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.
Activist-blogger Erin Reed has published a guest article:
"Washington Post Editorial Board Misleadingly Attacks Care Of Trans Youth"
In, fact, many of the claims in this essay challenging WaPo are themselves misleading.
I will go through them in this 🧵⬇️
"It selectively cites three European reviews critical of gender-affirming care, while ignoring the consensus of leading medical organizations—including the American Academy of Pediatrics, the American Psychological Association, the American Medical Association, the Endocrine Society, and the World Professional Association for Transgender Health—all of which support such care."
▶️While WaPo hyperlinks to three European reviews, there have, in fact, been a half-dozen systematic literature reviews of pediatric gender-transition treatment. All of them have found the evidence backing such interventions weak and inconclusive.
▶️This has lead the health authorities in the UK and four Scandinavian nations to reclassify such treatment as experimental, and to sharply restrict access, in some cases to research settings only.
▶️The Cass Review found that WPATH and the US medical societies that endorse such interventions have engaged in "circularity," which is a more polite term for "citation laundering." WPATH made claims that were not supported by strong evidence in its 2013 Standards of Care 7. Then other US medical societies referred to those claims. And then it its SoC 8 in 2022, WPATH referred to those other societies, not mentioning that the claim they were referring to originated with WPATH. The near unanimity in these organizations is in part a product of the same people cross-pollinating their ideas from one organization to the next.
*Hilary Cass was chosen not in spite of her lack of experience in pediatric gender medicine, but because of it. Ideally, people assessing the strength of evidence in a field will not have financial or intellectual conflicts of interest, as did every single author of WPATH's SoC8.
*A couple of dozen members of the BMA moved to denounce and scrutinize the Cass Review this summer. But after an internal outcry and a letter of protest signed by over 1,000 members, the BMA backpedaled and now has a neutral posture as it conducts its review of the Cass Review.
*Despite the fact that the Yale Law School put up the white paper criticizing Cass on its website, claiming it is the product of experts at Yale is a stretch. There is a Yale Law author, and otherwise Meredith McNamara is the lead author. Speaking of people who have no experience with pediatric gender medicine: she is such a person. Under pressure in a deposition in a Alabama civil case, she admitted that in her entire career as a pediatrician, she has only ever referred two patients to a pediatric gender clinic and has never prescribed pediatric gender-transition treatment. And yet she presents herself in myriad forums as a leading expert on this medical care.
In the wake of the detransitioner lawsuit against them, Children’s Hospital Los Angeles has released the following statement, as quoted in WSJ and many other outlets. This statement is highly misleading. The clinic didn’t start giving blockers and hormones to minors with gender dysphoria until 2008 or 2009, according to what I can ascertain. Boston Children’s was the first to do so in the U.S., and their operation began in 2007. So the statement from CHLA effectively doubles the amount of time that they have been engaging in the medical practices that the lawsuit concerns.
It is important for reporters to seek to verify claims made by the subjects of lawsuits. The claim about caring for such kids for 30 years would’ve been pretty easy to fact check.
Several things about Michael Hobbes' false suggestion that my reporting fell apart upon closer inspection:
1) Amy Tishelman was not a whistleblower. She characterized Boston Children's practices as part of a civil trial focused on other things. She filed a lawsuit claiming discrimination and was fired and sued and won her retaliation claim. She did not quit and then go to a higher authority to report the clinic's practices. Instead, she, like Boston Children's, kept them secret.
2) As Tishelman told the Globe, she was not concerned so much about the type of child that the Globe article primarily described: a child with longstanding gender dysphoria that started young. These children were intimately involved with the gender clinic, GeMS, for many years before it came time to assess them for a medical transition.
What Tishelman was concerned about was the type of minor who is now the prototype for those presenting at gender clinics: those who only first express gender dysphoria in adolescence. If these kids show up at the clinic, they will possibly seek medicalization immediately. And all they will get is a single two-hour assessment with a psychologist before being referred to endocrinology.
3) Nothing about the second Globe story contradicted my reporting or the previous Globe reporting. The article frankly blurred the lines between the different prototypes of gender dysphoric children to lend readers the impression that all kids under the Boston Children's system are going to get slow, ongoing care with no rushed decisions.
4) The fact remains that it is Boston Children's policy, and has been since 2018, that if a minor walks in the door and has already started puberty and is looking for transition medications, they will be provided only a single two-hour assessment appointment with a psychologist before being referred to endocrinology.
I stand by my reporting:
Michael Hobbes Is Wrong About Whether Kids Are Being Rushed Onto Gender-Transition Drugs
I juxtapose clips of debunking podcaster Michael Hobbes insisting there's no evidence kids are being rushed onto gender-transition drugs with testimony proving Boston Children's is doing just that.benryan.substack.com/p/michael-hobb…
I published my first article about pediatric gender medicine a year ago today.
Here is a 🧵of my reporting on the subject over the past 12 months:
Lawsuits by Regretful ‘Detransitioners’ Take Aim at Medical Establishment’s Support for Gender-Transition Treatments for Minors nysun.com/article/lawsui…
Sued Over Policies on Transgender Children, American Academy of Pediatrics Pulls Forthcoming Book, Takes Steps To Protect Emails From Prying Eyes nysun.com/article/sued-o…
BREAKING: Detransitioner Sues Johanna Olson-Kennedy, a Top Pediatric Gender Medicine Doctor, For Medical Negligence
🧵⬇️⬇️I report: Dr. Olson-Kennedy is the most prominent doctor yet to be sued by a detransitioner—for medical negligence after overseeing a mentally ill girl's gender-transition starting at 12 and mastectomy at 14. She recommended a hysterectomy at 17.
LINK: Detransitioner Sues Johanna Olson-Kennedy, a Top Pediatric Gender Medicine Doctor, For Medical Negligence
🧵 The plaintiff suing Johanna Olson-Kennedy reports having suffered from severe, worsening mental illness while Dr. Olson-Kennedy oversaw her gender-transition treatment, including a double mastectomy at age 14. Now a college student, she recently detransitioned. benryan.substack.com/publish/posts/…