This probably isn't as much as she could have gotten and it likely won't be enough to make malpractice insurers immediately balk and change their policies.
But as the first trial verdict, it sets a precedent. The first brick has fallen, and the second won't be far behind.
Soon enough we'll see $5m, $10m judgements and the liability insurers will pull the plug. When every person who passes through an affirmation-only system is a potential multi-million dollar lawsuit payout, nobody will be willing to back these butchers.
Dr. Hillary Cass, author of the Cass Review gave an interview with NPR in which she says that transition effectiveness should be measured by
Erin Reed at Erin In The Morning:
On Wednesday, Dr. Hillary Cass gave her first American interview with NPR about the Cass Review. The review, which appears heavily politicized and lends credence to debunked theories about being transgender, such as "social contagion," is being used as a pretext to ban care in the United Kingdom. In the interview, Cass called for "other ways" of managing dysphoria besides transitioning and blamed being trans on factors such as autism and pornography. However, one particular point of note was her response to a question about the evidence supporting gender-affirming care, where she suggested that the real measure of transition success should be the employment status of transgender people.
When asked about “actual outcomes” for the effectiveness of cross-sex hormones in transgender youth, Cass sated that there was a need for long followups to see if transgender people thrive on hormones, and that the outcomes that she was most interested in included employment, “getting out of the house,” and relationships. See her answer here:
[CHAKRABARTI: Regarding cross sex hormones, the systematic review authors said there is a lack of high-quality research assessing the actual outcomes of cross sex hormones.
CASS: Yes, because we need to follow up for much longer than a year or two to know if you continue to thrive on those hormones in the longer term. And we also need to know, are those young people in relationships? Are they getting out of the house? Are they in employment? Do they have a satisfactory sex life?]
It is important to note that all of these potential outcome measurements may be heavily influenced by transphobic sentiments in society. Should transgender people be judged on their ability to be "employed" or their willingness to "get out of the house," their own discrimination may then be used against their ability to access medication. According to the National Center for Transgender Equality, more than one in four transgender people have lost a job due to bias, and three-quarters report experiencing workplace discrimination. Therefore, it is inaccurate to blame transgender people and their medication for what appears to be an issue with societal discrimination.
In recent years, many reports have emerged showing high levels of satisfaction and low levels of detransition for transgender people. A recent report in the 2022 US transgender survey shows that out of 90,000 transgender people, less than 1% report feeling less satisfied after beginning gender affirming hormone therapy, with the vast majority feeling “a lot more satisfied.” Detransition appears to be similarly rare. One recent study out of Australia found complete data on 548 of 552 transgender patients and discovered only 1% of transgender youth detransitioned over several years before being transferred to adult services. Another study showed that transgender youth are stable in their gender identity 5 years after transitioning, with only 2.5% reidentifying as their assigned sex at birth. Even Cass’s own report found less than 10 detransitioners out of the 3,000 trans youth patients in England, which led to her claiming that the real reason she didn’t find more detransitioners is because adult clinics refused to provide private patient data.
Dr. Hilary Cass, the woman behind the anti-trans Cass Review, made absurd claims that a person’s transition success should be measured by their employment status instead of satisfaction and joy.
See Also:
Assigned Media: TWIBS: Cass Says Porn Makes You Trans
For years, proponents of pediatric gender medicine appeared to have an ironclad medical consensus behind them. “Gender-affirming care” — including puberty blockers, cross-sex hormones, and even irreversible surgeries — was simply a medical best practice. Many of them claimed these treatments were “life saving,” suggesting there was no difference between them and, say, the suite of interventions oncologists might prescribe for cancer patients.
But the consensus was always a mirage — and this week, at least among major US medical groups, it officially vanished.
On Tuesday, the American Society of Plastic Surgeons came out in opposition to providing gender-transition surgeries to minors. The recommendation, the first of its kind from a mainstream medical association, was published in a nine-page policy statement that marks a watershed moment in these debates. It’s part of a broader rethink among many experts, a reminder that science can trump ideology when investigators follow time-tested, evidence-based processes.
To wit, the ASPS examined the thorny cross-section of scientific research and medical ethics that inform the question of whether to provide gender-transition interventions for minors. After considering the weakness of the relevant scientific evidence and the balance of risks versus benefits, the organization urged its 11,000 members to delay gender-transition surgeries — including breast removal and augmentation, penis inversions, and facial-feminization surgery — until patients reach age 19.
The document — which, while addressed to plastic surgeons, is not a clinical-practice guideline — also cautions that the prospect of treating gender distress in minors with blockers and hormones raises serious ethical concerns due to the shaky state of the supporting science, the challenges of procuring minors’ informed consent, and the irreversibility of hormones in particular.
While supporters of gender-transition surgeries often falsely characterize them as rare, approximately 1,000 minors received such interventions annually in recent years — overwhelmingly mastectomies for girls who identify as male or nonbinary.
The ASPS’s position is grounded in systematic literature reviews — the gold standard of scientific evidence — and pays deference to Britain’s mammoth Cass Review of the field. Accordingly, the document validates the evidence-based-medicine approach to this discipline advocated by the quietly influential — and much-maligned by transgender activists — Society for Evidence-Based Medicine.
The policy document points to widely debated and criticized research that has suggested that, absent a gender transition, most youths with gender dysphoria will grow out of it. It goes on to point out that even highly experienced clinicians are unable to reliably predict which adolescent patients will persist in their gender-related distress. It then tips its hat to the massive report on pediatric gender medicine commissioned by the US Department of Health and Human Services, which was published in its final form in November and has been roundly dismissed as politically tainted, biased and therefore irrelevant by transgender advocates.
The ASPS continues: “The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and nonmaleficence (i.e., promoting health and well-being while avoiding harm) requires a precautionary approach.”
Those bold assertions are all but guaranteed to enrage and demoralize transgender activists, especially given that this policy statement arrives amid attacks on pediatric gender medicine by the Trump administration as well as a larger fracturing of the global elite consensus about pediatric gender medicine. The cracks have fast expanded after multiple systematic literature reviews found that the evidence backing the benefits of giving gender-transition interventions to minors is weak and uncertain.
Health authorities in a swath of European nations and the ruling Labour party in Britain sharply restricted minors’ access to gender-transition interventions. In the United States, just more than half of states, all of them red, have banned these practices. And on Friday, a jury in Westchester County awarded $2 million in damages to a detransitioner after her attorney convinced a jury that her psychologist and plastic surgeon had deviated from best practices and harmed her by removing her breasts when she was 16 years old. It was a landmark case — the first decision of its kind — and is expected to serve as a catalyst for others.
The ASPS’s position statement calls into question the logic pushed by many transgender activists that patient autonomy should be paramount — even absolute — among minors seeking these interventions. The document states that “patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk-benefit profile.”
Wading into the policy debate, the ASPS asserted that it opposed the criminalization of gender-transition interventions for young people and other “punitive legislative approaches.” A few states — Idaho, Oklahoma and Florida among them — impose such harsh criminal penalties. And yet, the ASPS stopped short of explicitly opposing bans that impose only civil consequences, which comprise the vast majority of state bans on pediatric gender medicine.
The ASPS policy document’s age cut-off of 19 for surgeries puts the ASPS in line with policies of the Trump administration as it has engaged in a whole-of-government assault on what remains of the pediatric gender medicine field.
Yet leaders at the ASPS saw the new recommendations as necessary. Dr. Scot Glasberg is a plastic surgeon in private practice in New York and a past ASPS president. He was not directly involved with the new policy statement but said he was intimately familiar with its development. He said the organization selected age 19 as a cutoff because by that point young people are safely out of puberty.
“This entire statement revolves around a vulnerable population,” Glasberg told UnHerd. “The ages of development are key.” And given the weakness of the evidence base, he continued, “we felt it would be best to recommend to wait until the age of 19” to allow young people time to mature.
Facing what is sure to be considerable backlash from liberal groups and transgender advocates, Glasberg asserted that the ASPS’s work on this document was fully independent of the Trump administration. “We have the beauty as an organization to be out of the line of politics,” Glasberg said. “We deal with science and evidence and data, and that’s why we made the decision we did.”
The ASPS had telegraphed its discomfort with gender-transition interventions for minors during the Biden administration. In August 2024, the organization made clear that it did not endorse such practices. The organization’s president at the time, California plastic surgeon Dr. Steven Williams, said in an Instagram live interview the following month that he wouldn’t commit to the ASPS coming out in opposition to those bans.
