🧵The Cass Review and reviews in Sweden and Finland have recommended that puberty blockers only be used in a research setting. However, Cass was clear that any research studies would need ethical approval and the case for further research on children is not there. 1/ Before any more children are put at risk, the existing data on puberty blockers needs to be studied properly. A first step should be publishing the data from the Joanna Olson-Kennedy study which have been withheld for political reasons. 2/cnn.com/2024/10/25/hea…

1/ The US Supreme Court decision on gender affirming care for minors will probably have less impact on gender medicine in general than anticipated. The bans only affect about half the states and only apply up to are 18. There are two other factors that will be more important. 2/ The first is litigation, which is starting against some of the biggest names in medicine. There are also investigations by state governments and congressional investigations will follow.

1/ Here's what Trump has said about stopping medical transition of minors. Some of it makes sense but other parts are questionable and probably unconstitutional.
2/ "I will sign and executive order instructing every federal agency to cease all programs that promote the concept of sex and gender transition at any age." Easy to do, and will make it easier to work for reform at the state and local level. Note that it includes adults.

1/ Some thoughts from Canada on how the US election will impact the gender debate. Rachel Levine will be fired and most of Biden's executive orders on the application of Title IX to sports and trans health care will be repealed. 2/ The Supreme Court will hear the Skremetti case on state bans on youth gender medicine before Trump takes office. If the case goes as expected, the result will be to leave the issue of youth gender medicine to the states.

1/ The authors of the Canadian Paediatric Society position statement on gender affirming care have now published a response to the recent letter to the editor calling for a review of the position statement in light of the Cass Review.
academic.oup.com/pch/advance-ar… 2/ The response repeats falsehoods such as the claim that the systematic reviews commissioned by the Cass Review excluded studies which were not randomized control trials when in fact the systematic reviews considered and evaluated all types of studies.
cass.independent-review.uk/home/publicati…

1/ The proposals by @ABDanielleSmith to protect gender-questioning youth in schools and healthcare are generally consistent with best international practice and evidence but there are still a few problem areas. .

@ABDanielleSmith 2/ Banning gender reassignment surgery on minors should be a non-issue. Activists claim it never happens but it does. Someone too young to get a tattoo shouldn't be able to get an elective double mastectomy.
nationalpost.com/news/young-det…

1/ The Trevor Project study which claims that "anti-transgender" laws caused increases in suicide attempts among trans and non-binary youth is a flawed study that is being presented in a misleading and irresponsible way. 2/ The 72% increase in suicide attempts highlighted in the press release misrepresents data in the study which refers to an increase of 72% above the sample mean. Also, the methodology used cannot prove causation.

1/ The Department for Education in England no longer recognizes the concept of a trans child. The latest version of it statutory guidance on keeping children safe in schools has replaced LGBT with LGB and
gender questioning children.
assets.publishing.service.gov.uk/media/66cef97c…


2/ Compare with the 2023 statutory guidance which simply referred to "children who are LGBT" as a group and talks about the need for staff to provide a "safe space."
web.archive.org/web/2024082215…

1/ This has not been a good year for the World Professional Association for Transgender Health @WPATH. It began with the news that its membership had plummeted by 60% over a year.
criticaltherapyantidote.org/2024/01/17/bre… @wpath 2/ In March, the WPATH Files by Mia Hughes (@_CryMiaRiver) exposed internal discussions which showed WPATH members' disregard for science and medical ethics.

https://x.com/shellenberger/status/1764799914918490287

1/ A recent critique of the Cass Review exposes the real agenda of the activist clinicians supporting gender affirming care. They don't care about evidence based medicine because their case for GAC has nothing to do with promoting good health.

https://x.com/Chris_Noone_/status/1800624884999229688

2/ This is made clear in this paragraph which argues that "evaluating the efficacy of GAC based on psycho social well-being is misguided." In the authors view, looking for mental health benefits from GAC involves pathologizing "transness."

1/ This excellent New York Times interview with Hilary Cass ends with a statement from the president of the @AmerAcadPeds about their so-called systematic review which shows that he does not understand evidence-based medicine.
nytimes.com/2024/05/13/hea… @AmerAcadPeds 2/ AAP president Dr. Benjamin Hoffman said that the group had considered the Cass Review and "added it to the evidence base undergoing a systematic review." This is not how systematic reviews work.

