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Leor Sapir Profile picture
@LeorSapir
Jul 13, 2023 • 12 tweets • 3 min read • Read on X
BREAKING:

21 leading experts on pediatric gender medicine from 8 countries have written a Letter to the Editor of @WSJopinion expressing disagreement with the @TheEndoSociety and its new president @StephenHammes over the treatment of youth gender dysphoria.

This is huge. 🧵
Although they have commented on the problems of the American "affirming" model in the past (e.g., Cass Report), this is the first time international experts have publicly weighed in on the American debate over "gender-affirming care."
Among the intl' experts is Dr. Riita Kaltiala, chief psychiatrist at Tampere University gender clinic, author of numerous peer-reviewed articles on trans medicine, and Finland's top authority on pediatric gender care.
The letter follows an illuminating exchange between @donoharm and @TheEndoSociety @StephenHammes in the pages of @WSJopinion.

The letter states that while Endocrine Society president and "gender-affirming care" practitioner Dr. Hammes’ may think his own clinical experience and existing research support his position, his belief "is not supported by the best available evidence."
It mentions that (unlike U.S. medical associations) health authorities abroad have relied on systematic reviews of evidence for the benefits of hormonal interventions and found these benefits to be without reliable evidence.
To recall, the main value of systematic reviews is that they don't just summarize the available studies but assess their strengths and weaknesses. This is key, because proponents of child sex trait modification frequently just mention individual studies.
Dr. Hammes' claim that "gender-affirming care" is a suicide prevention measure, the intl' experts say in their WSJ letter, "is contradicted by every systematic review."
Dr. Kaltiala had previously called the affirm-or-suicide narrative "purposeful disinformation" and its promotion (given the contagious nature of suicide) "irresponsible."

tabletmag.com/sections/scien…
"The politicization of transgender healthcare in the US is unfortunate," write the intl' experts. "The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks."
Read the letter here: wsj.com/articles/trans…
For an analysis of how and why the U.S. and Europe are diverging:

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More from @LeorSapir

Leor Sapir Profile picture
Nov 21
1/ As @abigailandwords correctly notes in @NRO, the @APApsychiatric agreed to participate in the peer-review process and condemned the report for overlooking 16 studies, but the APA itself overlooked the HHS report's evidence review, which included 12 of those studies. In fact, several of them (e.g., Tordoff, Chen, de Vries) were discussed in detail in the main report. Of the remaining 4 studies, 3 were on adults rather than youth, and 1 was published after the HHS Review came out (though the final version does account for it).

#ReadtheReportImage
2/ Here is a summary of the allegedly overlooked studies cited by @APApsychiatric and where they appear in the HHS Review. It can easily be found in the Supplement, which was published on Wednesday. Image
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3/ The APA had no response to our analysis of studies like Chen (2023) and Tordoff (2022), or to the umbrella review, which is mentioned throughout the report.

The APA did not engage with, and possibly did not even see, the most critical part of the HHS Review.
Read 8 tweets
Leor Sapir Profile picture
Nov 21
🚨With a puberty blocker trial looming in the UK, here is why the HHS Review concludes: "administering [pediatric medical transition] to adolescents, even in a research context, is in tension with well-established ethical norms for human subjects research." 1/5

#ReadtheReport Image
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Read 7 tweets
Leor Sapir Profile picture
Oct 23
Big news 🚨

District court vacates Biden-era rule declaring that “sex” in Section 1557 of the ACA includes “gender identity.”

This rule and its antecedents in the Obama years mandated that healthcare providers offer “gender-affirming care.” 1/ Image
2/ The court disagreed with the Biden HHS that the Supreme Court’s reasoning in Bostock v. Clayton Country (2020) requires interpreting Title IX (imported into 1557) to mean that sex = gender identity.

Even if that were true, the court adds, Bostock doesn’t compel gender Rx.
3/ The court finds that the Biden HHS exceeded its authority when interpreting Section 1557 as it did.

Interpreting sex as “gender identity” is a legislative act, and thus something only Congress may do.
Read 5 tweets
Leor Sapir Profile picture
Aug 27
NEW: My analysis of the @AmerMedicalAssn videos published yesterday and today by @realDailyWire @benshapiro is now available at @CityJournal.

This is the most vivid illustration I’ve seen of the broken chain of trust in medicine. 1/Image
2/ The AMA president, Dr. Bobby Mukkamala, cites false stats on gender medicine and suicide (“50 to 70 percent”).

Worse, he seems unaware of how evidence-based medicine works, specifically with regard to conflicts of interest in evidence evaluation.
3/ He then recommends that @BradPaquetteMI speak to an “expert” on the evidence: a recently graduated physician named Jesse Krikorian, who identifies as transgender and practices in Michigan. Image
Read 8 tweets
Leor Sapir Profile picture
May 13
Scott Leibowitz, a gender clinician and author of @wpath SOC-8, writing in @medpagetoday makes some pretty astonishing claims about the recently published @HHSGov report on pediatric gender dysphoria.

Here are four examples🧵
Regret and Bans

According to Leibowitz, the report "heavily emphasizes concern for regret to justify its extreme positions supporting gender care bans."

FACT: The report explains that while "proponents and critics alike consider the question of regret as central to the ethics of PMT," in fact "regret alone... is not a valid indicator of whether an intervention is medically justified." Patients can regret justified medical interventions or be satisfied with unjustified ones. See Section 13.4.

The report does not recommend or condemn bans; it explicitly says that it "does not issue legislative or policy recommendations" (p. 10).
Psychotherapy

Leibowitz: "the definition of 'appropriate' psychotherapy [the report] employs is questionable, especially considering the apparent lack of input from experienced clinicians in the field, whose public perspectives are conspicuously absent from the publication."

FACT: the word "apparent" is doing a lot of work here. More importantly, it is ironic for Leibowitz to complain about lack of balance among the report's authors. Leibowitz was co-chair of the Adolescent chapter of WPATH SOC-8, a guideline that was developed with a strictly enforced litmus test: only "affirming" clinicians supportive of medical interventions were invited to participate. The HHS report discusses this issue at length (Section 10.3).
Read 7 tweets
Leor Sapir Profile picture
Mar 17
🚨Dr. Daniel Shumer of @UMichMedSchool is a prolific expert witness in transgender litigation. He has served as expert witness in “about 15” lawsuits and has been paid around $150,000 over the past 4-5 years.

Shumer has admitted to plagiarism in his expert report.

🧵Image
The admission was made in a deposition on March 5, in the context of litigation (Doe v. Horne) over an Arizona law prohibiting males from competing in female sports.Image
At the beginning of the deposition, the examining lawyer asks Shumer to confirm his sworn attestation that he is the sole author of his expert report.

"I was the sole author of the report," he replies (12:25, 13:1).
Read 12 tweets

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