Shannon Minter, legal director at the National Center for LGBTQ Rights, held a spirited debate about pediatric gender medicine with Sullivan on his podcast. Then I gave critiques of their arguments.
Thank you for publishing the debate here....I had just finished reading it on Andrew's substack.
I am particularly interested in the question of whether, as it appears to me, "gender affirming care" is a sub rosa version of gay/lesbian conversion therapy, except worse.
In addition, Is "gender dysphoria" and "gender non-conformity" new ways of re-pathologizing homosexuality?
> "... sub-rosa version of gay/lesbian conversion therapy, except worse."
I'd go with the "except [much, much] worse".
I really don't think Sullivan -- or our host Benjamin -- quite understands exactly what "gender-affirming care" really boils down into. Which is the sterilization and castration of dysphoric and autistic children, turning them into sexless eunuchs, largely because they're "gender non-conforming", because they exhibit personality and behaviour traits that are not typical for their sex. "Conversion therapy" writ large, in great red flaming letters 10 feet high.
Fine, I guess, if "adults" like Bruce Jenner and "Debbie" Hayton wish to do that themselves. But to trick children into thinking that mangling their genitalia into some Frankensteinian transmogrification and ersatz replica that looks "vaguely" like those of the other sex? Medical scandal and crime of the century. Whole bunch of "doctors", "lawyers", and pundits -- including a cast of thousands, the usual suspects -- responsible for that -- in absolutely any way at all -- should be strung up by their nuts and left to twist in the wind, figuratively speaking of course ...
Y'all might take a gander at this old post from Helen Joyce:
Of particular note in that last link is the section on "Sex Reassignment Surgery" -- though not for the squeamish or easily shocked. No indication that the photos there is "his" vagina -- something that I expect that most red-blooded Amurican boys, and Canadian ones too would "hit" without much in the way of any encouragement at all required. But no testicles there that I can see -- Conway, and others in his tribe, had/have sterilized and castrated themselves, turned themselves into sexless eunuchs.
And that is what Ben and Andrew and Minter are encouraging and promoting, one way or another? "Monstrous" does not begin to describe that.
The argument over whether the Utah study was or wasn’t a systemic review feels very meta: if the authors *say* it was, and *believe* it was, then it was—no matter that systematic reviews have terms, requirements, etc. All that’s required is that the authors *believe* they have created a systematic review in order for it to *be* one.
Thank you for having and publishing this discussion. The debate about the Utah review really drove home the fact that the only way to argue that evidence shows that pediatric medical transition improves mental health and well-being is to be scientifically ignorant or disingenuous. Minter's response to your well-informed explanations why this report isn't a systematic review was the typical vacuous appeal to authority that is always the resort of the "follow the science" crowd when they realize the science is not on their side, ending with Minter claiming that a stalemate had been reached due to a lack of credentials on both sides, when it was you who had clearly displayed a serious grasp of the issues while Minter did not.
We also have to ask if a short-term improvement in mental health, were it to be shown, would really justify these medical interventions, in children or even in adults. Only long-term outcomes could justify such radical alterations of the natural body, and what we would really need is a control group to learn anything definitive about the treatment's value. Such a prospective study, especially in randomized form as would be needed to truly establish causality, is probably never going to be conducted. In the absence of that, I continue to believe that nobody becomes their "true self" by altering the biological reality of their body, with all the negative consequences this has for its functioning. I also cannot imagine that living as an impostor of the opposite sex, constantly depending on society participating in their fiction, can be good for anyone's mental health.
THIS. One of the major questions I have from following all this is how on earth an ethical study could be conducted. To me, it seemed like that was a concession that Cass made to placate the activists and/or seem even-handed, but how could kids be given treatments with irreversible consequences, even in a clinical trial setting? I don’t know how the planned NHS trial supposes it will do this ethically.
Your comment on long-term outcomes is spot on though. The arguments made for mental health improvements that rely on short-term self report outcomes seem so ridiculous to me. Long-term outcomes should be the standard. And if even one kid who has had irreversible medical changes to their bodies later detransitions, then there would need to be very powerful contradicting reasons to persist in using these treatments. Which don’t exist.
I thought they didn't assess the overall quality of the evidence. They say they don't.
So they followed part of prisma maybe?
Not all.
The points you made and those by Cantor are crucial...
Does Cantor's having treated a child or not have bearing on what he does or doesn't find is accurate in a systematic review? Ad hominem fallacy. If he's right he's right, and one can check. If he's wrong about an objective fact, ditto. What did he say that was incorrect?
