For more, read my report for the Manhattan Institute, where I address the five most common allegations against residential treatment—chief among them, the claim that abuse is “systemic,” a conclusion largely based on isolated incidents that have been generalized to the entire industry.

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A few weeks ago, I published The Tragedy of Yarden Silveira in City Journal on Detransition Awareness Day. It recounted the life of a young detransitioned man who is believed to have died by suicide after struggling to get help for severe complications from genital “sex reassignment” surgery.

The City Journal article focuses on Yarden’s experiences with the healthcare system—the long line of professionals who failed him, and the irreversible harm they caused. But it only briefly touches on what came before: the formative influences that shaped Yarden’s thinking and led him to adopt a trans identity. This article is meant to supplement that reporting. I encourage readers to read the original article for the full narrative.

I’ve been reporting on trans issues for nearly three years. It was detransitioner stories like Yarden’s that led me to become a journalist. In that time, I’ve come to recognize the vulnerabilities that make some young people especially susceptible to adopting a trans identity.

This article will take a closer look at those vulnerabilities. I’ll share excerpts from Yarden’s writing, offer additional context, and explore the broader cultural, medical, and psychological forces that shaped his story—and continue to shape the stories of other at-risk youth like him.

Yarden had every vulnerability stacked against him. He struggled with emotional issues and a difficult home life from an early age. He was autistic and young—factors that contributed to his naivety, black-and-white thinking, and identity confusion. He was also gay and exhibited gender nonconformity, traits closely associated with a higher likelihood of trans identification.

He entered adolescence at the worst possible time: the “transgender tipping point” in 2014, when trans narratives gained mainstream traction and biological explanations for trans identity became widely promoted. These ideas offered a powerful cultural script to adolescents in distress—and youth trans identification began to soar.

With the prevailing gender-affirming model of care in the U.S.—in which affirmation, not exploration, is the standard—the inherent authority of physicians, the absence of care pathways for detransitioners, and the callousness of more than a dozen doctors he encountered, it’s hard to imagine Yarden’s story ending in anything but tragedy. And sadly, it did.

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Early Childhood Difficulties

Yarden Silveira, born in 1998, grew up in California—a national leader in facilitating youth gender transition and the first state to declare itself a sanctuary for minors seeking such interventions. His mother was 22 when she had him and raised him on her own in a modest household with his two younger sisters. His biological father was largely absent, and his stepfather, who was briefly present, was described by Yarden’s aunt as “abusive.”

From an early age, Yarden showed signs of emotional distress. He was often angry, anxious, and prone to sudden outbursts. His mother sought help early; he began therapy at age five and cycled through various psychiatric diagnoses throughout childhood, including ADHD, OCD, and oppositional defiant disorder, before finally being diagnosed with Asperger’s syndrome at age ten.

Coming Out Gay and Gender Nonconformity

Historically, the majority of young people presenting to gender clinics were boys, and most of them were homosexual. Childhood gender nonconformity—traits, preferences, and behaviors atypical for one’s sex—is common among people who grow up to be gay. For some, this can be deeply distressing.

Before the adoption of the gender-affirming model of care, clinicians practiced “watchful waiting.” Most children eventually desisted from a trans identity and grew up to be healthy gay adults. Today, most youth are no longer given that opportunity—they are instead “affirmed” in a trans identity and often steered toward medicalization.

Yarden recognized he was gay from an early age:

“When I was 9 years old, I simply thought I was gay.”

His mother’s side of the family accepted him, but his relationship with his father’s side was strained by their strict religious beliefs. At 13, he posted a conversation on Facebook with his paternal grandmother in which he told her about his sexuality. She replied that, according to the Bible, being gay was a sin. The exchange ended with Yarden removing her as a friend. This rejection likely deepened his discomfort with being gay.

From a young age, Yarden also displayed gender nonconforming traits. His aunt recalled that although he played with traditional boys’ toys—often lining up toy cars in the characteristic autistic fashion—he also enjoyed playing with baby dolls and was very nurturing.

"I have always enjoyed femininity over masculinity."
"I'm already androgynous as it is."

Being both gay and gender nonconforming made Yarden more vulnerable to transgender narratives. In today’s climate, activist and medical organizations increasingly conflate gender nonconformity with being transgender. As a result, it’s easy for young people to misread sex-atypical traits as evidence that they were “born in the wrong body.”

Gender ideology is a belief system rooted in sex-based stereotypes. It holds that if you exhibit enough traits commonly associated with the opposite sex, you may actually be the opposite sex on the inside. Yarden seemed to believe, at one point, that sharing certain emotional experiences common among females was evidence that he must be one.

"What even is being a woman? I don't know. It feels like fear when I walk alone at night or through groups of boisterous males by myself. It feels like powerlessness when I get ignored and talked over. It feels like frustration, sadness, failure when my body does not look thin and beautiful. It feels shameful to show this body to others, because it is not perfect."

