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
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@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/…
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@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:
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More from @benryanwriter

Feb 19
Taylor Lorenz Plagiarism Scandal Erupts

YouTube sleuths found: @TaylorLorenz apparently copied substantial portions of a TechDirt article about Joseph Gordon-Levitt @hitRECordJoe and Section 230.

Lorenz appeared to pass off the article's text as if it was her own script.🧵⬇️Image
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Go to 4:22 in this video to see the part where the YouTube hosts assert that @TaylorLorenz has plagiarized her narration from a TechDirt article about Joseph Gordon-Levitt @hitRECordJoe and Section 230:
youtube.com/live/JXI9uRwfG…
Here is @TaylorLorenz's video in which Lorenz appears to have lifted much of her script from a TechDirt article. Go to 9:34:
youtube.com/watch?v=b0RRxR…
Cross reference with this article: techdirt.com/2026/02/12/jos… Image
Read 11 tweets
Feb 18
I can’t even begin to enumerate all the nasty things Parker Molloy has said about me in an effort to punish me for reporting about pediatric gender medicine and to scare off other reporters who might dare to enter this arena. My policy with responding to such behavior is I report what people such a Molloy say or do, and will often fact check errors. They then turn around and make vicious and demeaning claims about who I am.
Update: Parker Molloy is expressing her rage toward me on Bluesky right now.
Update: Parker Molloy is not an activist. Nothing in her behavior, rhetoric or discourse would suggest she is one. Image
Read 5 tweets
Feb 10
The Federal Trade Commission has opened a consumer protection probe into the American Academy of Pediatrics and has demanded its records regarding pediatric gender medicine.

In 2018, the AAP published its foundational policy document on the gender-affirming care method. It was written by a single medical resident, Dr. Jason Rafferty, and edited by a small committee. It was subjected to a brutal fact check by Canadian sex researcher Dr. James Cantor the following year. The AAP never responded to the fact check. In 2023, the AAP reaffirmed the policy statement with no changes.

The statement asserts that even very young children know their gender identity as well as anyone and should be trusted to guide the way in their own pathway of transition.Image
Read 6 tweets
Feb 7
How Can Doctors Like This Provide Competent Care To Their Patients?

Some beef with Dr. Jonathan Howard, by @JesseSingal.
jessesingal.substack.com/p/how-can-doct…
Dr. Jonathan Howard, a neurologist and psychiatrist at @NYULangone Health, is furious at Michael Shermer, the founding publisher of Skepticmagazine.

Howard is an impressive figure. Like many doctors at university-affiliated medical centers, he also serves as a professor, in this case at the @NYUGrossman School of Medicine. He has, according to his biography, “authored and edited multiple textbooks” on multiple sclerosis, his area of specialty.

Why is Dr. Jonathan Howard furious at @MichaelShermer? It has to do with a recent exchange between Senator Josh Hawley and an OB-GYN named Dr. Nisha Verma. Hawley, seeking to make a point about “gender ideology” (as he might call it) during a hearing, repeatedly asked Verma if men can get pregnant and Verma could not give a straight answer. Shermer chimed in to suggest an answer Verma could have given that accounts for the fact that, as Shermer (and anyone else using the traditional, biological definition of the term) sees it, men cannot, in fact, get pregnant.

That’s why Howard is furious, and that’s why he wrote a deeply aggrieved article in Science-Based Medicine about Shermer’s bigotry. The headline? “The Anti-Trans Obsessions of ‘Skeptic’ Michael Shermer: Hallucinating Imaginary Demons to Empower Actual Villains, Once Again.” The subheadline? “I want to demonstrate to Michael Shermer that it’s possible for men like us to not talk about trans people constantly. If I can do it, so can he.” (If you’re unfamiliar with Science-Based Medicine’s strange recent trajectory, see here or here.)

Not only does Dr. Jonathan Howard of NYU Langone Medical Center disagree with Michael Shermer that men can’t get pregnant — Howard thinks that to even ask this question puts other humans in danger.

That probably sounds like a caricature on my part, or a sloppy and inaccurate gloss of Howard’s actual views. But that’s exactly what he wroteImage
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Jonathan Howard has gotten it into his head, meanwhile, that I am personally responsible for the MAHA movement because once I published an essay on Vinay Prasad’s Substack about trans medicine researchers deceiving the public. This is bonkers conspiracy thinking by Howard.
After @jessesingal explained in exacting detail why the study Jonathan Howard cited as evidence of pediatric gender-transition treatment’s efficacy was bunk, Howard respond with this mischaracterization of what Singal said about Howard’s inability to understand the paper. Image
Read 6 tweets
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

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