This focus on the person in some other capacity rather than the facts they present should not be accepted as an argument regarding fact! Perhaps if he had a track record of misstating facts, but that's not the claim. And Cantor is reliably accurate from what I've seen.
I just want to say that you do excellent work. Always it is thoughtful, thorough and sticks to the facts as much as possible. You’re very upfront about what we know and don’t know and you refrain from editorializing.
It is a fundamental tenet of logic, and of evidence based medicine, that the burden of proof accrues to those who claim a benefit from X. And the basic proof of causation comes from randomized controlled trials. So if the gender activists want to claim that puberty blockers and/or cross sex hormones provide some sort of benefit, it behooves them to conduct RCT to demonstrate causative proof of such benefit. This is a concept they should’ve learned in medical school. It is mind boggling that they fail to grasp such fundamental first principles.
As for systematic reviews or meta-analysis, they are only as good as their component studies. If those foundational studies are methodological garbage, it will simply be garbage in garbage out. Which is essentially what Cass told us. It’s pretty motivated reasoning for these folks who trot out that Utah paper it seems.
There is a continuing faulty premise underlying these discussions is that trans is anything except the human form of sexual mimicry present across the animal kingdom, and in some places the plant kingdom, in nature. It is one of a variety of mating strategies and in some cases protective in deployment.
In humans some sexual mimicry is delusional and compulsive, some is facultative, some is fetishistic. It evolved to avoid male aggression and sexual competiton in men, and to avoid unwanted male sexual attention in women.
Physicians, including psychiatrists, as well as politicians, teachers, parents and other humans are precisely the target of human sexual mimicry. Behavioral mimicry evolved and elaborated in parallel with human culture to be generally successful, but once exposed it is impossible to reconstitute the act. Men are seen to be men, and not females.
Because mimicry is fragile - a single failure collapses the mimic’s act - humans indulging in the mimicry seek to maximize the logical extent of mimicry and constantly work to make the mimicry real by avoiding any referent to the target of the mimicry, which exposes truth. The obvious presence of women is an existential threat to the act of female mimicry by men. Denying obvious existence of women is part of the higher order set of behaviors the mimicry institutes.
In framing all sexual relation to hide mimicry, part of it is involved in reframing all sexual ambiguity as part of the mimicry itself. Childhood effeminacy in boys and masculinity in girls is identified as mimicry instead of early signs of Gay or Lesbian orientation in later life.
Since the mimicry is delusional, all debate and argument with mimics is not rational. In no case in my reading in 45 years has a committed male mimic ever admitted what they do is mimicry, and that they are a man. Similarly, nobody with any “bizarre” class delusion will ever admit the delusion is not fact. Delusions are not rational.
Because of this, no debate with a mimic on the subject of sex is rational, because the premise that a man mimicking a female and has existential commitment to maintaining the facade can make rational statements on sex is false.
It is a simple Catch-22 - if they could make rational statements about sex, they would say they were male. If they said they were male then they could not comment on their state as women and the state of others.
The premise is flawed, and the outcomes will be riddled by failures of reason.
Olson Kennedy at least hypothesized, along with her co PIs at Chicago, Boston and UCSF, it's not just her, that kids would have improvements from puberty blockers and hormones in several areas they tested.
It's in the protocol. An appendix to Chen et al. 2023. The hormones one hasn't had most of the outcomes published either as Jesse Singal noted quickly in his Chen et al review. Some kids clearly worsened given the two tragic outcomes in Chen et al 2023.
Your writeup was the cherry on an Interesting debate. I've followed Andrew Sullivan for years but this was my introduction to Shannon Minter. I thought he was a really nice person--but I was surprised by his promoting of the Utah study at the expense of the Cass Report.
My shorthand review of the debate between Sullivan and Minter. As the discussion turned to so called “gender affirming care” for children, Minter: deny reality, deny reality, deny reality. Later in the discussion after Sullivan had steadfastly called her out she began to: concede a little reality, concede a little reality, concede a little reality.
Whole issue is a dog's breakfast, a case of pretty much everyone riding madly off in all directions. Largely because of inconsistent, incoherent, and contradictory definitions for both sex and gender, the latter in particular.
Relative to the former, you might be "amused", or catatonically depressed as the case may be, by this repudiation and denial of any substance at all to the concepts of "male" and "female" from Chase Strangio in Slate some years ago:
CS: "There is plainly no one type of body that we could accurately label a 'male body.' ..."
