The New York Times reported in October that the lead author, Dr. Johanna Olson-Kennedy, had held off from publishing the study, which did not see mental health improvements, for political reasons.
"...Given that the mental health of youth with gender dysphoria who are older is often poor, it is likely that puberty blockers prevent the deterioration of mental health.”
So she gets no improvement, not even enough in suicidality to wave that flag and use that messaging to try and save her study, so she imagines an alternate universe where her subjects didn't get blockers and creates an imaginary control group that got worse and supports her claims? Sounds like solid science. Unfortunately the media will just unquestioningly report that claim, report only her conclusion sentence that contradicts her own abstract, and tell everyone there's yet another study showing why kids need puberty blockers
Without any comparison group, Johanna Olson-Kennedy sought to compare the mental health markers of the minors put on puberty blockers to that of the general population per a CDC study that used different metrics. So even then the comparison was a little awkward. If they had thought in advance to make such a comparison, they might have thought to use the CDC metrics from the outset. But they started this study in 2016, so they couldn't go back.
She needed a control group of ‘trans identified kids’ who did not get puberty blockers to make that claim. Her study design was not appropriate to that claim. And she knows it. I’m a retired academic pediatrician and I wrote manuscripts (not in this field) and reviewed for many journals and I would not have let that statement stay in. Basically the study had null findings. Why? Maybe the self report measures are always inflated. But that’s what she found. Nothing.
100% agree. Causal inference cannot be done without a control group. Olson-Kennedy et al. identify the causal impact of puberty blockers by assuming that if their study subjects had not had their puberty blocked, their mental health would have declined (because gender dysphoria would have persisted or intensified). The problem here is that reliance on a theoretical assumption. We can make a different theoretical assumption, and then our conclusion from the study will be quite different, namely that allowing puberty to proceed while also providing psychotherapy would have lead to the dissolution of gender dysphoria in most study subjects (we do have empirical evidence to support this assumption). With this alternative assumption, the administration of puberty blockers is bad because puberty blockers lead to cross-sex hormones which, at least, leads to sterility and severely degraded sexual functioning.
Olson-Kennedy et al. spent millions of tax dollars and took 6 years to produce a study that is obviously methodologically defective because it has an indeterminate research design, that is a research design that cannot distinguish between two different theories that have diametrically opposed conclusions about the advisability of puberty blockers.
Why did they choose this research design? Because they are true believers in the affirmative approach, and hence believe that not giving blockers to gender-dysphoric children leads to bad outcomes and is therefore ethically impermissible. This study should not have received taxpayer funding because of its obvious methodological unsoundness. The money spent on it was simply wasted.
In the last line of their abstract Olson-Kennedy et al. make an improper comparison. They compare their study subjects with “youth with gender dysphoria who are older.” This comparison precludes the possibility that a young person, who had gender dysphoria at the start of puberty, experienced the dissolution of gender dysphoria by going through puberty plus at the same time receiving supportive psychotherapy. And let me repeat again: We do have empirical evidence for the plausibility of this possibility.
This 1000%. She did not disprove the null hypothesis. Anyone who knows basic research design would know that. She tries to dance around it in an abstract that should not have been published as is.
It's the "If we prevent onr child from committing suicide" argument. Forget all the collateral damage and the moral or ethical rationale for not doing something just because we can. Unfoubtedly, some of these ghouls are in it for the money, but others are like Dr. Jekyll and Dr. Frakenstein, blinded by their own hubris and ambition, to think otherwise, and a day of reckoning for them will come, like Drs. Jekyll and Frakenstein, if not in this life, certainly in the next. May not be the best analogies since its been a while since I've read the books, but still. I just know that hell will not be hot or cold for this woman and her ilk, if there is no change of heart. And I make no apologies for feeling that way.
Even the "if we prevent just one suicide" rationale can't be supported and they know it because they are loudly and actively shouting messages and making claims that are well established in research to increase suicidality and create suicide social contagion. They routinely violate guidelines by groups like the CDC, journalist groups, and even some lgbt orgs on how NOT to talk about suicide because it can INCREASE rates of suicide. It's maddening
That speculation sounds plausible to me, though speculation isn’t science. It sounds like she started with a bunch of happy kids with good families; whatever you think of transgender health, was it ever realistic to think their lives would get even better?
Johanna Olson-Kennedy sees it as her mission to help kids obtain "appearance congruence" first and foremost. This, her previous paper suggests, is associated with improved mental health. But the effort to obtain it is not predicated on having poor mental health or distress to begin with.
But it's not really a plausible claim with such a biased group of subjects. It would be like doing a research study on a diabetes drug, having the vast majority of your subjects come into the study with normal blood sugar numbers, and then say it's reasonable to assume that the drug kept their already normal blood sugar levels normal, and making that claim without a control group or consideration of other variables on the child's life that may be stabilizing blood sugar. It's not just an unscientific assumption that may still be correct. unscientific. It potentially manufactures bad data that can cause harm.
Ironically, I was listening to the podcast this morning while waiting for on a video call with my psychiatrist (she's under 40). I didn't see when she joined so she overheard a big snippet if it and when I jumped on she said it sounded interesting and wrote it down to listen to. Maybe we should all start playing it casually in public and at the doctor's office.
I am not sure. Even though the NYT podcasters admit that the protocol has gone off the rails in the US, they still operate on the assumption that there are truly "trans kids", and do not probe the implication that those kids, who are the ones who exhibit extreme and persistent gender non-conformity early on, are most likely to grow up gay if left alone to develop normally.
Anyone who listens to this podcast series should also watch its critical discussion on the Informed Dissent podcast.
