Association of Health Care Journalists Makes Extensive Changes to Faulty Primer On Transgender Medicine Reporting, But Flaws Remain

After journalist Jesse Singal objected to the AHCJ's false claims about his reporting and I covered the primer's flaws, the organization backpedaled—but has egregiously not acknowledged any errors.

The faulty primer on reporting about transgender medicine that the Association of Health Care Journalists published Sept. 12

After the Association of Health Care Journalists on Sept. 12 published a primer on covering transgender medicine that I reported on Sept. 14 was highly misleading and at certain points erroneous, the AHCJ has made extensive changes to the document as of Sept. 17.

However, the organization has not acknowledged publishing any errors in the original document and has not issued an official correction, as it definitely should. Instead, AHCJ added an editor’s note to the opening of the document that states the following:

​Editor’s note: This article has been revised to more clearly describe who is affected by state laws on gender-affirming care. It has also been edited to clarify that The Economist’s reporting relied on emails and multiple court documents rather than solely on an amicus brief. Additionally, the characterization of the impact of the Cass Review has also been revised to reflect its defense of its methodology.

Here is the archived original version of the reporting primer.

Here is the new version.

Here is my original Substack report from Sept 14:

Let’s walk through the changes the ACHJ made, and the ones they didn’t make.

Opening paragraph

The opening paragraph, also known as the lede, remains unchanged. This despite the link to the flawed Science editorial, which I discussed in my previous Substack.

Clarifying who the state bans apply to

Old version:

New version:

As you can see, in the original version, the AHCJ had conflated the 26 state bans on pediatric gender-transition treatment for minors with state bans in a smaller number of states on Medicaid coverage of gender-transition treatment for all ages.

Politicization in Europe

AHCJ made no change to this passage, despite my reporting about how the European policy changes on gender-transition treatment for minors have largely come from health authorities, not politicians.

Referring to Tordoff and Baker studies

AHCJ made significant changes to the segment of the primer that erroneously referred to a 2022 study known as Tordoff et al that studied gender-transition treatment among 13 to 20 year olds for 12 months. The primer had erroneously suggested that that was a study in adults, rather than one focusing on adolescents and young adults.

Old version:

New version:

In the new version, the first highlighted sentence removes hyperlinks to Tordoff from the words “depression” and “anxiety” and adds a new one to the word “addiction”: a 2022 Dr. Jack Turban study that analyzed 2015 survey data. Survey studies are certainly not the best way to assess the impact of medications. But this entire field is dominated by weak studies.

The revised sentence, however, makes no acknowledgement of the limitations of gender-transition treatment research as found in the WPATH-commissioned Baker et al systematic literature review that is hyperlinked in the words “Recent studies.” That review reached the following conclusions about the evidence base behind gender-transition treatment at any age:

Hormone therapy was associated with increased [quality of life], decreased depression, and decreased anxiety. Associations were similar across gender identity and age. Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions. We could not draw any conclusions about death by suicide.

Then, in the last highlighted sentence in the new version, AHCJ continues to hyperlink to Tordoff in the words “One study.” AHCJ’s claims about Tordoff’s findings ignore how flawed the study is and the fact that the participants in the study’s treatment group experienced no change in their suicidality over the 12 months of the study; what changed was there was high loss to follow-up in the untreated comparison group, which had a high concentration of five mentally unwell people at the 12-month mark.

Also, using the term “associated with reductions in” is erroneous. The Tordoff study did not find that there was any actual reduction in suicidality among the group receiving treatment. They found that compared with the ever-smaller untreated comparison group, they had lower suicidality overall—a crucial distinction.

Here is Singal’s critique of Tordoff:

Researchers Found Puberty Blockers And Hormones Didn’t Improve Trans Kids’ Mental Health At Their Clinic. Then They Published A Study Claiming The Opposite. (Updated)

Dialing up emphasis on need for more research

Notwithstanding failing to acknowledge the Baker systematic literature review’s conclusion about the weakness of the evidence, and not acknowledging that a half-dozen other systematic literature reviews have found the evidence backing pediatric gender-transition treatment in particular is weak and largely inconclusive, the ACHJ juiced up the wording in the following passage:

Old version:

New version:

Changes to claims about Jesse Singal’s Economist article about WPATH

Old version:

New version:

The new version is still false. The Economist headline does not say that WPATH manipulated data, as AHCJ claims. It says, “Research into trans medicine has been manipulated.” As the WPATH emails subpoenaed by the Alabama attorney general and unsealed in June clearly show, WPATH commissioned Johns Hopkins to conduct research: multiple systematic literature reviews about gender-transition treatment. And then when WPATH did not like the findings of this research, it manipulated the Hopkins teams’ efforts, changing the terms of their agreement and ensuring that only one such review ever saw the light of day—the Baker et al paper. Also, WPATH did not engage in “attempts to influence the research,” they succeeded in influencing it, over adamant objections from the Hopkins contact, who was finally worn down in the end and acquiesced.

Jesse Singal’s June 2024 Economist article—no mention of “data” in the headline

The Cass Review

Old version:

New version:

The AHCJ has removed the hyperlink to the flawed Mother Jones article that was linked in the words “reported uncritically” after I reported that that article cites a parade of gender clinicians who did not acknowledge their conflicts of interest when criticizing the Cass Review: Cass and the systematic literature reviews on which it was partly built had criticized their work and their professional affiliations.

In part by changing its hyperlinked sources, the edited AHCJ primer switches from suggesting that the Cass Review impacted American bans on gender-transition treatment for minors, almost all of which were passed before the review was published in April, to correctly emphasizing how the review has indeed impacted British medical practices.

The new version is wrong to say that Cass “acknowledges limitations in the existing evidence base for gender-affirming care,” because Cass has nothing to acknowledge; Dr. Hilary Cass herself is not responsible for the evidence base in this field. Rather, Cass reported those limitations. In the editor’s note at the opening of the new version of the reporting primer, AHCJ states, “Additionally, the characterization of the impact of the Cass Review has also been revised to reflect its defense of its methodology.” Therefore, AHCJ seems to be confusing the weakness of the evidence base in this medical field with criticisms about the methodology that Cass followed and that was followed by the team at the University of York that published the seven systematic literature reviews on which the Cass Review was partially based.

At the end of the highlighted new passage, the AHCJ has toned down the language regarding the British Medical Association’s move to scrutinize Cass. And yet the edited primer still doesn’t acknowledge the internal revolt in the BMA over this move, or the fact that the move to engage in the critique was put in place fewer than two dozen BMA members. It’s also worth nothing that a number of major British medical groups have endorsed Cass, and that the BMA isn’t a science organization; it’s a trade union.

AHCJ still claims that gender-transition surgeries are rare

The edited primer makes no changes to the false claim that gender-transition surgeries, whether for adults or minors with gender dysphoria, are rare.

As a reader just pointed out, this 2023 study found evidence of at least 48,000 gender-affirming surgeries (GAS) in the U.S. between 2016 and 2020. And rates of such surgeries continue to climb each year, especially among adolescents and young adults:

And as I reported:

In sum, I’ll say that pediatric gender medicine in particular is a byzantine topic, rife with contradictory claims by warring camps. It is extremely difficult for anyone to wrap their head around it. I spent the better part of a year reading about it extensively before I ever published a word about it. So I can sympathize with how difficult it is to report on this topic accurately. That said, people who have clear trouble doing so are in no position to advise other journalists on how to report on the topic.

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I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News and The New York Sun.  I have also written for the Washington Post, The Atlantic and The Nation. 

Follow me on Twitter: @benryanwriter.

Visit my website: benryan.net