Thread by @LeorSapir

Jack Turban (@jack_turban) is one of the chief sources of misinformation on pediatric gender medicine. Fortunately, his tweets always provide opportunities to educate the public.🧵

Turban says that European countries have “not abandoned care.” That’s highly misleading. They HAVE abandoned the affirmative approach to “care,” which Turban supports, in favor of the Dutch protocol, which he apparently does not support.

See e.g.,

gendergp.com/exploring-detr…

The Europeans are well aware of this distinction. For instance, the Cass Report explicitly identified “an affirmative approach” that “originated in the USA” as contributing to the lack of medical safeguarding of minors at Tavistock.

Especially due to its unscientific and excessive use of “minority stress,” the affirmative approach leads to what the Cass report called “diagnostic overshadowing.” The affirmative model makes differential diagnosis very difficult, resulting in unnecessary medicalization.

Turban is one of the leading proponents of “minority stress” theory (or I should say, the minority stress insurance policy for doctors, since its end result is to ensure that any wrongful transitions were only wrong because “society is awful” and did not accept a person’s true… twitter.com/i/web/status/1…

Further, European countries have restricted hormonal interventions to research settings, acknowledging the “very low” certainty of evidence for benefits. Finland’s COHERE calls the use of puberty blockers and cross sex hormones to treat gender dysphoria in minors “an experimental… twitter.com/i/web/status/1…

Turban, by contrast, believes that research confirms the benefits. He relies, however, on what a recent @bmj_latest report calls “consensus-based” medicine (“most major medical associations agree”), as opposed to evidence-based medicine.

bmj.com/content/380/bm…

Systematic reviews are at the top of the information hierarchy in evidence-based medicine. Countries that have done SR have all found “very low” certainty evidence for the benefits of hormones. That includes in the “gold standard” Dutch study/protocol.

An overview of SR (“umbrella review”) conducted by experts in research methods and evidence based medicine at McMaster University last year confirmed these findings.

ahca.myflorida.com/content/downlo…

Incidentally, it also found that Turban’s 2022 suicide study suffers from “critical risk of bias.” Perhaps that’s why he ignores the SRs.

Finally, Turban claims that Europe is still following WPATH. Is it? WPATH recently condemned the NHS for parting ways with its recommendations.

listloop.com/wpath/mail.cgi…

The director of Belgium’s Center for Evidence Based Medicine also said that he would “toss [the WPATH guidelines] into the bin.”

https://twitter.com/segm_ebm/status/1641950432540135424