We need to be able to tolerate perspectives that aren't 100% in alignment with our own during this time and that no conversation podcast, or article is going to be able to cover it all. I also don't think the gender critical folks can prove that there aren't people who were helped by transition.
Absolutely. I just don't think this podcast is the excellent primer on the whole debate it could have been. Too many assumptions remain unquestioned, too few critics have been interviewed or even mentioned. They wanted to construct a particular historical narrative, and failed to give a bigger picture of the full depth of this issue.
I'm not saying people shouldn't listen to it, but they should not stop there and think they now have a comprehensive understanding of this debate. The "transing of proto-gay kids" issue in particular was not really discussed, nor was the lack of control groups in any of these studies, which is a fundamental problem of the argument that the kids who were ostensibly helped by these interventions would have done worse with a non-medicalized approach. Remember, when someone promotes an intervention, the burden of proof is always on them that the benefits outweigh the risks, not on the opponents to prove the opposite.
I have to say, I hadn't gotten all the way to the end until today but assumed Azeen Ghorashi would handle this topic in the same way she has in her reporting and the first couple of episodes seemed fair. She did not. I am very surprised. Lots of holes and missing context.
Thanks, I will listen to the Informed Dissent podcast. I appreciate this podcast because it walks a middle road that opens people up to more skepticism.
It's definitely great that the NYTimes allowed at least SOME critical perspective. I just wish they had gone beyond the neat historical narrative of "the Dutch were so careful, then Americans went overboard, and now it's all politicized and Republicans want to ban it, and these poor trans kids have to suffer." I wish they had been more honest about the fact that it's not just Republicans who think these treatments should not be offered to minors at all (according to polls, that's the opinion of a significant majority of Americans). Jamie Reed isn't the only one on the left who supports these bans and speaks in favor of them, and the whole discussion in Britain is even less of a left-right issue. All that was glossed over to construct a narrative of this as a typical culture war problem.
I listened to all podcasts. I wondered about a couple of editing decisions:
1. In terms of the Dutch Protocol studied cohort, one died after receiving vaginoplasty. The podcast did not go into much detail at all about that. I mention it since the death is directly attributable to the micro penis that result from young males taking puberty blockers, necessitating the use of additional tissue to line the neo-vagina. And in this case, tissue from the colon not properly sterilized was used.
2. In one episode, the one about the US?, toward the very end, you hear the voice of Supreme Court Justice Samuel Alito reading briefly from the Cass Review to Chase Strangio, lawyer arguing against Skrmetti. But it unfortunately leaves out that stunning moment when Strangio admits that there were rarely any actual completed suicides. Given how often the phrase "life saving", etc came up, this would have been a refreshing note.
In other notes, I read this morning Erin Reed's delight that the series included an interview with the very first patient to undergo these procedures, and how much of a regular guy he now is. But Reed, in typical Reed fashion, totally omits his remarks which clearly show his suspicion that much of what's going on today in gender world is a fad, like "Goth".
Yes, Chase Strangio's admission before the Supreme Court that there is a lack of data supporting the claim that pediatric gender transition treatment is life saving and that suicides among children with a trans identity are rare was a historic moment.
They instead quoted the study saying 41% consider suicide....that survey of 27 minors, totally unreliable...
" But it unfortunately leaves out that stunning moment when Strangio admits that there were rarely any actual completed suicides. Given how often the phrase "life saving", etc came up, this would have been a refreshing note."
<< But it unfortunately leaves out that stunning moment when Strangio admits that there were rarely any actual completed suicides. Given how often the phrase "life saving", etc came up, this would have been a refreshing note.>>
Good gods, yes. I listened to the arguments live, and when Strangio demurred on the suicide issue the teeth just about fell out of my jaw. That's game over for the live son/dead daughter thing they use to scare parents. I tell people ALL THE TIME that the ACLU won't defend the suicide scaremongering in court, which means that they know there's just no basis for it.
Strangio suspected, probably knew, that that moment/admission would not be amplified by media....and Strangio was right. It represents strategic goal post moving in front of the court, which Strangio knew not to bullshit.
Now that they can no longer claim that paediatric gender medicine saves lives by preventing suicide, they claim it saves lives by allowing “trans” people to “pass”, thereby reducing their risk of transphobia-related homicide.
The reliance on self-reports and parental assessments is a key factor in these studies. Every single study that claims to show benefits to transition relies entirely on them.
Kids and their parents are the last people on earth who can be objective assessors of their psychological symptoms. “Bias” doesn’t BEGIN to describe the problems with that method.
A proponent of this garbage would argue that the bias is relatively controlled for, because the same method is used at baseline and at the end of the study period. Presumably, the argument goes, whatever bias is present, was present in relatively similar amounts at the beginning and at the end, so whatever change occurred can be safely assumed to be free of that bias.
But that’s bullshit, in a study that is assessing kids who have been led to fervently believe that they will feel better as time goes on because of the treatment. So their bias is specifically in regards to the end of period assessment, and will contaminate their and their parents’ end of period assessments accordingly. They will tend to say they are feeling better because they really want to feel better and have been told they will feel better. Indeed, the fact that this study showed no such improvement is a hint that they are likely actually feeling worse.
Psychological evidence in scenarios where high levels of bias are likely to be present needs to be based on relatively objective data, such as actual documented suicide attempts, actual documented hospitalizations, inpatient and outpatient treatments, clinical diagnoses, and psych med prescriptions.
It's no coincidence that every study that makes use of these objective criteria shows transition having no benefit or making things worse.