That will be news to most reputable biologists since "male", by definition, means "produces sperm" so that one might argue that the prototypical "male body", at least the human one, is one with testicles, pretty much everything else then being an "accidental property":
So Bruce Jenner and Debbie Hayton then have lost, or turned in, their membership cards in that category so have to qualify as sexless.
But y'all might be likewise amused or depressed by this conversation I had with Ms., or Mrs. "Kimberly Ryan House", apparently a mother though she got quite "offended" -- then blocked me -- when I mildly questioned the claim:
She, like too many, doesn't seem to have much of a flaming clue about the difference between sex and gender and what it takes to qualify as a male (sex) or as a female (sex).
Hey Ben, my earlier comment noted I was a decades-long reader of Andrew Sullivan who was impressed by your contribution to this debate. So I was surprised just now to see a new post by Jonathan Katz about Substack's Nazi/Extremism Problem that labels you "anti-transgender" in the process of calling you out by name. I suppose any publicity is good publicity but I was frankly surprised to see you included in the list (and I suppose Andrew by inference given his inclusion of you in the debate). Katz's attack on you seems like extremism in the name of anti-extremism. I'm not sure if/how you'll respond but I take it as a sign you're scoring points. Keep up tbe good work!
Thanks. I doubt very much that Katz has ever read a word I’ve written. If you look at the hyperlink on the bit about my Substack being anti-trans, you’ll see it links to Andrea James’ defamatory page on me, which is nothing but lies and was written before I had a Substack and hasn’t been updated since.
Thank you for publishing the debate here....I had just finished reading it on Andrew's substack.
I am particularly interested in the question of whether, as it appears to me, "gender affirming care" is a sub rosa version of gay/lesbian conversion therapy, except worse.
In addition, Is "gender dysphoria" and "gender non-conformity" new ways of re-pathologizing homosexuality?
> "... sub-rosa version of gay/lesbian conversion therapy, except worse."
I'd go with the "except [much, much] worse".
I really don't think Sullivan -- or our host Benjamin -- quite understands exactly what "gender-affirming care" really boils down into. Which is the sterilization and castration of dysphoric and autistic children, turning them into sexless eunuchs, largely because they're "gender non-conforming", because they exhibit personality and behaviour traits that are not typical for their sex. "Conversion therapy" writ large, in great red flaming letters 10 feet high.
Fine, I guess, if "adults" like Bruce Jenner and "Debbie" Hayton wish to do that themselves. But to trick children into thinking that mangling their genitalia into some Frankensteinian transmogrification and ersatz replica that looks "vaguely" like those of the other sex? Medical scandal and crime of the century. Whole bunch of "doctors", "lawyers", and pundits -- including a cast of thousands, the usual suspects -- responsible for that -- in absolutely any way at all -- should be strung up by their nuts and left to twist in the wind, figuratively speaking of course ...
Y'all might take a gander at this old post from Helen Joyce:
https://web.archive.org/web/20201113021904/https://standpointmag.co.uk/speaking-up-for-female-eunuchs/
And a post from the NYTimes on a transman, "How Ben Got [Her] Penis":
https://www.nytimes.com/2022/05/10/magazine/phalloplasty.html?unlocked_article_code=1.Zk8.AVrg.eZwMjgdUvWwH&smid=url-share
Finally, a transexual, a transwoman of some apparently justified repute, "Lynn Conway":
"Lynn Conway, 1938-2024: The Computer Architect Who Helped to Revolutionize Digital IC Design"
https://www.eejournal.com/article/lynn-conway-1938-2024-the-computer-architect-who-helped-to-revolutionize-digital-ic-design/
https://en.wikipedia.org/wiki/Lynn_Conway
https://ai.eecs.umich.edu/people/conway/conway.html
Of particular note in that last link is the section on "Sex Reassignment Surgery" -- though not for the squeamish or easily shocked. No indication that the photos there is "his" vagina -- something that I expect that most red-blooded Amurican boys, and Canadian ones too would "hit" without much in the way of any encouragement at all required. But no testicles there that I can see -- Conway, and others in his tribe, had/have sterilized and castrated themselves, turned themselves into sexless eunuchs.
And that is what Ben and Andrew and Minter are encouraging and promoting, one way or another? "Monstrous" does not begin to describe that.
Well put, Steersman!
