Thread by @benryanwriter

SCOOP: ‘Shocking’ and ‘Reckless’—Top Gender Clinic Assesses Kids For Gender-Transition Treatments in Just 2 Hours
🧵I report for @NewYorkSun: @BostonChildrens slashed the time slated for psychologists to assess and write a report on kids seeking gender-transition treatment from 20 hours to 2.5 hours, alarming experts.

🧵LINK: ‘Shocking’ and ‘Reckless’: Top Gender Clinic Assesses Children for Gender-Altering Medical Treatments in Just 2 Hours, Lawsuit Lays Bare, I report for The @NewYorkSun.
nysun.com/article/shocki…

🧵Supporters of gender-transition treatment for kids—see: Michael Hobbes—have insisted there’s no evidence kids are being rushed onto these meds.

@BostonChildrens, we now know, in 2018 started referring kids for such meds after a single 2-hour assessment appointment with a staff psychologist.

Boston Children’s is home to one of the nation’s pre-eminent gender clinics, known as GeMS. It was the first of its kind to be established in the United States, after a Boston Children’s team in 2007 imported the so-called Dutch model of prescribing puberty blockers and cross-sex hormones to gender-dysphoric minors.

The clinic, whih spawned a gender-clinic revolution in the United States, has since abandoned the many guardrails that defined that protocol.

@RottenInDenmark @ifbookspod @yrfatfriend @yourwrongabout

Read the @NewYorkSun article here:
nysun.com/article/shocki…

Connection Between Boston Children's and Johanna Olson-Kennedy:
Details about @BostonChildrens Hospital’s gender-clinic practices have come to light in a bitter civil trial that started last week. A former BCH gender-clinic psychologist, Amy Tishelman, is suing them for gender- and age-based discrimination. She was fired in 2021, a year after she first filed suit.

Dr. Tishelman alleged in court that her supervisor at Boston Children’s, Dr. Yee-Ming Chan, was threatened by her success and had long subjected her to sexist and ageist treatment. Dr. Chan, who denies these claims, is a pillar in the field of pediatric gender medicine in his own right. He is a co-principal investigator of an ongoing and multipronged $10 million National Institutes of Health–sponsored research endeavor of the care transgender youth, including studies of the use of puberty blockers and cross-sex hormones to treat gender-related distress.

Republican members of Congress last week pledged to launch an investigation into the federal grant funding this study. They were inspired to do so after The @NYTimes reported that the research project’s leading investigator, Dr. Johanna Olson-Kennedy of Children’s Hospital Los Angeles, said that she had refrained, expressly for political reasons, from publishing the team’s study finding that puberty blockers were not tied to psychological benefits.

Read about it in the @NewYorkSun:
nysun.com/article/shocki…

🧵Here's how the total time declined that @BostonChildrens gave for psychologists to assess gender-distressed kids and write a report on whether to refer them to endocrinology for puberty blockers and cross-sex hormones:
2014: 20 hrs
⬇️
2016: 6 hrs
⬇️
2018: 2.5 hrs
Read my article about it in The @NewYorkSun:
nysun.com/article/shocki…

🧵Boston Children's staffers who testified in court over the past week that its gender clinic in 2018 reduced the hours psychologists spend directly assessing gender-distressed kids and their families from 4 hours to 2 hrs:
▶️Former psychologist Amy Tishelman, the civil trial’s plaintiff
▶️Psychologist Kerry McGregor, assoc. dir. of the gender clinic
▶️Jeremi Carswell, dir. of the clinic
All three have a long history at the clinic.

Read my article about this in The @NewYorkSun:
nysun.com/article/shocki…

🧵Leading gender-care psychologists told me for The @NewYorkSun that they were appalled by the news that the @BostonChildrens gender clinic, GeMS, only provides gender-distressed kids and their families a single 2-hour psych appointment to assess whether the kids should be referred for life-altering gender-transition treatment. They said:
nysun.com/article/shocki…