And of course, any discussion of the evidence for medical transition must include the growing evidence of the negative physiological effects of puberty-blocking the young - bone demineralization, lack of sexual functioning, pelvic floor dysfunction, lack of cognitive/emotional development. The pioneers of the Dutch Protocol ignored this question entirely, a profoundly irresponsible decision that has led to immeasurable harm.
You’re correct and referring to the placebo effect. Same thing with assessing food dyes & ADHD symptoms. They gave kids food dyes, let everyone know, and asked teachers if they seemed worse. Happened again with sugar causing hyperactivity in kids (it doesn’t). Only when they blinded the studies did it show parents couldn’t notice any behavioral changes with/without sugar.
Yes; there is also the coaching effect unfortunately. By the time many of these kids tell their parents or clinicians they are trans, they have already been coached online by activists on what to say in order to get what they want. Incredibly, even some clinicians get in on the coaching:
Gender doc admits advising people to lie about being suicidal to get medical transition:
This collective of therapists explicitly provides the required letters of recommendation for hormones or surgery, free and on demand. Their motto: "Gatekeeping Sucks":
Yes. There was an interesting moment when JOC says that there’s no point in those pesky, long, gate keeping assessments because kids know what they need to say to convince people to get this treatment. Does she not hear the irony in that? Also, her disparagement of pre-treatment IQ tests is so ignorant. First of all, the gold standard of IQ testing is the Weschler scale, and it is such a subtle measure of all sorts of factors that can be affecting people‘s functioning. Second of all, because there is increasing concern that puberty blockers stunt cognitive ability, a baseline measure of cognitive function is of extreme importance.
Lisa Littman's 2018 paper introducing her concept of ROGD was said to be invalid because it used parental reports. Will the people who criticized and tried to get Littman's paper retracted criticize JOK for also using parental reports?
“Was said to be” by what idiots? Who cares. Dismiss them.
Pointing out troon and troon-apologist hypocrisy could be a full-time job, and still you wouldn’t be addressing but a fraction of the huge volumes of BS they are throwing against the wall.
It’s also a weak approach, because it’s reactive to them.
They WANT us to be reactive to them, to stay on the defensive coping with the loads of flying BS, instead of going on the offensive.
Don’t let them intimidate you, and never, ever, EVER let them put you on the defensive.
Let’s focus on pro-active, aggressive, assertive arguments where we set the parameters of the debate and make THEM react to US.
Interesting debate about the difference between thinking that success for GAC should be measured by customer satisfaction (Dr. Bowers) vs long term quality evidence both for the medical aspects and life signals like having a job, a partner, kids, moving out of parent's house, successful citizen (Dr. Cass). I wish this had been more broadly juxtaposed in the podcast. The Dr. Bowers approach does line up with my thinking that GAC is much more similar to elective cosmetic surgery than life saving medical care (like chemotherapy for a cancer diagnosis).
It's remarkable how angry pediatric gender medicine advocates get when anyone suggests looking to objective measures of well-being, such as having a job or leaving the house, following gender-transition treatment rather than self report.
If the children’s mental health was so good to start with then it raises questions in my mind as to why they needed drug treatment for a mental health condition (gender dysphoria) to begin with.
I’m curious about at what point she and the research team had analyzed the data (how long they’ve known the results) and if that makes her (and any of these other authors) liable for statements after that point that blockers “improve mental health”? Could that bolster any claims of fraud or malpractice suits?
How can anything that halts pubertal brain development improve mental health? As peers move ahead and mature mentally, these kids are stuck in brain limbo. Sounds like a recipe for disaster in fact.
Case in point: patient zero, FG, is 50 years old, but has the self-consciousness and terror of being “found out” and hassled like a 14-year-old lying to her parents about recreational drug use.
The physicians and psychologists in charge urge patients to prioritize appearance conformity over objective markers of health, in order to satisfy patient demand, an abject abandonment of their hippocratic mission and medical ethics. But it feels psychologically good to the treaters, I guess. I don’t believe pecuniary motivations are the primary driver.
A great summary, thanks. Medicine helps launder the ideas of true trans into the broader culture yet there's no empirical evidence or even any theory of aetiology apart from 'gendered souls'. These children are partly being groomed by doctors in my view and a lack of controls and new potential alternative treatments is not being explored due to researcher hubris.
JOK has always come across as an ideologue to me. In a gender, a wider lens podcast she said that children were showing us the way with gender, which is a very strange frame in my view. In reality new and socially constructed ideas were being given to them that were iatrogenic. A life as trans is a life by definition curtailed, and how much say do these children get at such a vulnerable stage of their lives.
I had to laugh out loud when in the 5th episode of the podcast, WPATH is quoted justifying their assertion that giving kids blockers and hormones was "helpful and often life-saving" by saying it was based on "research and consensus-based evidence". WTF is "consensus-based evidence"?? Is that an attempt to redeem low-quality evidence, by asserting that it corroborates a "consensus" among the 'experts' who profit from these interventions? It's practically an admission that this consensus itself is considered sufficient evidence, a sentiment that both Bowers and Leibovitz seem to echo in their statements.
This reminds me so much of the "Follow The Science" talk during the pandemic, when the lowest quality evidence, including simply "expert" opinion, was touted as a solid basis for such obviously harmful or absurd interventions as masking kids and closing schools, and calls for higher quality evidence were dismissed as unnecessary or downright unethical.
Democrats have done so much to damage the credibility of science and experts, and now we have to deal with the consequences.
Indeed, gender-affirming surgeon and former WPATH head Marci Bowers made a full throated argument in the Times' gender medicine podcast for relying on expert opinion, which sits at the bottom of the evidence-based medicine pyramid, even as she dismisses the Cass Review, which was based in part on systematic literature reviews, which sit at the top of the EBM pyramid.
