This project of medicalizing “gender affirmation” in children will not end well, and it is time for bioethicists to bring the ethical scrutiny that is the point of our field.
I applaud Dr. Curlin and his willingness to speak out on this very important topic for our American culture. The evidence is lacking to support the medicalization of children in the treatment of gender dysphoria. Unfortunately, there will likely be a day of reckoning for American medicine and how we as a society failed our children at a time of their greatest need.
We are witnessing Medical Lysenkoism. Historically, Lysenkoism was responsible for up to 60 million starvation deaths, one order of magnitude greater than the Holocaust.
As we have seen with Covid, Medical Lysenkoism has done great harm this decade, and pediatric sex trait modification falls under that label.
Thank you for this well written, well argued piece. I applaud the courage of the author. Thank you to the Sensible Medicine team for posting it. I do believe medical professionals have good intentions in this field, but it is time to recognize that the US is becoming an outlier in its approach to caring for gender questioning youth…and not in a good way. The UK, Sweden, France, Norway, Germany & others are all taking a step back, tapping the breaks & being more cautious in their approach to care for this group of patients. They have all realized that there are profound problems with the existing research. The Cass Review reveals this & calls for using medications only in research settings moving forward. In addition, recent court proceedings in Alabama have unearthed information which shows that WPATH commissioned Johns Hopkins to do systematic literature reviews for them in 2020, but then suppressed publication of all but one report when it became clear that the evidence contradicted WPATH’s current policies. This should alarm all of us.
WPATH is also the same agency who removed a chapter on ethics and listed recommendations which lack a grading system to indicate the quality of the evidence in their own updated “Standards of Care 8.”
When the evidence base dictates, changes in practice standards must be made, and we ought not let our own hubris stand in the way.
I have followed this issue more closely than most because I have never been able to shake the uncomfortable feeling that there are many parallels between the opioid epidemic (read or watch “Dopesick” to better understand the analogy) & the evolution of gender medicine for adolescents in the US in the last 7-10 years. In both instances there were good intentions —to help patients in distress—but both led to poor / sometimes catastrophic outcomes when evidence emerged that should have led to a change in course, but was ignored. We owe it to these children & their parents to be honest (especially in the realm of informed consent) & to provide better care. That starts with simple initial approaches like treating kids who are gender non-conforming with unconditional love (you are OK as you are), showing them that there is more to them as human beings than their gender identity, avoiding adherence to old gender stereotypes & doing a proper Biopsychosocial assessment. Sometimes less is more.
Excellent post on a long overdue topic. I strongly urge SM explore this topic further. For example, WPATH is cited by pro-trans stakeholders as if it follows respectable evidence based care. It does not. It is a highly unethical organization built on pseudo-studies published by strong arm tactics of pro-trans fanatics. No researcher or publisher dares challenge the trans narrative.
I appreciate the author's comparisons to the Tuskegee study, conversion therapy, therapeutic lobotomies, etc. I'd add the eugenics movement of the first half of the twentieth century. This movement was widely held by respected members of society as illustrated by the famous declaration of SC Justice Oliver Wendell Holmes, Jr.: "Three generations of imbeciles are enough [to mandate involuntary sterilization]." Eugenic only died post WW2 when Nazi doctors testified at the Nuremberg trials that their inspiration was partly from the eugenics literature of countries such as England and the USA.
Thank you for FINALLY taking on this issue. I used to be a paid subscriber to "Sensible Medicine" but quit when you kept ignoring this greatest medical scandal of all time.
You simply MUST keep it up. We need much more information on the policies of the US federal government and the various medical associations. (In the US, these are all still 100% in favor of pediatric sex-trait modification.) We need much more information on revelations such as the WPATH papers and the varous whistleblowers (Dr. Haim is not the only one).
I used to carry a heroin bottle, heroin prescriptions, alcohol prescriptions, quaalude bottle, among other cool trinkets when I’d speak on addiction. We can look back and laugh at the ridiculousness of thinking that heroin was wonderful for the moods of women with periods and children who were teething. Yet that’s how medicine was back then. Now there’s a great big machine that makes it even harder to expose. Our children should not have to suffer the consequences of a great big machine.