In one of his final posts, Yarden described seeing a happy gay couple on the subway and acknowledged that internalized homophobia had played a role in his decision to transition:

"You just really wanted to escape the label."

A 2021 survey of detransitioners found that internalized homophobia was a common reason given for transitioning. For many, adopting a transgender identity is not about becoming their true selves, but about escaping who they are.

Autism and Youth

Today, mild autism is increasingly prevalent among those who self-identify as transgender. Some gender clinics report that up to 35% of patients exhibit moderate to severe autistic traits, and even one clinic has found that nearly half had formal autism diagnoses.

Yarden came to recognize that autism had played a significant role in his decision to transition:

"Maybe if I didn’t have autism—maybe if my brain wasn’t so defective—I would have caught on before it was too late."

His autistic traits shaped many aspects of his life: difficulty socializing, identity confusion, and intense fixations. Like many on the mild end of the spectrum, he spent significant time online and was drawn to social justice spaces—environments where transgender narratives are widely promoted.

"I never had friends, not even in elementary school."

His mother confirmed that, as a child, he was often alone, but his obsessive interests kept him occupied. Autistic “special interests” can become all-consuming, often shaping one’s sense of identity. When transgender narratives entered the picture, that identity took hold. He spent much of his time online researching and writing about his experience as a “transgender woman” through Tumblr blogs and personal websites.

At 18, new special interests emerged—each quickly becoming central to how he saw himself. He developed a fascination with genealogy, tracing his family roots to Cherokee ancestry on his mother’s side and Russian heritage on his father’s. At the time, he went by Emily Nashoba Dykes, incorporating Nashoba, a Choctaw word meaning “wolf.”

When he discovered he shared ancestry with Joseph Stalin, it became another fixation. He legally changed his name to Emily Galilahi Jugashvili—adopting Stalin’s birth surname and the Cherokee word Galilahi, meaning “attractive woman.” He also sometimes went by Emily Halona Stalin, with Halona meaning “fortunate” in Zuni. During this period, he became involved in social justice activism, joined the Communist Party, wrote political essays, and even self-published a 36-page book titled A People’s History of the Soviet Union.

Later, his fixation on religion led him to convert to Judaism online, despite having no apparent Jewish background. Taken together, these rapid and dramatic shifts in identity pointed to a deep instability in his sense of self, which he later came to recognize.

"I wish I had the knowledge that I have today. I was a confused kid with no identity. I wish I could have done everything different, but it’s too late now."

As an 18 year old, he had a sexual encounter with another male that went wrong, that further limited his ability to trust others. Despite his solitary nature, he longed for connection and was deeply sensitive to rejection.

"What hurts me the most is the loneliness and the inability to find a partner. I can't have a normal sex life… I just wanted friendship and love."

During detransition, as Yarden began to reject the beliefs that had once led him to transition, it became clear that—like many autistic individuals—he had interpreted language literally. His posts reflect the painful realization that becoming a woman had never been possible.

"It isn’t possible to biologically transition from one sex to another, which really smacked me in the face when that reality became clear to me."

He also came to recognize how naive he had been—and how much he had trusted the medical system.

"My doctors and therapists said it was possible to change genders and even recommended that I transition. Given how naive I’ve always been, I genuinely believed them and started transitioning at 15. Why wouldn’t I believe them? I had no reason not to trust them."

Though he was legally an adult when his surgeries took place, the process had been set in motion at 16, when he told his mother he planned to get a vaginoplasty as soon as he turned 18. It would take another year before his first surgery, just after his 19th birthday.

Many detransitioners who began medical transition shortly after turning 18 don’t receive the same sympathy as those who transitioned as minors—but they should. The prefrontal cortex, responsible for executive functioning (decision-making, planning, emotional regulation), continues developing into the mid-to-late twenties. Because this part of the brain isn’t fully mature in adolescents, they are more prone to impulsive decisions, risk-taking, and difficulty anticipating long-term consequences. In autistic individuals, research suggests the prefrontal cortex may develop differently—further impairing executive functioning and increasing vulnerability to poor decision-making.

The Transgender Tipping Point and Cultural Scripting of Distress

How we interpret psychological distress is shaped by the cultural narratives around us—a process known as the cultural scripting of distress, in which internal suffering is filtered through the frameworks available in one’s environment.

Humans are meaning-making creatures. When we’re in pain—especially the kind that is diffuse or difficult to name—we look for explanations. Adolescents are especially susceptible to this, as they’re actively forming their identities while navigating intense emotional shifts. The cultural environment around them plays a significant role in how they come to understand themselves.

"I wanted to be a woman since I was 15."

Yarden entered adolescence as transgender narratives were gaining mainstream visibility. He was 15 in 2013, as cultural, political, and legal shifts set the stage for what would come to be known as the “transgender tipping point” in 2014.