▶️“It’s shocking,” Laura Edwards-Leeper, a former Boston Children’s psychologist who helped found the hospital’s gender clinic in 2007. “When Amy [Tishelman] first shared that with me, I was just in disbelief.” She said she fears the system she set up has been woefully degraded.
▶️Erica Anderson @eanderh, who is transgender and a former head of @WPATH’s US branch, said that the assessment-related testimony from multiple Boston Children's employees in Dr. Tishelman’s trial – who gave no indication that the drastically shortened assessment time is anything but a long-standing clinic policy – suggested a “fall from grace” for the prestigious hospital. The institution, she said, has “capitulated to the medicalization of children in a way that is reckless.”
“When people like Amy Tishelman are forced to draw a line in the sand and say, ‘no,’ and institutions come down hard on someone like her, we’re in deep trouble in America,” Dr. Anderson said.
▶️ Former GeMS psychologist Amy Tishelman denounced as “reckless” the clinic’s policy it adopted in 2018 of allotting just 2 hours of assessment-appointment time and a half hour for report writing. “I didn’t feel like that was doable at all,” she testified in her civil trial.
▶️"It is way too short an amount of time!" another leading psychologist who wished to remain anonymous told me, expressing shock over GeMS’s policy.
▶️Anna Hutchison worked for the British pediatric gender clinic, GIDS, from 2013-2017. “What can you realistically achieve in that time?” Dr. Hutchinson said of the 2-hour appointment. “There are risks in changing what we do clinically based only on resources.” Referring to the increasing demand at GIDS for services from increasingly troubled children, she said, “Because numbers are going up, complexity is going up, and the amount of time per patient her family goes down…We essentially became an assessment and medication service.”

🧵A @BostonChildrens attorney suggested in court last week that its gender clinic, GeMS, could not keep up with demand, saying that the clinic “had a really long waiting list.” Francie Mandel, a GeMS social worker, testified that the reduction in 2018 in appointment hours allotted for assessments of gender-dysphoric kids was driven not by clinical factors but by billing-related concerns.
Read my article about this in The @NewYorkSun:
nysun.com/article/shocki…

🧵How do @BostonChildrens leaders rationalize only requiring gender-distressed kids and their parents attend a single 2-hour appointment with a psychologist before the clinic decides whether to recomment the kid see an endocrinologist for puberty blockers and cross-sex hormones?
nysun.com/article/shocki…

Psychologist Kerry McGregor, who is now the associate director of the Boston Children's gender clinic, GeMS, testified in court this week:

On reducing the appointment from 4 hours to 2 hours in 2018: “I thought it was appropriate. But some people wished they’d had that time.”

Further asked by a Boston Children’s attorney about why the assessment time was reduced, Dr. McGregor said: “I think that four hours was too much time. If you ever try and get an adolescent to pay attention to you for four hours straight, it’s a little bit difficult. And also we were able to get all the information in much less time. So, in order to see our growing patient population, it made sense to make that time more efficient.”

Dr. McGregor, who said she spent about 15 to 45 minutes writing her assessment reports, with the aid of a template she created, continued: “And we also could always ask for more time if we needed to. So I’ve met for a second session with patients. It’s pretty rare, but I do it if I need it.”

Asked if two hours was typically sufficient to perform what the attorney called “a hormone-readiness assessment,” Dr. McGregor replied that it was. And asked for greater specifics about occasions when she said this was not sufficient time, she said, “Very rarely, but usually if someone has extreme social anxiety, they don’t want to talk, it takes a while to warm them up, maybe they’re on the autism spectrum, things like that, it might make sense to have a second session.”

🧵Evidently concerned, at least in part, by the potential for threats of violence, attorneys for @BostonChildren’s have sought to keep shielded from public view allegations about the practices of its gender clinic, called GeMS, that were included in exhibits former psychologist Amy Tishelman submitted for her lawsuit.

In an Oct. 2023 filing successfully requesting that the judge overseeing the case seal portions of those exhibits the attorneys wrote: “Public disclosure of these allegations will add fuel to an already highly charged public debate over the care of gender diverse youth and could cause serious, irreversible harm to the Hospital and the practitioners who Plaintiff now, for the first time, accuses of providing substandard care to this already at-risk population.”

The attorneys further asserted: “GeMS practitioners provide individualized, safe, and affirmative care.”

