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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
Feb 6
Dr. Blair Peters,a gender-transition surgeon at OHSU, responds with disdain to the American Society of Plastic Surgeons coming out against such surgeries for minors. He says the broader membership was never polled about this.

Which is the same thing that has happened at the American Academy of Pediatrics, for example, but going in the other direction. No matter how hard @JuliaMasonMD1 has pushed, the AAP’s 2018 policy statement on the gender-affirming care method has never been up for a vote by the broader membership.

All of the major medical organizations that have led the way in establishing pediatric gender medicine’s broader credibility, including the AAP and the Endocrine Society in particular, have supported these practices in minors based on the decisions of small committees.

The AAP’s 2018 policy statement was written by a single person, Dr. Jason Rafferty, who was a resident at the time.

All of the other medical societies’ little committees have followed these other groups’ lead, along with WPATH. This has given the illusion that all medial providers support these practices in minors.

But I’ve spoken to pediatricians who are too afraid to express their concerns at the AAP’s annual conference for fear this will destroy their careers.Image
More from Blair Peters: Image
Image
Image
In 2024, Dr. Blair Peters, aka “Queer Surgeon,” spoke with the head of the ASPS and they had this remarkable exchange about whether doctors can be trusted to self police.

The ASPS president, Dr. Steven Williams, brought up Tuskegee. open.substack.com/pub/benryan/p/…Image
Image
Read 6 tweets
Benjamin Ryan Profile picture
Feb 4
People are shocked that all it took for the AMA to change its policy on pediatric gender transition surgeries was for another medical group, the ASPS, to do it. But this phenomenon is how the unanimity among the medical groups fell into place in the first place. It was only ever based on a few small committees within a couple of medical organizations, putting aside WPATH, which is a quasi-activist-medical organization.

It got started in the 2010s as WPATH and the Endocrine Society, which have a lot of overlap between them and referred to one another's guidelines in their citations, put out guidelines. And then in 2018 a single medical resident wrote the American Academy of Pediatrics' policy statement on the gender-affirming care method. Along the way, other major medical associations took these other groups' lead, including the APA and AMA. And then all the other ones fell in line.

These groups did not conduct major independent analyses of the evidence. Even the AAP never conducted a systematic literature review to support its policy statement. And in August 2023, the AAP said it was going to conduct one. But there is no sign that the organization has even started on that. Because if they ever did, there is only one conclusion that it could have: that the evidence backing providing gender-transition interventions to minors is weak and inconclusive.

All this is to say is that the mantra "all major medical association support gender affirming care for kids" was always a hallow claim. What it really meant is that: "A few small committees at a few organizations decided to support this, in part because of one another, and all the other small committees at all the other organizations followed their lead."
If you want to go down the rabbit hole of how citation laundering laid the groundwork for the supposed medical consensus on gender-transition treatment for minors, I highly recommend @buttonslives's reporting: buttonslives.news/p/new-systemat…Image
@buttonslives Hollow, not hallow*
Read 5 tweets
Benjamin Ryan Profile picture
Feb 2
A Legal First That Could Change Gender Medicine

At 16, Fox Varian got a mastectomy while undergoing a gender transition. She sued her psychologist and plastic surgeon for leaving her ‘disfigured for life.’ Benjamin Ryan reports from the courtroom.

Read the @TheFP article: thefp.com/p/a-legal-firs…

Follow and support my Substack, where I cover pediatric gender medicine: benryan.substack.com. I was the only reporter to attend the entire three-week trial and will be providing more in-depth reporting and commentary on the case.

The opening of my Free Press article:

Fox Varian had a turbulent childhood. Her parents split when she was seven, triggering a three-year custody battle that ultimately saw her estranged from her father. She suffered from a constellation of mental health problems, including depression, anxiety, and social phobia. She was diagnosed with autism and bounced around various schools. Her first period sent her into a meltdown, and she battled disordered eating and body-image issues. By mid-adolescence, she was completely lost.

At 15, she began questioning her gender during sessions with her psychologist. She changed her birth name, Isabella, to Gabriel, which she saw as androgynous. Over the next two months, she cut her hair short, began binding her breasts, switched her name again, to Rowan, and started telling people she was transgender.

In December 2019, 11 months after she started this public social transition, Varian underwent surgery to remove her breasts. She was 16 years old.

Varian, who adopted the name Fox at 18 and is now 22, is one of thousands of minors who underwent gender-transition surgery over the past decade. And she is just one of the young people who have come to regret permanently addressing what was only a temporary identity shift.

Three years after her mastectomy, Varian stopped identifying as transgender and began a process known as detransitioning. In May 2023, she filed a medical malpractice lawsuit against the two principal Westchester County, New York, care providers who oversaw her gender transition: her long-time psychologist, Kenneth Einhorn, and Dr. Simon Chin, who performed the mastectomy.

On Friday, a jury in White Plains, New York, awarded Varian $2 million in damages. Varian’s case is the first malpractice suit from a detransitioner to go before a jury, and I was the only reporter to attend the entire three-week trial. Represented by personal-injury attorney Adam Deutsch, Varian said she had been injured by the defendants due to their deviation from standard practices and a lack of informed consent. While there are no guarantees in medical malpractice lawsuits, legal experts believe Varian’s victory could inspire a wave of similar cases that would significantly disrupt pediatric gender medicine.Image
Claire Deacon, mother to Fox Varian, the detransitioner who won a $2M jury award after suing her care providers over the mastectomy she got at 16, testified that Varian's psychologist, Kenneth Einhorn, browbeat her into consenting with threats of her child's suicide.