Academia (including academic medicine) is very much a left-coded space.
This gender religion stuff is red meat for that space.
So the true believers forge ahead in the absence of evidence, in a manner and with a vigor that is truly a sight to behold. And most normies (esp those who work in left-adjacent spaces….like most physicians) who would otherwise bristle at this affront to primum non nocere are disincentivized to speak freely (Scott Alexander has an interesting piece on Astral Codex substack yesterday about the dynamics of cancel culture that speak in part to this). Especially when it’s not directly in their wheelhouse or clinical concern.
But it is disappointing that medical ethicists on this side of pond have remained largely silent on this assault to basic medical and EBM principles. I can only invoke (with hand-waving) the generic (and understandable)impulse of self-preservation to explain the silence.
Thank you, it is a cult like response and beahviour whenever this subject is mentioned, as so many issues seem to become these days, All i have to say in the matter is ... The Cass Report. Cass, Cass, Cass, Cass, Cass. Link below to final report.
"To provide an evidence base upon which to make its recommendations, the Review commissioned the University of York to conduct a series of independent systematic reviews of existing evidence and new qualitative and quantitative research to build on the evidence base.
Dr Cass also conducted an extensive programme of engagement with young people, parents, clinicians and other associated professionals."
Farr, thank you so much for standing up for our kids! You have my utmost respect. I'm saddened that I haven't heard of you and your book earlier.
I'm in California where the government wants you to believe that kids can make life-altering decisions as early as age 12. Whether it's allowing themselves to be vaccinated without their parents knowing, being admitted for mental services without their parents even being notified, or transitioning against their parents wishes. We as parents all know this is ridiculous, but it feels like a huge mountain pushing against us. Thank you for standing with us.
The huge mountain pushing against us has a name: the Democratic Party.
Those California laws were passed with UNANIMOUS support of Democrats in the state legislature. Similar laws have been passed in mulitple blue states, also with unanimous support of elected Democrats. Any elected Democrat who opposes pediatric sex-trait modification is primaried and removed, as happened this cycle to Texas House member Shawn Nicole Thierry.
Thank you for this extremely important and valuable article. The sexualization of children is abhorrent enough on its own. Equally important is the fact that this is a predictable step in the program to devalue the institution of the family. A couple of the initial steps were removing the need for parental consent for birth control meds and devices and then even for abortion. The psychopaths that want to control everyone and everything realized early on that the only vehicle that could carry this out was the coercive force of government. They also realized the need to minimize or eliminate competing sources of authority---namely religion and family. Many of the seemingly insane policies in recent years become more understandable in the context of those aims. Government run schools were seen as one of the best ways to subvert the competing institutions of religion and family. Before the age of public relations, these aims were explicitly outlined by Cecil Rhodes and his Roundtable and others as well. In the medical field today, organized Pediatric groups should be specifically censured for their complicity in this.
Thank you for this very thought-provoking piece. First, cancel culture is annoying and is a different topic than gender, affirming care. From birth I knew I was a girl. From fourth grade I knew I was a girl who liked boys. I could not imagine what it would’ve been like if I was born in a girls body and knew I was a boy. It was Embarrassing enough as a girl in a girls body when things started to develop in puberty. I have no idea how bad it would be if I was a boy developing female secondary sex characteristics in puberty. As a culture we certainly encourage girls to shave their legs and bleach or pluck facial hair to fit norms. Like you and everyone posting I want the best for trans youth. Good conversations to have.
"I have no idea how bad it would be if I was a boy developing female secondary sex characteristics in puberty"
The thing is, this is not possible. You might believe you were a boy, but you would still be a girl. There is ZERO evidence that there is such a thing as a brain/body mismatch of sex. All that there is is kids who are confused about their sexuality. But now kids who begin to develop same-sex attraction at puberty (or before) are told that they are "born in the wrong body". Kids whose interests are not stereotypical (in our culture) of their sex are told that they are "born in the wrong body".
“Gender affirming therapy” is no different than prescribing emetics to bulimics. Utter insanity.
