The authors of a new study analyzing 2018 to 2022 insurance claims data characterized such prescriptions as rare and said this rarity undermined arguments for bans of these interventions.
The moral relativism in this study is astounding. It's like saying the Manson Family deserved to go free because they only harmed a small percentage of the population of California. And of course we have no numbers for the drugs obtained from online grey-market and illegal sources which cannot be claimed on health insurance.
It's possible that some public health care beneficiaries may receive these treatments at surprisingly high rates. In Canada, children in foster care show disproportionate rates of prescriptions, and may in fact be targeted as patients by providers.
Yes, and doctors at Texas Children's Hospital were caught by a whistleblower fraudulently submitting Medicaid claims for transition treatment of minors despite an active state ban on such treatments. They code them as an endocrine disorder on the submitted claim:
Yes, $ is to be had as in such this case: "The Transgender Health Clinic at Vanderbilt University Medical Center took down its entire website after a leaked video went viral. The video featured one of the clinic’s physicians describing how these surgeries have become “huge money makers” and that in some cases, an “entire clinic is supported just by the phalloplasty.” " Truly disgusting.
Magnolia can you share the citation for this information? I've been curious about children in care and children receiving acute mental health services/interventions, and the disproportionate representation of trans-identification within these cohorts.
A 2015 systematic review (https://www.sciencedirect.com/science/article/pii/S0924933815000917) whose authors include Jon Arcelus and Walter Bouman (the latter is a past president and a current member of the Executive Committee of WPATH, and both Arcelus and Bouman are coauthors of WPATH's SOC 8) arrived at a meta-estimate of 0.0046% (or 4.6 per 100,000): 0.0068% being trans women and 0.0026% trans men (the ratio of 2.6:1 between the two is consistent with the historical preponderance of transwomen). That number - 0.0046% - is about 22 times larger than the 0.1% that these researchers are claiming as "rare."
Numbers like those presented in the 2015 systematic review are not outliers either. A 2019 narrative review found five different ways of classifying transgender and nonbinary (TGNB) population estimates across 43 studies conducted in various locations at different times. This narrative review, all of whose six authors share authorship of WPATH’s SOC8 (including the SOC8’s lead author, Eli Coleman), was subsequently cited by Baker et al. (2021) - the WPATH-commissioned systematic review on the mental health benefits of hormones (https://academic.oup.com/jes/article/5/4/bvab011/6126016). In their systematic review, Baker et al. distinguished between studies that “rely on clinical records” and those that “focus… on self-report among nonclinical populations" (p. 2).
Other researchers who studied the size of the transgender population have also highlighted this distinction. For example, one systematic review (of 27 studies) from 2016 (https://academic.oup.com/jsm/article/13/4/613/6940166) stressed “the importance of adhering to specific case definitions [“transgender-related diagnoses” and “self-reported transgender identity”] because the results can range by orders of magnitude” (p. 13). Specifically, its estimate for “self-reported transgender identity” among adults (0.871%) was 128 times larger than the estimate for “transgender-related diagnoses” (0.0068%).
The 2019 narrative review (mentioned above) found that the median estimate of those who received or requested medical interventions in countries as varied as the United States, Italy, Serbia, Netherlands, Belgium, Sweden, Spain, and Singapore between 1968-2011 is 0.00526%. Remember, this is a review authored by WPATH SOC8 writers and approved by WPATH's systematic review on the mental health outcomes from cross-sex hormones.
Claiming 0.1% to be "rare" even when there are several reviews within the last 10 years - authored by the doyens of WPATH, no less - that show that the actual numbers are orders of magnitude smaller, is the height of chutzpah. For every minor who might have qualified for medical interventions less than 10 years back, 21 more are being given these medications. On the basis of what evidence? That of Johanna Olson Kennedy, who did not publish her findings about puberty blockers, or published findings about hormones after changing the study protocol wholesale, one that Jesse Singal had to spend two giant posts (the first one here: https://jessesingal.substack.com/p/on-scientific-transparency-researcher) to find all its shortcomings?
Thank you. You confirmed what I was thinking when I was reading about this study. The manipulative reporting of data by advocate researchers is out of hand.
SCANDAL. Why are so many professionals caving and lying? What happened to personal moral and protecting CHILDREN. Thank you for this thorough analysis. My daughter is collateral damage.