I report for @TheFP:
thefp.com/p/a-legal-firs…

Subscribe to my Substack for further in-depth reporting about the case. I was the only reporter to attend the entire three-week trial. benryan.substack.comImage
Dr. Loren Schechter, the head of gender-affirming surgery at Rush University Medical Center in Chicago and the president-elect of the World Professional Association for Transgender Health (WPATH), testified that gender-transition surgery is not form of suicide prevention. thefp.com/p/a-legal-firs…Image
Read 12 tweets
Benjamin Ryan Profile picture
Jan 31
NYU neurologist/psychiatrist Jonathan Howard has been making a stink over @MichaelShermer's recent statements about transgender issues on @BrianLehrer's show.

Here, Howard cites a @Harvard study that falsely claimed youth "rarely" get gender-transition surgeries. In fact, about 1,000 minors got a mastectomy for this purpose annually in recent years, before state bans set in.

I wrote about that Harvard study when it came out. I demonstrated how its authors had quite evidently sought to mislead the public about this issue: benryan.substack.com/p/how-harvard-…

So, in fact, it is not Shermer who is "making things up" about this point in particular, it was Harvard researchers that at least effectively did so.

As for expressing concerns about minors getting these surgeries, I would like Howard to look into the eyes of the mother who testified in the detransitioner civil trial that I just finished attending yesterday (the plaintiff won a $2M judgment against her care providers; my article on the suit will run in a major outlet next week) and tell her that the loss of her daughter's breasts when she was 16 amounts to a false concern.Image
Image
How Harvard Teed Up the False Claim That the 'Vast Majority of Minors Getting Gender-Affirming Surgeries Are C-s Kids'

An opaquely written Harvard study and linked press release prompted false reporting that gynecomastia surgeries for boys are vastly more common than gender-affirming surgeries for transbenryan.substack.com/p/how-harvard-…Image
The other day, Howard wrote some screed where he referred to me as a "malignant actor" nefariously pursuing this line of inquiry for money. (Someone suggested that as a cancer survivor, maybe I am intrinsically malignant...) To that I say that Howard might get his facts straight about any of this stuff before he passes judgement on my reporting.
Read 5 tweets
Benjamin Ryan Profile picture
Jan 31
BREAKING: 1st Detransitioner to Take a Medical-Malpractice Lawsuit to Trial Wins $2 Million Judgement

Fox Varian sued her Westchester, NY, area psychologist and plastic surgeon for the gender-transition mastectomy she got at 16.

I was the only reporter to attend the entire 3-week, historic trial. Subscribe to my Substack to receive an alert about the feature article I have coming out next week in a major publication out about the trial: benryan.substack.com. I cover pediatric gender medicine as a specialty on my Substack.

Sorry to just give just a teaser for now about the case! But I wanted to get the word out about the verdict promptly, the slower pace of feature-article publishing notwithstanding.

The entire case file was put under seal when the trial started (although I obtained all those documents before they was sealed), and all the transcripts from the trial are also under seal. The riveting trial was sparsely attended and there was only one other reporter at the trial; and he only attended for part of it and, as I observed, took few notes. So my own hundreds of pages of notes from the trial will likely remain the only way for the public to learn about the all finer details of what transpired, possibly ever (or until an appeal, should that happen).

In addition to my article coming out in the media outlet soon, I intend to write a lot about what I observed and learned on my Substack over the coming weeks. Stay tuned…Image
I have identified 28 detransitioner lawsuits filed to date. Varian v. Einhorn was the first to go to trial and the first to win a judgment, making history. If anyone knows of any additional cases that are not on my spreadsheet below or sees any errors, please DM me.Image
Quite a few of the detransitioner lawsuits have run up against strict statutes of limitation, such as the case against leading pediatric gender doctor Johanna Olson-Kennedy. Attorneys intend to appeal this dismissal, as I wrote in November:
benryan.substack.com/p/detransition…Image
Read 4 tweets
Benjamin Ryan Profile picture
Jan 12
Media outlets that claim that transgender women have no competitive advantage over women in athletics are not making evidence-based claims.

Two recent review papers, by @DrMJoyner and @Fondofbeetles, have found that even after sustained testosterone suppression and estrogen treatment, biological males still maintain a competitive advantage in women's sports. The research is less clear about those who have undergone pubertal suppression and then estrogen treatment starting soon after puberty's onset. However, Dr. Joyner's research indicates that prepubescent boys have a small but significant competitive advantage over girls, likely because of exposure to testosterone in utero and a surge of T during "mini puberty" during infancy.

Sources: link.springer.com/article/10.100…

pubmed.ncbi.nlm.nih.gov/39716906/
Notice how @NPR doesn't even mention the review papers by @DrMJoyner and @Fondofbeetles finding that trans women on gender-transition treatment maintain a competitive advantage in women's sports. I spoke with Dr. Joyner and other experts who criticized the methodology of the IOC study. They all called its conclusions weak and unreliable. npr.org/2026/01/11/nx-…Image
@NPR @DrMJoyner @FondOfBeetles The claim by NPR that there is only a handful of trans youth playing sports is belied by survey data, reported by @HRC, that 19% of trans and gender expansive youth play sports. That translates, based on data from a CDC survey, to about 135,000 middle and high school students. Image
Read 9 tweets

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