The argument over whether the Utah study was or wasn’t a systemic review feels very meta: if the authors *say* it was, and *believe* it was, then it was—no matter that systematic reviews have terms, requirements, etc. All that’s required is that the authors *believe* they have created a systematic review in order for it to *be* one.
That’s an interesting analogy!
Thank you for having and publishing this discussion. The debate about the Utah review really drove home the fact that the only way to argue that evidence shows that pediatric medical transition improves mental health and well-being is to be scientifically ignorant or disingenuous. Minter's response to your well-informed explanations why this report isn't a systematic review was the typical vacuous appeal to authority that is always the resort of the "follow the science" crowd when they realize the science is not on their side, ending with Minter claiming that a stalemate had been reached due to a lack of credentials on both sides, when it was you who had clearly displayed a serious grasp of the issues while Minter did not.
We also have to ask if a short-term improvement in mental health, were it to be shown, would really justify these medical interventions, in children or even in adults. Only long-term outcomes could justify such radical alterations of the natural body, and what we would really need is a control group to learn anything definitive about the treatment's value. Such a prospective study, especially in randomized form as would be needed to truly establish causality, is probably never going to be conducted. In the absence of that, I continue to believe that nobody becomes their "true self" by altering the biological reality of their body, with all the negative consequences this has for its functioning. I also cannot imagine that living as an impostor of the opposite sex, constantly depending on society participating in their fiction, can be good for anyone's mental health.
THIS. One of the major questions I have from following all this is how on earth an ethical study could be conducted. To me, it seemed like that was a concession that Cass made to placate the activists and/or seem even-handed, but how could kids be given treatments with irreversible consequences, even in a clinical trial setting? I don’t know how the planned NHS trial supposes it will do this ethically.
Your comment on long-term outcomes is spot on though. The arguments made for mental health improvements that rely on short-term self report outcomes seem so ridiculous to me. Long-term outcomes should be the standard. And if even one kid who has had irreversible medical changes to their bodies later detransitions, then there would need to be very powerful contradicting reasons to persist in using these treatments. Which don’t exist.
There is a prisma checklist. One can just look at that....https://www.prisma-statement.org/prisma-2020-checklist
It's a list of items. How many did Utah do?
I thought they didn't assess the overall quality of the evidence. They say they don't.
So they followed part of prisma maybe?
Not all.
The points you made and those by Cantor are crucial...
Does Cantor's having treated a child or not have bearing on what he does or doesn't find is accurate in a systematic review? Ad hominem fallacy. If he's right he's right, and one can check. If he's wrong about an objective fact, ditto. What did he say that was incorrect?
This focus on the person in some other capacity rather than the facts they present should not be accepted as an argument regarding fact! Perhaps if he had a track record of misstating facts, but that's not the claim. And Cantor is reliably accurate from what I've seen.
I just want to say that you do excellent work. Always it is thoughtful, thorough and sticks to the facts as much as possible. You’re very upfront about what we know and don’t know and you refrain from editorializing.
Thank you for your meticulous work in this area.
Gender activists remain impressively insane.
It is a fundamental tenet of logic, and of evidence based medicine, that the burden of proof accrues to those who claim a benefit from X. And the basic proof of causation comes from randomized controlled trials. So if the gender activists want to claim that puberty blockers and/or cross sex hormones provide some sort of benefit, it behooves them to conduct RCT to demonstrate causative proof of such benefit. This is a concept they should’ve learned in medical school. It is mind boggling that they fail to grasp such fundamental first principles.
As for systematic reviews or meta-analysis, they are only as good as their component studies. If those foundational studies are methodological garbage, it will simply be garbage in garbage out. Which is essentially what Cass told us. It’s pretty motivated reasoning for these folks who trot out that Utah paper it seems.
There is a continuing faulty premise underlying these discussions is that trans is anything except the human form of sexual mimicry present across the animal kingdom, and in some places the plant kingdom, in nature. It is one of a variety of mating strategies and in some cases protective in deployment.
In humans some sexual mimicry is delusional and compulsive, some is facultative, some is fetishistic. It evolved to avoid male aggression and sexual competiton in men, and to avoid unwanted male sexual attention in women.
Physicians, including psychiatrists, as well as politicians, teachers, parents and other humans are precisely the target of human sexual mimicry. Behavioral mimicry evolved and elaborated in parallel with human culture to be generally successful, but once exposed it is impossible to reconstitute the act. Men are seen to be men, and not females.