Yet major LGBTQ and liberal nonprofits, including GLAAD, the Human Rights Campaign, and the ACLU, have continued to routinely make the false claim that all major medical organizations endorse what they call gender-affirming care for minors.
As recently as December, the ACLU made this claim in a statement about its efforts to combat the Trump administration’s threats to strip Medicaid funding from hospitals that provide gender-transition interventions to patients under age 19. The ACLU release stated: “The administration’s proposal seeks to block the provision of evidence-based, medically necessary care for transgender people under 18 — care that is supported by every major medical association in the United States, including the American Medical Association and the American Academy of Pediatrics.”
After UnHerd challenged the ACLU over the veracity of its statement, a representative replied: “The ASPS opposes bans on gender-affirming medical care, like those the ACLU has challenged in court, so your claim is misleading at best.” Contacted for further comment after the ASPS released its new policy statement, the ACLU didn’t reply. GLAAD and HRC also didn’t reply to a request for comment.
The ASPS’s policy statement is already providing ample fodder for the legal profession.
Alabama Attorney General Steve Marshall, who has tangled with the ACLU in court, was eager to provide a comment. “For years, legal advocacy groups like the ACLU have worked hand-in-hand with medical interest groups,” he said, “to manufacture a narrative for use in court that providing sex-change procedures to children is medically necessary and recommended by every major medical organization,” he told UnHerd. “The claim has always been false, and I am glad that responsible medical organizations are finally beginning to put patient safety and evidence-based review ahead of ideology.”
Legal experts said the ASPS appeared eager to ward off attempts by litigators to leverage its new policy document in detransitioner lawsuits against plastic surgeons. More than two dozen suits have been filed by such plaintiffs so far, including some that, like the case that won the judgment in Westchester on Friday, include a plastic-surgeon defendant.
A critical statement in the ASPS document reads: “This position statement is not a retroactive judgement, but a forward-looking response to evolving evidence.”
Yet Charles LiMandri — a partner at the California law firm LiMandri and Johnna, which is behind two of the most famous detransitioner lawsuits — still sees an opening. “What the opposition has always said,” LiMandri told UnHerd, is that pediatric gender medicine “is evidence-based medicine, and that the science was settled and supportive. Those were lies.” He continued: “The fact that people are coming out now and saying there never was good science to support this proves those were lies. So in one sense they could say, ‘Well, the new ASPS standards can’t be applied retroactively.’ But on the other hand, they can’t deny the fact that if there’s no evidence for it now, there never was. And they said there was.”
Adam Deutsch, a personal-injury attorney in White Plains who represented the plaintiff in the detransitioner lawsuit, referenced the difference, dissected during the three-week trial, between the 16-year-old girl’s desire for surgery and the responsibility of the care providers to determine whether it was in a minor’s best interest. He said that the ASPS position statement validated his successful effort to point the finger at the defendants.
Deutsch noted another element of the policy document that dovetailed with his client’s lawsuit: what he interpreted as the ASPS asserting that plastic surgeons needed to conduct their own due diligence when screening patients and not merely rely on the independent word of a referring mental-health professional.
The attorney suggested that the ASPS might be putting more doctors on notice than just those who care for minors. He said he thought such a position by the ASPS would place greater pressure on surgeons when considering performing gender-transition surgeries on adults, as well.
The once-impenetrable edifice of gender activism is beginning to crumble.
The most rigorous academic analysis to date of the research backing puberty blockers and cross-sex hormones as treatments for gender-related
By: Benjamin Ryan
Published: Jan 23, 2025
The most rigorous academic analysis to date of the research backing puberty blockers and cross-sex hormones as treatments for gender-related distress in young people has found it has produced ‘very uncertain’ evidence.
A pair of major new analyses of research into providing gender-transition drugs to adolescents and young adults have indicated that a prevailing orthodoxy in the U.S. medical community — that such treatments are safe and effective for gender-distressed minors — is largely based on “very uncertain” scientific evidence.
The most rigorous such analyses of their kind to date, these new academic papers are the latest reports to cast doubt on the transgender movement’s battle, now on the defensive, to protect minors’ access to ultimately irreversible gender-transition treatments. The new analyses reach the damning conclusion that almost all the research assessing such treatments is decidedly unreliable at anticipating risks and benefits alike, thanks to consistently weak study designs that leave the door wide open for biased and unreliable results.
This sweeping finding echoes the four-year independent assessment of the field of pediatric gender medicine, called the Cass Review, that was commissioned by Britain’s National Health Service and published to great fanfare in April. The nearly 400-page report was anchored on the finding that the field was based on “remarkably weak evidence.”
These critical assessments of the controversial medical practices – which in recent years have been banned for minors in 24 states – stand in direct conflict with a nearly united front among American medical associations who endorse the prescribing of puberty blockers and cross-sex hormones for minors experiencing gender dysphoria, which is distress stemming from a conflict between an individual’s sex and gender identity. Prominent societies such as the American Academy of Pediatrics and the American Medical Association have touted such treatments as effective and even life saving – since, advocates claim, gender treatments prevent suicides.
Dr. Gordon Guyatt, a physician and professor at McMaster University in Ontario, effectively begs to differ, having found that there is no such clear-eyed certainty about the impacts of these treatments on young people. Known as the “godfather of evidence-based medicine,” Dr. Guyatt on Thursday published in the Archives of Disease in Childhood a pair of systematic review papers of pediatric gender medicine that are the first of their kind to pool study findings and conduct meta-analyses regarding particular outcomes among young people who have received these interventions.
One of the analyses examined studies on puberty blockers given to youth with gender dysphoria. The other looked at studies of cross-sex hormones to treat gender dysphoria in adolescents and young adults.
Dr. Guyatt and his colleagues concluded in both papers that there is “considerable uncertainty regarding the effects” of each intervention, given that the available research almost entirely yielded evidence of “very low certainty.” Regarding hormone treatment in particular, the authors concluded that “we cannot exclude the possibility of benefit or harm.” The only research finding they considered to be of “high certainty” was that a small percentage of people who started cross-sex hormones subsequently experienced cardiovascular health events.
“These papers come to the same conclusion as many other evidence syntheses — which is that we do not have a good evidence base to suggest that these treatments are effective,” said Dr. Ronny Cheung, a consultant general pediatrician in London. Dr. Cheung is the lead author of a recent peer-reviewed rebuttal to a white paper spearheaded by Yale University pediatrician Meredithe McNamara that sharply criticized the Cass Review.
The publication of these two papers from Dr. Guyatt is certain to provoke a chorus of disapproval among the many fierce defenders of pediatric gender medicine in America in particular, given their response to the Cass Review. That report has led the UK to ban puberty blockers outside of a promised clinical trial; and it has been broadly cited in litigation in the U.S. by opponents of these interventions for minors. Striking back, a coterie of academics such as Dr. McNamara has mobilized to cast doubt upon the report’s methodology and conclusions.
These champions of pediatric gender medicine have asserted in a string of recent publications, most of which have not been peer reviewed, that, for example, Cass has held these medical interventions to an exceptionally and impossibly high evidentiary standard. Pediatric treatments for all sorts of conditions, some of these champions have pointed out, are routinely based on low-certainty or very-low-certainty evidence (as opposed to moderate- or high-certainty evidence).
“It is true that many treatments in medicine have been, and are, used without a satisfactory evidence base. Sometimes this has led to belated evidence gathering in terms of clinical trials, which have subsequently shown benefit,” Dr. Cheung said in an email. “Equally, others have resulted in disastrous outcomes for patients despite the best intentions and biological plausibility. But it is a logical fallacy to say that because many treatments are given without sufficient evidence base, therefore any treatment without sufficient evidence base should be given.”
Moti Gorin, an associate professor of philosophy at Colorado State University said that given the “complexity and vulnerability” of pediatric gender dysphoria cases, “our standards should be very high.”
The Sun asked the lead authors of all of the recent Cass critiques to comment on Dr. Guyatt’s new papers. The sole respondent was Chris Noone, a lecturer in psychology at the University of Galloway, who argued that the new papers comment “on already identified limitations of research on these interventions related to sample size and comparison groups that are inevitable due to the small population, the impossibility of blinded comparison groups, and the ethics of preventing access to these interventions.”
