message or just follow up with a polite ‘Thank you for reaching out. I’m not able to speak with you.’”

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I obtained a video of this presentation, the slides of which are all labeled with the admonition “DO NOT COPY OR RECORD,” along with hundreds of other conference videos thanks to a subpoena that the Alabama attorney general waged in a lawsuit over that state’s ban on pediatric gender transition treatments. The videos come from 2021 to 2023 conferences held by the World Professional Association for Transgender Health (WPATH) and its U.S. offshoot, USPATH.

I reviewed all the videos pertaining to pediatrics and covered them in an article for Compact magazine, which I encourage you to read. I am otherwise publishing the most notable of the conference videos on my Substack. I will put links to all of them on this landing page if you want to bookmark that for future reference. This is the fourth video in the series.

In this video, a team of six self-described “providers, clients, advocates and activists” presented an assessment model at the 2023 USPATH conference that a collective of them had spent two years developing. Dr. Colt St. Amand, a psychologist and family medicine doctor in New York state, introduced the session, cautioning attendees to keep a lid on it: “By viewing this presentation, you also agree not to record or photograph or transmit any portion of the presentation or the slide deck or conversations among the participants,” he said. Here are the collective members:

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Here Dr. St. Amand is speaking about addressing youths’ “embodiment goals:

WPATH’s 2022 trans-care guidelines recommend a comprehensive biopsychosocial assessment for all minors seeking access to gender-transition interventions. However, as I wrote in Compact, many presenters at the WPATH and USPATH conferences seemed eager to chip away at these assessments:

But the conference videos suggest a gulf between WPATH’s guidance and actual practice by at least some in its membership. Dr. Scott Leibowitz, a child psychiatrist, current WPATH board member, and coauthor of the 2022 guidelines’ adolescent chapter, said at the 2023 training conference that the guidelines are “very flexible” and essentially aspirational.

“What we’re putting forward is more of a gold standard—not necessarily: ‘You must do this,’” Leibowitz said.

Even presenters who favored a more cautious and circumspect approach often characterized assessments primarily as a conduit for individualizing care. They rarely made clear that the assessments were at least partly meant to prevent poor outcomes by selecting out those who didn’t meet diagnostic criteria.

Indeed, the presenters in this session eyed assessments warily. Like many presenters at these conferences, they were eager to disparage any effort to assess whether a child is truly transgender. Similarly, they were dismissive of any suggestion that a trans identity in a young person might be an outgrowth of a deeper psychopathology.

Laura Kuper, a psychologist at UT Southwestern Medical Center and a coauthor of the WPATH trans-care guidelines’ nonbinary chapter said in the 2023 video: “Assessment of someone’s gender identity from the perspective that providers have an ability to discern some true identity that exists beyond what is articulated by the person—and related to that attempts to identify root causes of gender identity, expression, or embodiment that would somehow disqualify one from treatment when they are otherwise able to articulate their treatment goals and provide informed consent.” Dr. Kuper said that “these conceptualizations reflect a pathologizing lens. And we find them inconsistent with that perspective of cultural humility.”

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Today’s Substack is my first effort to publish all the Olson-Kennedy videos. This particular video, featured in full above, contains her astonishing admission that she is not “interested in” the “conversation” about whether young patients who present to pediatric gender clinics are “really trans.”

I covered 130 of the pediatrics-related conference videos in a feature article for Compact magazine last week. I encourage you to read that. And please subscribe and support my work, as I begin the long process of publishing and providing analysis about all these videos.

This particular video features a symposium of leading figures in pediatric gender medicine, held at the USPATH conference in November 2023. The panel was moderated by Dr. Maddie Deutsch, director of University of California, San Francisco’s gender clinic, who was USPATH’s president at the time. (She would pass the torch to Dr. Olson-Kennedy.)

The panel included (from left to right in the video):

• Dr. Natalie Nokoff, a pediatric endocrinologist at Children’s Hospital Colorado

• Laura Kuper, a child and adolescent psychologist in Dallas

• Dr. Olson-Kennedy, a pediatrician who was then the head of the gender clinic at Children’s Hospital Los Angeles (which was closed in July 2025 under pressure by the Trump administration)

• Dr. Robert Garofalo, who runs the pediatric gender clinic at Lurie Children’s in Chicago (which is teetering under pressure from Trump)

• Dr. Stephen Rosenthal, a pediatric endocrinologist and the medical director at UCSF’s gender clinic

• Lisa Griffin, a clinical psychologist working with children and adolescents in Baltimore

Dr. Deutsch emphasized that there was to be no photography or recording of the panel—part of the veil of silence that WPATH and USPATH imposed over these confabs during an increasingly secretive time for the joint organizations. WPATH fought tooth and nail to keep a federal judge from unsealing the nearly 500 conference videos that the Alabama attorney general subpoenaed, and ultimately lost that fight last year. That led me to obtain the lot of them.