Because mimicry is fragile - a single failure collapses the mimic’s act - humans indulging in the mimicry seek to maximize the logical extent of mimicry and constantly work to make the mimicry real by avoiding any referent to the target of the mimicry, which exposes truth. The obvious presence of women is an existential threat to the act of female mimicry by men. Denying obvious existence of women is part of the higher order set of behaviors the mimicry institutes.
In framing all sexual relation to hide mimicry, part of it is involved in reframing all sexual ambiguity as part of the mimicry itself. Childhood effeminacy in boys and masculinity in girls is identified as mimicry instead of early signs of Gay or Lesbian orientation in later life.
Since the mimicry is delusional, all debate and argument with mimics is not rational. In no case in my reading in 45 years has a committed male mimic ever admitted what they do is mimicry, and that they are a man. Similarly, nobody with any “bizarre” class delusion will ever admit the delusion is not fact. Delusions are not rational.
Because of this, no debate with a mimic on the subject of sex is rational, because the premise that a man mimicking a female and has existential commitment to maintaining the facade can make rational statements on sex is false.
It is a simple Catch-22 - if they could make rational statements about sex, they would say they were male. If they said they were male then they could not comment on their state as women and the state of others.
The premise is flawed, and the outcomes will be riddled by failures of reason.
Olson Kennedy at least hypothesized, along with her co PIs at Chicago, Boston and UCSF, it's not just her, that kids would have improvements from puberty blockers and hormones in several areas they tested.
It's in the protocol. An appendix to Chen et al. 2023. The hormones one hasn't had most of the outcomes published either as Jesse Singal noted quickly in his Chen et al review. Some kids clearly worsened given the two tragic outcomes in Chen et al 2023.
Your writeup was the cherry on an Interesting debate. I've followed Andrew Sullivan for years but this was my introduction to Shannon Minter. I thought he was a really nice person--but I was surprised by his promoting of the Utah study at the expense of the Cass Report.
My shorthand review of the debate between Sullivan and Minter. As the discussion turned to so called “gender affirming care” for children, Minter: deny reality, deny reality, deny reality. Later in the discussion after Sullivan had steadfastly called her out she began to: concede a little reality, concede a little reality, concede a little reality.
Whole issue is a dog's breakfast, a case of pretty much everyone riding madly off in all directions. Largely because of inconsistent, incoherent, and contradictory definitions for both sex and gender, the latter in particular.
Relative to the former, you might be "amused", or catatonically depressed as the case may be, by this repudiation and denial of any substance at all to the concepts of "male" and "female" from Chase Strangio in Slate some years ago:
CS: "There is plainly no one type of body that we could accurately label a 'male body.' ..."
https://slate.com/human-interest/2016/07/theres-no-such-thing-as-a-male-body.html
That will be news to most reputable biologists since "male", by definition, means "produces sperm" so that one might argue that the prototypical "male body", at least the human one, is one with testicles, pretty much everything else then being an "accidental property":
https://plato.stanford.edu/entries/essential-accidental/
So Bruce Jenner and Debbie Hayton then have lost, or turned in, their membership cards in that category so have to qualify as sexless.
But y'all might be likewise amused or depressed by this conversation I had with Ms., or Mrs. "Kimberly Ryan House", apparently a mother though she got quite "offended" -- then blocked me -- when I mildly questioned the claim:
https://substack.com/@humanuseofhumanbeings/note/c-143593963
She, like too many, doesn't seem to have much of a flaming clue about the difference between sex and gender and what it takes to qualify as a male (sex) or as a female (sex).
> "Shannon Minter, a transman [<strike>transgender man</strike>] ..."
FTFY ...
Hey Ben, my earlier comment noted I was a decades-long reader of Andrew Sullivan who was impressed by your contribution to this debate. So I was surprised just now to see a new post by Jonathan Katz about Substack's Nazi/Extremism Problem that labels you "anti-transgender" in the process of calling you out by name. I suppose any publicity is good publicity but I was frankly surprised to see you included in the list (and I suppose Andrew by inference given his inclusion of you in the debate). Katz's attack on you seems like extremism in the name of anti-extremism. I'm not sure if/how you'll respond but I take it as a sign you're scoring points. Keep up tbe good work!
Thanks. I doubt very much that Katz has ever read a word I’ve written. If you look at the hyperlink on the bit about my Substack being anti-trans, you’ll see it links to Andrea James’ defamatory page on me, which is nothing but lies and was written before I had a Substack and hasn’t been updated since.
Have a look at Malcolm Clarke's work on substack if u haven't already