I applaud Dr. Curlin and his willingness to speak out on this very important topic for our American culture. The evidence is lacking to support the medicalization of children in the treatment of gender dysphoria. Unfortunately, there will likely be a day of reckoning for American medicine and how we as a society failed our children at a time of their greatest need.
Thank you for your bravery in speaking up. This is an excellent analogy and an excellent article.
We are witnessing Medical Lysenkoism. Historically, Lysenkoism was responsible for up to 60 million starvation deaths, one order of magnitude greater than the Holocaust.
As we have seen with Covid, Medical Lysenkoism has done great harm this decade, and pediatric sex trait modification falls under that label.
Thank you for this well written, well argued piece. I applaud the courage of the author. Thank you to the Sensible Medicine team for posting it. I do believe medical professionals have good intentions in this field, but it is time to recognize that the US is becoming an outlier in its approach to caring for gender questioning youth…and not in a good way. The UK, Sweden, France, Norway, Germany & others are all taking a step back, tapping the breaks & being more cautious in their approach to care for this group of patients. They have all realized that there are profound problems with the existing research. The Cass Review reveals this & calls for using medications only in research settings moving forward. In addition, recent court proceedings in Alabama have unearthed information which shows that WPATH commissioned Johns Hopkins to do systematic literature reviews for them in 2020, but then suppressed publication of all but one report when it became clear that the evidence contradicted WPATH’s current policies. This should alarm all of us.
WPATH is also the same agency who removed a chapter on ethics and listed recommendations which lack a grading system to indicate the quality of the evidence in their own updated “Standards of Care 8.”
When the evidence base dictates, changes in practice standards must be made, and we ought not let our own hubris stand in the way.
I have followed this issue more closely than most because I have never been able to shake the uncomfortable feeling that there are many parallels between the opioid epidemic (read or watch “Dopesick” to better understand the analogy) & the evolution of gender medicine for adolescents in the US in the last 7-10 years. In both instances there were good intentions —to help patients in distress—but both led to poor / sometimes catastrophic outcomes when evidence emerged that should have led to a change in course, but was ignored. We owe it to these children & their parents to be honest (especially in the realm of informed consent) & to provide better care. That starts with simple initial approaches like treating kids who are gender non-conforming with unconditional love (you are OK as you are), showing them that there is more to them as human beings than their gender identity, avoiding adherence to old gender stereotypes & doing a proper Biopsychosocial assessment. Sometimes less is more.
Amen!
Excellent post on a long overdue topic. I strongly urge SM explore this topic further. For example, WPATH is cited by pro-trans stakeholders as if it follows respectable evidence based care. It does not. It is a highly unethical organization built on pseudo-studies published by strong arm tactics of pro-trans fanatics. No researcher or publisher dares challenge the trans narrative.
I appreciate the author's comparisons to the Tuskegee study, conversion therapy, therapeutic lobotomies, etc. I'd add the eugenics movement of the first half of the twentieth century. This movement was widely held by respected members of society as illustrated by the famous declaration of SC Justice Oliver Wendell Holmes, Jr.: "Three generations of imbeciles are enough [to mandate involuntary sterilization]." Eugenic only died post WW2 when Nazi doctors testified at the Nuremberg trials that their inspiration was partly from the eugenics literature of countries such as England and the USA.
Thank you for posting this!
Thank you for FINALLY taking on this issue. I used to be a paid subscriber to "Sensible Medicine" but quit when you kept ignoring this greatest medical scandal of all time.
You simply MUST keep it up. We need much more information on the policies of the US federal government and the various medical associations. (In the US, these are all still 100% in favor of pediatric sex-trait modification.) We need much more information on revelations such as the WPATH papers and the varous whistleblowers (Dr. Haim is not the only one).
I used to carry a heroin bottle, heroin prescriptions, alcohol prescriptions, quaalude bottle, among other cool trinkets when I’d speak on addiction. We can look back and laugh at the ridiculousness of thinking that heroin was wonderful for the moods of women with periods and children who were teething. Yet that’s how medicine was back then. Now there’s a great big machine that makes it even harder to expose. Our children should not have to suffer the consequences of a great big machine.
Academia (including academic medicine) is very much a left-coded space.
