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Benjamin Ryan

@benryanwriter

Aug 8, 2024 • 17 tweets • 14 min read • Read on X

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A Few Fact Checks of The New Attack on the Cass Review
🧵A pair of doctors who worked for the UK's pediatric gender clinic, GIDS, and its nascent successor, have put onto a public Google doc an attack of the Cass Review of pediatric gender care. Most notably, they claim that Dr. Hilary Cass told them before she started work on the review at that they should read @AbigailShrier's Irreversible Damage book.

Otherwise, there are a few errors that I spotted in the Google doc, which I'll post in the thread below.

The Google doc paper, shown in the screenshot on the left, claims that an audit of GIDS patients, detailed in Appendix 8 of the Cass Review, showed that kids had 6 to 15 appointments prior to a referral to endocrinology. This is incorrect, as the chart from that appendix demonstrates (the screenshot on the right). A substantial proportion of kids were referred to endocrinology after 2-5 appointments. And as the authors of the Google doc paper noted, the average number of appointments prior to the Dec 2020 Bell v Tavistock decision was 6.7. (Note that for some reason, the Google doc piece sometimes refers to GIDS as GID.)

docs.google.com/document/d/e/2…
cass.independent-review.uk/home/publicati…

It's also important to note that the audit data included in Appendix 8 of the Cass Review only includes data on GIDS patients who were discharged, whether because they left the clinic or because they aged out. It is not a comprehensive sweep of all children seen by GIDS from 2018 to 2022 as the Google doc asserts.

I have repeatedly corrected the math and the logic in the following claim about detransitioning at GIDS, but here we go again. In the Google doc, the authors claim that just 0.3% of the kids at GIDS detransitioned.

Firstly, because the audit only included discharge data, it could only capture GIDS patients up to age 18. It had no information on their young-adult lives; the NHS adult clinics refused to share with Cass any data on former GIDS patients. And since it can take quiet a few years after a medical transition for detransition to occur (Cass said experts told her it can take 5-10 years), this audit is incapable of capturing a comprehensive account of any detransitioning. This is especially true considering that the typical GIDS patient only started puberty blockers at age 15 or 16 and had to be on them for a substantial period (I believe it was 1 year) before they were allowed to start hormones, leaving a very short window for any detransitioning to occur by age 18.

Second, the Google doc authors have the denominator wrong. To detransition, someone would need to have taken cross-sex hormones. Only 516 of the young people included in the audit took CSHs. If fewer than 10 detransitioned by age 18, let's say that's 8 people. 8/516 = 1.5%

The screenshot on the left is from the Google doc. The one on the right is p 168 of the Cass Review.

docs.google.com/document/d/e/2…
cass.independent-review.uk/home/publicati…

The authors of the Google doc attack on the Cass Review also claim that that after the Care Quality Commission gave the GIDS gender clinic at Tavistock a grade of "inadequate" in 2021, the CQC came back and gave them a "much more positive" assessment in 2023. In the link that the Google doc provides in the footnotes, the CQC states of its inspection of GIDS: "Inspectors did not re-rate the service following this latest inspection. Therefore, the ratings from the previous inspection remain in place until the service closes." While all of Tavistock had a good rating, GIDS's remained "inadequate".

Screenshots: 1) The Google doc paper; 2) The ratings of the various components of Tavistock, per the CQC; 3) and 4) The main findings of the 2023 CQC re-assessment of GIDS.

docs.google.com/document/d/e/2…
cqc.org.uk/press-release/…
cqc.org.uk/provider/RNK?r…
api.cqc.org.uk/public/v1/repo…

I remain surprised when academics and doctors, such as the authors of the Google doc paper, deny the very well documented shift in demographics of young people presenting at gender clinics. I recently wrote: "As recently as the late 2000s, this was a tiny group comprised largely of biological males who displayed marked gender incongruence starting in early childhood. Now these clinics are inundated by a ballooning population of predominantly natal girls, many of whom had no apparent early-childhood gender incongruence and first expressed a trans identity only in adolescence."

capmh.biomedcentral.com/articles/10.11…
reuters.com/investigates/s…
pubmed.ncbi.nlm.nih.gov/31619510/
cass.independent-review.uk/home/publicati…