The panel was comprised by members of a “quality task force” that had been established within WPATH to assess the quality of care provided by mental-health and medical professionals in the gender-medicine field. In particular, they sought to assess such providers’ adherence to WPATH’s trans-care guidelines when caring for minors. Those guidelines are known as The Standards of Care, Version 8, or SoC 8. The group, which had met every couple of months since the spring of 2023, wanted to know what the process of assessing pediatric patients seeking gender-transition interventions looks like in practice.

Here are the members of the task force:

“There may be barriers to the recommendations that we come up with and then make recommendations for training, qualifications and access to care,” Dr. Deutsch said of the task force’s efforts. “So we see this as sort of a companion document to the SoC 8.”

The panel was held a year after WPATH secretly capitulated to pressure from the American Academy of Pediatrics, the Trevor Project, and a Biden health official to remove the age limits in the SoC 8, which was published in September 2022. At the 2023 conference, Dr. Deutsch, whether she knew the truth or not, effectively glossed over why the age limits were removed when addressing the subject.

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A large study of health data on Finnish youths who sought care from gender clinics has found evidence that its authors suggest challenges the prevailing claim that gender-transition interventions are tied to improvements in mental health. The study found that the use of specialist psychiatric care—a general, if imperfect, indication of serious mental health problems—increased dramatically among those adolescents and young adults who underwent gender-transition interventions.

Among such youths, the proportion who had appointments with specialist psychiatrists prior to attending the gender clinic, compared with the proportion who had such appointments during later years, surged: among natal males, from 10 percent to 61 percent; and among natal females, from 22 percent to 55 percent.

The study, published Saturday in Acta Paediatrica, included data on nearly 2,100 Finnish people who first sought care from a gender clinic before age 23 between 1996 and 2019. Thirty-eight percent …

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I obtained near-exclusive access to these videos after Alabama’s attorney general, Steve Marshall, subpoenaed them and a federal judge unsealed the lot last year. The videos include USPATH’s 2021 and 2023 conferences, WPATH’s 2022 conference, and a 2023 WPATH conference devoted to training care providers.

I’ll be posting links all of the videos I publish here:

After spending months reviewing over 130 of the videos that concern the care of minors who identify as transgender, I reported my findings in a feature article for Compact magazine on Wednesday. I encourage you to read that piece, which charts how WPATH responded to a mounting political backlash against gender-transition interventions for minors by doubling down and trying to manage the message. (Kindly comment on and share my thread about the Compact article on X.)

I hope you’ll consider supporting my efforts to make public—and put into context—these fascinating and edifying historical documents by becoming a paid subscriber to my Substack. This project demands an extraordinary amount of time and energy. Thanks very much.

My Compact article opens with an account of a rousing speech Mr. Strangio gave at USPATH’s virtual conference in November 2021, the full video of which is posted above. The speech was entitled “Criminalizing Trans Bodies and Medicine: a Look at the Pivotal Next Year in Trans Advocacy.”

At that moment in history, the transgender movement stood at a critical precipice. During 2021, Arkansas had passed the first state ban of gender-transition interventions for minors—a harbinger for what came next as Republican legislatures in other states geared up to do the same.

In his address, Mr. Strangio, who is a transgender man and the co-director of the ACLU’s LGBT & HIV Project, called upon USPATH members to rise up and fuse trans activism with their work as care providers.

The speech serves as a remarkable time capsule, revealing Mr. Strangio’s various absolutist stances: demanding transgender inclusion in sports and opposing engaging with critics—positions that he would wind up walking back (and in the case of calling skeptics transphobes, would claim he never held) by the time of his December 2025 sit-down with The New York Times’ Ross Douthat.

“This is an all-hands-on-deck moment,” Mr. Strangio said at USPATH 2021. Referring to pediatric gender-transition interventions, he continued: “We need people testifying in every state legislative hearing in 2022, to make clear that this is care that is effective, that it is safe, that it is important and that it is provided pursuant to protocols—that banning it, which is fundamentally unlike how medical care is treated in every single other context, is inappropriate and deeply harmful, not only to our trans community, not only to your patients, not only to my clients, but to the practice of medicine.”

