Benjamin Ryan Profile picture
Sep 18, 2024 24 tweets 13 min read Read on X
New Evidence Challenges Institutionalized Belief That Transgender Teens Become Transgender Adults, Undermining Core Defense of Medical Gender Transitions for Minors

🧵New from me for @NewYorkSun:
A pair of analyses of insurance-claims data each found that the majority of youths diagnosed with gender-related distress saw that diagnosis vanish from their medical chart within six years.Image
LINK:

New Evidence Challenges Institutionalized Belief That Transgender Teens Become Transgender Adults, Undermining Core Defense of Medical Gender Transitions for Minors

nysun.com/article/new-ev…
A pair of new analyses of medical-records data are challenging the orthodoxy on the permanence of adolescent gender dysphoria. German and American investigators found that the majority of gender dysphoria-related diagnoses, including so-called gender incongruence, recorded in a minor or young adult’s medical chart were gone within within five or six years.
The belief that youth gender dysphoria is permanent is likely behind a bold argument recently made by the World Professional Association for Transgender Health. Wpathis an influential, largely U.S.-based medical activist group that publishes widely followed care and treatment guidelines for trans persons. The organization stated in April that the majority of trans-identified youths would be best served by a medical transition.Image
The ethics of beginning minors on what is typically meant to be lifelong hormonal treatment are controversial. Such powerful drugs pose the risk of rendering young people infertile and burdening them with permanent sexual dysfunction. And a half-dozen systematic literature reviews — the gold standard of scientific evidence — have found that the use of such medications to treat pediatric gender dysphoria is supported by weak and largely inconclusive research. nysun.com/article/new-ev…Image
Vocal supporters of broad pediatric access to such medical interventions, such as the Lgbtq nonprofits Human Rights Campaignand GLAAD and the ACLU, frequently seek to tip the ethical balance by claiming that gender-transition treatment is “life saving” for adolescents. The only study ever to assess the veracity of this oft-repeated claim — a paper that was published in February to considerable pushback and scrutiny from the pediatric gender medicine field — found that such treatment was not independently associated with a statistically significant difference in the suicide death rate among young people. nysun.com/article/new-ev…Image
All these complex ethical considerations notwithstanding, a widely influential 2018 policy statement from the American Academy of Pediatrics on what’s known as the gender-affirming care method for trans-identified minors instructs care providers to show deference to the child’s self-concept and preferences. These can include a medical gender transition.
The AAP policy statement goes so far as to assert that “research substantiates that children who are prepubertal and assert an identity of TDG”—meaning transgender or what’s known as gender diverse — “know their gender as clearly and as consistently as their developmentally equivalent peers” whose sex and gender identity are aligned. nysun.com/article/new-ev…Image
Leor Sapir, a research fellow at the Manhattan Institute, analyzed insurance-claims information from a database covering about 85 percent of insured Americans and spanning from 2017 to 2023. Publishing his findings on August 30 in the institute’s lay publication, City Journal, Dr. Sapir estimated that overall, about 320,000 to 400,000 minors received a gender dysphoria-related diagnosis during this period.  

@LeorSapir zeroed in on a cohort of about 6,600 adolescents who in 2017 were between 12.5 years and 17.5 years old, had a gender dysphoria-related diagnosis in their medical chart that year, and for whom doctors continuously filed medical claims through 2023. He found that at the end of this six-year period, only about 45 percent of these young people had such a diagnosis entered in their file. 

nysun.com/article/new-ev…Image
In June, a German team published a similar study in Deutsche Aertzeblatt, for which they analyzed 2013 to 2022 medical claims data in Germany among those who were 5 to 24 years old. They found that the annual diagnosis rate of gender dysphoria-related conditions in these young persons increased eightfold over the course of the decade, with 15- to 19-year-old natal females consistently posting the highest diagnosis rates. nysun.com/article/new-ev…Image
The investigators found that of the nearly 7,900 young persons with gender dysphoria-related diagnoses in 2017, just 36 percent, including the majority of all age groups, still had such a diagnosis entered in their file in 2022. The steepest drop-off was among the group of natal females who were in their late teens in 2017, just 27 percent of whom retained such a diagnosis five years later. nysun.com/article/new-ev…Image
M.I.T. philosophy professor Alex Byrne @byrne_a, on Monday published a letter to the editor in the Archives of Sexual Behavior in which he summed up the persistent enigma about this medical field: “Is childhood-onset gender dysphoria that persists into early puberty — or, alternatively, worsens with early puberty — highly persistent in adolescence and adulthood if untreated?” he asked. “In the opinion of many experts, yes. But the published evidence does not bear this out. The persistence rate, like the detransition rate, is unknown.”

link.springer.com/article/10.100…Image
Referring to pediatric gender medicine, @LeorSapir said in an email, “The field is virtually built on the assumption that, unlike childhood gender dysphoria which almost always desists, adolescent GD almost never does, resulting in a favorable risk: benefit ratio and ethical justification. At minimum, the evidence simply isn’t there.”