1/ I suppose it's good that the @globeandmail have featured this article by @RobynUrback on the front page but the kids the medical system is labelling as trans and sterilizing deserve better still.theglobeandmail.com/opinion/articl… @globeandmail @RobynUrback 2/ The article starts with a discussion of the Dutch approach to affirmative care but fails to note just how weak their research was. The whole model of care is based on a study of 55 subjects with a 1 year follow up period, and no control group.
tandfonline.com/doi/full/10.10…

1/ It is two weeks since the Cass Review was published the The @globeandmail, which describes itself as Canada's national news organization has not printed a word about it. Why the silence? @globeandmail 2/ The @globeandmail cannot claim that the Cass Review is not newsworthy. Its main competitor, the @Nationalpost has written on it extensively as has every other major newspaper in the English speaking world.

1/ Another falsehood in the awful CBC coverage of the Cass Report which needs to be refuted in detail is the claim the puberty blockers are reversible.
cbc.ca/news/health/pu…
2/ This issue did not receive a lot of attention in the Cass report because NHS England updated its website to remove a claim that puberty blockers are fully reversible back in 2020. However, the claim still persists in Canada in the face of the evidence.
transgendertrend.com/nhs-no-longer-…

1/ The dismal CBC news report on the Cass review is dangerously misleading on evidence based medicine. It quotes Calgary family physician Jake Donaldson as saying this about the evidence base on ear infections. 2/ There is a link to a Cochrane Review of antibiotics for acute middle ear infection in children which concludes that in high-income countries most children recover spontaneously and the benefits of antibiotics do not outweigh the risks.
cochrane.org/CD000219/ARI_a…

1/ At last, @CBCNews covers the Cass Review, but the article is packed with so much misinformation that it would have been better if they had said nothing. The story ignores key parts of the report and misrepresents others.
cbc.ca/news/health/pu… @CBCNews 2/ The @CBC story on Cass repeats many of the common myths and misconceptions which are demolished in this excellent article by @lecanardnoir and adds a few new ones.
quackometer.net/blog/2024/04/b…

1/ The justified outrage over some of the sexual materials used in schools missed an important point. Teenage boys need to be taught about safe-sex but giving them wooden phalluses and pornography isn't the best way to do it.
reduxx.info/boys-reportedl… 2/ In Canada the age of consent to sexual activity is 16. There are exceptions for 12 and 13 year olds with someone no more than 2 years order and 14 and 15 year olds with someone no more than 5 years older provided there is no relationship of trust.
justice.gc.ca/eng/rp-pr/othe…

1/ The Hill Times suggests that gender identity could become a critical issue in marginal seats where there are significant numbers of socially conservative minority voters, but it could become more than that.
hilltimes.com/story/2024/02/… 2/ Canadian Liberals have traditionally been good at brokering compromises in this kinds of conflict but transgender activists have insisted on no compromise / no debate. Neither the Liberals nor the NDP will want to risk being the first to break ranks on gender issues.

1/ Danielle Smith has got a lot of things right with the unroll of her policy on gender identity. The announcement by a video statement was a brilliant move. It allowed her to control the message without committing to any specifics in writing. 2/ She now has the freedom to build support and work out the details at her own pace. In Saskatchewan and New Brunswick the governments rushed ahead with actual policies and were immediately faced with court challenges for which they were not prepared.

1/ The Canadian debate on pediatric gender transition needs new language. The debate has been reduced to one where slogans replace substance. Rather than framing it as a conflict between parents' rights and children's rights, we need to start talking about child safeguarding. 2/ The problem with the concept of parents' rights is that it can be misinterpreted to means that parents claim a proprietary rights over their children which the law does not recognize. This is not what the self-described parents' rights movement is actually claiming.

1/ 🚨 Action alert and update. The World Health Organization has responded to public criticism of its guideline development process on transgender health by extending the deadline for public comment to February 2.
who.int/news/item/15-0… 2/ The most visibly biased member of the GDG, Florence Ashley, has been dropped due to an alleged scheduling conflict but the committee membership is still dominated by activists and clinicians with significant conflicts of interest.
cdn.who.int/media/docs/def…