The APA sought to keep shielded from the public two panel discussions on the subject, including a remarkably nuanced address by leading pediatric gender psychiatrist Dr. Scott Leibowitz.
While his efforts at nuance and good faith are admirable, he is making the same core error as all alternative medicine and pseudoscience: refusing to take seriously the sufficiency of chance and human suggestibility as adequate explanations for a given phenomenon.
The sophisticated advocate for homeopathy will argue that millions of people claim to have been helped by it, and even if 99.9% of them are wrong there are still thousands of legitimate results. The same goes for UFO sightings, ghost stories, paranormal psychology, etc.
If I had been there I may have asked, “Dr Leibowitz, a chiropractor in my town does dangerous neck manipulations on teenagers and claims it will help them with anxiety and depression. He admits the evidence base is imperfect, but he believes in what he does. What argument are you making that the chiropractor could not also make?”
"He did not answer the question of why doctors should route children through the opposite-sex puberty and prevent them from undergoing their endogenous puberty."
But...they don't go through opposite-sex puberty, they get an endocrine disorder that mimics some of the secondary sex characteristics associated with puberty of the opposite sex. Their puberty has been disrupted and their development into a fertile adult (one of the main endpoints of puberty) has not occurred.
For biological basis-- He didn't quote the twin study which showed that fraternal twins had more concordance than identical twins ( https://pubmed.ncbi.nlm.nih.gov/35927439/ ). Just quoted a study that went the way he wanted, why? It's not a secret.
He seems to have sexual orientation mixed in there, also.
So much of what he says is simply wrong.
van der Miesen 2020--"The present study can, therefore, not provide evidence about the direct benefits of puberty suppression over time and long-term mental health outcomes."
Maybe he should read Abbruzzese et al. 2023, and the HHS report about the studies he mentions. Especially the long term Dutch outcomes, some of them are now >9 years but not great follow-up fractions. They do not seem like positive outcomes for many of the kids. As far as his comments on the Cass Review, he should read Cheung et al 2024 and McDeavitt et al 2025, he's echoing criticisms that have already been addressed.
His opinions were incorporated into WPATH SOC8, as he co-led the adolescent chapter, so why would Dr. Cass need to call him, she could read it? There were already problems noted in there, by the Cass Review final report, before the WPATH suppression of the systematic reviews came out. Why did he sign his name to something saying systematic reviews were not possible when there were already some NICE systematic reviews out there and even an umbrella review commissioned by the Florida public health agency?
Where in the WPATH recommendations are mental health issues prioritized? Looking at the summary of requirements for youth for hormones:
"Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally."
They don't know what diagnostic clarity looks like--because they don't have long term outcomes! Their assessments do not indicate long term likely outcomes either with or without medical intervention.
I have sympathy for the families who are terrified about the bans--but were they actually provided with accurate information about benefits/risks/etc? Or were they inaccurately told these interventions were life saving, as the Gov of Ohio claimed, I think, when he vetoed the bill?
What do his assessments indicate about likely long term outcomes for someone who is deemed appropriate for medical interventions? He doesn't know. No one does. He has been doing these interventions since 2007. What are the 5 and 10 year outcomes of his patients? Is he following them up? Has he characterized outcomes of all the people he treated? Why should this not be considered experimental, given how poorly the outcomes are understood and how significant and life-altering the interventions are? It has been almost 20 years since he started doing this, why doesn't he know how they are doing long term? Why doesn't he have a follow-up detransitioner/regret study?
Completely disagree:
"This should really be a discussion about how to do the care, not whether to do the care."
There is still a question of whether this qualifies as medical care, where benefit is likely to outweigh risk and where these interventions are more beneficial than the alternatives.
I don't think anyone has a right to be perceived a certain way by someone else.
I’ve read some bizarre statements in this field, but Liebiwitz’s “Everyone had the right to perceived as they want,” takes some kind of award. From now on you must all perceive me as Gwyneth Paltrow.
I wish this guy could have been there to ask him questions. One of the early young transitioners, he's now 30 and still looks and sounds (and acts, and probably thinks) 14. He recently started detransitioning:
Thank you for your continued objective reporting on this.