He continued: “Nor is the retreat to ‘true trans’ persuasive. As noted by the Cass Review, there is no diagnostic test that’s reliable enough to pick out the true trans kids from the temporary trans kids. And even if such a test existed, the vast majority of gender clinicians (it would seem) are not even trying to make such distinctions.”

nysun.com/article/new-ev…Image
Thomas D. Steensma, a health psychologist at Amsterdam UMC in the Netherlands and a leading pediatric gender medicine researcher, tells the Sun that identity exploration is a central, and perhaps the defining, quality of adolescence. “What we can conclude from these analyses,” he said of the new medical-claims investigations, “is that the prevalence of gender incongruence-related diagnoses has increased over the years; that the diagnosis does not persist in all people diagnosed; and that gender identity is still in development in children and minors.” nysun.com/article/new-ev…Image
Stephen Rosenthal, a professor of pediatrics in the division of pediatric endocrinology and the emeritus medical director of UCSF’s Child and Adolescent Gender Center, added that the pair of new insurance-claims analyses are limited by the fact that they don’t provide information about the context in which the gender dysphoria-related diagnoses were made. “In particular,” he said, “was there a thorough assessment by a qualified mental health gender specialist prior to making a determination of gender dysphoria and initiating some form of gender-related care?”
“Unfortunately, in my opinion,” Dr. Rosenthal said, “this interdisciplinary model of care is not followed by all gender clinics.” nysun.com/article/new-ev…Image
In stark contrast to his junior colleague at @UCSF, Dr. @Jack_Turban, Dr. Stephen Rosenthal suggested that a wider adoption and optimization of such comprehensive assessments could help identify which adolescents with gender dysphoria are most likely to see the condition persist.

“Can thorough mental health assessments be more widely integrated into care and optimized so that those who really need or benefit from gender-related care can be more clearly identified?” Dr. Rosenthal asked. nysun.com/article/new-ev…Image
@byrne_a @LeorSapir @UCSF @jack_turban Dr. Robert Garofalo, a pediatric gender clinician at @LurieChildrens in Chicago, has no means of assessing whether a child’s gender dysphoria is likely to persist. If the kid comes in looking for blockers, he just asks them their gender identity.
Diane Ehrensaft and @Jack_Turban of UCSF, who are major leaders in the pediatric gender field, published a paper in the journal of @AACAP about how to conduct a @WPATH assessment of a gender dysphoric adolescent. They tell people not to assess whether the child is “truly trans.”
jaacap.org/article/S0890-…Image
Image
@jack_turban @AACAP @wpath In his new book, @UCSF’s @Jack_Turban strongly suggests he thinks that assessments before putting minors on gender transition treatment should be done away with entirely and that such drugs should be as easy to obtain as Prozac.

open.substack.com/pub/benryan/p/…
Image
@ValidScience @NewYorkSun Image
@ValidScience @NewYorkSun Here’s the 2022 update:

nytimes.com/2022/05/04/hea…
Here is the original 2020 video of Robert Garofalo of Lurie Children's, in which he said that there is no method to determine whether a child is truly trans when they come in seeking puberty blockers. All they do is ask the kid what their gender ID is.
Over and over, I have told the truth about Dr. @Jack_Turban's writing and statements and how they sometime totally contradict one another. And so he tells a falsehood about my reporting. My reporting about him is solid. It is accurate.
Whistleblower Jamie Reed on how, she says, gender clinics work:
If you're interested in more reporting from me about gender medicine, check out and subscribe to my newsletter:
benryan.substack.com

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More from @benryanwriter

Feb 6
Dr. Blair Peters,a gender-transition surgeon at OHSU, responds with disdain to the American Society of Plastic Surgeons coming out against such surgeries for minors. He says the broader membership was never polled about this.

Which is the same thing that has happened at the American Academy of Pediatrics, for example, but going in the other direction. No matter how hard @JuliaMasonMD1 has pushed, the AAP’s 2018 policy statement on the gender-affirming care method has never been up for a vote by the broader membership.

All of the major medical organizations that have led the way in establishing pediatric gender medicine’s broader credibility, including the AAP and the Endocrine Society in particular, have supported these practices in minors based on the decisions of small committees.

The AAP’s 2018 policy statement was written by a single person, Dr. Jason Rafferty, who was a resident at the time.

All of the other medical societies’ little committees have followed these other groups’ lead, along with WPATH. This has given the illusion that all medial providers support these practices in minors.

But I’ve spoken to pediatricians who are too afraid to express their concerns at the AAP’s annual conference for fear this will destroy their careers.Image
More from Blair Peters: Image
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In 2024, Dr. Blair Peters, aka “Queer Surgeon,” spoke with the head of the ASPS and they had this remarkable exchange about whether doctors can be trusted to self police.