Major LGBT organizations, anticipating the legalization of same-sex marriage, had begun shifting their focus and promoting “transgender rights” as the next civil rights frontier. Mainstream media followed suit. Television, books, and news coverage increasingly normalized transgender identities, especially among youth. Between 2010 and 2015, several teen-oriented shows featured trans-identified characters, including Glee, Degrassi, and The Fosters. The successful Netflix series Orange Is the New Black, which featured a trans-identified character, was also popular among teens. The reality series I Am Jazz, centered on a trans-identified child, averaged 1.3 million viewers per episode. When I asked specifically about I Am Jazz, Yarden’s mother confirmed they had watched it together.

Transgender narratives were especially prominent on Tumblr—where Yarden maintained multiple accounts—particularly between 2010 and 2013, often referred to as its “trans heyday.”

In 2014, at age 16, Yarden fully socially transitioned. He changed his name, pronouns, and appearance, and successfully advocated for those changes to be recognized at school. That same year, California—where Yarden lived—became the first state to allow students to access bathrooms and sports teams based solely on self-declared identity, sparking national debate.

With the mainstreaming of transgender identity in media and culture, it’s not hard to see why youth trans identification began to soar during this period. For Yarden, these narratives were a powerful influence during a formative period and played a significant role in how he interpreted his distress—contributing to his decision to adopt a trans identity.

Bionarratives and Medical Authority

Alongside cultural forces, the medical and scientific establishment played a key role in shaping beliefs about transgender identity. Doctors and researchers began searching for biological explanations—and many people, including Yarden, found those ideas persuasive.

“A trans woman (such as myself) was born with a male body, but she has always had her female brain. Literally born with a female brain.”

Yarden wrote this in 2016. When I asked his mother about it, she confirmed that the “female brain” narrative had been a major influence on him. His literal-mindedness—likely related to his autism—made such explanations especially convincing. But this wasn’t unique to him. The idea gained traction because it was promoted by medical authorities and widely reported as settled science.

The 1980s saw two major developments in psychiatry: the introduction of the gender identity disorder (GID) diagnosis in the DSM-III, and a growing belief that brain imaging could reveal biological causes for mental distress. But despite decades of research, no consistent biomarkers have been found. That’s because, unlike many medical diagnoses, most DSM-defined disorders do not explain the source of distress; they merely classify its presentation. The same limitation applies to GID, now called gender dysphoria.

Between 2014 and 2017—around the time Yarden was researching these topics—brain studies on trans-identified individuals peaked. Some findings suggested that certain brain regions in trans-identified males resembled those of females, fueling the “brain-body mismatch” theory. These studies received widespread media attention.

What got far less coverage were the follow-up studies that debunked the findings after controlling for sexual orientation and hormone use—both of which affect brain structure.

The belief in a biological basis for being transgender can deeply influence how individuals understand themselves. When that belief is reinforced by medical professionals—figures seen as trusted authorities—it carries extraordinary weight. Under such influence, both young people and their parents may come to view medical intervention not as an option, but as the only responsible course of action to treat what they believe is a biologically determined condition.

Yarden had easy access to all four surgeries he underwent, as each was covered by California’s state insurance, Medi-Cal, which relies on WPATH standards in its coverage decisions. With insurers classifying these procedures as “medically necessary” and gender-affirming clinicians clearing the path, it’s not hard to see how someone like him could undergo so many operations in such a short span of time.

To a layperson, the phrase “medically necessary” may sound like an imperative. But in insurance terms, it simply means a treatment meets certain criteria for coverage—not that it’s always the best or only option.

Read more: Transgender Brain Studies Are Fatally Flawed

Rigid Thinking and the Gender-Affirming Model of Care

Black-and-white thinking—also known as rigid thinking—is especially common in adolescents, autistic individuals, and those with certain mental health conditions. It can lead some to believe that all of their distress stems from being transgender, and that medical transition will resolve it.

The gender-affirming model of care, first established at Boston Children’s Hospital in 2007, quickly spread across the U.S. Over time, the previous standard of “watchful waiting” gave way to an affirmation-only approach. In gender-affirming therapy, the therapist does not question or investigate the source of a patient’s distress but instead validates the declared identity. The underlying (though incorrect) assumption is that people are born transgender in the same way they can be born gay—and that to suggest otherwise is considered “conversion therapy.”

As a minor, Yarden began seeing a gender-affirming therapist who, according to him, encouraged his transition. In hindsight, he saw this as a profound betrayal.

“I consider everything she did to me to be psychological abuse.”

At 17, he received a prescription for cross-sex hormones from a Fresno clinic. In many clinics, patients can access hormones after a brief consultation—sometimes as short as 30 minutes.

Surgical intervention often follows the same logic. The role of the gender-affirming surgeon is not to evaluate medical necessity, but to confirm that the patient meets basic administrative criteria—usually a letter from a gender-affirming therapist—before proceeding.

