If you want to see heartbroken parents, head over to pitt.substack.com -- these are parent essays, left, right, religious, atheist, across all sorts of backgrounds, sharing heartbreak. Young people are encouraged to cut their parents off if the parents do not agree quickly "enough" (according to the young person's opinion, the affirmative model is based on "following the child").
(Her comment about needing to transition young children--I suspect she has changed her opinion on that now, most who are gender dysphoric from a very young age do outgrow it by mature adulthood if not socially or medically transitioned, or did in the past. It's not known for older groups. No one knows how to identify those who will not outgrow it, assessments are a guess but there is inadequate follow-up to know how those assessed have done long term.)
Practically, in Oregon the age of consent for these interventions is 15 years old. Parental consent is not needed. Young people can go full speed ahead with the medical interventions without understanding how to weigh risks and benefits. Even puberty blockers appear to be irreversible in some ways, hormones and surgeries are for sure and due to people following WPATH (see Ben Ryan's discussion), there are no minimum ages for anything but phalloplasty.
Also, for hormones it is several thousand a year starting, according to Reuters (Respaut and Terhune), and hormones are intended to be taken for life.
When they hit 18, too young to smoke, or drink, or rent a car, because they are not yet mature enough on average to estimate risks, they can head over to Planned Parenthood and get the hormones quickly (or online from e.g. plume).
Being gay doesn't mean sterilizing yourself or taking high doses of steroids long term/giving your body an endocrine disorder or removing functioning parts of your body. The idea is that these risks are outweighed by the benefits but aside from anecdotes, there are plenty of anecdotes of both beneficial and adverse outcomes, it is unknown how likely it is that benefit will outweigh the risks. That is why several countries are hitting the brakes. They did systematic reviews, required for trustworthy guidelines, and realized the evidence was inadequate. So now they want follow-up (and one question, how would people do if there were no medical interventions, is a crucial one, it is *not known*).
The US medical associations which are not hitting the brakes are not following the outcomes of systematic reviews. See Block, 2023, Gender dysphoria is rising...
As Ben Ryan notes, WPATH (which many rely upon, but if you learn more about them you'll wonder why) did commission some systematic reviews, but (as court documents show) they interfered with the publication of the outcomes.
"The hesitation among some WPATH SOC8 authors was that independent appraisals of the evidence would undermine legal efforts to protect affirming interventions from legislative restriction in minors. In a form that appears to have been part of WPATH’s SOC8 publication process and is now legal evidence, a chapter author wrote, “Our concerns, echoed by the social justice lawyers we spoke with, is that evidence based review reveals little or no evidence and puts us in an untenable position in terms of affecting policy or winning lawsuits.” Several WPATH SOC8 authors were serving as expert witnesses in lawsuits brought by the American Civil Liberties Union and other plaintiffs. Another commented that any language in the guidelines undermining medical necessity—such as “insufficient evidence” or “limited data”—would empower the people calling treatments experimental and arguing for limiting them to clinical trials."
As far as the regret rate--the 1% rate is not reliable at all, even in the older studies. It has been known for a long time that they are unreliable. They are quoted even though the recent paper on the regret rate claiming to be that low had a letter to the editor pointing out serious flaws that undermine it (Exposito-Campos & D'Angelo, 2021) and a later paper discussed other recent estimates' flaws as well (Cohn, 2023). The biggest study contributing to the 1% was one where regret was taken from a record search of the clinic treating 95% of the people in the country...but 36% of the patients stopped their lifetime treatment and so were dropped (Wiepjes et al., 2018). The authors point this out but when the study is quoted, that part is not quoted.
No one actually knows the regret rate. A study would have to follow up people at least past a regret time, and those seem to be from 5-10 years depending on intervention/study (also see the Cass Review discussion, final report, 2024). They would need small enough loss to follow-up. They would need a way of measuring regret (one study just assumes that anyone who didn't come back and tell the clinic, unasked, did not regret!). The physicians providing the interventions have not checked.