As he has previously, Dr. Noone criticized the particular tool Dr. Guyatt’s team used to score the quality of the evidence, which he said, “given the aforementioned limitations will automatically lead to a judgment of very low certainty in the evidence.”
“The authors fail to articulate how a study of puberty blockers or hormone therapy for young people with gender dysphoria could ever produce evidence that is considered certain” by this tool, Dr. Noone said.
Dr. Guyatt was not available for comment.
The Trans Turning Point
The stakes have never been higher for the beleaguered and politicized medical field of pediatric gender medicine. The Supreme Court is set to rule, probably in June, on the constitutionality of state bans on gender treatments for minors in a case, first marshalled by the ACLU, in which the Biden Administration challenged Tennessee’s law. And while Donald Trump has yet to make good on his campaign promise to further restrict access to pediatric gender-transition treatment, within hours of his inauguration on Tuesday he signed a sweeping executive order attacking what his administration calls “gender ideology” throughout federal law.
This turning point in the history of transgender advocacy writ large follows a decade of dramatic growth in the population of young people diagnosed with gender dysphoria or otherwise identifying as trans, both in the United States and across the Western World. A research letter out of Harvard published in JAMA Pediatrics on Jan. 6 found about one in 1,000 privately insured 17-year-olds received cross-sex hormones between 2018 and 2022; and recent trends suggest this figure was likely considerably higher at the end of that period, especially among biological girls.
Another paper published Thursday in the Archives of Disease in Childhood reported that between 2011 and 2021, diagnoses of gender dysphoria among adolescents in primary care practices in England surged by more than 50-fold. Following a pattern well documented in the United States, diagnosis rates were similar between biological boys and girls until 2015, at which point they split, until the rate among natal girls was nearly twice that of boys in 2021. By that time, about one in 250 youths had such a diagnosis at age 18. Levels of anxiety, depression, and self-harm were high among this overall population, especially the girls.
The 2020s has seen the publication of a slew of systematic literature reviews – the gold standard of scientific evidence – assessing the quality of research and the resulting reliability of the evidence it produces among studies of gender-transition treatments for youths. All these papers have reached essentially the same conclusion: that the evidence backing prescribing gender-transition medications to minors is wanting and highly uncertain.
Such critical findings have led the health authorities in a swath of Northern and Western European nations, including the UK, to reclassify such treatments as experimental and to sharply restrict access to minors — or to at least consider pulling back on such access. In America, which lacks a comparable centralized health authority, medical-practice standards tend to be set by medical associations; and with the exception of one group representing plastic surgeons, those societies have overwhelmingly held firm in their support of such interventions.
The Evidence-Based Medicine Revolution Confronts Pediatric Gender Medicine
With Dr. Guyatt as one of its talismen, the field of evidence-based medicine emerged during the 1990s as a movement to hold scientific evidence to a higher standard. The goal was to assess the likelihood that the findings of research on any particular subject would actually bear out in clinical practice and that the recommendations based on that evidence were arrived upon in a rigorous and transparent way.
The field, for example, sought to confront the fact that, even if multiple studies reach similar findings, this might be due to the fact that they were all biased in a similar way and not because the results were valid. The type of analyses pioneered by Dr. Guyatt are meant to identify potential sources of bias in scientific research and to separate the evidentiary wheat from the chaff.
“Systematic review procedures block opportunities for cherry-picking studies that support only one side of an issue and help ensure all relevant studies are included,” said James Cantor, a Toronto psychologist and sex researcher who has often served as a paid expert hired by states to aid in defending their bans of this treatment. (Dr. McNamara has conversely often served as a paid expert for the other side. Both she and Dr. Cantor have been criticized for never having treated gender dysphoria in a minor.)
“The methods also work to ensure that all studies get evaluated with the same standards, minimizing opportunities to be more critical or favorable with studies on one side,” Dr. Cantor continued. “Because so many authors have been engaging in exactly these kinds of biased tactics when claiming what the science says about the effects of medicalized transition, the anti-bias methods of systematic reviews are even more important than usual.”
For the new paper on puberty blockers published Thursday, Dr. Guyatt and his colleagues scoured the relevant medical literature and settled on 10 key studies to analyze. Those papers, they concluded, “provided very low certainty evidence,” meaning the investigators had very little confidence the findings reflected the true impact of the treatment on gender dysphoria, global function (how well a person functions in daily life), depression, and bone mineral density.
Dr. Guyatt’s puberty blocker paper also highlighted a review paper out of England that recently called into question the veracity of the oft-repeated claim that the treatments are “fully reversible.”
The cross-sex hormone analysis examined 24 studies in which the average participant was younger than age 26 upon starting treatment (the average age ranged from age 15 to 25). These papers, the authors concluded, largely provided very low certainty evidence regarding such treatment’s impacts on gender dysphoria, global function, depression and bone mineral density changes. One study, which had an untreated comparison group, provided simply “low certainty” evidence—meaning the investigators had merely “limited confidence” it reflected the true effect of the treatment—that taking hormones was linked to a somewhat lower odds of having depression.
The only outcome the investigators considered to be of “high certainty,” meaning they were “very confident” it was close to reflecting the treatment’s true impact in clinical practice, was that there was a 4% rate of cardiovascular events among biological females 7 to 109 months after they started testosterone. That was due to a 2019 research letter by Dutch investigators that found that estrogen use in patients who were born male, with a median age of 30, was tied to a nearly doubled rate of stroke and a greater than fourfold higher rate of blood clots; and that testosterone use in biological females, with a median age of 23, was tied to an almost quadrupled heart attack rate.
Dr. Noone said that particular study could not isolate the impact of hormones on such outcomes, and that the heart disease events might have been driven by higher rates of tobacco smoking among trans people or the impacts of anti-trans stigma.
Overall, the design of the puberty blocker and cross-sex hormones literature reviews meant they could provide insights into the quality of life of youth on the drugs, the study authors concluded. But the analyses could not answer questions about the impacts of the drugs, such as whether quality of life or global function is better among those receiving the medications compared with others who were not.
The Battle Over Research Standards
Many advocates of pediatric gender medicine have insisted that randomized controlled trials, or RCTs, of gender-transition treatments for minors are not ethical—because, they argue, the benefits of these interventions are already so well established.
There is broader consensus among research experts that RCTs might not be feasible. For one, it would be impossible to blind such a study, since it soon becomes obvious to any young person whether they are experiencing physical changes indicative of being on hormones or off of blockers. And youth randomized to an untreated control group might be disinclined to remain in a study they saw as providing them no benefit.
All that said, Dr. Guyatt and his colleagues wrote in their new papers that to understand the impacts of both puberty blockers and cross-sex hormones on young people, “methodologically rigorous studies,” such as those that follow a population over time “are needed to produce higher certainty evidence.” They noted that this includes “RCTs (if ethical)” for blockers in particular.
Thus, the study authors did not insist on “high certainty” evidence, as many critics of the evidence-based approach to assessing pediatric gender medicine often attest, accurately or not, is the topline argument stemming from systematic literature reviews of the field; they called for higher certainty.
Similarly, despite a recent editorial in the New England Journal of Medicine suggesting that the Cass Review set the standard at the RCT level, the British report actually made a more general call for improved methodological rigor in studies of these treatments.
Dr. Guyatt’s papers further argued that physicians counseling young people about receiving these interventions have an obligation to communicate to these patients and their caregivers about the very low certainty of the supporting scientific evidence. Acknowledging the crucial role that patients’ so-called values and preferences play in such clinical decision-making, the investigators called upon the authors of clinical guidelines and policy makers to be transparent about “whose values they prioritize when developing treatment recommendations and policies.”
Supporters of minors’ access to these medications often claim that the rate of regret-based detransitioning — in which someone stops gender-transition drugs and reverts to identifying and presenting as their birth sex — among those who started treatment as minors is extremely low. The Cass Review, though, found that due to limited patient follow-up, the true detransitioning rate is unknown.
Approximately two dozen detransitioners have filed lawsuits against their care providers, often claiming to have suffered irreversible harms to their body. Many of these plaintiffs are represented by a Texas firm established by a quartet of former white-shoe attorneys who set up their practice for the sole purpose of representing detransitioners — a population that they anticipate will only grow given the recent surge in trans identification among adolescents.