The ASPS president, Dr. Steven Williams, brought up Tuskegee. open.substack.com/pub/benryan/p/…Image
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Read 6 tweets
Feb 4
People are shocked that all it took for the AMA to change its policy on pediatric gender transition surgeries was for another medical group, the ASPS, to do it. But this phenomenon is how the unanimity among the medical groups fell into place in the first place. It was only ever based on a few small committees within a couple of medical organizations, putting aside WPATH, which is a quasi-activist-medical organization.

It got started in the 2010s as WPATH and the Endocrine Society, which have a lot of overlap between them and referred to one another's guidelines in their citations, put out guidelines. And then in 2018 a single medical resident wrote the American Academy of Pediatrics' policy statement on the gender-affirming care method. Along the way, other major medical associations took these other groups' lead, including the APA and AMA. And then all the other ones fell in line.

These groups did not conduct major independent analyses of the evidence. Even the AAP never conducted a systematic literature review to support its policy statement. And in August 2023, the AAP said it was going to conduct one. But there is no sign that the organization has even started on that. Because if they ever did, there is only one conclusion that it could have: that the evidence backing providing gender-transition interventions to minors is weak and inconclusive.

All this is to say is that the mantra "all major medical association support gender affirming care for kids" was always a hallow claim. What it really meant is that: "A few small committees at a few organizations decided to support this, in part because of one another, and all the other small committees at all the other organizations followed their lead."
If you want to go down the rabbit hole of how citation laundering laid the groundwork for the supposed medical consensus on gender-transition treatment for minors, I highly recommend @buttonslives's reporting: buttonslives.news/p/new-systemat…Image
@buttonslives Hollow, not hallow*
Read 5 tweets
Feb 2
A Legal First That Could Change Gender Medicine

At 16, Fox Varian got a mastectomy while undergoing a gender transition. She sued her psychologist and plastic surgeon for leaving her ‘disfigured for life.’ Benjamin Ryan reports from the courtroom.

Read the @TheFP article: thefp.com/p/a-legal-firs…

Follow and support my Substack, where I cover pediatric gender medicine: benryan.substack.com. I was the only reporter to attend the entire three-week trial and will be providing more in-depth reporting and commentary on the case.

The opening of my Free Press article:

Fox Varian had a turbulent childhood. Her parents split when she was seven, triggering a three-year custody battle that ultimately saw her estranged from her father. She suffered from a constellation of mental health problems, including depression, anxiety, and social phobia. She was diagnosed with autism and bounced around various schools. Her first period sent her into a meltdown, and she battled disordered eating and body-image issues. By mid-adolescence, she was completely lost.

At 15, she began questioning her gender during sessions with her psychologist. She changed her birth name, Isabella, to Gabriel, which she saw as androgynous. Over the next two months, she cut her hair short, began binding her breasts, switched her name again, to Rowan, and started telling people she was transgender.

In December 2019, 11 months after she started this public social transition, Varian underwent surgery to remove her breasts. She was 16 years old.

Varian, who adopted the name Fox at 18 and is now 22, is one of thousands of minors who underwent gender-transition surgery over the past decade. And she is just one of the young people who have come to regret permanently addressing what was only a temporary identity shift.

Three years after her mastectomy, Varian stopped identifying as transgender and began a process known as detransitioning. In May 2023, she filed a medical malpractice lawsuit against the two principal Westchester County, New York, care providers who oversaw her gender transition: her long-time psychologist, Kenneth Einhorn, and Dr. Simon Chin, who performed the mastectomy.

On Friday, a jury in White Plains, New York, awarded Varian $2 million in damages. Varian’s case is the first malpractice suit from a detransitioner to go before a jury, and I was the only reporter to attend the entire three-week trial. Represented by personal-injury attorney Adam Deutsch, Varian said she had been injured by the defendants due to their deviation from standard practices and a lack of informed consent. While there are no guarantees in medical malpractice lawsuits, legal experts believe Varian’s victory could inspire a wave of similar cases that would significantly disrupt pediatric gender medicine.Image
Claire Deacon, mother to Fox Varian, the detransitioner who won a $2M jury award after suing her care providers over the mastectomy she got at 16, testified that Varian's psychologist, Kenneth Einhorn, browbeat her into consenting with threats of her child's suicide.

I report for @TheFP:
thefp.com/p/a-legal-firs…

Subscribe to my Substack for further in-depth reporting about the case. I was the only reporter to attend the entire three-week trial. benryan.substack.comImage
Dr. Loren Schechter, the head of gender-affirming surgery at Rush University Medical Center in Chicago and the president-elect of the World Professional Association for Transgender Health (WPATH), testified that gender-transition surgery is not form of suicide prevention. thefp.com/p/a-legal-firs…Image
Read 12 tweets
Jan 31
NYU neurologist/psychiatrist Jonathan Howard has been making a stink over @MichaelShermer's recent statements about transgender issues on @BrianLehrer's show.

