Fact Checking Claims About Pediatric Gender Medicine By The Majority Report's Sam Seder
The hot-headed host of the progressive YouTube political punditry show has a history of indignant speeches on this controversial subject that betray his shaky knowledge of the relevant science.
Sam Seder, the hot-headed host of the popular progressive YouTube political-punditry show The Majority Report, has a long history of weighing in on pediatric gender medicine in spirited speeches that are heavy on emotion and indignation but betray a shallow knowledge of the facts.
You may recall the time in the fall of 2023 when science journalist
called in to the show and was subjected to such a belligerent barnstorming by Mr. Seder and his cohost, Emma Vigeland, that Mr. Singal could barely get a word in edgewise as he attempted to explain and explore the nuances of this complex topic.On today’s show (the video of which is at the top of this Substack), Mr. Seder and Ms. Vigeland responded to the new research letter out of Harvard, which was published in JAMA Pediatrics on Monday and that I covered for my Substack, that assessed the rates of prescriptions of puberty blockers and cross-sex hormones to adolescent minors with transgender-related diagnoses.
As I explored on Monday, the research letter and its accompanying press release were crafted with an advocacy bent, with the explicit intention of combatting conservative efforts to ban minors’ access to these medical interventions. In further evident service of that goal, the investigators’ data analysis was conducted in such a way that it likely lowered the prescription rates they reported in the research letter. Their write-up clearly sought to provoke the public to interpret these figures as rare.
Every other journalist who reported on the new Harvard study, in outlets such as the AP and NPR, essentially parroted the research letter and press release without conducting any of their own more trenchant and independent analysis of the available data.
This sort of unquestioning reporting a big problem in science journalism today.
Not to be outdone, Mr. Seder followed suit on today’s episode of The Majority Report.
Fact checks of Mr. Seder’s claims about the Harvard study
Sam Seder: Age “12 to 18, 2,000 of them over the course of five years” received gender transition treatments. Prescriptions of gender-transition drugs to minors are “incredibly rare.”
These raw numbers, which were not actually reported in the research letter and yet were given to some reporters, are not an accurate reflection of the true number of minors who received puberty blockers and cross-sex hormones for gender dysphoria over the 2018 to 2022 study period. The study relied on a limited database of only 5.1 million adolescents with private health insurance. That leaves out the vast majority of minors in age bracket—8 to 17 years old—they studied. Consequently, it’s better just to look at the rates—not the numbers—that the study reported, which I will address further down.
The best figures we currently have of the approximate numbers of minors receiving these interventions come from the recent analysis by Do No Harm. As I previously reported, that analysis produced these conservative estimates regarding 2019 to 2023:
13,994 unique minors received gender-transition surgeries, treatment, or both.
5,747 minors received gender-transition surgeries.
8,579 minors received puberty blockers, cross-sex hormones, or both (the analysis did not disaggregate to show how many minors received each type of medication). Between them, these minors were written 62,682 prescriptions.
Are these figures “incredibly rare” as Mr. Seder insists? The public seems to be split on this assessment.
The AP headline that Mr. Seder broadcast on his show, as I said, simply parroted the Harvard press release’s framing, which took an average of cross-sex hormone use across all adolescents, age 8 to 17 to produce the “less than 1 in 1,000” rate. But hormone use was largely clustered among 14 to 17 years olds and increased considerably with each successive year of age. So providing only this average across a 10-year age span likely lowers the rate considerably.
If you want to answer the question of what proportion of minors wind up taking cross-sex hormones before they turn 18, the best proxy for that cumulative-use figure is the rate of use at age 17. Fortunately, the study did report this data. Overall, about 1 in 1,000 privately insured minors with a trans-related diagnosis had received cross-sex hormones by that age, including 1.4 natal girls in 1,000 and 0.8 natal boys in 1,000.
But Do No Harm’s analysis indicated that prescribing rates of gender-transition drugs increased dramatically between 2019 and 2022 in particular. (Prescribing pulled back at least a bit in 2023.) And so, again, reporting only an average across time, as the Harvard team did, likely produces a lower rate than if they had reported the figures for 2022 in particular.
If you want to eyeball the prescribing-rate trajectories over time, state by state, I’ve posted charts in this report:
Sam Seder: “Other researchers have found” that gender-transition surgeries “are extremely rare.”
This is a reference to a previous research letter about gender-transition surgeries among minors that came out of the same public health school at Harvard that produced the new study about medication interventions. As I previously reported, that previous Harvard study relied on a woefully limited insurance-claims data set to falsely suggest that only 85 minors received gender-transition surgeries in 2019.
That previous Harvard study also made some awkward and misleading comparisons between the rates of gynecomastia surgery in boys and breast reductions (as opposed to mastectomies) in natal girls with gender dysphoria. I wrote about that here:
A recent analysis by Leor Sapir a the Manhattan Institute found that, in fact, by a conservative estimate, about 1,000 natal girls under age 18 got a double mastectomy, aka top surgery, annually to treat gender dysphoria in recent years. The rates also generally rose year by year.
Dr. Sapir broke down the figures in this chart:
Do these represent “rare” or “extremely rare” figures? The public appears to be split on this.
Sam Seder: “That suggests, if it’s not explicit, that there are safeguards, that this isn’t being done will-nilly.”