The authors of the two new analyses found they could reach no conclusions about rates of regret, anxiety or pelvic pain tied to receiving puberty blockers or hormones. Nor could they reach any conclusions about whether cancer was connected to hormone use or whether puberty blockers were linked to the suicide death rate. The analysis on hormones referenced one two-year U.S. study, published in 2023, in which, among 315 persons who started cross-sex hormones between ages 12 and 20, two died by suicide. Dr. Guyatt’s team deemed this association based on very low certainty evidence.
Nor did these analyses provide any substantial insights into a key concern: fertility. Concerns that providing treatment for childhood gender dysphoria with blockers and hormones might cause infertility have motivated many critics of this medical field to call for a higher quality of evidence than might otherwise be acceptable for pediatric medical interventions.
Leor Sapir, a fellow at the Manhattan Institute who studies pediatric gender medicine, praised Dr. Guyatt’s new analyses as the most “methodologically rigorous systematic reviews” in this field to date. He said that a notable shortcoming of the papers was the limited information they provided about various potential harms of these treatments — a fault he attributed to the wider medical field.
“Gender clinics and clinicians are usually the ones who study medical interventions in this area,” Dr. Sapir said, “And they have little interest or incentive to conduct rigorous, longitudinal studies on the harms of the interventions they adamantly support.”
Following the Science
Dr. Guyatt’s papers are likely to impact ongoing litigation over pediatric gender medicine. Alabama’s attorney general, Steve Marshall, made that evident in a statement to the Sun, when he praised the new papers and said they confirmed “that states like Alabama are on firm footing in restricting these treatments for minors and by encouraging the medical community to finally follow the science itself.”
The papers did not, however, call for such bans, rather for better research. Some of the nation’s major pediatric gender care research hubs are in states that have passed such bans, which threaten to end their research entirely.
As Mr. Marshall’s scathing amicus brief to the Supreme Court for the case over Tennessee’s ban laid bare, records that the attorney general subpoenaed from the World Professional Association for Transgender Health, a prominent transgender medical-activist group, revealed that WPATH suppressed publication of systematic reviews it had commissioned from evidence-based medicine experts at Johns Hopkins University as it developed its 2022 revision to its widely referenced trans-care guidelines.
“It is no great mystery why WPATH acted the way it did,” said Mr. Marshall. In a nod to Dr. Guyatt’s advice for guidelines committees, Mr. Marshall continued: “As these latest systematic evidence reviews confirm, there is woefully insufficient evidence to support WPATH’s strong recommendation that kids be given puberty blockers, cross-sex hormones, and surgeries to treat their gender-related distress.”
Dr. Guyatt’s papers are likely to be attacked due to their funding source. The research was commissioned by the Society for Evidence-based Gender Medicine, or SEGM, which is a collective of physicians and researchers who are skeptical of the evidence supporting pediatric gender medicine and are regarded as an adversary by the transgender rights movement.
The Southern Poverty Law Center has gone so far as to brand SEGM a hate group that traffics in pseudoscience. (The SPLC has itself faced heavy criticism from the right in recent years for expanding its label of hate groups to apply broadly to religious conservatives and other groups that oppose liberal orthodoxy.) However, a three-day conference SEGM held in New York City in the fall of 2023 was almost entirely lacking in politics or any trace of prejudice or animus against transgender people. Instead, it offered a trenchant crash course in evidence-based medicine principles and their application to this field.
That said, SEGM’s critics assert that the organization leans on such intellectual principles as a mere pretext to sow doubt among the public and policymakers alike and, above all, to lend academic credibility to efforts to outright ban these interventions.
In an interview, SEGM cofounder Zhenya Abbruzzese, a health researcher, firmly denied any such political motivation. She further said that Dr. Guyatt’s team kept her organization “at arm’s length” throughout the work on the review papers, and, unlike the Johns Hopkins team’s ultimate arrangement with WPATH, the academic team had full right to publish regardless of the findings.
Speaking to the effort in modern medicine to treat gender dysphoria in young people with blockers and hormones, Ms. Abbruzzese said, “We are operating in the dark. But we don’t have to be.”
She pointed to the robust national health databases in many European nations, in particular in Scandinavia, and argued that researchers could reach at least moderately certain conclusions about the potential impacts of these treatments by conducting research based on those health records.
“It’s time to look at that data in a very rigorous way,” Ms. Abbruzzese said.
Researchers have already conducted such health-database analyses regarding gender transition surgery’s association with mental health outcomes in Swedish adults and cross-sex hormones’ link to suicide deaths in Finnish youths.
Both studies found the interventions were tied to no such benefits.
[ Archive: https://archive.today/GSsQP ]
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History will judge this as worse than thalidomide. It's been clear for a long time that there's no evidence supporting the effectiveness of these 'treatments.' The evidence in support is of poor quality, while the evidence against shows that these treatments are not only ineffective but also harmful. Unlike thalidomide, which was withdrawn very quickly, the present day scandal continues on despite everything we already know solely because of suicidal empathy.
What NYT reported about Johanna Olson-Kennedy sitting on her null findings on puberty blockers is but one such story in a field in which man
By: Benjamin Ryan
Published: Oct 24, 2024
[ That’s a quote from a talk that pediatric gender medicine doctor Johanna Olson-Kennedy gave in which she was dismissing concerns about young people potentially regretting getting double mastectomies for a gender transition. ]
Some of the biggest names in the pediatric gender medicine field are part of an entrenched global trend in which they prioritize the transgender advocacy mission over honest and direct science. They hide inconvenient research findings. And they seek to prevent other researchers from even asking questions that might yield inconvenient answers. Supporting them is a cabal of activists and LGBTQ nonprofits standing at the ready to bully and cancel any scientists or journalists who might bring to light any of the more questionable aspects of pediatric gender medicine.
This pattern is not just limited to Children’s Hospital Los Angeles’ Dr. Johanna Olson-Kennedy. If you haven’t already heard, according to reporting in The New York Times, this major leader in the pediatric gender medicine field has been sitting on null findings from her National Institutes of Health–funded study of puberty blockers for gender dysphoric children because, she said, publishing them would prove politically inexpedient. (I wrote about an undercover video of her talking about mastectomies here.)
Where have we heard this story before?
Let’s take a trip across the pond to the British National Health Service’s now-shuttered pediatric gender clinic, GIDS. (I encourage you to read all about this troubled clinic in Hannah Barnes’ book Time to Think. Make sure to get the new 2024 U.S. paperback, which has a vital new epilogue.) After it was founded in 2011, GIDS’s leaders sought to recreate the findings of the original Dutch protocol that was first cultivated in the mid-1990s and that ultimately gave rise to the global pediatric gender-transition treatment movement during the 2000s and 2010s.
But the British team failed. They did not find a substantial benefit from providing puberty blockers to gender dysphoric children by following the Dutch protocol. So did these researchers alert the world to their troublesome findings? Did they send a word of caution to a field that by then was circumnavigating the globe, setting up what would soon be hundreds of pediatric gender-clinic outposts?
No, they kept their failure secret.
It wasn’t until Oxford sociologist Michael Biggs became suspicious and ultimately rooted out the truth that the GIDS clinicians finally owned up and published their failed study.
Also in England, the NHS’s Cass Review, which was published in April after a four-year effort to assess pediatric gender medicine at home and worldwide, sought to assess the long-term outcomes of the wider population of former GIDS patients. But the adult NHS gender clinics refused to share their de-identified data on those now-adult patients, providing only specious reasons for their refusal.
Now it seems as if the NHS will ultimately force them to do so. But for now, the world is poorer for not having that data. Because this entire field is compromised by a woeful lack of long-term data, in particular about the more recent cohorts of gender-dysphoric adolescents who have undergone gender-transition treatment, and whose profiles are vastly different from those kids who entered the original Dutch study.
After the Cass Review came out, activists went into overdrive to tell wild falsehoods about it, as I reported at the time. Hilary Cass, the pediatrician lead author of the report, was appalled, and told a reporter that those activists were harming children.
A flood of false claims about England's Cass Review has coursed across social media and the press and among activists and academics. If only
Even when fact checked, Erin Reed, who has a popular Substack and X account, has repeatedly made demonstrably false claims about England's C
There are also plenty of examples of academics being discouraged from even asking research questions that might lead to an answer that would prove inconvenient for the pediatric gender medicine movement. Take, for example, the trio starting a long-term study to assess whether rapid-onset gender dysphoria is a true phenomenon. These three seasoned investigators have had to self-fund their research and are subject to persistent derision and scorn by trans activists for daring to ask difficult questions about this medical field and about the reasons for the recent surge in trans identification in natal girl adolescents in particular.