I thought that interview was pretty incredible. The way Bowers dismissed systematic reviews in favor of anecdotal experience, and tried to disqualify Cass from evaluating the evidence because of her outsider status, while appearing completely oblivious to the bias of people like Bowers who have both financial and reputational (and possibly legal) stakes in upholding this protocol... It makes me wonder if they are really this ignorant about how evidence-based medicine works, or if they are just pretending because they have to.
He’s certifiably psychotic. His fetish has consumed him completely. He’s not lost his ability to wield a scalpel yet, but he’s definitely not a well man.
It reminds me of the debate about vaccines, the statement that they are all well researched and found not to have any bad side-effects…then we go on to learn that they have not actually all been tested/trialed/RCT at all, they base that on one vaccine trial done decades ago.
I don't think there is any comparison between the weakness of the evidence for "gender-affirming care" and the evidence for traditional childhood vaccines (the situation with the Covid vaccines is a bit more complicated). But your comment exemplifies the detrimental consequences of compromising trust in science and public health expertise by promoting treatments and interventions for political and tribal reasons.
Have you read “Turtles all the way down.?” I come from a medical family. I completely trusted vaccines and doctors. Now I know better. It’s not just the mRNA vaccines that were not properly trialed or RCTested.
No, I have not. You mean the novel? I come from a medical family, too - both my parents and stepfather are doctors (in Europe). My dad is an anti-Covid-vaccine extremist (as in "the Covid vaccines are the deadliest vaccines ever made"), who now also questions other vaccines. He's really been radicalized by this whole experience, and I think he went off the deep end. A medical education and decades of professional experience don't protect against the effects of broken trust and the desire to prove those who harmed you wrong on everything else. I know the traditional vaccines weren't all trialed against placebo or pure placebo, but I still believe the evidence in favor of vaccines like the MMR are strong, and certainly much stronger than the evidence for "gender affirming care" or masks and lockdowns.
This book was apparently written by an anonymous team associated with the Children's Health Defense, a notorious anti-vax activist group founded by RFK Jr. I would not trust it. Just because it is full of references from "mainstream scientific papers and textbooks" doesn't mean it isn't cherry-picking and distorting the evidence and making misleading claims and arguments. The fact that it promises to "resolve the vaccine question for you, once and for all" is a glaring red flag signaling that this isn't a dispassionate critical appraisal of the evidence.
Just an anecdote here, but I’ve noticed my Instagram “debates” with people about this have become more civil over the past few months. Usually it’s immediate insults about transphobia and being an idiot, but lately people seem to know the science isn’t perfect. Unfortunately, it’s probably 100% due to NYT articles.
I’m convinced we all knew better. Gender affirmative care made no logical sense nor did it make psychological sense. It was a part of third wave feminism gone awry. And it was not uncommon for adolescent clients to come into see me to begin therapy after they had made one visit to Children’s Hospital and were prescribed hormones. So much of it was a social contagion. I’m so happy scientific confidence is starting to come out, we let our children down, and some actually lead them down the slippery slope of gender affirming care.
It is mind boggling how far over their skis many clinicians in this field seem to be.
And unlike Europe where they seem to have pulled back from this idiocy, it seems many practitioners in North America in this field are generally not so discerning about the concept of burden of proof.
Lack of reproducibility. Null effect. This validates the Cass report (duh). And it validates the recent HHS report. Very disappointing that so many physicians in this field are simply ignorant to the requirements for scientific evidence. It’s almost like they’re driven purely by ideology…🙄😉
What blows my mind is how easily these children got puberty blockers, surgery etc. given how difficult it is to get doctors in general to even prescribe more benign drugs, such as Retin A, steroids etc, to adults. Just blows my mind.
And wow, the rigamarole to get my menopausal self a prescription for HRT… and then compete with the trans-identified males who “require” 10x the dose I do, resulting in supply shortages for women trying to sleep and function.
What were the selection criteria for this study? How is it that they were generally so psychologically and emotionally healthy when the entire case for GAC seems predicated on the idea that kids with gender dysphoria tend to be less happy and well-adjusted?
I think that young children coming in are probably more psychologically well than those who come into gender clinics when they’re already at tanner 4 or 5. Also, this study recruited during the early years of the surge of psychologically unwell natal girls coming into gender clinics after they started puberty. So it's possible the study authors didn't encounter as many of those kids at that time.
"...Given that the mental health of youth with gender dysphoria who are older is often poor, it is likely that puberty blockers prevent the deterioration of mental health.”
So she gets no improvement, not even enough in suicidality to wave that flag and use that messaging to try and save her study, so she imagines an alternate universe where her subjects didn't get blockers and creates an imaginary control group that got worse and supports her claims? Sounds like solid science. Unfortunately the media will just unquestioningly report that claim, report only her conclusion sentence that contradicts her own abstract, and tell everyone there's yet another study showing why kids need puberty blockers
This is how "consensus-based evidence" works, didn't you know that?
She never proved that they prevented worsening. That wasn’t what she studied. She’s full of garbage.
Without any comparison group, Johanna Olson-Kennedy sought to compare the mental health markers of the minors put on puberty blockers to that of the general population per a CDC study that used different metrics. So even then the comparison was a little awkward. If they had thought in advance to make such a comparison, they might have thought to use the CDC metrics from the outset. But they started this study in 2016, so they couldn't go back.