They say “the data don’t lie”. That’s possibly true at some level of abstraction. However, analysts of data can and do lie - well perhaps “lie” is a bit too strong. But they certainly spin their analysis to suit their arguments.
And there are so many ways to do the spin - the data you look at and the data you ignore, the study design including the methodology you use, the types of statistical analysis you perform, the results you report and the ones you ignore, how you frame the results, the inferences you take from the results, and the conclusions you reach. I’m sure I’ve missed a few but you get the idea. Thanks Ben for your ongoing efforts to cut through the spin.
what should we make of "studies" produced by organizations and persons whose stated goal is to further access to gender affirming care and has created goal statements with the usual misinformation that frames persons who opt to ID as transgender, or were tricked into it, as marginalized based solely on this voluntary identification? These groups paint a one sided picture of severe interventions that add to inaccurate perception that gender care is evidenced based or that it will lead to positive outcomes.
their data and study conclusions must be assumed to be one sided, typically filled with ommissons with the single goal of activism
"The LGBTQ Health Center of Excellence...aims to advance health equity for LGBTQ people"
Another great example of why you CANNOT understand these articles without the appropriate context, and why the vast majority of mainstream reporting has so egregiously failed the public in their reporting on it. Thank you again, Ben.
I can't access the article so I don't know if this was shared in it, but I was curious how "rare" 0.1% of the population in question looks like in terms of actual numbers of youth. Using the per 100,000 numbers from the chart for ages 13-17 and an assumption of 4,000,000 people in the US at each of those ages I get on average about 10,000 minors on cross-sex hormones in the US at any given point during the period referenced in the study. I suppose one can argue whether 10,000 is "rare" for that kind of treatment in minors.
There are varying definitions of what constitutes a rare disease: the World Health Organization uses the ratio of less than 65 per 100k people, the European Union <1 in 2000, the US NIH says anything affecting <200k Americans. To pick another rare disease, cystic fibrosis, which affects 40k people (adults & children) in the US. Its genetic origin was discovered in the 20th century, though the symptoms were first mentioned in medical texts from the 16th century.
By these standards puberty blocking/cross-sex hormone treatments are "rare" but the striking statistic about it is the astronomical rate of increase of its diagnosis over the past 10-15ish years (not to mention the lack of any definitive test for it, evidence of treatment efficacy, etc.). This is why supporters redefine gender non-conforming historical figures, claiming these numbers were always present, just not being counted.
I'd be curious to know the geographic spread of these 1 in 1,000. If trans is some kind of naturally occurring, totally normal human variation, you'd expect it to be fairly evenly spread across the US, but I suspect that there's a good deal of clumping. Of course, some might respond, "People who don't live near gender clinics aren't getting treatment, and so aren't billing their insurance companies", which I guess would be true. Then we're left with the puzzle of the totally normal human variation that nonetheless requires 21st-century medical treatments or else those possessing it will kill themselves. Ugh.
I have a question I read somewhere there was a peer reviewed critique of this article Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care
Diana M Tordoff someone link me that critique I can't find it anywhere
For Jesse's post the other day but I think the paper I was looking for critiquing that pro hormone study was called this As one peer-re viewedcritique of the study observed,
“The spin of Tor doffis dramatic” Abbruzzese et al., supra, at
688. The fact thatMcNamara et al. cite this study as “valuable,”
McNamara Br. at13–14, I can't find a link to it anywhere does anyone have one
No, you're misunderstanding what that figure means. It means that they had an average of little over 2 years of data regarding 5 million minors. You multiply the average number of years of data by the total number of people in the dataset. This is known as person-years of follow-up.
It's worth the feedback that that expression, which I've been using for the past 13 years, doesn't make sense to everyone. It's hard to find a succinct way to describe person-years of follow-up in laymen's terms.
The moral relativism in this study is astounding. It's like saying the Manson Family deserved to go free because they only harmed a small percentage of the population of California. And of course we have no numbers for the drugs obtained from online grey-market and illegal sources which cannot be claimed on health insurance.
Or Kaiser operating on the West Coast, which aggressively pushes for gender affirming "care"
It's possible that some public health care beneficiaries may receive these treatments at surprisingly high rates. In Canada, children in foster care show disproportionate rates of prescriptions, and may in fact be targeted as patients by providers.