Branded as gender heretics by the pediatric gender-medicine establishment and transgender-rights activists, Michael Bailey, Dr. Lisa Littman
One of those three investigators, physician-researcher Dr. Lisa Littman, spoke to me for my article on The Trans Tipping Point in the New York Post. She said of the activists who attack her: “It’s as if their loyalty is to the transition interventions and not to the long-term health and well-being of transgender-identified young people.”
Here’s another example. When UCL neuropsychologist Sallie Baxendale sought to obtain peer review for her review paper about what scientists know—and don’t know—about the neuropsychiatric impacts of puberty blockers, here was what happened, according to what she wrote in Unherd:
None of the reviewers identified any studies that I had missed that demonstrated safe and reversible impacts of puberty blockers on cognitive development, or presented any evidence contrary to my conclusions that the work just hasn’t been done. However, one suggested the evidence may be out there, it just hadn’t been published. They suggested that I trawl through non-peer reviewed conference presentations to look for unpublished studies that might tell a more positive story. The reviewer appeared to be under the naïve apprehension that studies proving that puberty blockers were safe and effective would have difficulty being published. The very low quality of studies in this field, and the positive spin on any results reported by gender clinicians suggest that this is unlikely to be the case.
Another reviewer expressed concerns that publishing the conclusions from these studies risked stigmatising an already stigmatised group. A third suggested that I should focus on the positive things that puberty blockers could do, while a fourth suggested there was no point in publishing a review when there wasn’t enough literature to review. Another sought to diminish an entire field of neuroscience that has established puberty as a critical period of brain development as “my view”.
Dr. Baxendale ultimately published her vital review paper, which concluded: “Critical questions remain unanswered regarding the nature, extent and permanence of any arrested development of cognitive function associated with puberty blockers. The impact of puberal suppression on measures of neuropsychological function is an urgent research priority.”
Meanwhile, the American Academy of Pediatrics has assured the public in its 2018 policy statement on the gender-affirming care method that puberty blockers are “reversible.” Twenty Republican attorneys general recently sent a stern, probing letter to the AAP, suggesting that that claim, which they assert is false, violates consumer protection laws. A lawsuit is likely imminent. The AAP is already being sued by a detransitioner over the statement. The original legal complaint lambasts the AAP for never responding to Canadian sex researcher James Cantor’s scathing fact check and critique he published of the policy statement in 2019.
Personally, I don’t think the claim that puberty blockers are reversible is definitively false, given what science is able to tell us at this time. But on the flip side, we also know that it is not definitely true either. As Dr. Baxendale’s paper demonstrates, there remain too many substantive and unanswered questions about how using drugs that throw vital human development processes out of synch might impact a young person, possibly for the rest of their lives.
The AAP announced in August 2023 that it was going to conduct a systematic literature review of the evidence behind pediatric gender medicine—and then never said another word about it. The authors of such reviews are expected to publish their methodology in advance, and the there is no sign that the AAP has done so.
Then there’s the World Professional Association for Transgender Health, or WPATH, which as the Alabama attorney general’s subpoenas have revealed and Jesse Singal reported for The Economist in June, suppressed systematic literature reviews about this field that it commissioned from Johns Hopkins. And after a Biden Health official and the AAP strong armed WPATH into removing the age restrictions on gender-transition treatment and surgeries in the update to its trans-care guidelines in 2022, WPATH president Dr. Marci Bowers coordinated for the leadership to lie about why they had done so. All of this is detailed in scathing, unsparing detail in the Alabama AG’s amicus brief to the Supreme Court, which argues that the court should uphold Tennessee’s law banning pediatric gender-transition treatment.
And in the wake of today’s news about Dr. Olson-Kennedy, we have an example of yet another front in this battle over pediatric medicine: the sheer denial and deflection coming from transgender activist Ari Drennen of Media Matters and the LGBTQ “media watchdog” GLAAD. As you can see from the tweet below, all they could do in the face of such a damning report was deflect.
This makes me wonder: What exactly is GLAAD’s endgame? This is the same nonprofit that had the temerity to condescend to the New York Times last year and falsely claim that the “science is settled” on pediatric medicine with their protest truck they drove around the Times building in Midtown Manhattan.
The science is, of course, not settled. No science is. It is always evolving, in particular in this tempestuous and troubled field of pediatric gender medicine. And there are many people in this wider movement who are seeking to suppress the full, ever-changing truth from coming to light.
At the center of this story is a burgeoning population of very troubled children. They are owed the best science possible. They are owed the truth, whatever that might be.
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I previously posted about Olsen-Kennedy's tone-deaf endorsement of medical mutilation.
Imagine a medical study of a cancer treatment that was found to be ineffective, which was then covered up. Why would a report about that coverup need to quote people who had had cancer? These fanatics think we're stupid.
People wonder why the trust in our institutions is so low. It's because they keep producing this kind of fraud, which isn't science any more than Intelligent Design is science.
When the devoutly Christian John Templeton Foundation funded a study on intercessory prayer, they were forced to publish it, even though it found that it was ineffective. Or worse.
Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clini
Conclusions
Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.
These genderists are doing religious proselytization.
The findings of a comprehensive analysis of insurance-claims data by the advocacy nonprofit Do No Harm.
By: Benjamin Ryan
Published: Oct 10, 2024
Medicalized gender transitions for minors were rapidly becoming more common in the United States until state bans of such medical interventions started to go into effect. Even in blue states where these medical practices remain legal, quite a few states saw a downturn in 2023, including in California and New York.
At least 14,000 minors underwent gender-transition treatment, surgeries, or both between 2019 and last year. This five-year tally is a conservative estimate, meaning that the true figure is likely higher, if not quite a bit higher. The figure is the product of a new analysis of national insurance-claims data that was released on Tuesday by Do No Harm.
This medical advocacy nonprofit is fervently opposed to minors accessing puberty blockers, cross-sex hormones, and gender-transition surgeries to treat gender dysphoria. Consequently, Do Not Harm’s word choice when describing these medical practices may strike some people as incendiary and even offensive.
“We feel very strongly that the science behind using these treatments in children is extraordinarily flawed and suggests that children are being harmed,” said the chair of Do No Harm’s board, Dr. Stanley Goldfarb, in a press briefing on Monday.
Do No Harm has published the findings of their medical-claims-data analysis in a comprehensive website—DoesMyHospitalTransitionKids.com—that allows users to investigate pediatric gender-transition and surgery data by state and by individual institutions within each state.
Main Findings in the 2019 to 2023 Medical-Claims Data:
13,994 unique minors received gender-transition surgeries, treatment, or both.
5,747 minors received gender-transition surgeries.
8,579 minors received puberty blockers, cross-sex hormones, or both (the analysis did not disaggregate to show how many minors received each type of medication). Between them, these minors were written 62,682 prescriptions.
Health care providers billed $119,791,202 for all these patients. The analysis did not reveal the dollar figure of how much these providers were actually reimbursed, mind you; that figure could be at least somewhat smaller.
The Williams Institute at UCLA estimates that 300,000 Americans age 13 to 17 identity as transgender. In April, the World Professional Association of Transgender Health (WPATH) argued that the majority of such minors would do best to undergo a medicalized gender transition. Consequently, from WPATH’s perspective, 14,000 minors receiving such a medical intervention over a five-year period is equivalent to only about 10 percent of the target population. However, on Tuesday, the Centers for Disease Control reported that 3.3 percent of high school students identified as transgender, compared with 1.4 percent according to the Williams Institute. It is difficult to discern whether this difference is a result of differences in survey methods, a rapid increase in youth trans identification, or both.
The math-minded among you may notice that there appears to be little overlap between the group that received surgeries and the group that received medication treatment, given that the sum of the two groups is 14,326; that is only 332 greater than the total number of minors who received either type of intervention. This defies logic, since presumably the vast majority of minors who undergo such surgeries are already taking cross-sex hormones.
This apparent lack of overlap between the two groups is a product of the analysis’ conservative methodology. The authors of the report only counted a cross-sex hormone prescription if it was written a maximum of 90 days following the entry into a patient’s medical file of a gender-dysphoria-related diagnosis code. Consequently, there may have been any number of cross-sex hormone prescriptions that the analysis did not include in its tally because too much time passed between the recording of a gender dysphoria-related diagnosis and the prescription of hormones.