In a short span—between the ages of 19 and 21—Yarden underwent a series of procedures: penile-inversion vaginoplasty (with follow-up revisions using skin grafts), breast augmentation, a second vaginoplasty using a section of his colon, and facial feminization surgery. His writing reveals a pattern of rigid thinking. Even as serious complications emerged, he remained fixed on the belief that the next procedure would finally bring him peace. Before undergoing facial surgery in the summer of 2019, he wrote:

“If this one surgery is a massive success, then I wouldn't have wasted so many years of my life for nothing. I wouldn't have lost all my friends and the vast majority of my family for nothing. It would all be worth it!”

He was not alone in this mindset. It’s a familiar experience among those with gender dysphoria and body dysmorphic disorder (BDD): once one perceived flaw is addressed—surgically or otherwise—another takes its place. The focus of distress simply moves to a new target. See examples highlighted by detransitioner Exulansic: [Example 1, Example 2, Example 3, Example 4].

Unsurprisingly, the result of the facial feminization surgery left him disappointed: 

“I thought I would look beautiful, but I see myself as unattractive. This too wasn't what I had imagined.”

Just as he had once clung to the idea of the next surgery, he also clung to the idea that the next surgeon might finally fix what had been broken:

“I want to find a surgeon who can help me, but they always end up causing more damage to my body.”

Having already sacrificed so much—his health, relationships, and sense of self—it took time for Yarden to accept that continuing down this path was not helping. But by then, the damage had been done.

As his complications became increasingly dire, and not one of more than a dozen doctors he turned to would help him, Yarden is believed to have taken his own life at just 23 years old. This was 2021—just before detransitioners began gaining broader public recognition. Had he lived, I imagine he would have become a public-facing detransitioner, campaigning for change.

Yet even today, there is no established protocol for medical detransition. No clinical guidelines. No medical billing codes. Few insurance plans cover reversal procedures. The system still offers only a path forward—not back. In a better system, the vulnerabilities Yarden carried would have prompted caution—not a fast track to harm.

In interviews, I’ve often shared how I became a journalist after discovering the stories of detransitioners—stories that deeply resonated with my own struggles with mental health and identity. I’ve been very open about the severe mental health crises I faced in my youth and have frequently alluded to the "bad decisions" I made as a young adult. As my public profile grew, I was prepared for the inevitability that those bad decisions would become known. Now that they have, I want to use this moment to share my story in the hope that it can be instructive and bring attention to an issue I believe is preventing many from recovering from mental illness.

There’s been much speculation about the ongoing youth mental health crisis, particularly about why liberals—especially liberal girls—report the highest rates of mental illness. Some have suggested that locus of control plays a contributing role. Those with an external locus of control, who believe their lives are shaped by forces beyond their control, tend to be less mentally well and lean more liberal. In contrast, those with an internal locus of control, who believe they have agency over their lives, are generally mentally healthier and more likely to align with conservative values.

This idea resonates deeply with me and my own experiences, and I want to expand on it. I believe young people, especially liberals, are constantly bombarded with messages that reinforce an external locus of control. This concept is central to the book I am writing, where I lay out the origins of this mindset and the effect it has on people. A significant contributor is the brain disease model of mental illness. This biomedical model, which portrays mental illness as a medical condition, profoundly shaped my sense of self growing up and, I believe, continues to influence how many young people perceive themselves and their struggles.

The Brain Disease Model of Mental Illness

In the 1980s, psychiatry sought to establish itself as a legitimate branch of scientific medicine by adopting a biomedical model, which framed mental disorders as brain diseases. This approach offered a straightforward explanation: mental illnesses result from biological dysfunctions, such as chemical imbalances, and require medical treatment. One of the most influential narratives born from this model was the serotonin theory of depression, which claimed that depression was caused by low levels of serotonin in the brain.

Endorsed by professional organizations like the American Psychiatric Association (APA), the National Institute of Mental Health (NIMH), textbooks, and influential research papers, the brain disease model of mental disorders became a cornerstone of psychiatric practice and public understanding for 40 years. Pharmaceutical companies spent billions on advertising campaigns promoting psychotropic drugs as solutions to chemical imbalances. Public awareness initiatives claimed it would reduce stigma surrounding mental illness. As a result, surveys find that 80–90% of people believe depression is caused by a chemical imbalance.

However, this narrative was built more on marketing than science. Billions of dollars in neuroscience research over decades have failed to uncover clear and convincing evidence for a biological basis for mental disorders. The serotonin theory of depression, in particular, lacked substantial evidence and was debunked in 2022 by a systematic umbrella review. Despite this, there has been no major effort to correct public misconceptions or hold accountable those who promoted this idea without evidence.

The chemical imbalance theory remains the dominant cultural narrative about depression in the United States. Many states are now incorporating mental health education into K-12 curricula, but depending on how this education is conducted, it could cause more harm than good. For example, a Minnesota curriculum for middle and high school students, developed by the pharma-funded advocacy group National Alliance on Mental Illness (NAMI), teaches that mental illnesses are "brain disorders," emphasizing: "Biology, not a character flaw, causes mental illness."

