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Benjamin Ryan Profile picture
@benryanwriter
Feb 23, 2023 • 41 tweets • 33 min read • Read on X
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A bombshell article by @writingblock challenges claims by activists that the science supporting the treatment of gender dysphoria in minors is "settled" and that the use of puberty blockers and hormones in transgender kids is "evidence based." 🧵⬇️
press.psprings.co.uk/bmj/february/t… Image
Many argue that giving puberty blockers and hormones to trans minors is uncontroversial & backed by high-quality science. Block's reporting disputes this. Swedish health authorities, for example, say the risks "currently outweigh the possible benefits". 2/
press.psprings.co.uk/bmj/february/t… Image
@glaad, in its recent protest before the @nytimes building, echoed a common refrain: that "the science is settled" regarding giving puberty blockers and hormones to trans-identifying minors. @writingblock's peer-reviewed reporting challenges this claim. 3/ press.psprings.co.uk/bmj/february/t… Image
Trans kids has been a minefield topic, w/ activists like @Esqueer_ & lefty pundits like @RottenInDenmark battling heterodox writers @jessesingal @bariweiss @sullydish @LeorSapir & @AbigailShrier & w/ @MattWalshBlog throwing bombs. @JoyceCarolOates has lent her support to kids. 4/ ImageImageImageImage
The prescription of hormones to trans-identifying minors is often framed as a choice of life on meds vs death by suicide. But researchers have not actually shown that hormonal treatment for gender dysphoria impacts death by suicide. 5/
press.psprings.co.uk/bmj/february/t… Image
@HRC said in a press release today that "ALL gender-affirming care is age appropriate and medically necessary." But in the UK, health experts found there's "scarce & inconclusive evidence to support clinical decision-making" for kids with dysphoria. 6/
press.psprings.co.uk/bmj/february/t… Image
Mark Helfand of Oregon Health & Science University criticized @wpath's recommendations for treating #transgender minors, including a lack of grading system to assess the quality of scientific evidence backing the guidelines. #trans 7/
press.psprings.co.uk/bmj/february/t… Image
At an October meeting of the AAP, @writingblock reports, @DrScottHadland of Harvard Med said, "Ten thousand pediatricians stand in solidarity for trans and gender diverse kids & their families to receive evidence-based, lifesaving, individualized care." 8/
press.psprings.co.uk/bmj/february/t… Image
Gordon Guyatt (@GuyattGH) of McMaster University found "serious problems" with the Endocrine Society's guidelines for treating #trans kids, such as making strong recommendations based on weak evidence--meaning they should not be called "evidence based". 9/
press.psprings.co.uk/bmj/february/t… ImageImage
In contrast to @DrScottHadland, @GuyattGH said, "When there's been a rigorous systematic review of the evidence" about treating #trans kids "and the bottom line is 'we don't know,' anybody who then claims they *do* know is not being evidence based." 10/
press.psprings.co.uk/bmj/february/t… ImageImage
While myriad medical organizations in the US back prescribing puberty blockers & hormones to trans-identifying minors, standards abroad are very different. Sweden did systematic reviews in '15 and '22, found evidence was "insufficient and inconclusive."11/
press.psprings.co.uk/bmj/february/t… ImageImage
The Endocrine Society (@TheEndoSociety) commissioned 2 systematic reviews for its clinical practice guideline for treating #trans adolescents with sex steroids and found the quality of the evidence regarding health risks was "low" or "very low". 12/ press.psprings.co.uk/bmj/february/t… Image
In sum, @writingblock's reporting suggests that @wpath and @TheEndoSociety's guidelines for treating #trans adolescents are not truly "evidence based", nor uncontroversial, nor do they balance the known and potential risks v benefits of such treatment. 13/ press.psprings.co.uk/bmj/february/t… Image
@MattWalshBlog, who doesn't so much debate the science behind care for trans minors as douse the field with gasoline & set it on fire, has made the topic so combustible in Tennessee, he teed up the politicization of #HIV prevention there, I reported:
14/ nbcnews.com/feature/nbc-ou…
@writingblock reviews the history of gender medicine in @bmj_latest. Note that her article was peer reviewed.
15/
 press.psprings.co.uk/bmj/february/t… ImageImage
@writingblock's assessment of the evidence backing standards of care for treating gender dysphoria in #trans minors comes a week after activists (eg: @glaad) and writers have pressured @nytimes to refrain from the type of reporting she has done. 16/ glaad.org/new-york-times…
Other articles finding a lack of high-quality science backing the treatment of trans minors have been published by @nytimes & Reuters, by @emilybazelon @mega2e @chadterhune @RobinRespaut @michelleconlin. 17/
nytimes.com/2022/06/15/mag…
nytimes.com/2022/11/14/hea…
reuters.com/investigates/s…
Myriad writers have criticized @nytimes reporting on #transgender issues, such as @_WrittenByHanna and @jackmirkinson in @thenation: 18/ thenation.com/article/societ…
thenation.com/article/societ…
Scores of @nytimes writers have pushed back against the charge by the paper's guild that its reporting on trans issues caused a hostile work environment, including @GiniaNYT @mattfleg @tripgabriel @apoorva_nyc @powellnyt @jimrutenberg @charlie_savage. 19/
@PressSec of @POTUS weighs in on the onslaught of bills introduced to statehouses this year that target #LGBTQ people:
20/
@ryanlcooper and @RottenInDenmark’s take on @assignedmedia:
@writingblock’s thread:
@jack_turban, MD, who treats trans kids, says there’s a lot of misinformation going around:
21/
@Esqueer_ responds to this thread: Image
The emailed responses to this thread are starting to come in. This is new: now I'm a Nazi and have autism to boot. Image
More charming exchanges with the readers of this tweet thread. Have a good one, @zunetopia. Image
Kindly do not come to this thread disrespectfully. I will not tolerate malicious statements toward anyone and the misgendering of transgender people.
Also, for anyone coming to this thread who thinks they know who I am, what I think or believe or what I'm about, do take note that I do not share my personal opinions about many issues on Twitter. I invite you to read my reporting on LGBTQ issues: benryan.net/lgbtq.html
@HRC will fly an airplane banner down the Hudson River protesting @nytimes coverage of #transgender issues today: Image
@Esqueer_ claims @writingblock can’t count, but the figure she cited in her BMJ article is the total number of minors receiving hormones and puberty blockers during that period, whereas the chart refers only to puberty blockers. Image
On the political front: cbsnews.com/news/texas-bil…
I get a lot of venomous emails, but I’d say this one regarding my tweet thread about the strength of the science behind the treatment of gender dysphoria in minors is one of the most heinous. Sadly for this person’s hopes, I was cured of cancer and have a 5% recurrence chance. Image
Also: it sucks for that person, but no one dies of testicular cancer anymore.
@meetzow wants me to die because I am engaging in science reporting and have illuminated the weakness of the science backing the treatment of gender dysphoria in minors.
Image
Also, gay people on Twitter get hit with a lot of tweets like this in the Musk era: @UIgliori Image
People tweet this to suggest that reduced stigma is the sole reason for the apparent tripling in trans identification between older adults & youths. But I think we can agree that gender identity is far more complex and driven by more complex factors than left vs right-handedness. Image
@CISCHASER hopes I die of the cancer I had: Image
If only this @ryanlcooper @TheProspect podcast had brought on academic experts to discuss youth gender care science. Instead, @RottenInDenmark provides a misleading overview that, for example, fails to note Finland & Sweden disagree with the US on this. 1/
prospect.org/podcasts/02-20…
@RyanCooper claims that what @jessesingal says about youth gender care science "makes no sense scientifically." Except Singal knows the science better than just about anyone, as he assiduously demonstrates. And his coverage is way more nuanced than Hobbes claims. 2/
My favorite is @ryanlcooper saying the best thing for science journos to do is: "You go into the studies to talk to the scientists, you don't talk to individual people, who may and probably do have an ax to grind," as he interviews two individual non-scientists about science. 3/
Hobbes himself is extraordinarily ideological, meanwhile. 4/