In their attack on what is sometimes known as exploratory therapy, the Google doc paper authors refer uncritically to activist and transfeminine jurist Florence Ashley, who has claimed that any therapy that is not by definition gender affirmative is, in fact, conversion therapy. Psychologists Laura Edwards-Leeper and Erica Anderson, who wrote about what's been called exploratory therapy in the Washington Post, disagree. Edwards-Leeper helped found the first pediatric gender clinic at Boston Children's in 2007. Anderson is the former head of USPATH. Both of them have become critical of the movement to medicalize gender transition of children. But neither support bans and both believe that for some children, a medical pathway may indeed be appropriate.

docs.google.com/document/d/e/2…
washingtonpost.com/outlook/2021/1…
pubmed.ncbi.nlm.nih.gov/36068009/

The Google doc paper attacking the Cass Review states that prescribing puberty blockers and cross-sex hormones to gender dysphoric minors "may have an uncertain evidence base, but one which broadly indicates benefit." I recently wrote: "Dr. Kathleen McDeavitt, a psychiatrist at the Baylor College of Medicine, recently analyzed 14 key studies of pediatric gender-transition treatment that followed participants over time, including many on Dr. Turban’s list. She reached a markedly different conclusion in her review paper, published in June, than he does. Dr. McDeavitt found 'inconsistent demonstration of benefit with respect to depression and suicidality' from providing gender-distressed kids with blockers, hormones or both. Some study authors, she further concluded, 'articulated positive outcomes about hormonal interventions even in the setting of insignificant, small or negative findings.'”

docs.google.com/document/d/e/2…
onlinelibrary.wiley.com/doi/10.1111/ap…

The Google doc paper claims that it is untrue that the GIDS clinic launched its medical gender transition program based on only one study. It absolutely is true that the GIDS program as it was known until it was shuttered in March 2024 was based on the 2011 paper on the Dutch model.

Regardless of whether today there are over 100 studies about gender-transition treatment in minors, that was the first longitudinal cohort study ever to published about prescribing puberty blockers and cross-sex hormones to treat gender dysphoria in children.

It's also important to note that there have been not much more than a dozen longitudinal cohort studies of pediatric gender-transition treatment.
pubmed.ncbi.nlm.nih.gov/20646177/

Nowhere in the Google doc paper do they mention the two most important ethical concerns about prescribing puberty blockers and cross-sex hormones to children: infertility and sexual dysfunction.
docs.google.com/document/d/e/2…

Yesterday, the NHS published a blueprint of how it intends to implement the recommendations of the Cass Review over the next two years. I wrote about those plans here: benryan.substack.com/p/englands-nat…

https://x.com/benryanwriter/status/1793830026854768805

Among those whom @MaxDavie, one of the authors of the paper attacking the Cass Review, thank are activist Mallory Moore @Chican3ry and debunking podcaster Michael Hobbes @RottenInDenmark. Moore, along with activist Alejandra Caraballo @Esqueer_, was centrally responsible for the misinformation about the Cass Review that it supposedly simply discarded most studies about pediatric gender medicine. Dr. Cass ultimately denounced Moore's efforts put children at risk and were "unforgivable."

Hobbes' podcasts and tweets about the Cass Review have been masterclasses in misinformation peddling.

bbc.com/news/health-68…

https://x.com/benryanwriter/status/1793830026854768805

https://x.com/benryanwriter/status/1797667270166253943

https://x.com/benryanwriter/status/1794017414859952238

https://twitter.com/maxdavie/status/1821195577809678356

@maxdavie @Chican3ry @RottenInDenmark @Esqueer_ The coauthor on why they didn’t seek peer review for the paper they put in a Google doc attacking the Cass Review:

https://twitter.com/maxdavie/status/1821195577809678356

https://twitter.com/benryanwriter/status/1808014903195668925

@BolyardLaura

https://twitter.com/benryanwriter/status/1808014903195668925

@BolyardLaura osf.io/preprints/osf/…

A coauthor of the Google-doc paper attacking the Cass Review distances himself from the activists and pundits he thanked as inspiration for his paper.

https://twitter.com/benryanwriter/status/1821960553809465500

https://twitter.com/benryanwriter/status/1821960553809465500

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Trans-activist Substacker Erin Reed has prompted an uproar over a panel of skeptics of pediatric gender medicine slated for Sunday at the Pediatric Academic Societies meeting in Boston.