She needed a control group of ‘trans identified kids’ who did not get puberty blockers to make that claim. Her study design was not appropriate to that claim. And she knows it. I’m a retired academic pediatrician and I wrote manuscripts (not in this field) and reviewed for many journals and I would not have let that statement stay in. Basically the study had null findings. Why? Maybe the self report measures are always inflated. But that’s what she found. Nothing.
100% agree. Causal inference cannot be done without a control group. Olson-Kennedy et al. identify the causal impact of puberty blockers by assuming that if their study subjects had not had their puberty blocked, their mental health would have declined (because gender dysphoria would have persisted or intensified). The problem here is that reliance on a theoretical assumption. We can make a different theoretical assumption, and then our conclusion from the study will be quite different, namely that allowing puberty to proceed while also providing psychotherapy would have lead to the dissolution of gender dysphoria in most study subjects (we do have empirical evidence to support this assumption). With this alternative assumption, the administration of puberty blockers is bad because puberty blockers lead to cross-sex hormones which, at least, leads to sterility and severely degraded sexual functioning.
Olson-Kennedy et al. spent millions of tax dollars and took 6 years to produce a study that is obviously methodologically defective because it has an indeterminate research design, that is a research design that cannot distinguish between two different theories that have diametrically opposed conclusions about the advisability of puberty blockers.
Why did they choose this research design? Because they are true believers in the affirmative approach, and hence believe that not giving blockers to gender-dysphoric children leads to bad outcomes and is therefore ethically impermissible. This study should not have received taxpayer funding because of its obvious methodological unsoundness. The money spent on it was simply wasted.
In the last line of their abstract Olson-Kennedy et al. make an improper comparison. They compare their study subjects with “youth with gender dysphoria who are older.” This comparison precludes the possibility that a young person, who had gender dysphoria at the start of puberty, experienced the dissolution of gender dysphoria by going through puberty plus at the same time receiving supportive psychotherapy. And let me repeat again: We do have empirical evidence for the plausibility of this possibility.
This 1000%. She did not disprove the null hypothesis. Anyone who knows basic research design would know that. She tries to dance around it in an abstract that should not have been published as is.
It's the "If we prevent onr child from committing suicide" argument. Forget all the collateral damage and the moral or ethical rationale for not doing something just because we can. Unfoubtedly, some of these ghouls are in it for the money, but others are like Dr. Jekyll and Dr. Frakenstein, blinded by their own hubris and ambition, to think otherwise, and a day of reckoning for them will come, like Drs. Jekyll and Frakenstein, if not in this life, certainly in the next. May not be the best analogies since its been a while since I've read the books, but still. I just know that hell will not be hot or cold for this woman and her ilk, if there is no change of heart. And I make no apologies for feeling that way.
Even the "if we prevent just one suicide" rationale can't be supported and they know it because they are loudly and actively shouting messages and making claims that are well established in research to increase suicidality and create suicide social contagion. They routinely violate guidelines by groups like the CDC, journalist groups, and even some lgbt orgs on how NOT to talk about suicide because it can INCREASE rates of suicide. It's maddening
That speculation sounds plausible to me, though speculation isn’t science. It sounds like she started with a bunch of happy kids with good families; whatever you think of transgender health, was it ever realistic to think their lives would get even better?
Johanna Olson-Kennedy sees it as her mission to help kids obtain "appearance congruence" first and foremost. This, her previous paper suggests, is associated with improved mental health. But the effort to obtain it is not predicated on having poor mental health or distress to begin with.
So this is basically cosmetic surgery.
But it's not really a plausible claim with such a biased group of subjects. It would be like doing a research study on a diabetes drug, having the vast majority of your subjects come into the study with normal blood sugar numbers, and then say it's reasonable to assume that the drug kept their already normal blood sugar levels normal, and making that claim without a control group or consideration of other variables on the child's life that may be stabilizing blood sugar. It's not just an unscientific assumption that may still be correct. unscientific. It potentially manufactures bad data that can cause harm.
Ironically, I was listening to the podcast this morning while waiting for on a video call with my psychiatrist (she's under 40). I didn't see when she joined so she overheard a big snippet if it and when I jumped on she said it sounded interesting and wrote it down to listen to. Maybe we should all start playing it casually in public and at the doctor's office.
The NY Times podcast on pediatric gender medicine is a great primer on the subject for the uninitiated. https://www.nytimes.com/audio/app/2025/06/02/introducing-the-protocol.html
I am not sure. Even though the NYT podcasters admit that the protocol has gone off the rails in the US, they still operate on the assumption that there are truly "trans kids", and do not probe the implication that those kids, who are the ones who exhibit extreme and persistent gender non-conformity early on, are most likely to grow up gay if left alone to develop normally.
Anyone who listens to this podcast series should also watch its critical discussion on the Informed Dissent podcast.
We need to be able to tolerate perspectives that aren't 100% in alignment with our own during this time and that no conversation podcast, or article is going to be able to cover it all. I also don't think the gender critical folks can prove that there aren't people who were helped by transition.
Absolutely. I just don't think this podcast is the excellent primer on the whole debate it could have been. Too many assumptions remain unquestioned, too few critics have been interviewed or even mentioned. They wanted to construct a particular historical narrative, and failed to give a bigger picture of the full depth of this issue.
I'm not saying people shouldn't listen to it, but they should not stop there and think they now have a comprehensive understanding of this debate. The "transing of proto-gay kids" issue in particular was not really discussed, nor was the lack of control groups in any of these studies, which is a fundamental problem of the argument that the kids who were ostensibly helped by these interventions would have done worse with a non-medicalized approach. Remember, when someone promotes an intervention, the burden of proof is always on them that the benefits outweigh the risks, not on the opponents to prove the opposite.
