The American Academy of Pediatrics and the Endocrine Society, the two most influential US medical societies in pediatric gender medicine, have issued their first known statements on England's Cass Review on the subject, to @WBUR's @OnPointRadio:
STATEMENT FROM AMERICAN ACADEMY OF PEDIATRICS: Statement from American Academy of Pediatrics President, Dr. Ben Hoffman:
“The AAP’s gender -affirming care policy, like all our standing guidance, is grounded in evidence and science. Pediatricians understand the complexities of gender-affirming care and they know how to counsel families. The goal is not a certain treatment or timeline, but instead to listen to the patient and create a safe environment to address their needs. “What we’re seeing more and more is that the politically infused public discourse is getting this wrong — and it’s impacting the way that doctors care for their patients.
Physicians must be able to practice medicine that is informed by their medical education, training, experience, and the available evidence, freely and without the threat of punishment. Instead, state legislatures have passed bills to ban and restrict gender-affirming care, which means that right now, for far too many families, their zip code determines their ability to seek the health care they need. Politicians have inserted themselves into the exam room, and this is dangerous for both physicians and for families.”
Here is the Endocrine Society's statement on the Cass Review, given to @WBUR's @OnPointRadio. In short, "Medical evidence, not politics, should inform treatment decisions."
STATEMENT FROM ENDOCRINE SOCIETY: We stand firm in our support of gender-affirming care. Transgender and gender-diverse people deserve access to needed and often life-saving medical care.
NHS England’s recent report, the Cass Review, does not contain any new research that would contradict the recommendations made in our Clinical Practice Guideline on gender-affirming care.
The guideline, which cites more than 260 research studies, recommends a very conservative approach to care, with no medical intervention prior to puberty. Estimates indicate only a fraction of transgender and gender-diverse adolescents opt to take puberty-delaying medications, which have been used to treat early puberty in youth for four decades.
• The guideline recommends beginning treatment with puberty-delaying medications that are generally reversible.
• As adolescents grow older and can provide informed consent, then hormone therapy can be considered.
• Our guideline suggests waiting until an individual has turned 18 or reached the age of majority in their country to undergo gender-affirming genital surgery.
Medical evidence, not politics, should inform treatment decisions.
Our Clinical Practice Guidelines are developed using a robust and rigorous process that adheres to the highest standards of trustworthiness and transparency as defined by the Institute of Medicine (now the National Academy of Medicine).
Our guideline development panels spend years developing each guideline based on a thorough review of medical evidence, author expertise, rigorous scientific review, and a transparent process.
More than 18,000 Endocrine Society members worldwide have an opportunity to comment on guideline drafts prior to publication.
The Society is in the process of updating the 2017 Clinical Practice Guideline. It was one of six selected for a routine update.
The process will incorporate the latest research and conduct systematic reviews to provide guidance on the safe and effective treatment of gender incongruence and dysphoria from an endocrine perspective.
We agree that increased funding for youth and adult transgender health research programs is needed to close the gaps in knowledge regarding transgender medical care and should be made a priority.
Although the scientific landscape has not changed significantly, misinformation about gender-affirming care is being politicized.
In the United States, 24 states have enacted laws or policies barring adolescents’ access to gender-affirming care, according to the Kaiser Family Foundation. In seven states, the policies also include provisions that would prevent at least some adults over age 18 from accessing gender-affirming care.
Cisgender teenagers, together with their parents or guardians, are deemed competent to give consent to various medical treatments.
Teenagers who have gender incongruence and their parents and guardians should not be discriminated against.
Transgender and gender-diverse teenagers, their parents, and physicians should be able to determine the appropriate course of treatment.
Banning evidence-based medical care based on misinformation takes away the ability of parents and patients to make informed decisions.
Medical evidence, not politics, should inform treatment decisions.
The @AmerAcadPeds never responded to @JamesCantorPhD's scathing fact check of its 2018 policy statement on the affirmative care model for gender distressed children. Instead, it reaffirmed the policy statement in Aug 2023 with no changes. ohchr.org/sites/default/…
The AAP is subject to a lawsuit from a detransitioner, as I wrote for the @NewYorkSun: nysun.com/article/lawsui…
The AAP has become increasingly secretive about its work on the subject of gender distressed children. nysun.com/article/sued-o…
In its statement to @WBUR, the Endocrine Society says that "only a fraction" of gender distressed children receive medical transition. This after @WPATH said in a statement responding to the Cass Review that the majority of such children would do better to medically transition.
Clara Jeffery, editor in chief of Mother Jones, says that it is for the best that JD Vance’s children be subjected to boos at Disneyland, so that they “know now what their father is about.”
Debunking podcaster Michael Hobbes also endorses the jeers at @JDVance’s family at Disneyland.
Clara Jeffery, editor in chief of Mother Jones, adds the following to her post endorsing the jeering of @JDVance while he is with his children at Disneyland. She argues that he actually wants the optics of being booed while having family time in public. bsky.app/profile/claraj…
Democrats Lost Voters on Transgender Rights. Winning Them Back Won’t Be Easy.