Also, as Ben Ryan notes,
"He also makes what is a common, yet very likely false, comparison between homosexuality and transgender identity. Researchers simply do not know whether the origins of cross-sex identification are akin to those of same-sex attraction—meaning that the disposition is fixed at an early age, unchanging, and not a product of social influence. "
In fact, there are hundreds of people who were trans and who were recommended by MDs for medical interventions, who now realize that they are no longer trans, in a single study underway (900 detransitioners, MacKinnon et al., 2024, described in NYT https://www.nytimes.com/2024/10/26/health/kinnon-mackinnon-detransition-research.html ), you can go to r/detrans for more anecdotes, I gather about 1/3 on that site are lurkers, but about 2/3 are not. There are 55,000 members of that subreddit.
The psychiatrist Az Hakeem ran group therapy sessions at the NHS for over a decade for those with gender dysphoria and noted that for most of his patients, their distress had become located in gender, but that after better understanding themselves and transition they no longer wished to transition. 98% of them. Some of those who detransition say there were social influences. You can check out papers by Littman and collaborators (especially Littman, 2021 and Littman et al., 2023). (And no, her 2018 paper wasn't retracted or even wrong, as is commonly said. Wikipedia is wrong on details on this too. You can read the correction and the original study for yourself. ) Being trans can be temporary and no one knows how to determine when it isn't going to be temporary.
Also many young people believe they will physically transform into the opposite sex with transition. But that will not happen. One's sex is based upon one's reproductive system and they do not acquire the reproductive system of the opposite sex. It's just they no longer have their own reproductive system. Several detransitioners say they finally understood this and that drove them to detransition.
Some number (unknown) of people are happy after transitioning but it is completely unclear right now how to figure out who those people might be ahead of time. This is additionally complicated because those who detransition are often ostracized by the LGBTetc community. Being trans or having gender dysphoria does not appear to reflect a single condition, there are many kinds (and arguments about how many, of course).
See also: "The myth of reliable research in pediatric gender medicine ..."Abbruzzese et al., 2023
and "Reconsidering informed consent in trans-identified......" Levine et al., 2022
As the latter says "“Confirming the young person’s self-diagnosis of gender dysphoria or gender incongruence is easy. Clarifying the developmental forces that have influenced it and determining an appropriate intervention are not.”
The Cass Review shook up the UK because people thought there was a careful and understood process to determine who would benefit, based upon evidence. And there isn't. The evidence is inadequate ("low quality").
"Firstly, you must have the same standards of care as everyone else in the NHS, and that means basing treatments on good evidence. I have been disappointed by the lack of evidence on the long-term impact of taking hormones from an early age; research has let us all down, most importantly you. "
Mr. Lipfert, criticizing those activists who are trying to shut down honest & important debate on this topic is not an attack on trans people. On the contrary, valuing people enough to want them to have the truth so they can make informed decisions about their health is the highest form of respect.
You were dismissive of the character assassinations perpetrated by the activists. Why don’t you ask these women if their lives have been negatively affected by speaking up on this issue?
Debrah Soh, PhD
Carole Hooven, PhD
Kathleen Stock, PhD
Lisa Littman, MD, MPH
Laura Edwards-Leeper, PhD
Erica Anderson, PhD
Katie Herzog
Theses ladies are all serious scientists, psychologists, academics, physicians, or journalists. They entered this conversation, at great cost to themselves, out of a sense of concern for vulnerable patients and a sense of duty to share the truth.
many more but now finally thanks to their bravery others are able to speak out too...
One can also recall the GLAAD truck parked outside the NYT which claimed "the science is settled" and attacked the NYT writers...the science is surely not settled as MDs cannot tell patients the likely risks, benefits or those of alternatives (e.g. psychological support, first line in the countries which are following the outcomes of systematic reviews unlike the US, Canada, etc.) or what will happen if there is no intervention (the natural history).
Agree with the above--how is this helping people, to not tell them how little is known and to find out what it and isn't known so they can make informed decisions?
Agree, to make the statement “the science is settled” in this environment says it all (about the lack of humility many use in their approach to this topic).