Yes, and doctors at Texas Children's Hospital were caught by a whistleblower fraudulently submitting Medicaid claims for transition treatment of minors despite an active state ban on such treatments. They code them as an endocrine disorder on the submitted claim:
https://dallasexpress.com/health/texas-childrens-hospital-whistleblower-ousted-after-exposing-medicaid-fraud-in-child-gender-procedures/
No telling how prevalent this practice now is in states with bans, but I'd bet it's a lot!
Yes, $ is to be had as in such this case: "The Transgender Health Clinic at Vanderbilt University Medical Center took down its entire website after a leaked video went viral. The video featured one of the clinic’s physicians describing how these surgeries have become “huge money makers” and that in some cases, an “entire clinic is supported just by the phalloplasty.” " Truly disgusting.
Magnolia can you share the citation for this information? I've been curious about children in care and children receiving acute mental health services/interventions, and the disproportionate representation of trans-identification within these cohorts.
A 2015 systematic review (https://www.sciencedirect.com/science/article/pii/S0924933815000917) whose authors include Jon Arcelus and Walter Bouman (the latter is a past president and a current member of the Executive Committee of WPATH, and both Arcelus and Bouman are coauthors of WPATH's SOC 8) arrived at a meta-estimate of 0.0046% (or 4.6 per 100,000): 0.0068% being trans women and 0.0026% trans men (the ratio of 2.6:1 between the two is consistent with the historical preponderance of transwomen). That number - 0.0046% - is about 22 times larger than the 0.1% that these researchers are claiming as "rare."
Numbers like those presented in the 2015 systematic review are not outliers either. A 2019 narrative review found five different ways of classifying transgender and nonbinary (TGNB) population estimates across 43 studies conducted in various locations at different times. This narrative review, all of whose six authors share authorship of WPATH’s SOC8 (including the SOC8’s lead author, Eli Coleman), was subsequently cited by Baker et al. (2021) - the WPATH-commissioned systematic review on the mental health benefits of hormones (https://academic.oup.com/jes/article/5/4/bvab011/6126016). In their systematic review, Baker et al. distinguished between studies that “rely on clinical records” and those that “focus… on self-report among nonclinical populations" (p. 2).
Other researchers who studied the size of the transgender population have also highlighted this distinction. For example, one systematic review (of 27 studies) from 2016 (https://academic.oup.com/jsm/article/13/4/613/6940166) stressed “the importance of adhering to specific case definitions [“transgender-related diagnoses” and “self-reported transgender identity”] because the results can range by orders of magnitude” (p. 13). Specifically, its estimate for “self-reported transgender identity” among adults (0.871%) was 128 times larger than the estimate for “transgender-related diagnoses” (0.0068%).
The 2019 narrative review (mentioned above) found that the median estimate of those who received or requested medical interventions in countries as varied as the United States, Italy, Serbia, Netherlands, Belgium, Sweden, Spain, and Singapore between 1968-2011 is 0.00526%. Remember, this is a review authored by WPATH SOC8 writers and approved by WPATH's systematic review on the mental health outcomes from cross-sex hormones.
Claiming 0.1% to be "rare" even when there are several reviews within the last 10 years - authored by the doyens of WPATH, no less - that show that the actual numbers are orders of magnitude smaller, is the height of chutzpah. For every minor who might have qualified for medical interventions less than 10 years back, 21 more are being given these medications. On the basis of what evidence? That of Johanna Olson Kennedy, who did not publish her findings about puberty blockers, or published findings about hormones after changing the study protocol wholesale, one that Jesse Singal had to spend two giant posts (the first one here: https://jessesingal.substack.com/p/on-scientific-transparency-researcher) to find all its shortcomings?
Thank you. You confirmed what I was thinking when I was reading about this study. The manipulative reporting of data by advocate researchers is out of hand.
Advocates are not researchers. At least not ethical researchers
SCANDAL. Why are so many professionals caving and lying? What happened to personal moral and protecting CHILDREN. Thank you for this thorough analysis. My daughter is collateral damage.
Thank You for this incredibly thoroughly-reported update!
They say “the data don’t lie”. That’s possibly true at some level of abstraction. However, analysts of data can and do lie - well perhaps “lie” is a bit too strong. But they certainly spin their analysis to suit their arguments.