Dr Liebowitz lost me at the first slide, "That gender identities are real and valid concepts that [are] distinct from assigned sex—although overlapping, very complexly intertwined—but a distinct concept."
Gender identity is based on contemporary gender theory - biological sex is a more concrete, observable reality, and gender identity, while a meaningful personal experience, may not have the same objective basis.
So yes, some young people experience distress with what they believe to be their "gender identity" - and they need appropriate care, but as Cass pointed out, most of them are not getting it.
Tavistock Clinicians estimated that ±80% of their referrals were same sex attracted and were concerned they were "transing away the gay". As Benjamin points out, the impetus behind the Dutch protocol was to help middle aged men who identify as women "pass" better - so embarked on an experiment on adolescents and children.
There is no "right" or "wrong" way to be a girl or a boy, man or woman. There are girly boys and boyish girls - many of whom will later discover they are homosexual. Nothing "wrong" with any of the above.
If adults believe in gender theory, then they are welcome to take such steps as they feel helps them live their best lives. What they are not entitled to do is compel the rest of society to share their belief system.
For myself, I have a sex (recorded with greater than 99.9% accuracy at birth) a sexuality and a personality. I do not have a "gender" which I believe is frequently rooted in regressive, sexist and homophobic stereotypes. Just like I don't believe I have a "soul" - another belief system which enforced compliance.
So, I guess the field can't acknowledge that sex isn't assigned at birth, but something that is observed. And the observation would be right >99% of the time.
I noticed that nowhere is there the question asked of whether it's people who would be gay/lesbian who are being transed. Are "gender dysphoria" and "gender non-conformity" just another way of pathologizing, de facto, homosexuality?
In terms of that Dutch study, the start n was 70 and ending 55, which became 54 after a member of the group had vaginoplasty, but had a micro penis thanks to blockers/hormones, so tissue from the colon was used not properly sterilized, sepsis ensued, then death. And aren't the satisfaction results overstated because of how the scales were used to measure it?
Dr. Leibowitz ignores several things, including the price of disrupting puberty on overall health (including neurodeveloppement) and the conflation of "gender identity" with sex stereotypes. And even if gender variance was normal, why medicate it instead of learning to accept one's body and personality at once? His lecture sounds like a vast effort just to justify intensive, irreversible medical treatments.
There’s a fairly straightforward answer to the question of why treat adolescents for gender affirming care. Gender dysphoria. It causes intense suffering and can lead to death. This significant factor is all but ignored by opponents to adolescent
Why only gender affirming care that disrupts puberty and turns a teen into a lifelong patient? Gender dysphoria might have multiple causes, including internalized homophobia/misogyny, sexual trauma or fear of puberty itself.
There is only one cause for gender dysphoria-a mismatch between one’s gender identity and one’s visible sex. Since gender identity is immutable, the only thing that can be changed to ease dysphoria is the body.
Puberty blockers do not “disrupt” puberty, they just delay it.
A shot every two weeks does not make one a lifelong patient.
The concept of "gender identity" (described as both immutable and fluid, ironically) is unfalsifiable (i.e. unverifiable) and relies only on self-description that can stem from a lot of psychological issues. Before youth transition existed, most gender dysphorias resolved naturally through puberty. Puberty blockers, on top of their risks for fertility, sexual function and bone and brain development (issues for patients treated for precocious puberty) also potentially "lock in" gender dysphoria, becoming a stepping stone for irreversible medical treatments.
All of the above has been thoroughly documented in studies, articles, the Cass Report , and reviews from European countries that sharply scaled back on youth transition.
This is why gender transition is not a good idea before adulthood, even if transitioned men keep some masculine traits as a result. Everyone needs a natural puberty.
While his efforts at nuance and good faith are admirable, he is making the same core error as all alternative medicine and pseudoscience: refusing to take seriously the sufficiency of chance and human suggestibility as adequate explanations for a given phenomenon.
The sophisticated advocate for homeopathy will argue that millions of people claim to have been helped by it, and even if 99.9% of them are wrong there are still thousands of legitimate results. The same goes for UFO sightings, ghost stories, paranormal psychology, etc.