I also forgot Colin Wright, PhD, and many, many more.
Most of those who spoke out early have entered into this conversation not because they have any particular advocacy bent, but because they want to preserve in science the pursuit of truth & the scientific method.
Julia, if you are referring to my comment above and my wondering about ‘retransitioning’, you didn’t ‘hear’ what I said. Yes I am older, 71 to be accurate and yes I practiced as a physician for 43 years. I actually am seeking to understand adolescent onset gender dysphoria. This is not a red or blue question. This is a question of how a human born with a certain set of chromosomes and all the attendant physical, hormonal, psychological and psychosocial ‘pressures’ and ‘pleasures’ makes a decision to be their gender counterpart. No guns no marginalizing.
I want to very much thank the medical student who wrote this short piece. Not sure why the other writer again got to put in his two cents again and in a longer form than ever before. I think it shows bias that Sensible Medicine writers in general and their readership are older and very happy to marginalize a group of people. I think this is a good example where you see an integral viewpoint where blue wants to fix what’s wrong and red wants to keep what’s good even if it has to be done by marginalizing a group or using guns.
I found Mr. Ryan’s remarks very cogent and well balanced. I would be interested in the number of preteens/teens who go through ‘retransitioning’, if such data is out there somewhere? Might there be data on the ‘contribution’ of different social media platforms? It’s good to be old; much easier in my youth and much of my life to understand ‘gay’ and lesbian. Gender fluid and non-binary though not trans, sow confusion for many of us. I practiced as a physician for 43 years and only in the last 3 years of that time, did I have patients with trans and non-binary teens. I watched them (parents) do what is right for supporting their ‘they’ and stuff their own feelings of fear and existential angst for their they’s future. What is Humanity doing and to what end? Sorry for this; ‘solo’ post for sure.
The detransitioning research is pretty thin. There’s so little follow up in the major cohort studies, with the exception of the Olson study out of Princeton. But that population is in adolescence right now. Kinnon MacKinnon at York University in Canada is doing good work on studying detransitioning. It’s mostly qualitative. He had a Q&A in the Times the other day you should check out. As for social influence, a trio of renegade researchers are seeking to follow youth with gender dysphoria to see if rapid onset gender dysphoria is a real phenomenon: https://open.substack.com/pub/benryan/p/controversial-gender-researchers?r=7wxo1&utm_campaign=post&utm_medium=web
The first principle in medicine (and logic) is that, if you assert an intervention to be of benefit in the management of some issue, the burden of proof is on the proponent to provide evidence that sustains the assertion, and compels us to reject the null (that the intervention does NOT work).
Mr. Ryan has documented a litany of people and activist types who have failed at step one, insofar as childhood gender dysphoria treatments goes.
Mr. Lipfert offers a logically weak and poorly argued critique here. And kudos to Mr. Ryan for providing a point-by-point rebuttal that exposes the weakness in Mr. Lipfert’s logic, and the lack of substance in his arguments.
We have laws limiting what minors can do because we recognize that childhood and adolescence are often mentally tumultuous and confusing times. It is a shame that some parents let their children make such life changing decisions during this period of their lives. It is criminal that public schools and advocacy groups push this agenda in many ways. Thank you Mr. Ryan for your honest reporting.
As a Medical Director for a mid-sized PPO/TPA (from 2011 to 2022), I was called upon to address issues of 'medical necessity' related to gender dysphoria. I would here simply state that my experiences in this area lead me to agree with the problems reported by Mr Ryan. In my view 'gender medicine' is seriously polluted by activist promoted ideology, and as such, great skepticism needs be applied to those claims which drive medical/surgical interventions for gender dysphoric children.
It’s worth noting that WPATH applied the term “medically necessary” to its treatment guidelines not because of research that supported this claim but to secure insurance coverage and as a hedge to help them win lawsuits. We know this because of internal documents revealed via subpoena by the Alabama attorney general.