“We have a very high level of confidence that what you are seeing here is directly related to sex-change treatments,” Michelle Havrilla, director of Do No Harm’s program to shield children from gender-transition treatment, said during Monday’s press briefing.
The Do No Harm analysis is also limited by the fact that its authors could not access medical-claims data regarding minor patients who either saw their care processed through internal Veterans Affairs claims, paid out of pocket, received charity care, or were cared for by Kaiser Permanente (which cares for a wide swath of patients across the West Coast in particular).
“What we’re really showing you today is a floor or a very conservative estimate of what’s happening throughout the country,” said Ms. Havrilla.
The Picture of Pediatric Gender-Transition Treatment Comes Into Sharper Focus
Do No Harm’s surgery figures are in the general ballpark of estimates put out by Leor Sapir of the Manhattan Institute in August. Dr. Sapir conducted a similar analysis of insurance-claims data and found that between 2017 and 2023, 5,288 to 6,294 minor natal girls underwent double mastectomies for gender dysphoria.
[ Sapir added these caveats: “2023 data are incomplete, making it premature to conclude that a dip occurred that year, relative to previous years. Second, even the liberal estimates are an undercount, as the data are limited by two constraints: the procedures had to be covered by insurance, and patients had to have a preexisting diagnosis of gender dysphoria.” ]
In an email to me regarding the Do Not Harm analysis, Dr. Sapir said: “The data on surgery align with our findings, though we looked at a broader range of years (2017-2023) and exclusively at mastectomy. In both cases, the analyses were deliberately based on conservative assumptions; with a field as contentious as this, it’s better to underestimate than to overestimate.”
“The practice of sex ‘change’ surgery in minors is not nearly as rare as its advocates have said,” Dr. Sapir told me. Indeed, the Do No Harm analysis re-affirms my previous reporting about how Harvard recently falsely claimed that gender-transition surgeries are rare among minors.
Dr. Sapir argued that at least for surgeries, the Do No Harm analysis has superseded an analysis conducted by the data analytics firm Komodo Health Inc. on behalf of Reuters, which was published in Oct. 2022. Komodo’s data for medication-based transition treatment was in the general ballpark of Do Not Harm’s. They found that between 2017 and 2021, 4,780 minors with gender dysphoria received puberty blockers and 14,726 received cross-sex hormones. But that analysis identified only 776 gender-transition surgeries.
[ Komodo Health Inc.'s findings for Reuters in 2022 ]
Also, a study published in Sept. 2023 in the journal Cureus analyzed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database. From 2018 to 2021, it identified just 108 minors who received such surgeries. But it did identify a swift increase in the number of surgeries with each passing year, similar to the growth in all types of gender-transition interventions identified by Komodo.
Top 12 Children’s Hospitals Providing Gender-Transition Treatment and Surgeries to Minors
Do No Harm assembled a list it derisively referred to as the “dirty dozen” of the “worst-offending children’s hospitals promoting sex change treatments for minors.”
Their criteria included:
The number of gender-transition patients under age 18
Whether the institution had a dedicated pediatric gender clinic that advertised gender-transition treatment
Which treatments and procedures were offered (surgeries put a clinic higher on the list)
The number of gender-transition treatment prescriptions written
The dollar amount of related medical claims
The promotion of gender-transition treatment within the community
Activism and public support by an institution and its leaders of what Do No Harm referred to as “gender ideology”
The top dozen hospitals includes:
The Children’s Hospital of Philadelphia, with 122 minor patients receiving gender-transition treatment, 5 of whom received surgery. They submitted $230,784 in bills over the five-year period.
Connecticut Children’s Medical Center in Hartford
Children’s Minnesota in Minneapolis
Seattle Children’s
Children’s Hospital Los Angeles
Boston Children’s Hospital (which in 2007 set up the nation’s first pediatric gender clinic, importing a treatment model pioneered by Dutch researchers)
Rady Children’s Hospital in San Diego
Children’s National Medical Center in Washington, DC
UCSF Benoff Children’s Hospital Oakland
Children’s Hospital Colorado in Aurora
UPMC Children’s Hospital of Pittsburgh
Cincinnati Children’s Hospital Medical Center
For a rather famous—or, according to gender-medicine skeptics, infamous—example of how Boston Children’s has advertised gender-transition surgeries for minors, check out the video below. It was first published in Aug. 2022, but was later taken down amid a firestorm of criticism over the OB/GYN, Dr. Frances Grimstad, effervescently describing what she calls “gender-affirming hysterectomies” for minors with gender dysphoria. But the video is still available via the internet archive.
Many of the doctors at these top children’s hospitals, such as UCSF’s Dr. Jack Turban, may have established themselves as the face of the pediatric gender medicine field. But only about 10 percent of claims for pediatric gender-transition treatment and surgeries are coming from children’s hospitals, Do Not Harm found. The vast majority of care is provided by non-pediatric clinics or hospitals.
Data Broken Down By State
“There are lots of ideas that this is a rare event, lots of ideas that this is localized to just a few places,” Dr. Goldfarb said of pediatric gender-transition treatment at the Monday press briefing. “We thought it was really crucial that we develop an approach that allows you all, as representatives of the people, to be able to inform people in their local hospitals and locales exactly what’s happening.”
Accordingly, users of the Do Not Harm website can zoom in to individual states to analyze data on local health care practices and billing histories. For example, over the five-year period of the analysis, California health care providers treated at least 2024 minors with gender-transition treatments, billing nearly $29 million for 1359 surgeries and prescribing puberty blockers and cross-sex hormones to 725 children.
Zooming in a little closer, here is a segment of the roster of California care providers and their respective shares of the tally:
Here is share of those cases from Children’s Hospital Los Angeles:
The Top Doctors and Medical Institutions By Billing
Gender-transition treatment is a substantial source of revenue for a number of large hospitals. Keep in mind, however, that even if Mount Sinai brought in all $8.2 million they billed for such medial care over five years, this would only have amounted to 0.05 percent of the hospital system’s total revenues during that period, of about $17 billion.
The following figures suggest that there is a small club of individual doctors who billed in excess of $2 million over a five-year period for gender-transition treatment for minors. A single doctor at Boston Children’s billed in excess of $5 million.
Overall trends
Interestingly, even in states where gender-transition treatment and surgeries for minors has remained legal, there was a sharp downturn in prescriptions and operations in 2023 in some but not all states—including California, Colorado, Illinois, New York, Pennsylvania and Washington. Do No Harm told me this was not because the data from 2023 is incomplete.
My recent reporting suggests that it is possible that in the face of backlash against pediatric gender medicine and waves of bad publicity—including the publication of Britain’s Cass Review, the release of the WPATH Files and the unsealing of damaging documents about WPATH in the federal lawsuit in Alabama—physicians in this field have started to become more conservative in their prescribing practices. Also, it is possible that parents have become more reticent about consenting to such treatment in the face of waves of news that might lead them to question the related evidence base.
Also, in the wake of gender-affirming surgeon Dr. Blair Peters’ recent conversation on Instagram Live with the American Society of Plastic Surgeon’s president, many wondered how many minors Dr. Peters has operated on. Dr. Peters works at Oregon Health and Science University. OHSU Portland had at least 19 minor patients who received gender-transition surgeries over the past five years.
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About the Author
Benjamin Ryan is an independent journalist, specializing in science and health care coverage. He has contributed to The New York Times, The Guardian, NBC News and The New York Sun. Ryan has also written for the Washington Post, The Atlantic, The Nation, Thomson Reuters Foundation, New York, The Marshall Project, PBS, The Village Voice, The New York Observer, the New York Post, Money, Men’s Journal, City & State, Quartz, Out and The Advocate.
Learn more about Ryan’s work on his website, follow him on X @benryanwriter, and subscribe to his Substack.
Even when fact checked, Erin Reed, who has a popular Substack and X account, has repeatedly made demonstrably false claims about England's C
By: Benjamin Ryan
Published: Apr 23, 2024
The prominent American transgender activist Erin Reed has repeatedly and insistently made demonstrably false claims about pediatric gender medicine.
