🧵Minors cannot consent to receiving puberty blockers and cross-sex hormones, which pose the risk of rendering them infertile and with lifelong sexual dysfunction. They are too young to be able to predict their future fertility desires or even to know how an orgasm feels and to be able to weigh those future needs against their desire to treat their current gender dysphoria. Only their parents or guardians may consent on their behalf. Therefore adults must decide on behalf of children whether the presumed benefits of this treatment outweigh the risks, known and unknown. These decisions must be made even with an evidence base that can provide no clear conclusions as to the actual benefits of treatment, according to a half-dozen systematic literature reviews—the gold standard of scientific evidence. Also, the one study that directly assessed whether these treatments were tied to a difference in the suicide death rate found they were not. Therefore the claim that the treatments are a matter of life and death is not evidence-based. @KristopherWells makes such a claim despite being an academic who is well versed in evidence-based-medicine principles. @tylerblack32
Here is Marci Bowers, the president of @WPATH, describing how natal males with gender dysphoria who under go pubertal suppression and estrogen treatment have no sexual function whatsoever. This child was going in for a vaginoplasty and didn’t even know what an orgasm was. alabamaag.gov/wp-content/upl…
Tyler Black, however, says that “Parents do not have absolute rights” when their kid wants gender-transition treatment. He dismisses various qualms about such treatment, such as the fact that its efficacy is unknown. And he makes a false comparison to cancer care, neglecting to note that absent treatment, cancer is typically certifiably fatal; whereas the same cannot be said about pediatric gender dysphoria. There is considerable evidence, in fact, that most minors with GD will grow out of it. Also, cancer surgery, such as an orchiectomy (testicular cancer does occur in teenage boys), removes a part of the body that is diseased. Gender-transition surgery removes a healthy part of the body that might have been used for a specific purpose if left in place (eg: sexual reproduction, breastfeeding). Lastly, saying that “Parents do not have the right to do whatever they want to kids” is moot when parents are arguing *against* doing something to their child and *for* leaving their child’s body alone to experience its own endogenous puberty.
@wpath 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…
@wpath None of the examples that Black provides in this thread are fair comparisons to gender-transition treatment for minors. And yet he concludes the thread suggesting that he’s just proven that minors have the capacity to consent to such treatment. He absolutely has not.
@TylerBlack32 is insinuating that either doctors or the state have the right to overrule parents who object to their child’s wish to undergo a gender-transition treatment. This poses the question of how these external authority figures can be certain they know better than the parents what is best for their child. Based on what research? We have established that the efficacy of this treatment remains unknown and that the known risks, saying nothing of the unknown risks, are severe. So how is this dynamic so exceptional that outside forces may be permitted to overrule the parents and put a child under a medical treatment that has very intense, irreversible, lifelong impacts?
Dr. @TylerBlack32's scenario in which parents' refusal to consent to gender-transition treatment for children is overruled by an outside authority is, in fact, supported by the American Academy of Pediatrics. After acknowledging what Dr. Black does not, that parental or guardian consent is required for such treatment, the @AmerAcadPeds then strongly suggests that pediatricians should look into having the state seize control of the child in question if the parents refuse to consent to a medical gender transition.
This screen shot is from the AAP's 2018 policy statement on gender-affirming care, which is thus far the subject of a detransitioner lawsuit and will likely soon be the subject of a lawsuit from Republican attorneys general, who suggested in a recent letter to the AAP that it violates consumer protection laws. publications.aap.org/pediatrics/art…
@tylerblack32 WPATH President Marci Bowers acknowledges that gender transition treatment can destroy the capacity for natal males to have an orgasm. @tylerblack32 insists that parents cannot always be trusted should they deny consent for such treatment.
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In response to a WaPo article in which an Italian child travels to Spain to obtain puberty blockers and does so on the first appointment following a single online consultation, journalist Evan Urquhart claims there “still hasn’t been a single reported example of a minor getting blockers or hormones without a lengthy assessment.”
Evan is ignoring Jesse Singal’s Economist article from earlier this month about Clementine Breen getting blockers after a single appointment with Johanna Olson-Kennedy.
And he is forgetting my reporting that since 2018, it has been Boston Children’s policy to provide only a single two-hour assessment appointment with a psychologist to determine whether a minor should get blockers or hormones.
The Mayo Clinic’s @DrMJoyner: “There are profound sex differences in human performance in athletic events determined by strength, speed, power, endurance, and body size such that males outperform females. These sex differences in athletic performance exist before puberty and increase dramatically as puberty progresses. The profound sex differences in sports performance are primarily attributable to the direct and indirect effects of sex-steroid hormones and provide a compelling framework to consider for policy decisions to safeguard fairness and inclusion in sports.”
The Mayo Clinic's @DrMJoyner concludes: "There are profound sex differences in human performance in athletic events determined by strength, speed, power, endurance, and body size such that males outperform females. These sex differences in athletic performance exist before puberty and increase dramatically as puberty progresses. The sex differences are markedly greater in magnitude (10 to 40%) than the advantages that policy-making bodies seek to eliminate when they regulate equipment or drugs that could enhance performance. As one example, World Athletics amended regulations on shoe manufacturing after advanced footwear technology was linked to a 1 to 2% performance advantage relative to other racing footwear (52–54). Regulation of sports technology and potential performance enhancing drugs is typically based on an evidence-base that is general in nature and based on plausibility, mechanism of action, and real-world data as opposed to RCTs. In this context, exogenous androgens administered to female (XX biology) athletes improve performance but do not close the male-female performance gap and do not eliminate the male advantage. Testosterone suppression among male (XY biology) athletes who have undergone male puberty reduces performance but much of he male advantage is retained, including: 1) muscle strength, power, and size, 2) maximal aerobic capacity, and other potentially performance enhancing attributes such as height and limb length. This evidence summary may provide a useful framework to understand claims about the nature and extent of the evidence that supports existing eligibility guidelines and to consider the merits of reforms that would govern the classification of transgender athletes and athletes with certain DSDs in competitive sports. Both the magnitude and duration of the influence of testosterone and puberty on sports performance should be recognized with appropriate consideration."
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…