Yes - I fought this . Because I was losing the battle, I refused to participate in pediatric cases other than to offer commentary - I would not participate in approvals. An associate psychiatrist medical director handled these. I warned her that the clinical science and legal risk due to detransitioners would be a big problem soon enough…
Yes, I’ve written about how there has been a recent pullback in the prescribing of blockers and hormones to kids for gender dysphoria, and it might be due to increasing caution from prescribers out of fear of litigation. The detransitioner lawsuits continue to mount, and I can assure you that more are in the pipeline.
Neither writer mentions the violation of medical ethics when a minor undergoes medical or surgical treatment for gender dysphoria. A minor can't possibly consent to these treatments. In general, a parent who consents on behalf of their child is guilty of abuse. This criticism doesn't include children with an intersex condition or precocious puberty.
Agree; I was thinking of a intersex teen who might be trending toward a gender, and justifiably benefit from medical and (rarely) surgical treatment to support that gender.
Thank you for this discussion. During my 40 years as a pediatrician I have had 3 children who did not feel “right” in their body. All presented by the age of 3. Speaking to others in my field the numbers are similar. I am not talking about the young adolescents for whom there was no prior history. Abigail Schrier writes about this phenomenon which is an adolescent psychiatric/social issue akin to anorexia. The most destructive part is the inability to treat these feelings as any other psychological issue ie discuss feelings, options, approaches. There is no doubt that questioning the current dogma is an uphill battle. I have experienced it myself. Even before Covid when I pointed out to a head of a transgender clinic in CT that European countries are questioning the adolescent transgender surge I was curtly cut off that there are no questions. I think there should always be questions. That at least leads to a discussion.
The ones who present very young are better understood...mostly they "desisted" by mature adulthood. A recent paper summarizing this is Singh, Bradley, Zucker, 2021.
In addition, it is unknown how to determine which of those were the ones who didn't, ahead of time, and it is unknown if those who didn't desist and then did have medical intervention, benefited. (What could go wrong?)
The two studies that were used as the basis for medical interventions for minors are the "Dutch studies". A summary of what is understood about those studies now is https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2150346 . It is unclear about the long term outcomes of these patients.
What is known is that the majority do tend to grow up to be gay or lesbian (not all!).
Genuinely curious, how does a 2 year old explain to you their sense of not feeling right in their body and how this feeling must be tied to their genitalia? As a pediatrician of only 10 years or so, as well as a parent of several, I’m generally happy if kids can say two word combinations by age 2 and start to learn their colors…
What I meant by this is that at that age these boys (my patients were all boys) showed a decided preference for dressing in dresses, wearing pinks and purples, playing with dolls, and playing with girls despite having more traditional role models. This is a process obviously .
Those younger-presenting patients are likely more in line with the kids who comprised the first Dutch cohort that established pediatric gender medicine starting in the mid-1990s. Shrier's book concerns a more recent phenomenon of the adolescent-presenting youths, mostly natal girls. They're the ones who prompted the controversial ROGD paper by Lisa Littman. See: https://benryan.substack.com/p/controversial-gender-researchers
This all madness. Dysphoria of any kind must first be treated, before being indulged. Would anyone in his/her right mind prescribe emetics to a bulimic?
What is trans person? What’s the difference between a man and a transwoman? Ben Ryan is obviously more correct and better informed. Thank you for publishing this debate.
If you want to see heartbroken parents, head over to pitt.substack.com -- these are parent essays, left, right, religious, atheist, across all sorts of backgrounds, sharing heartbreak. Young people are encouraged to cut their parents off if the parents do not agree quickly "enough" (according to the young person's opinion, the affirmative model is based on "following the child").
Dr. Erica Anderson discusses this here:
https://www.sfexaminer.com/archives/opinion-when-it-comes-to-trans-youth-we-re-in-danger-of-losing-our-way/article_833f674f-3d88-5edf-900c-7142ef691f1a.html
and here:
https://www.sfexaminer.com/archives/opinion-the-health-establishment-is-failing-young-adults-who-question-their-gender/article_52832479-1ddd-596b-b64b-6c7b60addbdf.html
(Her comment about needing to transition young children--I suspect she has changed her opinion on that now, most who are gender dysphoric from a very young age do outgrow it by mature adulthood if not socially or medically transitioned, or did in the past. It's not known for older groups. No one knows how to identify those who will not outgrow it, assessments are a guess but there is inadequate follow-up to know how those assessed have done long term.)