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More from @benryanwriter

Benjamin Ryan Profile picture
Jul 14
Clara Jeffery, editor in chief of Mother Jones, says that it is for the best that JD Vance’s children be subjected to boos at Disneyland, so that they “know now what their father is about.” Image
Debunking podcaster Michael Hobbes also endorses the jeers at @JDVance’s family at Disneyland. Image
Clara Jeffery, editor in chief of Mother Jones, adds the following to her post endorsing the jeering of @JDVance while he is with his children at Disneyland. She argues that he actually wants the optics of being booed while having family time in public.
bsky.app/profile/claraj…Image
Read 5 tweets
Benjamin Ryan Profile picture
Jul 13
Democrats Lost Voters on Transgender Rights. Winning Them Back Won’t Be Easy.

The party’s vanguard position got ahead of voters in 2024, and the internal debate now underway reveals an uncertainty on how to adapt, by @chashomans for @nytimes.

"Stuck in a widening gulf between the views of the party’s liberal voters and advocacy organizations on one side, and those of the broader American electorate on the other, many Democratic politicians had resolved to say as little as possible about the subject. In surveys, Ms. Erickson and other public-opinion researchers had found that this allowed Republicans, who spent hundreds of millions of dollars on ads attacking Democrats on transgender rights in 2024, to define voters’ perceptions of Democratic policy positions."Image
nytimes.com/2025/07/13/us/…
The dilemma is reflective of the Democratic Party’s broader struggles with identity politics as it dissects its losses in 2024. Recovering its standing with voters, many in the party believe, requires coming to terms with the party’s transformation during the Obama and first Trump presidencies, when American liberals broadly embraced what had previously been vanguard positions on a range of social and cultural issues, including gender and race, immigration and policing.Image
Read 8 tweets
Benjamin Ryan Profile picture
Jul 10
Dr. Rachel Levine, a former Biden administration health official, tells @TheAdvocateMag that "the evidence base is strong for the safety and efficacy" of prescribing puberty blockers and cross-sex hormones to treat gender dysphoria in minors.