Transgender activists and their allies are in an uproar over an upcoming medical-conference panel concerning pediatric gender medicine that features skeptics of this field whom activists accuse of being anti-trans.

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Benjamin Ryan

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https://x.com/benryanwriter/status/2041856288234025373

About Health Nerd's take-down of the Finnish study on mental health outcomes among youth attending gender clinics
🧵👇
The study isn't perfect by any means. There are fair reasons to criticize it. But Health Nerd's central thesis falls apart upon the simplest examination.

I find it very disappointing when people leverage their academic credentials to supposedly bust bad science or misinformation but only wind up spreading more misinformation in the process. Where are we these days if we can't trust people to use their credentials wisely and inspire trust in those with advanced degrees?

I've tried explaining to Health Nerd what he got wrong, to no avail. It was like arguing with a character in a Lewis Caroll poem.

See the thread below.

https://x.com/benryanwriter/status/2041856288234025373

Health Nerd's argument depends on redefining the study’s outcome variable as “how many times kids saw a psychiatrist for any problem.” No, that's not what the paper measures. It measures contacts with specialist-level psychiatric treatment. In Finland, that is referral-based care generally reserved for more serious mental illness. Milder mental health problems are handled in primary care. gidmk.substack.com/p/does-gender-…

That distinction between primary-care services and specialist psych care matters. It's the reason the authors use this variable in the first place. It's not a measure of casual or routine mental health visits.

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Benjamin Ryan

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HOW GENDER MEDICINE SET ITSELF UP FOR DISASTER

For @CompactMag, I report on what the 100s of WPATH conference videos I obtained tell us about this troubled field: compactmag.com/article/how-ge…

👉I 'll be publishing the conference videos on my Substack: benryan.substack.com/p/i-obtained-1…

As I write for Compact magazine:

This catalogue, which the World Professional Association for Transgender Health, or WPATH, fought to keep shielded, provides a rich account of how leading figures in pediatric gender medicine approached scientific research, drove the evolution of medical practices, and strategized politically during a critical turning point in this field’s brief and tortured history. The two years following Chase Strangio’s 2021 address were a period in which statehouse Republicans escalated their attacks on this field. The WPATH conference presenters largely responded to the political siege by doubling down. Rather than engage in soul searching over whether their methods in pediatrics were ethically sound and whether any criticisms had merit, they overwhelmingly stuck to their guns.

Presenters frequently downplayed fundamental hazards about irrevocably altering adolescents’ bodies. Meanwhile, a parade of systematic reviews—the gold standard of scientific evidence—was concluding that the evidencebacking pediatric gender medicine is weak and inconclusive. These findings have led health authorities in a number of European nations, concerned about risks such as infertility, to reverse course. They reclassified pediatric gender-transition interventions as experimental and sharply restricted minors’ access.

Not WPATH. The organization remained on an inexorable trajectory in the opposite direction, toward its eventual head-on collision with the second Trump administration.

For highlight clips, see the 🧵👇

Kellan Baker counseled against saying “gender-affirming care.” Messaging research indicated that when people hear it, he said, “they think ‘trans kids in the driver’s seat.’” But he said this was an accurate assessment. “I think we all support trans kids in the driver’s seat because it’s their bodies, it’s their lives,” he said.

“But when you think about folks who don’t know trans people, they are very scared by the idea that young people are making irreversible decisions and that no one else has any oversight over those decisions.”

To read my article in @CompactMag about the 100s of videos I obtained from the World Professional Association for Transgender Health (WPATH) and its US offshoot, USPATH: compactmag.com/article/how-ge…

I will be publishing the most notable conference videos on my Subsack: benryan.substack.com/p/i-obtained-1…

Johanna Olson-Kennedy: “I think that a lot of this conversation...gets talked about through a lens of ‘How can we make sure people are really trans,’ right? And ‘They’re not going to regret their decision later?’” But “that’s actually not the discussion that I’m interested in participating in," she said. "I’m interested in discussing and having a conversation about giving the very best possible care to trans young people—the care that they need and deserve.”

To read my article in @CompactMag about the 100s of videos I obtained from the World Professional Association for Transgender Health (WPATH) and its US offshoot, USPATH: compactmag.com/article/how-ge…

I will be publishing the most notable conference videos on my Subsack: benryan.substack.com/p/i-obtained-1…