I have to say, I hadn't gotten all the way to the end until today but assumed Azeen Ghorashi would handle this topic in the same way she has in her reporting and the first couple of episodes seemed fair. She did not. I am very surprised. Lots of holes and missing context.
Thanks, I will listen to the Informed Dissent podcast. I appreciate this podcast because it walks a middle road that opens people up to more skepticism.
It's definitely great that the NYTimes allowed at least SOME critical perspective. I just wish they had gone beyond the neat historical narrative of "the Dutch were so careful, then Americans went overboard, and now it's all politicized and Republicans want to ban it, and these poor trans kids have to suffer." I wish they had been more honest about the fact that it's not just Republicans who think these treatments should not be offered to minors at all (according to polls, that's the opinion of a significant majority of Americans). Jamie Reed isn't the only one on the left who supports these bans and speaks in favor of them, and the whole discussion in Britain is even less of a left-right issue. All that was glossed over to construct a narrative of this as a typical culture war problem.
I listened to all podcasts. I wondered about a couple of editing decisions:
1. In terms of the Dutch Protocol studied cohort, one died after receiving vaginoplasty. The podcast did not go into much detail at all about that. I mention it since the death is directly attributable to the micro penis that result from young males taking puberty blockers, necessitating the use of additional tissue to line the neo-vagina. And in this case, tissue from the colon not properly sterilized was used.
2. In one episode, the one about the US?, toward the very end, you hear the voice of Supreme Court Justice Samuel Alito reading briefly from the Cass Review to Chase Strangio, lawyer arguing against Skrmetti. But it unfortunately leaves out that stunning moment when Strangio admits that there were rarely any actual completed suicides. Given how often the phrase "life saving", etc came up, this would have been a refreshing note.
In other notes, I read this morning Erin Reed's delight that the series included an interview with the very first patient to undergo these procedures, and how much of a regular guy he now is. But Reed, in typical Reed fashion, totally omits his remarks which clearly show his suspicion that much of what's going on today in gender world is a fad, like "Goth".
Yes, Chase Strangio's admission before the Supreme Court that there is a lack of data supporting the claim that pediatric gender transition treatment is life saving and that suicides among children with a trans identity are rare was a historic moment.
They instead quoted the study saying 41% consider suicide....that survey of 27 minors, totally unreliable...
" But it unfortunately leaves out that stunning moment when Strangio admits that there were rarely any actual completed suicides. Given how often the phrase "life saving", etc came up, this would have been a refreshing note."
<< But it unfortunately leaves out that stunning moment when Strangio admits that there were rarely any actual completed suicides. Given how often the phrase "life saving", etc came up, this would have been a refreshing note.>>
Good gods, yes. I listened to the arguments live, and when Strangio demurred on the suicide issue the teeth just about fell out of my jaw. That's game over for the live son/dead daughter thing they use to scare parents. I tell people ALL THE TIME that the ACLU won't defend the suicide scaremongering in court, which means that they know there's just no basis for it.
Strangio suspected, probably knew, that that moment/admission would not be amplified by media....and Strangio was right. It represents strategic goal post moving in front of the court, which Strangio knew not to bullshit.
Now that they can no longer claim that paediatric gender medicine saves lives by preventing suicide, they claim it saves lives by allowing “trans” people to “pass”, thereby reducing their risk of transphobia-related homicide.
Thank You for this very thorough report.
The reliance on self-reports and parental assessments is a key factor in these studies. Every single study that claims to show benefits to transition relies entirely on them.
Kids and their parents are the last people on earth who can be objective assessors of their psychological symptoms. “Bias” doesn’t BEGIN to describe the problems with that method.
A proponent of this garbage would argue that the bias is relatively controlled for, because the same method is used at baseline and at the end of the study period. Presumably, the argument goes, whatever bias is present, was present in relatively similar amounts at the beginning and at the end, so whatever change occurred can be safely assumed to be free of that bias.
But that’s bullshit, in a study that is assessing kids who have been led to fervently believe that they will feel better as time goes on because of the treatment. So their bias is specifically in regards to the end of period assessment, and will contaminate their and their parents’ end of period assessments accordingly. They will tend to say they are feeling better because they really want to feel better and have been told they will feel better. Indeed, the fact that this study showed no such improvement is a hint that they are likely actually feeling worse.
Psychological evidence in scenarios where high levels of bias are likely to be present needs to be based on relatively objective data, such as actual documented suicide attempts, actual documented hospitalizations, inpatient and outpatient treatments, clinical diagnoses, and psych med prescriptions.
It's no coincidence that every study that makes use of these objective criteria shows transition having no benefit or making things worse.
And of course, any discussion of the evidence for medical transition must include the growing evidence of the negative physiological effects of puberty-blocking the young - bone demineralization, lack of sexual functioning, pelvic floor dysfunction, lack of cognitive/emotional development. The pioneers of the Dutch Protocol ignored this question entirely, a profoundly irresponsible decision that has led to immeasurable harm.
You’re correct and referring to the placebo effect. Same thing with assessing food dyes & ADHD symptoms. They gave kids food dyes, let everyone know, and asked teachers if they seemed worse. Happened again with sugar causing hyperactivity in kids (it doesn’t). Only when they blinded the studies did it show parents couldn’t notice any behavioral changes with/without sugar.