Practically, in Oregon the age of consent for these interventions is 15 years old. Parental consent is not needed. Young people can go full speed ahead with the medical interventions without understanding how to weigh risks and benefits. Even puberty blockers appear to be irreversible in some ways, hormones and surgeries are for sure and due to people following WPATH (see Ben Ryan's discussion), there are no minimum ages for anything but phalloplasty.
Also, for hormones it is several thousand a year starting, according to Reuters (Respaut and Terhune), and hormones are intended to be taken for life.
When they hit 18, too young to smoke, or drink, or rent a car, because they are not yet mature enough on average to estimate risks, they can head over to Planned Parenthood and get the hormones quickly (or online from e.g. plume).
Being gay doesn't mean sterilizing yourself or taking high doses of steroids long term/giving your body an endocrine disorder or removing functioning parts of your body. The idea is that these risks are outweighed by the benefits but aside from anecdotes, there are plenty of anecdotes of both beneficial and adverse outcomes, it is unknown how likely it is that benefit will outweigh the risks. That is why several countries are hitting the brakes. They did systematic reviews, required for trustworthy guidelines, and realized the evidence was inadequate. So now they want follow-up (and one question, how would people do if there were no medical interventions, is a crucial one, it is *not known*).
The US medical associations which are not hitting the brakes are not following the outcomes of systematic reviews. See Block, 2023, Gender dysphoria is rising...
As Ben Ryan notes, WPATH (which many rely upon, but if you learn more about them you'll wonder why) did commission some systematic reviews, but (as court documents show) they interfered with the publication of the outcomes.
"The hesitation among some WPATH SOC8 authors was that independent appraisals of the evidence would undermine legal efforts to protect affirming interventions from legislative restriction in minors. In a form that appears to have been part of WPATH’s SOC8 publication process and is now legal evidence, a chapter author wrote, “Our concerns, echoed by the social justice lawyers we spoke with, is that evidence based review reveals little or no evidence and puts us in an untenable position in terms of affecting policy or winning lawsuits.” Several WPATH SOC8 authors were serving as expert witnesses in lawsuits brought by the American Civil Liberties Union and other plaintiffs. Another commented that any language in the guidelines undermining medical necessity—such as “insufficient evidence” or “limited data”—would empower the people calling treatments experimental and arguing for limiting them to clinical trials."
See https://www.bmj.com/content/387/bmj.q2227 (BMJ, peer-reviewed article, Block, 2024)
As far as the regret rate--the 1% rate is not reliable at all, even in the older studies. It has been known for a long time that they are unreliable. They are quoted even though the recent paper on the regret rate claiming to be that low had a letter to the editor pointing out serious flaws that undermine it (Exposito-Campos & D'Angelo, 2021) and a later paper discussed other recent estimates' flaws as well (Cohn, 2023). The biggest study contributing to the 1% was one where regret was taken from a record search of the clinic treating 95% of the people in the country...but 36% of the patients stopped their lifetime treatment and so were dropped (Wiepjes et al., 2018). The authors point this out but when the study is quoted, that part is not quoted.
No one actually knows the regret rate. A study would have to follow up people at least past a regret time, and those seem to be from 5-10 years depending on intervention/study (also see the Cass Review discussion, final report, 2024). They would need small enough loss to follow-up. They would need a way of measuring regret (one study just assumes that anyone who didn't come back and tell the clinic, unasked, did not regret!). The physicians providing the interventions have not checked.