This gender religion stuff is red meat for that space.
So the true believers forge ahead in the absence of evidence, in a manner and with a vigor that is truly a sight to behold. And most normies (esp those who work in left-adjacent spaces….like most physicians) who would otherwise bristle at this affront to primum non nocere are disincentivized to speak freely (Scott Alexander has an interesting piece on Astral Codex substack yesterday about the dynamics of cancel culture that speak in part to this). Especially when it’s not directly in their wheelhouse or clinical concern.
But it is disappointing that medical ethicists on this side of pond have remained largely silent on this assault to basic medical and EBM principles. I can only invoke (with hand-waving) the generic (and understandable)impulse of self-preservation to explain the silence.
Thank you, it is a cult like response and beahviour whenever this subject is mentioned, as so many issues seem to become these days, All i have to say in the matter is ... The Cass Report. Cass, Cass, Cass, Cass, Cass. Link below to final report.
"To provide an evidence base upon which to make its recommendations, the Review commissioned the University of York to conduct a series of independent systematic reviews of existing evidence and new qualitative and quantitative research to build on the evidence base.
Dr Cass also conducted an extensive programme of engagement with young people, parents, clinicians and other associated professionals."
https://cass.independent-review.uk/home/publications/final-report/
In case anyone else is wondering, for those who want to support Dr. Ethan Haim's legal bills, you can go here:
https://www.givesendgo.com/texas_whistleblower
Farr, thank you so much for standing up for our kids! You have my utmost respect. I'm saddened that I haven't heard of you and your book earlier.
I'm in California where the government wants you to believe that kids can make life-altering decisions as early as age 12. Whether it's allowing themselves to be vaccinated without their parents knowing, being admitted for mental services without their parents even being notified, or transitioning against their parents wishes. We as parents all know this is ridiculous, but it feels like a huge mountain pushing against us. Thank you for standing with us.
The huge mountain pushing against us has a name: the Democratic Party.
Those California laws were passed with UNANIMOUS support of Democrats in the state legislature. Similar laws have been passed in mulitple blue states, also with unanimous support of elected Democrats. Any elected Democrat who opposes pediatric sex-trait modification is primaried and removed, as happened this cycle to Texas House member Shawn Nicole Thierry.
Thank you for this extremely important and valuable article. The sexualization of children is abhorrent enough on its own. Equally important is the fact that this is a predictable step in the program to devalue the institution of the family. A couple of the initial steps were removing the need for parental consent for birth control meds and devices and then even for abortion. The psychopaths that want to control everyone and everything realized early on that the only vehicle that could carry this out was the coercive force of government. They also realized the need to minimize or eliminate competing sources of authority---namely religion and family. Many of the seemingly insane policies in recent years become more understandable in the context of those aims. Government run schools were seen as one of the best ways to subvert the competing institutions of religion and family. Before the age of public relations, these aims were explicitly outlined by Cecil Rhodes and his Roundtable and others as well. In the medical field today, organized Pediatric groups should be specifically censured for their complicity in this.
Thank you for this very thought-provoking piece. First, cancel culture is annoying and is a different topic than gender, affirming care. From birth I knew I was a girl. From fourth grade I knew I was a girl who liked boys. I could not imagine what it would’ve been like if I was born in a girls body and knew I was a boy. It was Embarrassing enough as a girl in a girls body when things started to develop in puberty. I have no idea how bad it would be if I was a boy developing female secondary sex characteristics in puberty. As a culture we certainly encourage girls to shave their legs and bleach or pluck facial hair to fit norms. Like you and everyone posting I want the best for trans youth. Good conversations to have.
"I have no idea how bad it would be if I was a boy developing female secondary sex characteristics in puberty"
The thing is, this is not possible. You might believe you were a boy, but you would still be a girl. There is ZERO evidence that there is such a thing as a brain/body mismatch of sex. All that there is is kids who are confused about their sexuality. But now kids who begin to develop same-sex attraction at puberty (or before) are told that they are "born in the wrong body". Kids whose interests are not stereotypical (in our culture) of their sex are told that they are "born in the wrong body".
What's being done is "transing away the gay".