This is a vast oversimplification. While hereditary components and traits like neuroticism may predispose individuals to negative thinking or mental health challenges, they do not determine their fate. Yet, in my recent interviews with young adults in treatment for mental health crises, every one of them described their mental disorder as a chemical imbalance or brain condition. They attributed the actions that led them into treatment to their disorder, viewing it as a lifelong condition, which they lacked control over.

Given the ubiquity of the biomedical model, it should come as no surprise that mental disorders are among the leading causes of disability—costing the U.S. economy upwards of $280 billion annually. As of 2022, over one in five adults in the U.S.—59.3 million people—report a mental illness diagnosis. For adolescents aged 13–18, the rate is even higher, with an estimated 49.5%—nearly one in two—diagnosed.

The lead author of the 2022 systematic umbrella review, Dr. Joanna Moncrieff, stated that "telling people they have a brain abnormality, or some physical medical problem, is profoundly disempowering." She is absolutely right. Such messaging undermines a person’s sense of agency and is particularly harmful to young, developing minds.

As a teenager immersed in a mental health system rooted in the biomedical model, I internalized the belief that something was fundamentally wrong with my brain and that I lacked control over my behavior. My story is one of breaking free from the constraints of this medical framework, overcoming the mental health challenges it reinforced, and reclaiming a sense of personal agency over my life.

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Tumultuous Teen Years

I received many diagnoses throughout my life, the most recent being Asperger's syndrome at age 30. While I remain skeptical of behaviorally-diagnosed conditions and mindful of confirmation bias, I can see, in hindsight, early signs from childhood that align with the traits ascribed to Asperger's. From a young age, my life was continually punctuated by one all-consuming interest after another. I struggled to make and maintain friendships, and spent most of my time alone and engaging in solitary activities like staring into puddles and overturning rocks to observe small life forms, catching tadpoles, arranging my toys in elaborate setups, and drawing.

I was rigid and found comfort in routines, rewatching the same VHS tapes or listening to the same cassettes on repeat. My eating habits were similarly fixed—I was a very picky eater, choosing the same plain foods every day. I was also particular about textures, always preferring soft, stretchy fabrics. Physically, I was clumsy and uncoordinated, and I was highly sensitive to my environment.

But the real trouble didn't begin until early adolescence, when my family moved to a new city and I started middle school. I was not socially successful and was teased by other kids. The rejection felt monumental, leading me to become increasingly self-critical and withdrawn. The noisy, chaotic areas where kids gathered were overwhelming, so I often sought refuge in teachers’ classrooms during breaks and lunch or found quiet, secluded spots to be alone. 

I began experiencing feelings of body dysmorphia, becoming hyperfocused on my flaws. I wore the same baggy black sweatshirt and stretchy blue jeans every day. I thought I was hideous and hid my face behind a wall of hair. I developed dermatillomania, compulsively picking at my scalp, as a way to self-comfort.

In class, I would repetitively draw the same figures and faces, retreating into a fantasy world—first Sailor Moon, then The Legend of Zelda, then Lord of the Rings—to escape from reality. Sometimes, I became so overwhelmed that I would get up and walk out of class, only to be sent to the counselor’s office. They recommended to my parents that I see a therapist. After school, I would go straight to my room and draw the curtains. I spent countless hours on the computer, teaching myself to code and designing websites dedicated to whatever my current interest was.

In 2002, when I was 13, my 7-year-old neighbor Danielle van Dam was raped and killed by our 49-year-old neighbor, David Westerfield. It was a big event in our community, and it deeply affected me. I followed the trial closely and collected the newspaper clippings about the case. I developed insomnia and obsessive-compulsive habits: walking around the house at night, checking the locks over and over, and washing my hands until they were raw. 

Entering highschool, my mental health further plummeted and my relationship with my parents deteriorated. I was 14 when I started carving up my body with knives and razor blades. My outward appearance started to reflect my darker inner world; I dyed my hair red and wore heavy eyeliner. I became anorexic, and at 5’8”, my lowest weight was under 100 pounds. My biceps showed brown discoloration from muscle wasting. I began feeling like it would be better if I died.

It was during a visit to the psychiatrist in 2003 that I received a diagnosis of major depressive disorder after a brief meeting reviewing a checklist of symptoms. This was the first time I heard depression described as a "chemical imbalance" in my brain. This explanation made me feel hopeless, as it implied that my brain was somehow defective—I was born with this condition, and had no power to change it. During that appointment, I made a long slice down my arm in the bathroom with a razor blade, resulting in an emergency room visit and my first stay in a psychiatric hospital.

In 2004, I was caught in a cycle of crises, repeatedly accessing emergency rooms, psychiatric hospitals, outpatient programs, and group homes. I received numerous diagnoses from different psychiatrists and was prescribed a range of high-dose psychotropic medications—including one that caused a life-threatening rash and another that required regular EKGs.