A slew of systematic literature reviews have found this is not the case. Instead, they have found that the relevant evidence is weak and inconclusive. They have suggested that the World Professional Association for Transgender Health erred in making strong recommendations for these treatments. Evidence-based medicine guidelines discourage making a strong recommendation based on weak evidence.Image
Despite subpoenaed email records showing that Dr. Rachel Levine pushed WPATH to remove age limits on pediatric gender-transition treatments and surgeries for political reasons, Dr. Levine denied ever having done so in an interview with @TheAdvocate. Image
The New York Times reported last year:
nytimes.com/2024/06/25/hea…
One excerpt from an unnamed member of the WPATH guideline development group recalled a conversation with Sarah Boateng, then serving as Admiral Levine’s chief of staff: “She is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out.”

Another email stated that Admiral Levine “was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them.”Image
Read 7 tweets
Benjamin Ryan Profile picture
Jun 30
Fact checking Michael Hobbes

Debunking podcaster Michael Hobbes has a new episode of his podcast If Books Could Kill, about the US v. Skrmetti Supreme Court decision upholding Tennessee's ban on pediatric gender-transition treatment.

In this🧵I will fact check Hobbes:
⬇️Image
Here is a link to the podcast: podcasts.apple.com/us/podcast/the…
Michael Hobbes, referring to a video, published in 2022 by @MattWalshBlog, of a Vanderbilt doctor talking about the money that gender-transition surgeries bring in, including bottom surgeries: “Bottom surgeries are essentially not performed on children," Hobbes says. "So the fact that she's talking about bottom surgeries here makes it very clear that she's talking about adults.”

This depends on your definition of "essentially." Phallopasties are not recommended by @WPATH for minors, but vaginoplasties are. Dr. Marci Bowers, a gender-affirming surgeon and a former WPATH president, recommends that trans girls get a vaginoplasty the summer before they leave for college, when they are 17 or 18.

A 2023 paper on a limited dataset of US minor patients did find evidence of one vaginoplasty in 2021. This suggests that if the study authors had access to all records in the nation, they would identify more such surgeries in minors.

Consequently, Hobbes is incorrect to presume that the Vanderbilt doctor was not referring to minors in the speech that Walsh published. It is entirely possible she was.

pmc.ncbi.nlm.nih.gov/articles/PMC10…Image
Read 26 tweets
Benjamin Ryan Profile picture
Jun 30
If, for the sake of argument, no one can prove that pediatric gender-transition treatment prevents suicide death only because such deaths are so rare, then why has this treatment been sold, first and foremost, as “lifesaving”?

Why have people who have called that claim into question been savagely attacked and sidelined?

Marci Bowers, former head of WPATH, herself told me last year that suicide death has never been a good metric of the success of this treatment.Image
Image
Debunking podcaster Michael Hobbes is himself one of the prime sources of misinformation about pediatric gender-transition treatment. He has routinely falsely claimed that there is no evidence that children get these drugs after absent or cursory assessment periods. There is copious evidence that this happens routinely at some of the top gender clinics in the nation. Despite all this evidence, Hobbes has never acknowledged his fault.

But you can see here that he is combining his longstanding claim about assessments with a claim about what he characterizes as false claims that there are large numbers of kids getting these drugs. That question should not necessarily be conflated with the assessment question.

About 1 in 1,000 youth with private health insurance went on cross sex hormones by age 17 between 2018 and 2022. That number was higher for natal girls and was probably higher for all youth by the end of that period.

One thing that has concerned some people is not necessarily the number of kids getting these drugs, but the rate of increase of that number. They have been concerned over where that figure might end up.Image
If suicide deaths are so rare even in youth with gender dysphoria, then why have leading gender clinicians routinely told parents that absent blockers and hormones, their child was extremely likely to wind up dead? That’s what the mantra “Would you rather have a dead son or a live daughter?” implies. We now know from the leading litigator in this field that that threat was a false one, at the very least in the suggestion of how likely suicide death was in the first place.Image
Image
Image
Read 4 tweets
Benjamin Ryan Profile picture
Jun 29
The Liberal Misinformation Bubble About Youth Gender Medicine

How the left ended up disbelieving the science

By @HelenLewis for @TheAtlantic Image
theatlantic.com/ideas/archive/…
Debunking podcaster Michael Hobbes, a prime source of misinformation about pediatric gender-transition treatment, slams @HelenLewis of @TheAtlantic for criticizing people such as him.
Read 5 tweets

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