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Leor Sapir Profile picture
@LeorSapir
Jul 13, 2023 • 12 tweets • 3 min read • Read on X
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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
Feb 7
🚨While attention has been focused on medical groups backing off from gender surgeries in minors and a $2M detransitioner lawsuit, an important exchange has taken place in Stat News Opinion First between authors and critics of the HHS report on pediatric gender dysphoria.

👇
Last week, a group of self-described “pediatric bioethicists” and advocates for pediatric medical transition (PMT), including Yale Medicine’s Meredithe McNamara, criticized the HHS report, writing that “analysis of its poor ethical reasoning remains urgently needed.” Image
Today, a group of HHS report authors responded, explaining why the report’s reasoning is consistent with widely accepted principles of medical ethics and pointing to serious flaws in the McNamara group’s article. Image
Image
Read 5 tweets
Leor Sapir Profile picture
Feb 3
BREAKING: American Society of Plastic Surgeons issues new position statement opposing "gender-affirming" surgeries in adolescents under the age of 19.

ASPS also acknowledges risks of endocrine interventions, poor guidelines, and inappropriate use of "autonomy" principle. Image
plasticsurgery.org/for-medical-pr…
Here is the @HHSGov @HHSResponse press release

hhs.gov/press-room/asp…
Read 10 tweets
Leor Sapir Profile picture
Feb 2
Thousands of U.S. parents have consented to having surgeons remove their daughters' breasts after being assured that their daughters were at serious risk of suicide otherwise.

Now, the incoming president of WPATH says mastectomy "in and of itself" doesn't prevent suicide.
This is the result of our data analysis of U.S. insurance claims. A bare minimum of 5,200 teen girls had their breasts amputated as part of a "gender-affirming" procedure between 2017 and 2023.

The true number is likely quite a bit higher. Image
city-journal.org/article/a-cons…
Read 4 tweets
Leor Sapir Profile picture
Nov 21, 2025
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, 2025
🚨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
2/5 Image
3/5 Image
Read 7 tweets
Leor Sapir Profile picture
Oct 23, 2025
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

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