Also, as Ben Ryan notes,
"He also makes what is a common, yet very likely false, comparison between homosexuality and transgender identity. Researchers simply do not know whether the origins of cross-sex identification are akin to those of same-sex attraction—meaning that the disposition is fixed at an early age, unchanging, and not a product of social influence. "
In fact, there are hundreds of people who were trans and who were recommended by MDs for medical interventions, who now realize that they are no longer trans, in a single study underway (900 detransitioners, MacKinnon et al., 2024, described in NYT https://www.nytimes.com/2024/10/26/health/kinnon-mackinnon-detransition-research.html ), you can go to r/detrans for more anecdotes, I gather about 1/3 on that site are lurkers, but about 2/3 are not. There are 55,000 members of that subreddit.
The psychiatrist Az Hakeem ran group therapy sessions at the NHS for over a decade for those with gender dysphoria and noted that for most of his patients, their distress had become located in gender, but that after better understanding themselves and transition they no longer wished to transition. 98% of them. Some of those who detransition say there were social influences. You can check out papers by Littman and collaborators (especially Littman, 2021 and Littman et al., 2023). (And no, her 2018 paper wasn't retracted or even wrong, as is commonly said. Wikipedia is wrong on details on this too. You can read the correction and the original study for yourself. ) Being trans can be temporary and no one knows how to determine when it isn't going to be temporary.
Also many young people believe they will physically transform into the opposite sex with transition. But that will not happen. One's sex is based upon one's reproductive system and they do not acquire the reproductive system of the opposite sex. It's just they no longer have their own reproductive system. Several detransitioners say they finally understood this and that drove them to detransition.
Some number (unknown) of people are happy after transitioning but it is completely unclear right now how to figure out who those people might be ahead of time. This is additionally complicated because those who detransition are often ostracized by the LGBTetc community. Being trans or having gender dysphoria does not appear to reflect a single condition, there are many kinds (and arguments about how many, of course).
See also: "The myth of reliable research in pediatric gender medicine ..."Abbruzzese et al., 2023
and "Reconsidering informed consent in trans-identified......" Levine et al., 2022
As the latter says "“Confirming the young person’s self-diagnosis of gender dysphoria or gender incongruence is easy. Clarifying the developmental forces that have influenced it and determining an appropriate intervention are not.”
The Cass Review shook up the UK because people thought there was a careful and understood process to determine who would benefit, based upon evidence. And there isn't. The evidence is inadequate ("low quality").
"Firstly, you must have the same standards of care as everyone else in the NHS, and that means basing treatments on good evidence. I have been disappointed by the lack of evidence on the long-term impact of taking hormones from an early age; research has let us all down, most importantly you. "
Mr. Lipfert, criticizing those activists who are trying to shut down honest & important debate on this topic is not an attack on trans people. On the contrary, valuing people enough to want them to have the truth so they can make informed decisions about their health is the highest form of respect.
You were dismissive of the character assassinations perpetrated by the activists. Why don’t you ask these women if their lives have been negatively affected by speaking up on this issue?
Debrah Soh, PhD
Carole Hooven, PhD
Kathleen Stock, PhD
Lisa Littman, MD, MPH
Laura Edwards-Leeper, PhD
Erica Anderson, PhD
Katie Herzog
Theses ladies are all serious scientists, psychologists, academics, physicians, or journalists. They entered this conversation, at great cost to themselves, out of a sense of concern for vulnerable patients and a sense of duty to share the truth.
I encourage you to do your own research.
Jesse Singal
Lisa Selin Davis
....also Ben Ryan
many more but now finally thanks to their bravery others are able to speak out too...
One can also recall the GLAAD truck parked outside the NYT which claimed "the science is settled" and attacked the NYT writers...the science is surely not settled as MDs cannot tell patients the likely risks, benefits or those of alternatives (e.g. psychological support, first line in the countries which are following the outcomes of systematic reviews unlike the US, Canada, etc.) or what will happen if there is no intervention (the natural history).
Agree with the above--how is this helping people, to not tell them how little is known and to find out what it and isn't known so they can make informed decisions?
Agree, to make the statement “the science is settled” in this environment says it all (about the lack of humility many use in their approach to this topic).