During the two weeks since the publication of the Cass Review, England’s mammoth report about this controversial and politicized medical field, Reed has emitted a fusillade of false claims about the review, its findings and the systematic literature reviews on which it was partially based. Reed has only doubled down when fact checked, even when the corrections have come from lead author of the report, pediatrician Dr. Hilary Cass, herself.
Reed publishes a popular daily Substack, “Erin In The Morning,” focusing on trans legislative, civil-rights and medical issues. Over the past couple of years, as access to gender-transition treatment by children has become a major political fight in U.S. statehouses, Reed has amassed a large following, both through her coverage of these issues and her activism against such laws and for gender-distressed children’s access to such treatments.
The Cass Review was four years in the making and published to considerable fanfare in the UK on April 9. The 388-page report scrutinized the field of pediatric gender-transition treatment and found it was based on “remarkably weak evidence,” as I reported for The New York Sun.
The report has heralded the end of an era in England. It helped shutter the troubled pediatric gender clinic, known as GIDS, that once provided puberty blockers and cross-sex hormones to members of a burgeoning population of thousands of British minors distressed about their gender. Going forward in England, holistic psychological care will be prioritized for such young people, as it now is in multiple Scandinavian nations.
For gender-distressed minors in England, puberty blockers will only be available through a planned clinical trial. And the nation’s National Health Service looks likely to heed Cass’s counsel to reverse its recently announced policy to permit cross-sex hormones to 16 and 17 year olds. Furthermore, signs from Parliament suggest that the government will likely crack down on any private and overseas clinics prescribing of puberty blockers for gender distress. Even members of the Labour party have expressed support for Cass’s findings and recommendations.
Reed stands at the forefront of a full-court press by British and North American activists and online influencers to undermine and cast doubt on the Cass Review, including through falsehoods. This comes as English politicians and medical societies, the NHS, and even major UK LGBTQ organizations have fallen in line and pledged their support of the report’s findings, or at least refrained from fighting them. U.S. medical societies, meanwhile, have remained notably silent on the matter. They all unwaveringly support pediatric gender-transition treatment.
Most notably, Reed has falsely claimed on repeated occasions that the Cass Review simply “disregarded” a substantial proportion of the available medical literature on pediatric gender-transition treatment. Sometimes phrased as the notion that Cass tossed out 98% of available studies, some version of this false claim ran rampant during the first week after the report’s publication. The game of falsehood telephone stormed across social media, showed up in the opinions of LGBTQ charity leaders and English MPs, and in an error-laden Canadian Broadcasting Corporation article that I fact checked on X.
Finally, Dr. Cass herself cried foul.
In an interview with The Times published April 19, Dr. Cass did not mince words. She denounced those who had falsely claimed she had not included 100 papers on pediatric gender medicine in her review. (I explained the finer details of why this claim is egregiously incorrect in my Substack from last week, so I’ll go into only just a bit of explanatory detail about this later in this report.)
The Times reported:
Calling the assertion “completely wrong”, Cass said that it was “unforgivable” for people to undermine her report by spreading “straight disinformation”.
The physician, 66, who has spoken about the toxic debate around the issue, also revealed that she had been sent “vile” abusive emails and been given security advice to help keep her safe.
Of her critics, Cass said: “I have been really frustrated by the criticisms, because it is straight disinformation. It is completely inaccurate.
Reed’s false claims, about the Cass Review in particular and pediatric gender-transition treatment in general, have likely had a substantial impact on the global conversation about the care of young people with gender distress, given the wide reach of her platform. She has many eager followers and her tweets routinely rack up tens or hundreds of thousands of views. She is taken seriously by media outlets and even doctors and is routinely asked to speak at medical conferences.
I spoke with Erica Anderson, a trans woman, psychologist and the former head of USPATH, the U.S. branch of the World Professional Association for Transgender Health, or WPATH, about Reed’s influence on the larger conversation about pediatric gender medicine.
Dr. Anderson, who has become a vocal critic of WPATH’s full-throated support for pediatric gender-transition treatment, told me:
“It’s unfortunate that Erin Reed in her mistaken efforts to advocate for transgender persons repeatedly and demonstrably promotes falsehoods, including most recently about the Cass Commission report.”
Referring to the fact that, in every tweet thread that Reed posts promoting her Substack essays, Reed asks people to pay for a subscription, Dr. Anderson continued: “She asks the trans community to support her efforts financially. There is no way I can do so.”
[ All of Reed’s tweet threads about her Substack articles, which are often laden with errors, come with with a financial ask. ]
Reached for comment, Reed said: “Readers should not trust a fact check done by somebody like Benjamin Ryan, who himself has consistently misrepresented studies on gender affirming care and gotten basic facts about them incorrect.”
I stand by my own 23 years of professional science reporting and am proud that I have never had to run a major correction.
Erin Reed’s Two-Week Marathon of Falsehoods About the Cass Review
Over the past two weeks, Reed has repeated various versions of the false claim that Dr. Cass simply “disregarded” a stack of papers about pediatric gender medicine. Why did the author of the Cass Review do such a thing? Because, Reed claimed, those studies didn’t suit her “predetermined conclion [sic] ”—meaning conclusions.
Without going into too much detail, here is the truth:
Two systematic literature reviews, conducted by the University of York on behalf of the Cass Review and published by the BMJ the same day as the Cass Review, examined puberty blockers and cross-sex hormones as treatments for gender distress in minors.
Between them, these two reviews examined 103 studies. Using a validated scoring method, they identified two high-quality papers, 58 moderate-quality papers, and 43 low-quality papers.
Only the high-quality and moderate-quality papers were included in the review papers’ syntheses.
When reaching their ultimate conclusions—essentially that the evidence base was largely unreliable and inconclusive, although there was some evidence that hormones were associated with psychological benefits—the review papers leaned on the high-quality papers, but did not discount the moderate-quality papers.
[ The conclusion of the systematic literature review on cross-sex hormones. ]
Cass considered all these papers in her own analysis and did not simply disregard or discard any of them, as I reported on Substack last week.
That said, the central purpose of an evidence-based medicine approach is to discern which studies are more likely to provide reliable results and which are less likely to do so. This is meant to keep false study results, such as those driven by bias, from influencing medical practices. Reed and other activists mischaracterize this effort as capricious and biased, one that starts with a desired outcome and then reverse engineers it.
Discernment of study quality is particularly important, evidence-based medicine experts have insisted, when caring for the particularly vulnerable population of gender-distressed children. And it is of paramount importance, these experts say, to prioritize higher quality research when devising treatment guidelines for this group, considering that children cannot consent to their own care and may lose their fertility and sexual function as a result of treatment with puberty blockers and cross-sex hormones.
These systematic reviews were conducted independently and were structured to be agnostic about their results.
Reed was not convinced.
On April 18, she denounced the Cass Review as a member of a collection of “sham reports concocted to justify escalating crackdowns on their care.”
The day after the Cass Review was published, Reed published a Substack condemning it. The false or misleading claims Reed made in this report included:
The report did not, as Reed claimed, “call for restrictions” on social transition. It advised that families observe “caution” when considering the social transition of a child.
The Cass Review did not “[advocate] for the blocking” of trans young adults receiving cross-sex hormones,” as Reed claimed. It advised a review of young-adult gender services, suggesting that the problems that have plagued the pediatric clinic may be similar in young-adult care.
The theory of rapid-onset gender dysphoria has not been “discredited”, as she claimed. It remains a hypothesis under investigation by researchers.
Systematic literature reviews are considered the gold-standard source of scientific evidence. They are not mere “reviews”, as she wrote—in scare quotes meant to dismiss them.
The Cass Report stated that there was not sufficient research to determine the rate at which young people who receive cross-sex hormones will detransition—meaning revert to identifying and presenting as their biological sex.
But Reed insisted that an audit of some 3,500 GIDS patients, mentioned in Appendix 8 of the Cass Review, showed that only 8 out of 3,000 detransitioned, for a rate of just 0.27%. (Approximately 9,000 patients were seen at GIDS since 2011.)
As I explained in the tweet below, Erin had the denominator wrong, and the true rate was about 1.6%.
Regardless, the 1.6% figure is woefully incomplete. Because this audit only considered GIDS patients assessed upon discharge, including because they turned 18 and aged out. And as Cass stated, her interviews with clinicians suggested that detransitioning can take 5 to 10 years. So the young people would likely need to be followed into their mid- to late-20s to establish a true detransitioning rate. But such data was unavailable to Dr. Cass’s team, because the NHS adult gender services refused to share it with them. (It looks likely the British government will ultimately force those clinics to hand over the data. However, activists have sought to convince these patients to forbid the NHS to share their personal, if anonymized, health records.)