Read my article about this in The @NewYorkSun:
nysun.com/article/shocki…

🧵Boston Children’s sustained waves of bomb threats in 2022 after the influential conservative social-media account @LibsOfTikTok issued attacks on the Boston gender clinic and others like it. The account, run by @ChayaRaichik10, circulated videos that @BostonChildrens had published, and ultimately deleted, advertising its gender-transition services.

In one such video, still available on the internet archive, a Boston Children’s OB/GYN cheerfully touts the “gender-affirming” removal of the uterus and ovaries. web.archive.org/web/2024031420… The hospital later firmly denied performing such surgeries on minors. However, it had once indicated on its website that gender-distressed patients as young as 17 could receive a vaginoplastyand those as young as 15 could undergo double mastectomies.

nysun.com/article/shocki…

🧵That it has taken so many years for the news about Boston Children’s slashing the assessment times at its pediatric gender clinic to be laid bare lends weight, critics suggested to me at The @NewYorkSun, to the persistent allegations that pediatric gender care, a deeply controversial medical specialty, is critically lacking in transparency.

The associated political stakes are substantial. During the presidential campaign’s home stretch, Donald Trump has relentlessly hammered Kamala Harris for her past support of taxpayer funded  gender-transition treatments for prisoners, including detainees who are undocumented migrants. His campaign has funneled tens of millions of dollars into attack ads on this issue.

Read my article:
nysun.com/article/shocki…

🧵The @BostonChildrens employment trial has also shone a harsh light on a substantial blind spot in pediatric gender medicine: the crucial question of how those who medically transition as minors fare as adults.

nysun.com/article/shocki…

By stripping former Boston Children’s psychologist Amy Tishelman of her right to see patients in the gender clinic in 2019, she and her attorney alleged in court, the hospital compromised her vital research into the care of transgender children. And by firing her outright two years later, she said, the hospital terminated, among other research, her effort to establish a comprehensive database of all the patients the gender clinic had ever seen and to follow up with those who had reached adulthood.

“We were the first clinic to see transgender kids in the United States, and we don’t know whatever happened to them and how they’re doing,” Dr. Tishelman testified about the hundreds of former patients who have aged out of the clinic’s care.

“It’s damning that an institution like that, which has all those esteemed affiliations with major universities, would put the kibosh on an area of research that’s so desperately needed and would have informed their administrative decisions had they allowed it,” Erica Anderson @eanderh, a psychologist and former head of the U.S. division of the World Professional Association for Transgender Health, or @WPATH, told me at The @NewYorkSun.

Boston Children’s is most prominently affiliated with @Harvard Medical School @HarvardMed.

🧵The nonprofit Do No Harm recently conservatively estimated that @BostonChildrens provided gender-transition treatment, surgery, or both to at least 300 children from 2019 to 2023. @DoNoHarm otherwise found that 14,000 U.S. minors received such interventions during this period. (benryan.substack.com/p/at-least-140…) And @LeorSapir at the @ManhattanInst estimated, also conservatively, that 5,300 to 6,300 minors—as young as 12 years old—received gender-transition mastectomies between 2017 and 2023.

According to the Boston Children’s gender clinic’s website, the clinic has cared for more than 1,000 families. The site states: “We believe in a gender-affirmative model of care, which supports transgender and gender diverse youth in the gender in which they identify. This is a standard of care grounded in scientific evidence, demonstrating its benefits to the health and well-being of transgender and gender diverse youth.”

nysun.com/article/shocki…

🧵Gary Click, a Republican state representative from Ohio, marshaled that state’s ban on gender-transition treatment for minors into law. In an email to me at The @NewYorkSun, he responded to news from Amy Tishelman’s trial, specifically that @BostonChildren’s assesses gender-dysphoric minors in just two hours of appointment time, by criticizing the pediatric gender-transition treatment advocates with whom he has clashed.

“While I consistently advocated for mental-health over medical interventions, I was frequently and falsely accused of denying psychological care,” Mr. @ClickForOhio said of such advocates. “I’ve since discovered they are usually guilty of what they accuse us of doing. Now it appears that they are in a rush to medicate children before they have a chance to heal emotionally and choose a normal life.”