Yes; there is also the coaching effect unfortunately. By the time many of these kids tell their parents or clinicians they are trans, they have already been coached online by activists on what to say in order to get what they want. Incredibly, even some clinicians get in on the coaching:
Gender doc admits advising people to lie about being suicidal to get medical transition:
https://thebridgehead.ca/2019/04/22/gender-therapy-doctor-admits-to-advising-kids-to-fake-being-suicidal-to-get-transgender-treatments/
Activist admits that trans routinely lie in order to get treatment:
https://x.com/libsoftiktok/status/1702031201224077504
This collective of therapists explicitly provides the required letters of recommendation for hormones or surgery, free and on demand. Their motto: "Gatekeeping Sucks":
https://www.prospecttherapy.com/hrt-and-gcs-letters
Yes. There was an interesting moment when JOC says that there’s no point in those pesky, long, gate keeping assessments because kids know what they need to say to convince people to get this treatment. Does she not hear the irony in that? Also, her disparagement of pre-treatment IQ tests is so ignorant. First of all, the gold standard of IQ testing is the Weschler scale, and it is such a subtle measure of all sorts of factors that can be affecting people‘s functioning. Second of all, because there is increasing concern that puberty blockers stunt cognitive ability, a baseline measure of cognitive function is of extreme importance.
Lisa Littman's 2018 paper introducing her concept of ROGD was said to be invalid because it used parental reports. Will the people who criticized and tried to get Littman's paper retracted criticize JOK for also using parental reports?
This is indeed a theme throughout gender medicine. Parental reports were pivotal to the Kristina Olson study.
“Was said to be” by what idiots? Who cares. Dismiss them.
Pointing out troon and troon-apologist hypocrisy could be a full-time job, and still you wouldn’t be addressing but a fraction of the huge volumes of BS they are throwing against the wall.
It’s also a weak approach, because it’s reactive to them.
They WANT us to be reactive to them, to stay on the defensive coping with the loads of flying BS, instead of going on the offensive.
Don’t let them intimidate you, and never, ever, EVER let them put you on the defensive.
Let’s focus on pro-active, aggressive, assertive arguments where we set the parameters of the debate and make THEM react to US.
She also draws conclusions from stuff she didn’t study. ‘Prevents worsening.’ What the fuck Joanna. You know better than this.
Look at kuper et al 2020, comparison of clinician reports and self reports....they only put the latter in the abstract.
But indeed if the people giving the intervention are asking the patient how they are doing that has long been recognized as likely biased too.
Interesting debate about the difference between thinking that success for GAC should be measured by customer satisfaction (Dr. Bowers) vs long term quality evidence both for the medical aspects and life signals like having a job, a partner, kids, moving out of parent's house, successful citizen (Dr. Cass). I wish this had been more broadly juxtaposed in the podcast. The Dr. Bowers approach does line up with my thinking that GAC is much more similar to elective cosmetic surgery than life saving medical care (like chemotherapy for a cancer diagnosis).
It's remarkable how angry pediatric gender medicine advocates get when anyone suggests looking to objective measures of well-being, such as having a job or leaving the house, following gender-transition treatment rather than self report.
If the children’s mental health was so good to start with then it raises questions in my mind as to why they needed drug treatment for a mental health condition (gender dysphoria) to begin with.
Pediatric gender clinician Dr. Johanna Olson Kennedy is vocally opposed to requiring children to have distress about their gender to qualify for blockers and hormones. Having a cross-sex identity should be sufficient, she argues. You can see her argue this in these leaked videos: https://open.substack.com/pub/benryan/p/leaked-trans-care-training-videos?r=7wxo1&utm_medium=ios
Indeed! It’s all garbage
I’m curious about at what point she and the research team had analyzed the data (how long they’ve known the results) and if that makes her (and any of these other authors) liable for statements after that point that blockers “improve mental health”? Could that bolster any claims of fraud or malpractice suits?
How can anything that halts pubertal brain development improve mental health? As peers move ahead and mature mentally, these kids are stuck in brain limbo. Sounds like a recipe for disaster in fact.
Case in point: patient zero, FG, is 50 years old, but has the self-consciousness and terror of being “found out” and hassled like a 14-year-old lying to her parents about recreational drug use.
The physicians and psychologists in charge urge patients to prioritize appearance conformity over objective markers of health, in order to satisfy patient demand, an abject abandonment of their hippocratic mission and medical ethics. But it feels psychologically good to the treaters, I guess. I don’t believe pecuniary motivations are the primary driver.
A great summary, thanks. Medicine helps launder the ideas of true trans into the broader culture yet there's no empirical evidence or even any theory of aetiology apart from 'gendered souls'. These children are partly being groomed by doctors in my view and a lack of controls and new potential alternative treatments is not being explored due to researcher hubris.
JOK has always come across as an ideologue to me. In a gender, a wider lens podcast she said that children were showing us the way with gender, which is a very strange frame in my view. In reality new and socially constructed ideas were being given to them that were iatrogenic. A life as trans is a life by definition curtailed, and how much say do these children get at such a vulnerable stage of their lives.
I had to laugh out loud when in the 5th episode of the podcast, WPATH is quoted justifying their assertion that giving kids blockers and hormones was "helpful and often life-saving" by saying it was based on "research and consensus-based evidence". WTF is "consensus-based evidence"?? Is that an attempt to redeem low-quality evidence, by asserting that it corroborates a "consensus" among the 'experts' who profit from these interventions? It's practically an admission that this consensus itself is considered sufficient evidence, a sentiment that both Bowers and Leibovitz seem to echo in their statements.
This reminds me so much of the "Follow The Science" talk during the pandemic, when the lowest quality evidence, including simply "expert" opinion, was touted as a solid basis for such obviously harmful or absurd interventions as masking kids and closing schools, and calls for higher quality evidence were dismissed as unnecessary or downright unethical.
Democrats have done so much to damage the credibility of science and experts, and now we have to deal with the consequences.
