Thread by @jessesingal

1/ Until James Cantor wrote about it, I had been blissfully aware of how riddled with misleading and inaccurate information the American Academy of Pediatrics' new policy statement on trans and gender-diverse youth is. It's really bad. It's a total

sexologytoday.org/2018/10/americ…

2/ disservice to parents and to anyone else seeking accurate and evidence-based information about the nature of gender dysphoria and gender-identity development. Other than saying "Read Cantor's takedown," I just have one point to add -- an example of

pediatrics.aappublications.org/content/early/…

3/how flimsy and cherrypicking this document is that I don't think Cantor fully took apart.

As soon as I read the sentence containing the underlined phrase I knew EXACTLY what research the citation would point to: a study published a few years ago in which Kristina Olson and

4/ colleagues reported that trans boys/girls scored similarly to natal boys/girls (respectively) when the group was given gender-identity and -preference implicit association tests. It's an interesting study! But people have been overextrapolating from

ncbi.nlm.nih.gov/pubmed/25749700

5/ it ever since, ignoring the IAT's many weaknesses and the novelty of this use of it, and making arguments that rely on the premise that getting a certain IAT score "proves" someone is "really" male or female, deep down (imagine the implications...). Anyway, given that the

6/ AAP document is ostensibly about treatment questions -- whether kids should socially and (later) physically transition, what the timing should be, etc. it's unclear what we should take away from the fact that a small group of *already socially transitioned* kids scored in a

7/ particular way on a particular IAT. There is no conceivable world in which one can justifiably leap from that study to "research substantiates that children who are prepubertal and assert an identity of TGD know their gender as clearly and as consistently as [cis kids],"

8/ and usually when someone addressing Issue X says that "research shows" something definitive about X, pointing to a single study that only addresses X in a bankshot way, I have questions!

I have a MANY questions in this particular instance, because

9/*we HAVE some specific research on the long-term trajectories of kids who express that they have gender dysphoria at a young age*(!!!!). The single best study we have is this Steensma et al one from 2013. It, like every other study in this admittedly
ncbi.nlm.nih.gov/pubmed/23702447

10/ small subgenre, shows that for a significant percentage of kids, their dysphoria goes away in time (precise % has been hotly contested, likely depends on country/culture/diagnostic criteria/etc. -- I do think the commonly cited figure of 80% is

medium.com/@jesse.singal/…

11/probably an overestimate for kids with DSM-5 GD and that people shouldn't use it). These studies all suggest it is outright false to state that "children who are prepubertal and assert an identity of TGD know their gender as clearly and as consistently as [cis kids]," if by

12/ "consistently" we mean that the identity will stick around in the long run (unclear what else it could mean in this context). Neither the Olson nor the Steensma study, of course, can definitively answer this question, but one study (Steensma) was designed to chip away at

13/ it, and another (Olson's) wasn't, really. It's a complete no-brainer which one you'd pick if you were asked to evaluate this issue, and the Steensma study is famous among clinicians and researchers in this area. And yet the AAP document doesn't even reference it! This is

14/ a striking example of how, as Cantor suggests, the document is slanted toward an approach that's outside the currently accepted scientific mainstream. Its only mention of the desistance literature is to sweepingly dismiss all of it, as part of a paragraph so riddled with

15/ distortions of this area of research/clinical practice I could do a whole other tweetstorm on it. Seriously, it's astounding this paragraph was published by a respected medical organization. In fact, it's worrying to me that this *entire document* was published -- I think

16/ it's a telling example of how much of a disaster this discussion has become. Parents, in particular, are utterly screwed right now -- there's a cacophony of conflicting information out there, with misinformation coming from all corners. It just sucks that the AAP has made

17/ the situation worse rather than better. The organization could have done much, much better. It could have helped people and clarified things. I don't understand how this happened.

Anyway..............

theatlantic.com/magazine/archi…