My article:
nysun.com/article/shocki…

🧵Amy Tishelman testified in her civil trial against @BostonChildrens that by early 2018, GeMS (its gender clinic) administrators eliminated from the assessments a screening measure for autism. This despite the high rates of autism in gender-distressed youth. She alleged that despite what she characterized as the degradation of the assessments’ quality by that time, GeMS would include in various reports about the clinic’s work that its staffers followed @WPATH’s trans-care guidelines.

“Shortening evaluations” at GeMS “eventually became a big concern” among her research collaborators nationwide, Dr. Tishelman testified. “People would complain to me about my protocol from outside,” she said in reference to those national colleagues.

Dr. Tishelman specified that Dr. Robert Garofalo, a leading pediatrician at the gender clinic at @LurieChildren’s Hospital in Chicago, expressed a concern to her at around this time regarding GeMS excluding from the assessments a measure of family acceptance and support of transgender patients. Along with Dr. Yee-Ming Chan, Dr. Garofalo is a co-principal investigator on the newly besieged, long-running NIH-funded study of which Dr. Johanna Olson-Kennedy is the research lead.

“I would try to tell people that I was not in charge of the protocol,” Dr. Tishelman testified.

Read my article in The @NewYorkSun:
nysun.com/article/shocki…

🧵Amy Tishelman’s attorney asked @BostonChildren’s psychologist Kerry McGregor about the notorious videos that the gender clinic (called GeMS) put out advertising their services in 2022. She referred to one in which she suggested that, as she recalled in her testimony, “a lot of parents share that some of their children seem to know seemingly from the womb as if they come out kind of knowing who they are,” meaning transgender.

“There’s no scientific research that would support the assertion that kids know whether they’re transgender as soon as they come out of the womb, right?” Mr. Hannon asked Dr. McGregor.

“I don’t know how we would do that scientific research, so no,” she replied.

nysun.com/article/shocki…

🧵Jamie Reed @JamieWhistle famously blew the whistle on her employer in an article in @BariWeiss' @TheFP, The Washington University Transgender Center at St. Louis Children’s Hospital, where she had been a case manager. Ms. Reed has accused the since-shuttered clinic of shirking its responsibility to provide comprehensive aid to a population of vulnerable children with very complex needs. (An internal university investigation found the clinic followed “appropriate policies and procedures according to the accepted standards of care.”)
thefp.com/p/i-thought-i-…

“I long suspected that the sloppy care Wash U. provided would be found across the country,” Ms. Reed told me at the @NewYorkSun. During her time at the St. Louis clinic, she said, “I was often unable to refer patients to high-quality psychological assessment, and our clinicians were also limited to scheduling only two sessions to complete an assessment—matching Dr. Tishelman’s account.”

nysun.com/article/shocki…

Nearly two dozen medical-malpractice lawsuits have been filed by detransitioners –  people who medically transitioned and then regretted it, stopping treatment and reverting to identifying as their birth sex – against health and mental health providers over the past two years. Central to many of those suits are claims that minors or young adults suffering from multiple other psychiatric conditions were prescribed gender-transition treatment for dysphoria after only a cursory assessment that failed to meet the @WPATH standard.
nysun.com/article/lawsui…

Jordan Campbell, a partner at Campbell Miller Payne, a Dallas firm that represents many of these plaintiffs, told the Sun: “Dr. Tishelman’s testimony squares with what we see and hear from every single one of our clients: a general sense to rush patients into life-altering medicalization with very little—frequently even less than two hours—assessment, if any.”

nysun.com/article/shocki…

Psychologist Laura Edwards-Leeper has defended the value of the psychological assessments of gender-dysphoric children seeking gender-transition treatment in the face of a burgeoning movement across the pediatric gender medicine field to question their utility.

@UCSF child psychiatrist @Jack_Turban, for example, strongly suggested in his recent book on trans children that such assessments were useless and should be done away with. Gender-transition treatment should be as easy for adolescents to access as Prozac, he suggested. This is despite the fact that he has also frequently touted the assessments in other settings. benryan.substack.com/p/dr-jack-turb…

In a 2020 video interview posted to YouTube, Dr. Garofalo said there is no means of determining whether a child is “really trans” and that these assessments are not meant to make such a determination. (Dr. Turban similarly asserted the latter point in a recent paper.) Dr. Garofalo said that he simply asks a child for their gender identity and proceeds accordingly.

nysun.com/article/shocki…

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