(Mr. Strangio failed at this point to note that abortion was treated with similarly draconian legislative restrictions. And yet, a few minutes later, he compared the backlash to pediatric gender medicine to “entrenched backlash that we see to abortion.”)

Looking to the uncertain future, Mr. Strangio asked the USPATH crowd, “Are we on the verge of moving towards increased gains in law and policy and public discourse? Or are we about to be set on a trajectory of defensiveness and loss?”

“I would say 2022 is probably going to be the year that determines the trajectory of the next 10 to 15 years,” he said, in a prediction that now seems wholly accurate. “Because if we end up in a situation where five to 10 bills criminalizing care for trans minors pass, it may be that we spend the next 40 years trying to undo that rather than moving the ball forward.”

Perhaps the most remarkable moment in this speech was when Mr. Strangio appeared to dismiss sex-based differences in athletic competitiveness—contradicting what he told Mr. Douthat four years later. (More specifics on that contradiction below.)

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A spurious specter of suicide?

In his speech, Mr. Strangio repeatedly characterized the burgeoning legal attacks on the transgender movement as posing an existential threat to transgender youth in particular.

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Past the conference’s tightly sealed doors, conservative lawmakers had escalated their attack on pediatric gender medicine during the previous two years. This swift and decisive backlash was driven by the accusation that this care field’s practitioners egregiously deferred to the whims of children when prescribing irreversible, body-altering and potentially sterilizing medical interventions.

Amongst friends who were effectively sworn to secrecy about his speech, Dr. Baker advised that WPATH members keep from the public the fact that, in his words, “we all support trans kids in the driver’s seat” when it came to minors receiving gender-transition interventions. This wasn’t a fact that the Average Joe was prepared to hear, he said, given “they are very scared by the idea that young people are making irreversible decisions and that no one else has any oversight over those decision.”

Dr. Baker’s admission is but one of myriad remarkable revelations about WPATH and the wider field of pediatric gender medicine now coming to light due to a subpoena that Alabama’s attorney general, Steve Marshall, filed in a federal lawsuit over that state’s ban on gender-transition interventions for minors. Mr. Marshall’s legal maneuvering ultimately led a federal judge to unseal a trove of nearly 500 USPATH and WPATH conference videos, spanning 2021 to 2023.

I subsequently obtained the lot of those recordings and covered them in detail for Compact magazine. I am now beginning the long process of publishing the 130 videos pertaining to pediatrics, along with my analysis. (Subscribe to receive each video as I publish it over the coming weeks and months.)

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The uncovered video of Dr. Baker’s speech provides an invaluable window into how WPATH, which has become increasingly secretive in the face of burgeoning political opposition and attacks, has sought to reframe the truth about pediatric gender medicine. Warning of the “creeping trend of fascism,” Dr. Baker instructed conference attendees to avoid making certain empirical claims, to simplify or omit inconvenient truths, and to tailor their language to avoid pitfalls that would invite further backlash.

Dr. Baker is currently the senior advisor for health policy at the LGBTQ-focused nonprofit the Movement Advancement Project. At the time of his 2023 USPATH speech, he held a similar position at another LGBTQ nonprofit, the Whitman-Walker Institute.

He was the lead author of one of just two systematic literature reviews to have been published from the much larger collection that WPATH commissioned from evidence-based-medicine experts at Johns Hopkins University, where he received his PhD in 2021. The paper, published in 2021, examined the impact of cross-sex hormone treatment on psychological outcomes and included in its analysis three studies about adolescents.

Among the more astonishing moments in his speech was the point when Baker theatrically mocked concerns about the potential long-term impacts of puberty blockers, as addressed by a 2022 New York Times article. He dismissed this as “concern trolling, both-sidesing.” He quipped, “You can just feel the pearls being clutched.”

This Substack features greater details from Dr. Baker’s speech, which is published in full at the top of this page.

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The speech

Following an admonishment that recording and photography were forbidden, Dr. Baker opened his speech by referencing the sour state of political affairs that the transgender movement faced. “I’m hopefully not going to be too much of a downer because, you know, as you know, there’s some stuff going on out there in the world,” he said. “We are in the middle of an unprecedented explosion of hatred directed at our communities.”

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