In an April 18 appearance on the super-lefty Majority Report podcast with the super-cranky Emma Vigeland, Reed claimed that Dr. Cass was secretly conspiring to ban pediatric gender-transition treatment. Reed also falsely claimed that the Cass Review did not factor in the voices of trans people or their care providers.
Here is how the Cass Review diagrammed all the sources Dr. Cass and her team drew upon when crafting the report, including trans people and their care providers:
Reed then suggested to a super-credulous Vigeland that the Cass Review was aligning itself with an anti-trans propaganda machine, because in a footnote it referred to a video posted by that account’s YouTube channel.
Below is the video in question, which is an unedited, 37-minute video of GIDS director Dr. Polly Charmichael speaking at the 2016 WPATH conference. The YouTube account’s politics notwithstanding, the video itself is provided with no extra editorial comment by the account; it is just the words and slides of Dr. Charmichael.
In an April 18 Substack that she characterized as an opinion piece, Reed argued that “England’s Anti-Trans Cass Review Is Politics Disguised As Science.”
In the single paragraph below from that Substack, she made at least six false or misleading claims.
Reed falsely claimed that the Cass Review was crafted with a predetermined conclusion. In fact, as I mentioned, Dr. Cass commissioned seven independent systematic literature reviews on various facets of pediatric gender medicine from the University of York. Their findings informed Cass's conclusions.
Reed falsely claimed the systematic literature reviews were “highly susceptible to subjectivity.” The reviews used a validated scoring method, the Newcastle-Ottawa scale (NOS), and two independent reviewers each. The paper on the NOS scale to which Reed linked in her Substack actually states much more modestly that there is apparent “room for subjectivity in the NOS tool.”
She falsely claimed the Cass Review disregarded all research not deemed high quality.
She falsely claimed that the theory that gender dysphoria and trans identity may be influenced by social contagion has been "debunked". This remains an open question subject to ongoing research.
She makes the misleading suggestion about the YouTube footnote.
She falsely claims that the Cass Review asserts that rates of detransition are high. In fact, Cass states that the detransition rate is “unknown due to the lack of long term follow-up.”
In an April 19 Substack, Reed began pushing the particularly far-fetched claim that Dr. Cass had somehow, after publishing a nearly 400-page report following a four-year effort, suddenly reversed herself and endorsed the prescribing of puberty blockers and cross-sex hormones to minors outside of a clinical trial.
“Dr. Cass Backpedals From Review: HRT, Blockers Should Be Made Available,” Reed trumpeted in her headline.
Her source for this claim was a supposed transcript from an interview Dr. Cass had apparently given to The Kite Trust. The transcript was inexplicably written in the third person, referring repeatedly to “Dr. Cass.” Reed mischaracterized statements that Dr. Cass apparently made about how she envisioned children receiving puberty blockers and cross-sex hormones in clinical trials of such drugs; Reed presented those statements as if they applied to everyday prescribing of drugs.
Fact Checked By Cass, Reed Doubles Down, Repeats the Same Falsehoods
Reed has remained resolute that she is right and Dr. Hilary Cass is wrong regarding the evidence backing pediatric gender-transition treatment.
After Cass castigated those who propogate such “disinformation” in her interview with The Times, Reed repeated her false claim that Cass discarded perfectly good research.
In response to an April 22 BBC tweet thread that painstakingly diagrammed how the misinformation about the Cass Review spread around the world, and why it was wrong, Reed responded:
“Not accurate.”
Reed then proceeded to mischaracterize the systematic reviews syntheses, describing them as if they were capricious processes and not structured to weed out study results that are unreliable. Referring to the 58 moderate-quality studies that were factored into the syntheses, Reed wrote: “Much of what was in the moderate section was also discarded, especially in Cass’s conclusions.”
This tweet came as the UK LGBTQ charity Stonewall backed off of its previous claims that Cass had egregiously discarded a large crop of research.
“We are grateful to Dr Cass for taking the time to clarify that both ‘high’ and ‘moderate’ quality research were considered by as part of the evidence review, both in the media and directly to trans and LGBTQ+ organisations,” a contrite Stonewall tweeted.
That same day, the UK Royal College of Psychiatrists also backed the Cass Review. Its president, Dr. Lade Smith CBE, stated in a press release: “It is a comprehensive and evidence-based assessment that needs to be acted upon with a fully resourced implementation plan.”
Who Is Erin Reed?
Reed has been Substacking for a relatively short time, but has quickly amassed a large following. She has 54,000 subscribers, among whom a group that is apparently in the thousands pays either $50 per year or $5 per month for their premium subscription.
She is recommended by doctors.
In the wake of the March publication of the so-called WPATH Files by Michael Shellenberger’s nonprofit Environmental Progress, Dr. Carl Streed, the current USPATH head, wrote in a letter to USPATH colleagues that he was “grateful” for Reed’s reporting about the Files—for correcting the “numerous false claims running rampant in the media.”
(Dr. Streed, whom I’ve interviewed a couple of times, took a clear swipe at me in the letter. First he called into question the findings of a recent Finnish study that found no independent association between receiving gender-transition treatment and the suicide death rate among gender-distressed youths. Then he wrote, “I seriously question the motives and ethics of any reporter, legislator, or professional citing it as evidence.” I was the only reporter to cover the study for a major U.S. media outlet, the New York Post. Reed was no fan of the article either and, as she noted in her message to me about this Substack, published her own takedown of my work in the Los Angeles Blade. I stand by my reporting. My motive is to report the truth. As it happens, Cass also found that there was no evidence backing the suggestion that gender-transition treatment impacts suicide deaths in youths.)
The Cass Review excoriated WPATH, saying that it exaggerated the strength of the research backing its influential guidelines for treating gender distress in children.
The LGBTQ nonprofit GLAAD, which has falsely claimed the “science is settled” on pediatric gender-transition treatment, is also a vocal supporter of Reed’s writing.
However, not all doctors see Reed as a trustworthy intellectual. Last October, at the Society for Evidence Based Medicine conference in New York City, I cited Reed when asking a question of a panel of researchers and physicians. When I noted that one major media outlet refers to Reed as a “legislative analyst,” the room broke out into derisive laughter.
Reed is no fan of SEGM’s and repeatedly claims they are a hate group. I got no such impression from the conference in particular, which provided a crash course on evidence-based medicine practice. Politics came up only briefly. This was a science conference.
Reed recently became engaged to Montana state Rep. Zooey Zephyr, a Democrat.
Reed, whose writing has also been published by Harper’s Bazaar, was recently lionized as a journalistic force to be reckoned with by The Nation. The progressive outlet (which I have written for a few times) charactered Reed’s Substack as one of “the most reliable sources for information on the exploding campaign against trans rights.”
Don’t tell that to Laura Edwards-Leeper. She is a child psychologist who was part of the team to first import to the U.S., in 2007, the so-called Dutch model for prescribing puberty blockers and cross-sex hormones to treat gender-related distress in children. More recently, Edwards-Leeper, who practices in Oregon, has become one of the most prominent voices calling for reform and caution in the pediatric gender-care field from within its ranks.
[ Laura Edwards-Leeper ]
Dr. Edwards-Leeper is no fan of Reed’s.
“Erin Reed is harming children with her false claims about the Cass Review,” Dr. Edwards-Leeper told me. “Because many providers, parents, and even professional organizations are believing these claims without taking the time to read the actual review themselves. By ignoring the Cass Review, the most comprehensive examination of the evidence for treating gender-distressed youth medically to date, providers and parents who believe Erin’s false synopsis are making decisions that are not accurate and will undoubtedly harm children.”
Echoing Dr. Cass, who said, “This must stop,” of the toxic bullying that has intimidated many health professionals out of speaking out about the subject of pediatric gender medicine, Dr. Edwards-Leeper said of Reed’s routine publication of falsehoods about the Cass Review and pediatric gender medicine:
“This behavior is unforgivable and must stop immediately.”
I encourage you to retweet a thread about this Substack: https://x.com/benryanwriter/status/1782653360207761431
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Ben brought the receipts.
Follow-up:
PSA: Reed is most correctly addressed as Globally Discredited Shill Blogger "Erin" Reed.