At every step, the idea that mental illness was a brain disease I suffered from, and would have for the rest of my life, was reinforced. The lexicon of the Diagnostic and Statistical Manual of Mental Disorders (DSM) shaped my worldview, and I became preoccupied with finding the "correct" diagnosis so that I could better understand myself. The way the adults in my life referred to me as "sick" and "mentally ill" and described my behavior as "out of control" influenced my self-perception, and I took on the role of a sick person. 

Due to my extensive absences from high school, I had an Individualized Education Program (IEP). As part of the evaluation process, they conducted psychological testing and classroom observations. The evaluator’s notes documented my monotone voice, "limited eye contact," "flat affect," instances of "stumbling while walking and almost falling," and that “test results indicate a large number of atypical perceptual experiences.” They also noted "social immaturity," "significant inflexibility in her thinking," "difficulty identifying feelings," "tendency to express emotions indirectly and impulsively," and that “when the teacher used humor in the classroom, Christina did not smile or appear to respond in the same manner as her peers.” 

I also received a near-perfect score on Raven’s Progressive Matrices, a nonverbal intelligence test that measures an individual’s ability to identify patterns—a result I later learned is common among individuals with Asperger’s. However, Asperger’s was largely viewed as a "boys' disorder" at the time and was not considered in my case. Instead, my IEP labeled my disability as “Emotionally Disturbed.”

As my behavior escalated and became increasingly risky, I began seeking out drugs and alcohol. Things took a drastic turn for the worse when an internet predator found me on Myspace and began grooming me. He was 47, and I was only 15. He had deceived me, and when I met him in person, he raped me. The emotional pain was so unbearable afterwards that I tried to hang myself.

From the emergency room, I was placed in another psychiatric hospital—but this time there was no going home afterward. It became clear to my parents that I needed a higher level of care than they could provide. After running away from two lower-security residential treatment facilities, flunking out of a wilderness program in Idaho, and several more psychiatric hospital stays, I arrived at my final destination: a lockdown psychiatric residential treatment center in Utah called Provo Canyon School, where I would live for a year.

While other kids were getting their learner’s permits, celebrating their sweet sixteens, and attending school dances, I was in treatment. It was an intense, highly structured behavior modification program with a level system I had to work through to achieve a high status. It wasn’t easy or enjoyable, but it was effective in helping me break free from the cycle of crisis so that I could safely return home. (This type of treatment is in decline—a topic I’m passionate about and have several upcoming articles addressing.)

As for my rapist, he served less than six months in jail. This type of crime carried lighter penalties 20 years ago. I later learned that he reoffended four years later with another underage girl. He's still on the sex offender registry.

Young Adulthood

Things were stable at home for a while, and I managed to complete high school at 17, but my relationship with my parents remained strained. By 19, living at home was no longer an option, and I found myself on my own. A friend’s family offered me a temporary place to stay, but I didn't want to be a burden on them, so I quickly moved in with a boyfriend I had just met.

We had a roommate who eventually moved out, leaving me needing additional income to cover expenses. I began doing photoshoots, which were initially clothed. However, after I was let go from my job as a nanny, the shoots progressed to unclothed. My boyfriend at the time, who had stopped working, either encouraged it or didn’t discourage it. This period is difficult to recall, as I’ve tried hard to forget it.

When the relationship ended, he left the country, abandoning me with significant debt, unpaid rent, and lease-breaking fees from our apartment. Our former roommate, who was also on the lease, was forced to cover the apartment fees to protect her credit and threatened legal action against me, leaving me desperate to find money quickly.

I eventually agreed to meet with a representative from an agency that had been hounding me, which led to my decision to make adult films to pay off my debt. At the time, and for several months thereafter, I believed I had bipolar disorder. However, I later realized that the instability I felt stemmed from other factors, including heavy drinking. My behavior mirrored my sense of self-worth—I saw myself as a mentally ill, degenerate loser, and I acted accordingly.

I was purely in survival mode, with no one to call for help and without the kind of stability one typically needs to think about the future and consider how my choices would impact me later in life. I was also very naive, believing that the content would remain on obscure, paywalled websites, unaware that free porn sites were beginning to dominate the internet.

While I don’t judge others who have chosen to do sex work, I would strongly discourage anyone considering it, as my own experience was traumatic and soul-crushing. I decided to work with an agency because I thought it would be safer, but my last assignment proved otherwise. They sent me to a hotel room with a man with a camera who choked me, hurt me, and ignored my cries and pleas to stop. Even after that, the agency relentlessly pressured me to continue, but I was done. In three and a half weeks, I had made enough to pay off my debt and avoid homelessness. How the owners chose to distribute, repackage, and republish the content at later dates and under multiple titles was entirely beyond my control.

Getting Better

Afterwards, I worked as a freelance graphic artist, but I was still directionless, turning to dangerous combinations of drugs and alcohol. That changed when I was 22 and began working for an employer whose family became a surrogate family to me. He believed in me, saw potential I couldn’t see in myself, and encouraged me to go back to school. For the first time, someone expected more from me—he didn’t treat me like I was a sick person or try to take advantage of me.