I also forgot Colin Wright, PhD, and many, many more.
Most of those who spoke out early have entered into this conversation not because they have any particular advocacy bent, but because they want to preserve in science the pursuit of truth & the scientific method.
I love this format- cordial dialogue presenting two sided to a story. Thank you. Well done.
Julia, if you are referring to my comment above and my wondering about ‘retransitioning’, you didn’t ‘hear’ what I said. Yes I am older, 71 to be accurate and yes I practiced as a physician for 43 years. I actually am seeking to understand adolescent onset gender dysphoria. This is not a red or blue question. This is a question of how a human born with a certain set of chromosomes and all the attendant physical, hormonal, psychological and psychosocial ‘pressures’ and ‘pleasures’ makes a decision to be their gender counterpart. No guns no marginalizing.
I want to very much thank the medical student who wrote this short piece. Not sure why the other writer again got to put in his two cents again and in a longer form than ever before. I think it shows bias that Sensible Medicine writers in general and their readership are older and very happy to marginalize a group of people. I think this is a good example where you see an integral viewpoint where blue wants to fix what’s wrong and red wants to keep what’s good even if it has to be done by marginalizing a group or using guns.
I found Mr. Ryan’s remarks very cogent and well balanced. I would be interested in the number of preteens/teens who go through ‘retransitioning’, if such data is out there somewhere? Might there be data on the ‘contribution’ of different social media platforms? It’s good to be old; much easier in my youth and much of my life to understand ‘gay’ and lesbian. Gender fluid and non-binary though not trans, sow confusion for many of us. I practiced as a physician for 43 years and only in the last 3 years of that time, did I have patients with trans and non-binary teens. I watched them (parents) do what is right for supporting their ‘they’ and stuff their own feelings of fear and existential angst for their they’s future. What is Humanity doing and to what end? Sorry for this; ‘solo’ post for sure.
You can read:
The detransition rate is unknown: https://link.springer.com/article/10.1007/s10508-023-02623-5
The detransitioning research is pretty thin. There’s so little follow up in the major cohort studies, with the exception of the Olson study out of Princeton. But that population is in adolescence right now. Kinnon MacKinnon at York University in Canada is doing good work on studying detransitioning. It’s mostly qualitative. He had a Q&A in the Times the other day you should check out. As for social influence, a trio of renegade researchers are seeking to follow youth with gender dysphoria to see if rapid onset gender dysphoria is a real phenomenon: https://open.substack.com/pub/benryan/p/controversial-gender-researchers?r=7wxo1&utm_campaign=post&utm_medium=web
The first principle in medicine (and logic) is that, if you assert an intervention to be of benefit in the management of some issue, the burden of proof is on the proponent to provide evidence that sustains the assertion, and compels us to reject the null (that the intervention does NOT work).
Mr. Ryan has documented a litany of people and activist types who have failed at step one, insofar as childhood gender dysphoria treatments goes.
Mr. Lipfert offers a logically weak and poorly argued critique here. And kudos to Mr. Ryan for providing a point-by-point rebuttal that exposes the weakness in Mr. Lipfert’s logic, and the lack of substance in his arguments.
We have laws limiting what minors can do because we recognize that childhood and adolescence are often mentally tumultuous and confusing times. It is a shame that some parents let their children make such life changing decisions during this period of their lives. It is criminal that public schools and advocacy groups push this agenda in many ways. Thank you Mr. Ryan for your honest reporting.
As a Medical Director for a mid-sized PPO/TPA (from 2011 to 2022), I was called upon to address issues of 'medical necessity' related to gender dysphoria. I would here simply state that my experiences in this area lead me to agree with the problems reported by Mr Ryan. In my view 'gender medicine' is seriously polluted by activist promoted ideology, and as such, great skepticism needs be applied to those claims which drive medical/surgical interventions for gender dysphoric children.
It’s worth noting that WPATH applied the term “medically necessary” to its treatment guidelines not because of research that supported this claim but to secure insurance coverage and as a hedge to help them win lawsuits. We know this because of internal documents revealed via subpoena by the Alabama attorney general.