A bird's-eye view of rates of prescribing of gender-transition drugs to minors does not necessarily inform us about whether there are consistent safeguards against unwarranted prescribing of these drugs. Numerous sources have indicated that many pediatric gender clinics provide minors with only a short or otherwise cursory assessment before prescribing them blockers and hormones. For example: Boston Children’s Hospital has a longstanding policy of providing gender dysphoric minors and their parents with only a single two-hour assessment with a psychologist before deciding whether to refer them to an endocrinologist for gender-transition medications.
Mr. Seder was absolutely correct when he said that, in particular, the “castrating” of natal boys is not happening “willy nilly.” Vaginoplasties in minors are very rare. But at least some leaders in the pediatric gender medicine field, such as gender-transition surgeon Dr. Marci Bowers, do recommend that transfeminine teens (natal boys with gender dysphoria) get this surgery at around age 17. The idea is that their parents can care for them during their recovery and then they can leave home for college or elsewhere having had that taken care of. UCSF child psychiatrist Jack Turban’s recent book on trans kids, Free to Be, spotlights the experience of one such child (who is a composite character), who happily matriculates to Stanford afterward and reports having a delightful sex life with her boyfriend.
Sam Seder: “There’s one whistleblower that ends up being considered a freak by everybody who came in touch with her at a hospital.”
This is quite the boorish evident reference to Jamie Reed, who was a case manager at the Washington University at St. Louis pediatric gender clinic and blew the whistle on the establishment, accusing it of providing shoddy care, in an article in
in Feb. 2023. Her testimony triggered a series of events that eventually saw the clinic shuttered and gender-transition treatment banned in Missouri.
Azeen Ghorayshi of The New York Times reported out Ms. Reeds claims and was able to substantiate many of them. She wrote in Aug. 2023:
Some of Ms. Reed’s claims could not be confirmed, and at least one included factual inaccuracies. But others were corroborated, offering a rare glimpse into one of the 100 or so clinics in the United States that have been at the center of an intensifying fight over transgender rights.
Mr. Seder suggests that Ms. Reed is the only whistleblower of her kind. This is false. Two psychologists who each had a long history at Boston Children’s, Amy Tishelman and Laura Edwards-Leeper, have each been public about their concerns that that clinic is not providing appropriate care of minors with gender-related distress. Dr. Edwards-Leeper in particular has provided considerable public commentary expressing her worries that the entire field of pediatric gender medicine is in trouble and, overall, is not observing proper safeguarding.
Also, in Feb. 2024, The Free Press published an essay by Tamara Pietzke, a therapist who blew the whistle on the pediatric gender clinic in Washington state where she worked. Her criticisms of the establishment was strikingly similar to what Ms. Reed wrote about Wash U.
Sam Seder: “Not to mention the studies that the people who received this care almost overwhelmingly—well no, overwhelmingly—but almost totally, were happy they engaged in this care.”
This is an apparent reference to the ongoing study by Princeton’s Kristina Olson, who has been following a cohort of minors who all socially transitioned very young, at an average age of six. In a new paper, published in October that I reported about at the time, Dr. Olson provided an update on 220 of these minors who had started gender-transition treatment. A few years in, 97% reported—or their parents reported on their behalf—that they were happy with the treatment.
The problem with this study, which conducted its recruitment between 2013 and 2017, is that it is not comprised of a representative sample of children who identify as transgender. These kids are more representative of the traditionally gender dysphoric child that such clinics have been seeing for decades. These are the very rare cases of children who from a very young age were insistent, consistent and persistent, as the saying goes, about identifying as the opposite sex. The original Dutch model of gender-transition treatment, cultivated in the Netherlands in the mid-1990s and spread around the world starting in the late 2000s, was created for such children. (Dr. Edwards-Leeper was part of the team that first imported this model to the U.S., to Boston Children’s, in 2007.)
But today, the typical minor presenting at a gender clinic is a natal girl who only first started expressing gender incongruence and complaining of gender dysphoria after the onset of puberty. Unlike the children in Dr. Olson’s study and the Dutch study, these adolescents tend to have a very high rate of psychiatric comorbidities.
As Britain’s Cass Review found in its assessment of the pediatric gender medicine field that was published in April, the rate of detransitioning following the receipt of gender-transition treatment during adolescence remains woefully unknown due to limited follow-up in most of the available studies. We might know more on this subject had the adult gender clinics in England not refused to share their de-identified data about former pediatric patients.
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 theWashington Post, The Atlantic and The Nation. Follow me on Twitter: @benryanwriter and Bluesky: @benryanwriter.bsky.social. Visit my website: benryan.net
The idea that one child in 1,000 would be rare is astounding to me. During most of the 20th century, rates of diagnosed transsexualism in the *adult* population ranged between roughly one in 10,000 to one in 50,000 depending on the country. (Ben, I actually have a chart of these numbers in a 1999 doctoral thesis on the subject that I could share with you.)
The rate of childhood leukemia is 4.8 per 100,000 per year, which if we multiply that by 18 years (the number of years a person would count as a minor) is 86.4 per 100,000 and thus 0.864 per 1,000. This is the most common type of cancer in children and I’ve never heard it talked about as a super rare non-issue. And now we’re talking about a condition that zero children were treated for thirty years ago.
Innumerate policy wonks with influence drive me crazy