He introduced me to science, which quickly became my all-consuming passion. He gave me books on skepticism and debunking pseudoscience, which I devoured, and we watched debates on atheism that taught me about argumentation and logical fallacies.

I used to feel like a passive witness to my own life, watching myself make one bad decision after another, driven by emotions and impulses I couldn’t control due to my underlying mental illness. I had never been taught to think critically or base my beliefs on evidence, like a scientist. Learning how to think critically—and applying those techniques to myself—was the turning point when everything began to change.

There’s a meme I like that says, “Anxiety is just conspiracy theories about yourself.” The key is learning to debunk those conspiracy theories and spot the logical fallacies in your own thinking. This mindset shift helped me immensely. I also discovered Stoic philosophy, which taught me that I could choose not to react to emotional triggers and that no one could disturb my inner peace unless I allowed it—something I wasn't even aware was possible.

I believe many mental health challenges stem from the belief that we lack control over our thoughts and emotions. The truth is, you can train your brain. The mind is like a muscle; just as you wouldn’t expect to transform your body in a single day at the gym, strengthening your mind takes consistent effort and hard work. If you stick with it, you get stronger every day.

Challenging my negative self-talk was one of the hardest things I’ve ever done. After over a decade of habitual self-criticism, catastrophizing, and black-and-white thinking, breaking those thought patterns felt almost insurmountable. But this process—essentially cognitive behavioral therapy (CBT) in practice—was transformative. While a therapist trained in CBT can offer valuable guidance, real progress comes from consistently applying these strategies in your everyday life.

Through this work, I developed an internal locus of control and a sense of agency that had been missing for most of my life. For the first time, I no longer saw myself as mentally ill and destined for a life of failure: I felt like I was truly in charge of my thoughts, my actions, and my future.

Aftermath

I eventually reconnected with my family, and we’re very close now. While making friends became somewhat easier as I got older, maintaining those friendships remained a challenge. Throughout my twenties and early thirties, I still struggled with identity issues, which led to a somewhat unconventional life as I searched for direction. I moved frequently, even living in Switzerland at one point, changed my college major several times, changed my appearance often, worked as a caregiver for special needs children and adults, tagged along on tour with Alice Cooper, illustrated children’s books, and became a social justice meme-maker for a short time before undergoing a political realignment.

Clarity came at age 30, when I was assessed for and diagnosed with Asperger’s syndrome. This often presents differently in girls and can go undetected, as comorbidities tend to emerge around puberty, shifting the focus away from the underlying condition.

Hypersensitivity to light and sound, social difficulties, obsessive interests, repetitive behaviors, struggles with abstract thinking and executive functioning, auditory processing challenges, food intolerances, motor-balance issues, and possibly even the cerebellum abnormalities revealed in my MRI all finally seemed to fit into a cohesive narrative. However, I am now cautious not to let any diagnosis define my identity. Instead, I focus on accommodating myself to better manage the associated symptoms so that they don't interfere with the life I want.

Even after this revelation, my life still lacked purpose. It was only in recent years, after becoming a journalist, that I truly felt like I had found my calling. Journalism has given me a sense of accomplishment and self-worth. It’s an exciting career that allows me to leverage my strengths in research and writing, along with traits like hyper-focus, an obsessive drive to deeply understand topics, attention to detail, and the ability to work long hours without fatigue. It’s a profession where I can pursue my love of learning while helping others stay informed.

In my work with detransitioners, I conducted a survey revealing 85.7% reported that their healthcare providers, including doctors and therapists, described being transgender as a biological characteristic beyond their control—a medical condition necessitating treatment. Additionally, 49.2% recalled providers framing their transgender identity as a brain condition, using the phrase "male brain in a female body" and vice versa. This framing drew striking parallels to my own experience with the brain disease model of mental illness. Both present psychiatric conditions as innate and immutable traits, profoundly shaping young people's self-perception and undermining their sense of personal agency.

Learning about the history of psychiatry, combined with my personal experience, and the experiences of detransitioners, has really shaken my faith in the field, leading me to wonder if it deserves the outsized trust we place in it.

Diagnostic categories within the Diagnostic and Statistical Manual of Mental Disorders (DSM) reflect the opinions of appointed experts rather than being grounded in consistently replicated scientific research. Psychiatric diagnoses are often unreliable because they are based on subjective criteria, such as self-reports from patients, behavioral observations, and clinician interpretation, all of which are susceptible to bias and error. Recent research has highlighted a significant amount of overlap within DSM-defined disorder categories, leading some researchers to conclude that psychiatric diagnosis is "scientifically meaningless." 

And yet, the DSM has become a globalizing force, spreading predominantly Western concepts of mental health to other cultures, often driven by the interests of pharmaceutical companies and professional organizations. This has contributed to the rise of diagnostic fads and diagnostic inflation, where increasingly broad criteria pathologize human behavior, labeling it as mental disorders. 