If I had been there I may have asked, “Dr Leibowitz, a chiropractor in my town does dangerous neck manipulations on teenagers and claims it will help them with anxiety and depression. He admits the evidence base is imperfect, but he believes in what he does. What argument are you making that the chiropractor could not also make?”
"He did not answer the question of why doctors should route children through the opposite-sex puberty and prevent them from undergoing their endogenous puberty."
But...they don't go through opposite-sex puberty, they get an endocrine disorder that mimics some of the secondary sex characteristics associated with puberty of the opposite sex. Their puberty has been disrupted and their development into a fertile adult (one of the main endpoints of puberty) has not occurred.
For biological basis-- He didn't quote the twin study which showed that fraternal twins had more concordance than identical twins ( https://pubmed.ncbi.nlm.nih.gov/35927439/ ). Just quoted a study that went the way he wanted, why? It's not a secret.
He seems to have sexual orientation mixed in there, also.
So much of what he says is simply wrong.
van der Miesen 2020--"The present study can, therefore, not provide evidence about the direct benefits of puberty suppression over time and long-term mental health outcomes."
Maybe he should read Abbruzzese et al. 2023, and the HHS report about the studies he mentions. Especially the long term Dutch outcomes, some of them are now >9 years but not great follow-up fractions. They do not seem like positive outcomes for many of the kids. As far as his comments on the Cass Review, he should read Cheung et al 2024 and McDeavitt et al 2025, he's echoing criticisms that have already been addressed.
His opinions were incorporated into WPATH SOC8, as he co-led the adolescent chapter, so why would Dr. Cass need to call him, she could read it? There were already problems noted in there, by the Cass Review final report, before the WPATH suppression of the systematic reviews came out. Why did he sign his name to something saying systematic reviews were not possible when there were already some NICE systematic reviews out there and even an umbrella review commissioned by the Florida public health agency?
Where in the WPATH recommendations are mental health issues prioritized? Looking at the summary of requirements for youth for hormones:
"Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally."
They don't know what diagnostic clarity looks like--because they don't have long term outcomes! Their assessments do not indicate long term likely outcomes either with or without medical intervention.
I have sympathy for the families who are terrified about the bans--but were they actually provided with accurate information about benefits/risks/etc? Or were they inaccurately told these interventions were life saving, as the Gov of Ohio claimed, I think, when he vetoed the bill?
What do his assessments indicate about likely long term outcomes for someone who is deemed appropriate for medical interventions? He doesn't know. No one does. He has been doing these interventions since 2007. What are the 5 and 10 year outcomes of his patients? Is he following them up? Has he characterized outcomes of all the people he treated? Why should this not be considered experimental, given how poorly the outcomes are understood and how significant and life-altering the interventions are? It has been almost 20 years since he started doing this, why doesn't he know how they are doing long term? Why doesn't he have a follow-up detransitioner/regret study?
Completely disagree:
"This should really be a discussion about how to do the care, not whether to do the care."
There is still a question of whether this qualifies as medical care, where benefit is likely to outweigh risk and where these interventions are more beneficial than the alternatives.
I don't think anyone has a right to be perceived a certain way by someone else.
And...should have started with *thank you*!
It is just such a misleading talk--so discouraging there were no questions allowed at the end.
I’ve read some bizarre statements in this field, but Liebiwitz’s “Everyone had the right to perceived as they want,” takes some kind of award. From now on you must all perceive me as Gwyneth Paltrow.
Unfortunately, no one has that right.
I saw Dr. Leibowitz speak at the AACAP 2018 meeting in Seattle. Dr. Littman presented her research from this first paper:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330
Dr. Leibowitz was condescending.
An audience member mentioned Erik Erikson--in relation to adolescent identity formation.
Good point.
These genderists, such as Dr. Leibowitz, will never back down.
Why don't people point out the obvious, the gender dysphoric, or those in a state of angst, will all be fine without medical interventions?
https://x.com/wesyang/status/1924914163354366364
Thanks for your work in this.