The party’s vanguard position got ahead of voters in 2024, and the internal debate now underway reveals an uncertainty on how to adapt, by @chashomans for @nytimes.
"Stuck in a widening gulf between the views of the party’s liberal voters and advocacy organizations on one side, and those of the broader American electorate on the other, many Democratic politicians had resolved to say as little as possible about the subject. In surveys, Ms. Erickson and other public-opinion researchers had found that this allowed Republicans, who spent hundreds of millions of dollars on ads attacking Democrats on transgender rights in 2024, to define voters’ perceptions of Democratic policy positions."
The dilemma is reflective of the Democratic Party’s broader struggles with identity politics as it dissects its losses in 2024. Recovering its standing with voters, many in the party believe, requires coming to terms with the party’s transformation during the Obama and first Trump presidencies, when American liberals broadly embraced what had previously been vanguard positions on a range of social and cultural issues, including gender and race, immigration and policing.
Dr. Rachel Levine, a former Biden administration health official, tells @TheAdvocateMag that "the evidence base is strong for the safety and efficacy" of prescribing puberty blockers and cross-sex hormones to treat gender dysphoria in minors.
A slew of systematic literature reviews have found this is not the case. Instead, they have found that the relevant evidence is weak and inconclusive. They have suggested that the World Professional Association for Transgender Health erred in making strong recommendations for these treatments. Evidence-based medicine guidelines discourage making a strong recommendation based on weak evidence.
Despite subpoenaed email records showing that Dr. Rachel Levine pushed WPATH to remove age limits on pediatric gender-transition treatments and surgeries for political reasons, Dr. Levine denied ever having done so in an interview with @TheAdvocate.
The New York Times reported last year: nytimes.com/2024/06/25/hea…
One excerpt from an unnamed member of the WPATH guideline development group recalled a conversation with Sarah Boateng, then serving as Admiral Levine’s chief of staff: “She is confident, based on the rhetoric she is hearing in D.C., and from what we have already seen, that these specific listings of ages, under 18, will result in devastating legislation for trans care. She wonders if the specific ages can be taken out.”
Another email stated that Admiral Levine “was very concerned that having ages (mainly for surgery) will affect access to care for trans youth and maybe adults, too. Apparently the situation in the U.S.A. is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them.”
Debunking podcaster Michael Hobbes has a new episode of his podcast If Books Could Kill, about the US v. Skrmetti Supreme Court decision upholding Tennessee's ban on pediatric gender-transition treatment.
Michael Hobbes, referring to a video, published in 2022 by @MattWalshBlog, of a Vanderbilt doctor talking about the money that gender-transition surgeries bring in, including bottom surgeries: “Bottom surgeries are essentially not performed on children," Hobbes says. "So the fact that she's talking about bottom surgeries here makes it very clear that she's talking about adults.”
This depends on your definition of "essentially." Phallopasties are not recommended by @WPATH for minors, but vaginoplasties are. Dr. Marci Bowers, a gender-affirming surgeon and a former WPATH president, recommends that trans girls get a vaginoplasty the summer before they leave for college, when they are 17 or 18.
A 2023 paper on a limited dataset of US minor patients did find evidence of one vaginoplasty in 2021. This suggests that if the study authors had access to all records in the nation, they would identify more such surgeries in minors.
Consequently, Hobbes is incorrect to presume that the Vanderbilt doctor was not referring to minors in the speech that Walsh published. It is entirely possible she was.
If, for the sake of argument, no one can prove that pediatric gender-transition treatment prevents suicide death only because such deaths are so rare, then why has this treatment been sold, first and foremost, as “lifesaving”?
Why have people who have called that claim into question been savagely attacked and sidelined?
Marci Bowers, former head of WPATH, herself told me last year that suicide death has never been a good metric of the success of this treatment.
Debunking podcaster Michael Hobbes is himself one of the prime sources of misinformation about pediatric gender-transition treatment. He has routinely falsely claimed that there is no evidence that children get these drugs after absent or cursory assessment periods. There is copious evidence that this happens routinely at some of the top gender clinics in the nation. Despite all this evidence, Hobbes has never acknowledged his fault.
But you can see here that he is combining his longstanding claim about assessments with a claim about what he characterizes as false claims that there are large numbers of kids getting these drugs. That question should not necessarily be conflated with the assessment question.
About 1 in 1,000 youth with private health insurance went on cross sex hormones by age 17 between 2018 and 2022. That number was higher for natal girls and was probably higher for all youth by the end of that period.
One thing that has concerned some people is not necessarily the number of kids getting these drugs, but the rate of increase of that number. They have been concerned over where that figure might end up.
If suicide deaths are so rare even in youth with gender dysphoria, then why have leading gender clinicians routinely told parents that absent blockers and hormones, their child was extremely likely to wind up dead? That’s what the mantra “Would you rather have a dead son or a live daughter?” implies. We now know from the leading litigator in this field that that threat was a false one, at the very least in the suggestion of how likely suicide death was in the first place.
Debunking podcaster Michael Hobbes, a prime source of misinformation about pediatric gender-transition treatment, slams @HelenLewis of @TheAtlantic for criticizing people such as him.