Indeed, gender-affirming surgeon and former WPATH head Marci Bowers made a full throated argument in the Times' gender medicine podcast for relying on expert opinion, which sits at the bottom of the evidence-based medicine pyramid, even as she dismisses the Cass Review, which was based in part on systematic literature reviews, which sit at the top of the EBM pyramid.
I thought that interview was pretty incredible. The way Bowers dismissed systematic reviews in favor of anecdotal experience, and tried to disqualify Cass from evaluating the evidence because of her outsider status, while appearing completely oblivious to the bias of people like Bowers who have both financial and reputational (and possibly legal) stakes in upholding this protocol... It makes me wonder if they are really this ignorant about how evidence-based medicine works, or if they are just pretending because they have to.
Bowers sounded unhinged in that interview, and provided quite a contrast to calm, even-handed Cass.
I agree. The way Bowers raved about the "light in the eyes" of the "girls" whose genitals he had recently cut off was creepy.
He’s certifiably psychotic. His fetish has consumed him completely. He’s not lost his ability to wield a scalpel yet, but he’s definitely not a well man.
Consensus based on a citation cascade of bullshit citing bullshit. Garbage in garbage out. That’s the so called science of trans.
It reminds me of the debate about vaccines, the statement that they are all well researched and found not to have any bad side-effects…then we go on to learn that they have not actually all been tested/trialed/RCT at all, they base that on one vaccine trial done decades ago.
I don't think there is any comparison between the weakness of the evidence for "gender-affirming care" and the evidence for traditional childhood vaccines (the situation with the Covid vaccines is a bit more complicated). But your comment exemplifies the detrimental consequences of compromising trust in science and public health expertise by promoting treatments and interventions for political and tribal reasons.
Hear hear!
Have you read “Turtles all the way down.?” I come from a medical family. I completely trusted vaccines and doctors. Now I know better. It’s not just the mRNA vaccines that were not properly trialed or RCTested.
No, I have not. You mean the novel? I come from a medical family, too - both my parents and stepfather are doctors (in Europe). My dad is an anti-Covid-vaccine extremist (as in "the Covid vaccines are the deadliest vaccines ever made"), who now also questions other vaccines. He's really been radicalized by this whole experience, and I think he went off the deep end. A medical education and decades of professional experience don't protect against the effects of broken trust and the desire to prove those who harmed you wrong on everything else. I know the traditional vaccines weren't all trialed against placebo or pure placebo, but I still believe the evidence in favor of vaccines like the MMR are strong, and certainly much stronger than the evidence for "gender affirming care" or masks and lockdowns.
Turtles All The Way Down: Vaccine Science and Myth by Zoey O’Toole, Mary Holland Food for thought.
Zoey O'Toole and Mary Holland are just the editors: https://catalog.libraries.psu.edu/catalog/41056285
This book was apparently written by an anonymous team associated with the Children's Health Defense, a notorious anti-vax activist group founded by RFK Jr. I would not trust it. Just because it is full of references from "mainstream scientific papers and textbooks" doesn't mean it isn't cherry-picking and distorting the evidence and making misleading claims and arguments. The fact that it promises to "resolve the vaccine question for you, once and for all" is a glaring red flag signaling that this isn't a dispassionate critical appraisal of the evidence.
Just an anecdote here, but I’ve noticed my Instagram “debates” with people about this have become more civil over the past few months. Usually it’s immediate insults about transphobia and being an idiot, but lately people seem to know the science isn’t perfect. Unfortunately, it’s probably 100% due to NYT articles.
The mudslinging against me on Blooskie has been pretty ferocious this week.
Of course. The heretic must be burned.
Why? From who? What kind of things are they saying. ?
I dunno, that I’m a transphobe and stuff.
I see. Thank you.
Because he dares say the truth and the transmaniacs don’t like to hear it.
Thank you for the thorough reporting!
Thanks!
I’m convinced we all knew better. Gender affirmative care made no logical sense nor did it make psychological sense. It was a part of third wave feminism gone awry. And it was not uncommon for adolescent clients to come into see me to begin therapy after they had made one visit to Children’s Hospital and were prescribed hormones. So much of it was a social contagion. I’m so happy scientific confidence is starting to come out, we let our children down, and some actually lead them down the slippery slope of gender affirming care.
It is mind boggling how far over their skis many clinicians in this field seem to be.
And unlike Europe where they seem to have pulled back from this idiocy, it seems many practitioners in North America in this field are generally not so discerning about the concept of burden of proof.
Lack of reproducibility. Null effect. This validates the Cass report (duh). And it validates the recent HHS report. Very disappointing that so many physicians in this field are simply ignorant to the requirements for scientific evidence. It’s almost like they’re driven purely by ideology…🙄😉
What blows my mind is how easily these children got puberty blockers, surgery etc. given how difficult it is to get doctors in general to even prescribe more benign drugs, such as Retin A, steroids etc, to adults. Just blows my mind.
And wow, the rigamarole to get my menopausal self a prescription for HRT… and then compete with the trans-identified males who “require” 10x the dose I do, resulting in supply shortages for women trying to sleep and function.
What were the selection criteria for this study? How is it that they were generally so psychologically and emotionally healthy when the entire case for GAC seems predicated on the idea that kids with gender dysphoria tend to be less happy and well-adjusted?
I think that young children coming in are probably more psychologically well than those who come into gender clinics when they’re already at tanner 4 or 5. Also, this study recruited during the early years of the surge of psychologically unwell natal girls coming into gender clinics after they started puberty. So it's possible the study authors didn't encounter as many of those kids at that time.
First do no harm.