Here, Howard cites a @Harvard study that falsely claimed youth "rarely" get gender-transition surgeries. In fact, about 1,000 minors got a mastectomy for this purpose annually in recent years, before state bans set in.

I wrote about that Harvard study when it came out. I demonstrated how its authors had quite evidently sought to mislead the public about this issue: benryan.substack.com/p/how-harvard-…

So, in fact, it is not Shermer who is "making things up" about this point in particular, it was Harvard researchers that at least effectively did so.

As for expressing concerns about minors getting these surgeries, I would like Howard to look into the eyes of the mother who testified in the detransitioner civil trial that I just finished attending yesterday (the plaintiff won a $2M judgment against her care providers; my article on the suit will run in a major outlet next week) and tell her that the loss of her daughter's breasts when she was 16 amounts to a false concern.Image
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How Harvard Teed Up the False Claim That the 'Vast Majority of Minors Getting Gender-Affirming Surgeries Are C-s Kids'

An opaquely written Harvard study and linked press release prompted false reporting that gynecomastia surgeries for boys are vastly more common than gender-affirming surgeries for transbenryan.substack.com/p/how-harvard-…Image
The other day, Howard wrote some screed where he referred to me as a "malignant actor" nefariously pursuing this line of inquiry for money. (Someone suggested that as a cancer survivor, maybe I am intrinsically malignant...) To that I say that Howard might get his facts straight about any of this stuff before he passes judgement on my reporting.
Read 5 tweets
Jan 31
BREAKING: 1st Detransitioner to Take a Medical-Malpractice Lawsuit to Trial Wins $2 Million Judgement

Fox Varian sued her Westchester, NY, area psychologist and plastic surgeon for the gender-transition mastectomy she got at 16.

I was the only reporter to attend the entire 3-week, historic trial. Subscribe to my Substack to receive an alert about the feature article I have coming out next week in a major publication out about the trial: benryan.substack.com. I cover pediatric gender medicine as a specialty on my Substack.

Sorry to just give just a teaser for now about the case! But I wanted to get the word out about the verdict promptly, the slower pace of feature-article publishing notwithstanding.

The entire case file was put under seal when the trial started (although I obtained all those documents before they was sealed), and all the transcripts from the trial are also under seal. The riveting trial was sparsely attended and there was only one other reporter at the trial; and he only attended for part of it and, as I observed, took few notes. So my own hundreds of pages of notes from the trial will likely remain the only way for the public to learn about the all finer details of what transpired, possibly ever (or until an appeal, should that happen).

In addition to my article coming out in the media outlet soon, I intend to write a lot about what I observed and learned on my Substack over the coming weeks. Stay tuned…Image
I have identified 28 detransitioner lawsuits filed to date. Varian v. Einhorn was the first to go to trial and the first to win a judgment, making history. If anyone knows of any additional cases that are not on my spreadsheet below or sees any errors, please DM me.Image
Quite a few of the detransitioner lawsuits have run up against strict statutes of limitation, such as the case against leading pediatric gender doctor Johanna Olson-Kennedy. Attorneys intend to appeal this dismissal, as I wrote in November:
benryan.substack.com/p/detransition…Image
Read 4 tweets
Jan 12
Media outlets that claim that transgender women have no competitive advantage over women in athletics are not making evidence-based claims.

Two recent review papers, by @DrMJoyner and @Fondofbeetles, have found that even after sustained testosterone suppression and estrogen treatment, biological males still maintain a competitive advantage in women's sports. The research is less clear about those who have undergone pubertal suppression and then estrogen treatment starting soon after puberty's onset. However, Dr. Joyner's research indicates that prepubescent boys have a small but significant competitive advantage over girls, likely because of exposure to testosterone in utero and a surge of T during "mini puberty" during infancy.

Sources: link.springer.com/article/10.100…

pubmed.ncbi.nlm.nih.gov/39716906/
Notice how @NPR doesn't even mention the review papers by @DrMJoyner and @Fondofbeetles finding that trans women on gender-transition treatment maintain a competitive advantage in women's sports. I spoke with Dr. Joyner and other experts who criticized the methodology of the IOC study. They all called its conclusions weak and unreliable. npr.org/2026/01/11/nx-…Image
@NPR @DrMJoyner @FondOfBeetles The claim by NPR that there is only a handful of trans youth playing sports is belied by survey data, reported by @HRC, that 19% of trans and gender expansive youth play sports. That translates, based on data from a CDC survey, to about 135,000 middle and high school students. Image
Read 9 tweets

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