I wish this guy could have been there to ask him questions. One of the early young transitioners, he's now 30 and still looks and sounds (and acts, and probably thinks) 14. He recently started detransitioning:
https://www.facebook.com/watch/?v=149678171127514
Thank you for your continued objective reporting on this.
Dr Liebowitz lost me at the first slide, "That gender identities are real and valid concepts that [are] distinct from assigned sex—although overlapping, very complexly intertwined—but a distinct concept."
Gender identity is based on contemporary gender theory - biological sex is a more concrete, observable reality, and gender identity, while a meaningful personal experience, may not have the same objective basis.
So yes, some young people experience distress with what they believe to be their "gender identity" - and they need appropriate care, but as Cass pointed out, most of them are not getting it.
Tavistock Clinicians estimated that ±80% of their referrals were same sex attracted and were concerned they were "transing away the gay". As Benjamin points out, the impetus behind the Dutch protocol was to help middle aged men who identify as women "pass" better - so embarked on an experiment on adolescents and children.
There is no "right" or "wrong" way to be a girl or a boy, man or woman. There are girly boys and boyish girls - many of whom will later discover they are homosexual. Nothing "wrong" with any of the above.
If adults believe in gender theory, then they are welcome to take such steps as they feel helps them live their best lives. What they are not entitled to do is compel the rest of society to share their belief system.
For myself, I have a sex (recorded with greater than 99.9% accuracy at birth) a sexuality and a personality. I do not have a "gender" which I believe is frequently rooted in regressive, sexist and homophobic stereotypes. Just like I don't believe I have a "soul" - another belief system which enforced compliance.
So, I guess the field can't acknowledge that sex isn't assigned at birth, but something that is observed. And the observation would be right >99% of the time.
I noticed that nowhere is there the question asked of whether it's people who would be gay/lesbian who are being transed. Are "gender dysphoria" and "gender non-conformity" just another way of pathologizing, de facto, homosexuality?
In terms of that Dutch study, the start n was 70 and ending 55, which became 54 after a member of the group had vaginoplasty, but had a micro penis thanks to blockers/hormones, so tissue from the colon was used not properly sterilized, sepsis ensued, then death. And aren't the satisfaction results overstated because of how the scales were used to measure it?
Dr. Leibowitz ignores several things, including the price of disrupting puberty on overall health (including neurodeveloppement) and the conflation of "gender identity" with sex stereotypes. And even if gender variance was normal, why medicate it instead of learning to accept one's body and personality at once? His lecture sounds like a vast effort just to justify intensive, irreversible medical treatments.
Once I hear ‘assigned sex ‘ I know it’s bullshit.
There’s a fairly straightforward answer to the question of why treat adolescents for gender affirming care. Gender dysphoria. It causes intense suffering and can lead to death. This significant factor is all but ignored by opponents to adolescent
gender affirming care.
Why only gender affirming care that disrupts puberty and turns a teen into a lifelong patient? Gender dysphoria might have multiple causes, including internalized homophobia/misogyny, sexual trauma or fear of puberty itself.
There is only one cause for gender dysphoria-a mismatch between one’s gender identity and one’s visible sex. Since gender identity is immutable, the only thing that can be changed to ease dysphoria is the body.
Puberty blockers do not “disrupt” puberty, they just delay it.
A shot every two weeks does not make one a lifelong patient.
"Since gender identity is immutable". This is nonsense...you would not have detransitioners nor the many people whose "gender" is fluid.
The concept of "gender identity" (described as both immutable and fluid, ironically) is unfalsifiable (i.e. unverifiable) and relies only on self-description that can stem from a lot of psychological issues. Before youth transition existed, most gender dysphorias resolved naturally through puberty. Puberty blockers, on top of their risks for fertility, sexual function and bone and brain development (issues for patients treated for precocious puberty) also potentially "lock in" gender dysphoria, becoming a stepping stone for irreversible medical treatments.
All of the above has been thoroughly documented in studies, articles, the Cass Report , and reviews from European countries that sharply scaled back on youth transition.
This is why gender transition is not a good idea before adulthood, even if transitioned men keep some masculine traits as a result. Everyone needs a natural puberty.