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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
May 8
NEW: UCSF's (@UCSF @UCSF_IHPS) Dr. Jack Turban (@jack_turban) claimed at @theDPUnion debate that the Cass-related systematic reviews found moderate quality evidence that puberty blockers improve mental health.

In a new article, I explain why this claim is false.

⬇️⬇️⬇️
2/ First, Turban confuses quality of studies with quality of evidence. These are distinct concepts in evidence-based medicine, and any clinician opining on the evidence base of medical treatments should understand the difference.
3/ Quality of studies has to do with risk of bias in research. Quality of evidence has to do with our confidence in the estimate of the effects of an intervention on outcomes of interest.
Read 18 tweets
Leor Sapir Profile picture
May 5
UCSF's (@UCSF @UCSF_IHPS) Jack Turban (@jack_turban) claims that a new systematic review of the evidence for puberty blockers, published alongside the Cass Review (@thecassreview), finds “moderate quality evidence" for the use of these drugs in youth gender medicine.

⬇️⬇️⬇️
In an upcoming article, I explain how Turban confuses quality of studies with quality of evidence—two very different concepts in evidence-based medicine—and ignores the significance of the scoring tool the authors of the systematic reviews used. 2/
As science journalist Ben Ryan (@benryanwriter) points out, Turban conveniently forgot to disclose to the Dartmouth audience that the new systematic review excluded his own 2020 study on puberty blockers from the final synthesis. 3/

Read 10 tweets
Leor Sapir Profile picture
Mar 27
I just read the complaint filed by the ACLU of Ohio (@acluohio) asking a state court for temporary injunction against HB68, the new law that restricts “gender-affirming care" to adults only.

What a mess of a document.

⬇️⬇️⬇️
1. ACLU can’t seem to decide if it’s alleging disparate treatment or disparate impact. These are different theories for why some law or policy may violate civil rights or constitutional provisions.
The ACLU says that “transgender people have obvious, immutable, and distinguishing characteristics that define that class as a discrete group.” HB68 “expressly discriminates against transgender adolescents… based on the incongruence between their sex and gender identity.”
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Read 26 tweets
Leor Sapir Profile picture
Mar 22
Andrea Long Chu's (@andrealongchu) March 11th cover story for @NYMag has sparked some thoughtful reflection in liberal journalism.

⬇️⬇️⬇️
Chu’s essay is worth reading. It makes the case for unrestricted minor access to hormones and surgeries, ignores everything we know about child and adolescent psychology, and openly states that humans have no obligation to come to terms with reality.
I would argue that what Chu says *should* happen in pediatric medicine *already is* happening, more or less.

nymag.com/intelligencer/…
Read 13 tweets
Leor Sapir Profile picture
Mar 10
The Mary Bridge Children's Gender Health Clinic (@Mary_Bridge), which is part of MultiCare health system (@MultiCareHealth) in Tacoma, Washington, and site of whistleblower Tamara Pietzke, offers kids resources on binding and tucking. /1

⬇️⬇️⬇️
Tucking is the process by which boys push their testicles up into the inguinal canal, use their testicle-free scrotum to wrap their penis, and then secure their wrapped penis within their butt cheeks using methods like compression underwear or tape. /2
The Mary Bridge gender clinic says that tucking is "normal for many identities." It admits, however, that "research on the safety" of this practice, including about harmful side-effects, "is very limited and sparse," and recommends that kids do "[their] own research." /3
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Read 8 tweets
Leor Sapir Profile picture
Mar 5
With the release of the WPATH Files, it's important to keep in mind that WPATH has been using mainstream medical associations like the Endocrine Society (@TheEndoSociety) to launder its pseudoscientific claims and promote experimental and harmful practices.

A thread.
At least 6 of the 10 authors of the Endocrine Society’s 2017 Clinical Practice Guideline were/are WPATH members. That guideline is still in effect today. Image
Recently, the Endocrine Society decided to convene a new group to update its guidelines. It did so in secret, but last week, I very likely forced the exposure of this initiative.

city-journal.org/article/stacki…
Read 10 tweets

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