And there are so many ways to do the spin - the data you look at and the data you ignore, the study design including the methodology you use, the types of statistical analysis you perform, the results you report and the ones you ignore, how you frame the results, the inferences you take from the results, and the conclusions you reach. I’m sure I’ve missed a few but you get the idea. Thanks Ben for your ongoing efforts to cut through the spin.
what should we make of "studies" produced by organizations and persons whose stated goal is to further access to gender affirming care and has created goal statements with the usual misinformation that frames persons who opt to ID as transgender, or were tricked into it, as marginalized based solely on this voluntary identification? These groups paint a one sided picture of severe interventions that add to inaccurate perception that gender care is evidenced based or that it will lead to positive outcomes.
their data and study conclusions must be assumed to be one sided, typically filled with ommissons with the single goal of activism
"The LGBTQ Health Center of Excellence...aims to advance health equity for LGBTQ people"
https://hsph.harvard.edu/news/new-center-to-tackle-health-disparities-affecting-lgbtq-community/
Another great example of why you CANNOT understand these articles without the appropriate context, and why the vast majority of mainstream reporting has so egregiously failed the public in their reporting on it. Thank you again, Ben.
I can't access the article so I don't know if this was shared in it, but I was curious how "rare" 0.1% of the population in question looks like in terms of actual numbers of youth. Using the per 100,000 numbers from the chart for ages 13-17 and an assumption of 4,000,000 people in the US at each of those ages I get on average about 10,000 minors on cross-sex hormones in the US at any given point during the period referenced in the study. I suppose one can argue whether 10,000 is "rare" for that kind of treatment in minors.
It's hard to generalize since not all minors have this type of insurance. But it's a fair statement that the definition of "rare" is fuzzy.
There are varying definitions of what constitutes a rare disease: the World Health Organization uses the ratio of less than 65 per 100k people, the European Union <1 in 2000, the US NIH says anything affecting <200k Americans. To pick another rare disease, cystic fibrosis, which affects 40k people (adults & children) in the US. Its genetic origin was discovered in the 20th century, though the symptoms were first mentioned in medical texts from the 16th century.
By these standards puberty blocking/cross-sex hormone treatments are "rare" but the striking statistic about it is the astronomical rate of increase of its diagnosis over the past 10-15ish years (not to mention the lack of any definitive test for it, evidence of treatment efficacy, etc.). This is why supporters redefine gender non-conforming historical figures, claiming these numbers were always present, just not being counted.
Thank you!
Thank you for your excellent reporting!
I'd be curious to know the geographic spread of these 1 in 1,000. If trans is some kind of naturally occurring, totally normal human variation, you'd expect it to be fairly evenly spread across the US, but I suspect that there's a good deal of clumping. Of course, some might respond, "People who don't live near gender clinics aren't getting treatment, and so aren't billing their insurance companies", which I guess would be true. Then we're left with the puzzle of the totally normal human variation that nonetheless requires 21st-century medical treatments or else those possessing it will kill themselves. Ugh.
I have a question I read somewhere there was a peer reviewed critique of this article Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care
Diana M Tordoff someone link me that critique I can't find it anywhere
I'm not sure, but Singal deconstructed it: https://jessesingal.substack.com/p/researchers-found-puberty-blockers
For Jesse's post the other day but I think the paper I was looking for critiquing that pro hormone study was called this As one peer-re viewedcritique of the study observed,
“The spin of Tor doffis dramatic” Abbruzzese et al., supra, at
688. The fact thatMcNamara et al. cite this study as “valuable,”
McNamara Br. at13–14, I can't find a link to it anywhere does anyone have one
Thank you for this important, timely, and complete critique.
“This included a cumulative 11.9 million years of insurance-claims data.”
This must have slipped through in editing/proofing.
This time period was within the Miocene Era. I image the health insurance of that time was quite primitive.
No, you're misunderstanding what that figure means. It means that they had an average of little over 2 years of data regarding 5 million minors. You multiply the average number of years of data by the total number of people in the dataset. This is known as person-years of follow-up.
Ah! Well don’t I feel sheepish.
🫢
It's worth the feedback that that expression, which I've been using for the past 13 years, doesn't make sense to everyone. It's hard to find a succinct way to describe person-years of follow-up in laymen's terms.
I wouldn’t feel too bad - this whole field is so complex and so fast moving that it’s pretty hard to get your head around.
Yes, and the gender ideologues do their best to create as much confusion as possible!