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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
Oct 23
NEW: Azeen Ghorayshi reports in the @nytimes that prominent gender clinician Johanna Olson-Kennedy of @ChildrensLA has refused to publish data from a study on puberty blockers, fearing that the unimpressive results will be "weaponized" by critics of "gender-affirming care." 🧵 Image
Olson-Kennedy told the Times that the kids didn't improve because their mental health was "in really good shape" at the start of the study.

As Ghorayshi notes, this seems to contradict what Olson-Kennedy et al. reported in 2022 about the study's cohort at baseline. Image
Olson-Kennedy fears the study's results could be cited by critics of pediatric sex "change" in court cases. She doesn't seem to think that, as a medical researcher and clinician, her primary responsibility is to her current and future patients.

Doctors as agents of lawfare. Image
Read 11 tweets
Leor Sapir Profile picture
Oct 15
NEW: On behalf of @ManhattanInst, @ishapiro @JKetcham91 and I filed an amicus brief in support of Tennessee in U.S. v. Skrmetti, the Supreme Court case dealing with state age restrictions for sex trait modification procedures ("gender-affirming care").

🧵Image
2/ Our brief is a rebuttal to the amicus brief submitted by "Expert Researchers and Physicians" (McNamara et al.), which is a version of the Yale Integrity Project's white paper, which criticizes the Cass Review. Image
3/ We argue that McNamara et al. misrepresent the Cass Review, principles of evidence-based medicine, the findings of key studies, and the consistency of pediatric "gender-affirming care" with the wider field of pediatrics on the question of low- or very low-quality evidence. Image
Image
Read 10 tweets
Leor Sapir Profile picture
Oct 9
🚨NEW DOCUMENTS in the Alabama lawsuit over sex "change" age restrictions.

Some very interesting facts now coming to light. 🧵
1/ @wpath sought but did not receive the American Academy of Pediatrics’ (@ameracadpeds) endorsement for its eighth “Standards of Care” (SOC8).

In private emails to WPATH a colleague, SOC-8 lead author Eli Coleman said that this was “highly confidential.” Image
2/ Coleman appears to admit that it is misleading to claim that medical groups writing amicus briefs against age restriction laws means these groups endorse SOC-8. WPATH tried but failed to get endorsements. (Exhibit #190) Image
Image
Read 10 tweets
Leor Sapir Profile picture
Aug 30
🚨 CRITICAL FINDING

An ongoing @manhattaninst analysis of an all payer, all claims insurance database shows that the 7-year diagnostic persistence rate of adolescent gender dysphoria is between 40-50%.

I discuss this major finding in a new article for @CityJournal 🧵Image
A central belief justifying medical interventions for gender dysphoric (GD) adolescents is that, unlike childhood GD, GD that persists into (or even arises in) adolescence is almost always permanent. If the condition isn’t permanent, why offer Rx with permanent effects?
First, we analyzed the number of minors with GD in the U.S. between 2017 and 2023. We found 272,181 to 342,476 minors who had the diagnosis.

If we account for the 15% missing claims data in our data set, the range is roughly 320,000 to 400,000.
Image
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Read 4 tweets
Leor Sapir Profile picture
Aug 21
🚨NEW: I’ve received a FOIA’d file from the Washington State Department of Social and Health Services (@waDSHS) about a 17-year-old receiving puberty blockers.

I’ve seen some extreme cases of medicalization in the past, but this one stands out even for a deep blue state. 1/5
The kid is reported to have a “past [of] extensive abuse [including sexual] and neglect” and to have been through “93 different placements,” which include Qualified Residential Treatment Programs. 2/5Image
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The kid has “borderline intellectual functioning,” with “adaptive scoring in the 2nd percentile.”

A recent study found “a possible detrimental impact [from GnRHa] on IQ. These findings accord with the wider literature on GnRH expression and brain structure and function.”

Unclear whether or how the kid’s use of GnRHa affected IQ in his case. 3/5

onlinelibrary.wiley.com/doi/10.1111/ap…
Read 5 tweets
Leor Sapir Profile picture
Aug 19
"McNamara et al. [the misleadingly titled 'Yale report' criticizing the @thecassreview @Hilary_Cass] is an exceptionally misleading, confused, and fundamentally unprofessional document."

A must-read by @jessesingal, but let me add a few additional details. 🧵 Image
2/ The white paper is a good example of "eminence-based medicine." Its authors seemed to want to use the reputation of @Yale @YaleMed @YaleLawSch to bolster the credibility of the report. But they did so seemingly without first getting the approval of Yale.
3/ On July 1, the report was published and submitted by McNamara, the lead author, into evidence in Boe v. Marshall (Alabama). A little over a week later, the report was republished with a disclosure that the views it contains do not reflect those of the authors' institutions. It's not clear if the revised report, with the disclosure, is the one currently submitted into evidence in the lawsuit.Image
Read 9 tweets

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