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Leor Sapir Profile picture
@LeorSapir
Oct 23, 2024 • 11 tweets • 5 min read • Read on X
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NEW: Azeen Ghorayshi reports in the @nytimes that prominent gender clinician Johanna Olson-Kennedy of @ChildrensLA has refused to publish data from a study on puberty blockers, fearing that the unimpressive results will be "weaponized" by critics of "gender-affirming care." 🧵 Image
Olson-Kennedy told the Times that the kids didn't improve because their mental health was "in really good shape" at the start of the study.

As Ghorayshi notes, this seems to contradict what Olson-Kennedy et al. reported in 2022 about the study's cohort at baseline. Image
Olson-Kennedy fears the study's results could be cited by critics of pediatric sex "change" in court cases. She doesn't seem to think that, as a medical researcher and clinician, her primary responsibility is to her current and future patients.

Doctors as agents of lawfare. Image
Ghorayshi's report is helpful in holding members of the gender Rx industry accountable, but it also has at least three problems.
First, Ghorayshi mentions the reported findings of the Dutch puberty blocking study but not the highly important critique of those findings, nor that systematic reviews (e.g., NICE 2020) have found it to be unreliable due to risk of bias.

More here: tandfonline.com/doi/full/10.10…Image
Second, Ghorayshi mentions the reported findings of the NIH-funded cross-sex hormone study but doesn't mention that the boys showed no improvement while the girls' improvement was very small. Nor does she mention the authors' HARK-ing and goalpost shifting. Critical problems. Image
I discuss these issues re: the NIH study in our recent amicus brief: supremecourt.gov/DocketPDF/23/2…

Jesse Singal has also written about the NIH study at length.

Part 1: jessesingal.substack.com/p/on-scientifi…

Part 2: jessesingal.substack.com/p/the-new-high… Image
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Finally, it's disappointing to see the Times continue to refer to the kids given Rx as "transgender adolescents." This isn't a neutral term. Whether these kids "are transgender," or what it means to say such a thing, is half the debate in a nutshell.
Neutral terms for journalists who want to remain independent of the controversy and not (intentionally or unintentionally) put their thumb on the scale:

Adolescents with gender dysphoria.
Adolescents who identify as transgender.
The article in the New York Times: nytimes.com/2024/10/23/sci…
x.com/benryanwriter/… x.com/benryanwriter/…

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More from @LeorSapir

Leor Sapir Profile picture
Nov 21
1/ As @abigailandwords correctly notes in @NRO, the @APApsychiatric agreed to participate in the peer-review process and condemned the report for overlooking 16 studies, but the APA itself overlooked the HHS report's evidence review, which included 12 of those studies. In fact, several of them (e.g., Tordoff, Chen, de Vries) were discussed in detail in the main report. Of the remaining 4 studies, 3 were on adults rather than youth, and 1 was published after the HHS Review came out (though the final version does account for it).

#ReadtheReportImage
2/ Here is a summary of the allegedly overlooked studies cited by @APApsychiatric and where they appear in the HHS Review. It can easily be found in the Supplement, which was published on Wednesday. Image
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3/ The APA had no response to our analysis of studies like Chen (2023) and Tordoff (2022), or to the umbrella review, which is mentioned throughout the report.

The APA did not engage with, and possibly did not even see, the most critical part of the HHS Review.
Read 8 tweets
Leor Sapir Profile picture
Nov 21
🚨With a puberty blocker trial looming in the UK, here is why the HHS Review concludes: "administering [pediatric medical transition] to adolescents, even in a research context, is in tension with well-established ethical norms for human subjects research." 1/5

#ReadtheReport Image
2/5 Image
3/5 Image
Read 7 tweets
Leor Sapir Profile picture
Oct 23
Big news 🚨

District court vacates Biden-era rule declaring that “sex” in Section 1557 of the ACA includes “gender identity.”

This rule and its antecedents in the Obama years mandated that healthcare providers offer “gender-affirming care.” 1/ Image
2/ The court disagreed with the Biden HHS that the Supreme Court’s reasoning in Bostock v. Clayton Country (2020) requires interpreting Title IX (imported into 1557) to mean that sex = gender identity.

Even if that were true, the court adds, Bostock doesn’t compel gender Rx.
3/ The court finds that the Biden HHS exceeded its authority when interpreting Section 1557 as it did.

Interpreting sex as “gender identity” is a legislative act, and thus something only Congress may do.
Read 5 tweets
Leor Sapir Profile picture
Aug 27
NEW: My analysis of the @AmerMedicalAssn videos published yesterday and today by @realDailyWire @benshapiro is now available at @CityJournal.

This is the most vivid illustration I’ve seen of the broken chain of trust in medicine. 1/Image
2/ The AMA president, Dr. Bobby Mukkamala, cites false stats on gender medicine and suicide (“50 to 70 percent”).

Worse, he seems unaware of how evidence-based medicine works, specifically with regard to conflicts of interest in evidence evaluation.
3/ He then recommends that @BradPaquetteMI speak to an “expert” on the evidence: a recently graduated physician named Jesse Krikorian, who identifies as transgender and practices in Michigan. Image
Read 8 tweets
Leor Sapir Profile picture
May 13
Scott Leibowitz, a gender clinician and author of @wpath SOC-8, writing in @medpagetoday makes some pretty astonishing claims about the recently published @HHSGov report on pediatric gender dysphoria.

Here are four examples🧵
Regret and Bans

According to Leibowitz, the report "heavily emphasizes concern for regret to justify its extreme positions supporting gender care bans."

FACT: The report explains that while "proponents and critics alike consider the question of regret as central to the ethics of PMT," in fact "regret alone... is not a valid indicator of whether an intervention is medically justified." Patients can regret justified medical interventions or be satisfied with unjustified ones. See Section 13.4.

The report does not recommend or condemn bans; it explicitly says that it "does not issue legislative or policy recommendations" (p. 10).
Psychotherapy

Leibowitz: "the definition of 'appropriate' psychotherapy [the report] employs is questionable, especially considering the apparent lack of input from experienced clinicians in the field, whose public perspectives are conspicuously absent from the publication."

FACT: the word "apparent" is doing a lot of work here. More importantly, it is ironic for Leibowitz to complain about lack of balance among the report's authors. Leibowitz was co-chair of the Adolescent chapter of WPATH SOC-8, a guideline that was developed with a strictly enforced litmus test: only "affirming" clinicians supportive of medical interventions were invited to participate. The HHS report discusses this issue at length (Section 10.3).
Read 7 tweets
Leor Sapir Profile picture
Mar 17
🚨Dr. Daniel Shumer of @UMichMedSchool is a prolific expert witness in transgender litigation. He has served as expert witness in “about 15” lawsuits and has been paid around $150,000 over the past 4-5 years.

Shumer has admitted to plagiarism in his expert report.

🧵Image
The admission was made in a deposition on March 5, in the context of litigation (Doe v. Horne) over an Arizona law prohibiting males from competing in female sports.Image
At the beginning of the deposition, the examining lawyer asks Shumer to confirm his sworn attestation that he is the sole author of his expert report.

"I was the sole author of the report," he replies (12:25, 13:1).
Read 12 tweets

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