Yes - I fought this . Because I was losing the battle, I refused to participate in pediatric cases other than to offer commentary - I would not participate in approvals. An associate psychiatrist medical director handled these. I warned her that the clinical science and legal risk due to detransitioners would be a big problem soon enough…
Yes, I’ve written about how there has been a recent pullback in the prescribing of blockers and hormones to kids for gender dysphoria, and it might be due to increasing caution from prescribers out of fear of litigation. The detransitioner lawsuits continue to mount, and I can assure you that more are in the pipeline.
Thanks to all for reading my reply on this important subject of pediatric gender medicine. I'd greatly appreciate your following me on:
Substack: https://benryan.substack.com/
X: https://x.com/benryanwriter
Bluesky: https://bsky.app/profile/benryanwriter.bsky.social
And here's the original piece I wrote that prompted this discussion: https://benryan.substack.com/cp/150760872
Neither writer mentions the violation of medical ethics when a minor undergoes medical or surgical treatment for gender dysphoria. A minor can't possibly consent to these treatments. In general, a parent who consents on behalf of their child is guilty of abuse. This criticism doesn't include children with an intersex condition or precocious puberty.
That said, many people say that intersex operations are also unethical, because the child (or toddler or infant) can't consent.
Agree; I was thinking of a intersex teen who might be trending toward a gender, and justifiably benefit from medical and (rarely) surgical treatment to support that gender.
Thank you for this discussion. During my 40 years as a pediatrician I have had 3 children who did not feel “right” in their body. All presented by the age of 3. Speaking to others in my field the numbers are similar. I am not talking about the young adolescents for whom there was no prior history. Abigail Schrier writes about this phenomenon which is an adolescent psychiatric/social issue akin to anorexia. The most destructive part is the inability to treat these feelings as any other psychological issue ie discuss feelings, options, approaches. There is no doubt that questioning the current dogma is an uphill battle. I have experienced it myself. Even before Covid when I pointed out to a head of a transgender clinic in CT that European countries are questioning the adolescent transgender surge I was curtly cut off that there are no questions. I think there should always be questions. That at least leads to a discussion.
The ones who present very young are better understood...mostly they "desisted" by mature adulthood. A recent paper summarizing this is Singh, Bradley, Zucker, 2021.
In addition, it is unknown how to determine which of those were the ones who didn't, ahead of time, and it is unknown if those who didn't desist and then did have medical intervention, benefited. (What could go wrong?)
The two studies that were used as the basis for medical interventions for minors are the "Dutch studies". A summary of what is understood about those studies now is https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2150346 . It is unclear about the long term outcomes of these patients.
What is known is that the majority do tend to grow up to be gay or lesbian (not all!).
The cultish demand for absolute adherence to orthodoxy is pathognomonic for “woke”.
“ All presented by the age of 3.”
Genuinely curious, how does a 2 year old explain to you their sense of not feeling right in their body and how this feeling must be tied to their genitalia? As a pediatrician of only 10 years or so, as well as a parent of several, I’m generally happy if kids can say two word combinations by age 2 and start to learn their colors…
What I meant by this is that at that age these boys (my patients were all boys) showed a decided preference for dressing in dresses, wearing pinks and purples, playing with dolls, and playing with girls despite having more traditional role models. This is a process obviously .
Those younger-presenting patients are likely more in line with the kids who comprised the first Dutch cohort that established pediatric gender medicine starting in the mid-1990s. Shrier's book concerns a more recent phenomenon of the adolescent-presenting youths, mostly natal girls. They're the ones who prompted the controversial ROGD paper by Lisa Littman. See: https://benryan.substack.com/p/controversial-gender-researchers
This all madness. Dysphoria of any kind must first be treated, before being indulged. Would anyone in his/her right mind prescribe emetics to a bulimic?
What is trans person? What’s the difference between a man and a transwoman? Ben Ryan is obviously more correct and better informed. Thank you for publishing this debate.