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Leor Sapir Profile picture
@LeorSapir
Oct 23 • 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
Oct 15
NEW: On behalf of @ManhattanInst, @ishapiro @JKetcham91 and I filed an amicus brief in support of Tennessee in U.S. v. Skrmetti, the Supreme Court case dealing with state age restrictions for sex trait modification procedures ("gender-affirming care").

🧵Image
2/ Our brief is a rebuttal to the amicus brief submitted by "Expert Researchers and Physicians" (McNamara et al.), which is a version of the Yale Integrity Project's white paper, which criticizes the Cass Review. Image
3/ We argue that McNamara et al. misrepresent the Cass Review, principles of evidence-based medicine, the findings of key studies, and the consistency of pediatric "gender-affirming care" with the wider field of pediatrics on the question of low- or very low-quality evidence. Image
Image
Read 10 tweets
Leor Sapir Profile picture
Oct 9
🚨NEW DOCUMENTS in the Alabama lawsuit over sex "change" age restrictions.

Some very interesting facts now coming to light. 🧵
1/ @wpath sought but did not receive the American Academy of Pediatrics’ (@ameracadpeds) endorsement for its eighth “Standards of Care” (SOC8).

In private emails to WPATH a colleague, SOC-8 lead author Eli Coleman said that this was “highly confidential.” Image
2/ Coleman appears to admit that it is misleading to claim that medical groups writing amicus briefs against age restriction laws means these groups endorse SOC-8. WPATH tried but failed to get endorsements. (Exhibit #190) Image
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Read 10 tweets
Leor Sapir Profile picture
Aug 30
🚨 CRITICAL FINDING

An ongoing @manhattaninst analysis of an all payer, all claims insurance database shows that the 7-year diagnostic persistence rate of adolescent gender dysphoria is between 40-50%.

I discuss this major finding in a new article for @CityJournal 🧵Image
A central belief justifying medical interventions for gender dysphoric (GD) adolescents is that, unlike childhood GD, GD that persists into (or even arises in) adolescence is almost always permanent. If the condition isn’t permanent, why offer Rx with permanent effects?
First, we analyzed the number of minors with GD in the U.S. between 2017 and 2023. We found 272,181 to 342,476 minors who had the diagnosis.

If we account for the 15% missing claims data in our data set, the range is roughly 320,000 to 400,000.
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Read 4 tweets
Leor Sapir Profile picture
Aug 21
🚨NEW: I’ve received a FOIA’d file from the Washington State Department of Social and Health Services (@waDSHS) about a 17-year-old receiving puberty blockers.

I’ve seen some extreme cases of medicalization in the past, but this one stands out even for a deep blue state. 1/5
The kid is reported to have a “past [of] extensive abuse [including sexual] and neglect” and to have been through “93 different placements,” which include Qualified Residential Treatment Programs. 2/5Image
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The kid has “borderline intellectual functioning,” with “adaptive scoring in the 2nd percentile.”

A recent study found “a possible detrimental impact [from GnRHa] on IQ. These findings accord with the wider literature on GnRH expression and brain structure and function.”

Unclear whether or how the kid’s use of GnRHa affected IQ in his case. 3/5

onlinelibrary.wiley.com/doi/10.1111/ap…
Read 5 tweets
Leor Sapir Profile picture
Aug 19
"McNamara et al. [the misleadingly titled 'Yale report' criticizing the @thecassreview @Hilary_Cass] is an exceptionally misleading, confused, and fundamentally unprofessional document."

A must-read by @jessesingal, but let me add a few additional details. 🧵 Image
2/ The white paper is a good example of "eminence-based medicine." Its authors seemed to want to use the reputation of @Yale @YaleMed @YaleLawSch to bolster the credibility of the report. But they did so seemingly without first getting the approval of Yale.
3/ On July 1, the report was published and submitted by McNamara, the lead author, into evidence in Boe v. Marshall (Alabama). A little over a week later, the report was republished with a disclosure that the views it contains do not reflect those of the authors' institutions. It's not clear if the revised report, with the disclosure, is the one currently submitted into evidence in the lawsuit.Image
Read 9 tweets
Leor Sapir Profile picture
Aug 12
BREAKING: The American Society of Plastic Surgeons, an organization representing 92% of all board-certified plastic surgeons in the U.S., becomes the first major medical association to break from the consensus over “gender-affirming care” for minors.

This is big news. 🧵
2/ In the U.S., the use of puberty blockers, cross-sex hormones and surgeries to help kids who feel distressed about their developing bodies has depended on a perceived consensus of medical groups.
3/ Critics argue that the consensus is manufactured and enforced through suppression of alternative viewpoints and of evidence reviews. The @AmerAcadPeds, for instance, has suppressed member initiatives to get the group to conduct a systematic review of the evidence.
Read 15 tweets

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