We have to consider how the DSM serves as a powerful cultural script, and influences how we express and communicate our distress. While there is some utility in classifying mental and emotional distress, diagnoses are often misunderstood as the cause of a person’s struggles, leading many to define themselves by these labels. This can create a self-fulfilling prophecy, where belief in a diagnosis influences the manifestation of symptoms—even when the diagnosis is incorrect.

We need to step back from the brain disease model of mental illness and rethink how we understand life’s difficulties. Unwanted thoughts and emotions are not simply the result of abnormal brain chemistry requiring chemical correction. In many cases, they can be changed with effort and persistence—but that process begins by rejecting the idea that you lack the power to make those changes.

Mental illness should not be viewed as a permanent condition or a defining aspect of one's identity. Instead, it should be seen as something to work toward overcoming—to the extent it is possible. This perspective may not apply uniformly to all conditions, such as psychotic disorders, but in most cases, recovery even from serious mental illness is attainable. Believe you are sick, and you will be sick; believe you can get better, and you can.

In April, the U.K.’s Cass Review, along with its associated systematic evidence reviews–representing the most thorough appraisal of pediatric gender medicine to date–found “remarkably weak” evidence supporting all interventions for gender transition in minors. Those who continue to advocate for “gender-affirming care” are promoting gender pseudoscience—a term I introduced two years ago. 

The other half of gender pseudoscience, which is less talked about, centers on the unsupported claims about a fixed and immutable gender identity. Advocates of this view argue that everyone possesses a gender identity and it is discernible from a very young age. If there's a discrepancy between the gender identity and the child's biological sex, the child is claimed to be transgender. 

If you haven’t been following the developments around trans-ideology closely, the evolving definitions and concepts can be difficult to grasp. Over the years, influential activist organizations and advocates have downplayed gender dysphoria as a meaningful diagnosis due to the stigma associated with psychiatric conditions. Instead, they advocate the perspective that being transgender is an innate trait, mirroring the successful "born that way" narrative of the gay rights movement.

Gay people, for the most part, do not choose their sexual orientation. As a liberal and staunch advocate of gay rights, I believe that other well-intentioned liberals support transitioning children because they have been led to believe that being transgender is exactly like being gay. Therefore, it is very important to understand the current state of biological evidence there is for an innate and immutable gender identity.

In February, psychiatrist and youth transition advocate Jack Turban announced his new book, Free to Be: Understanding Kids & Gender Identity, which presents research that he claims supports "a strong innate biological scaffolding for our gender identities." Turban is known for publishing deeply flawed studies on gender-affirming care and for his refusal to engage with critiques of these studies. His influence is notable: he recently appeared on PBS and is responsible for reviewing the American Psychiatric Association’s page on gender dysphoria. When Free to Be was released last month, I ordered a copy to gain insight into his arguments and supporting evidence justifying his position. 

Most of the book relies on emotion-filled stories to shape its narrative, featuring conversations with individuals who are or were trans-identified as children. Throughout the book, he offers many confusing definitions for gender identity, which he describes as a “complex multidimensional construct.” He also has a particular fondness for the word “transcendent,” using it seven times to describe a “transcendent sense of gender.” He explains that you "simply feel a certain gender," and it is a "hard-to-put-into-words feeling." (Yes, we can tell.) The clearest definition he provides is "one’s psychological understanding of oneself in terms of masculinity, femininity, a combination of both, and sometimes neither."

If gender identity were simply a psychological concept or a feeling, it might not be so contentious. However, Turban claims that gender identity has an “innate biological basis,” which he insists is supported by a large body of evidence.

Currently, there is no brain, blood, or other objective test that can detect gender identity or otherwise distinguish a trans-identified from a non-trans identified person, once variables like sexual orientation are controlled for (at the group level, not the individual level). Gender identity is subjectively determined by the individual based on how well they feel they align with sex-based stereotypes.

To represent gender identity as a biological property of human beings is an extraordinary claim. When this claim is used to justify medically transitioning children, among other things, you had better have good evidence for it.

From my observation of the research landscape, I often see researchers approach the inquiry into gender identity in a deceptive manner. A prime example is an influential review article by Dr. Joshua Safer, who co-authored two sets of clinical guidelines for the medical care of transgender patients. Instead of objectively assessing whether or not gender identity exists, their objective is to seek out “current literature that supports” their conclusion—a hallmark of pseudoscience.

Safer and colleagues compiled a collection of loose theories and cherry-picked studies that found evidence for sexual orientation, gender nonconformity, disorders of sexual development (DSD), and other conditions influenced by prenatal gonadal hormone exposure that contribute to natural human diversity. But none of these studies offer empirical evidence to substantiate the validity of an innate gender identity.

Turban does the same thing in Chapter 3 of his book, titled “Gender Foundation: The Biology of Diverse Gender Identities.” He claims there is “strong evidence that transness has an innate biological basis,” but an alternative interpretation is that this evidence supports the concept of gender nonconformity.

Gender nonconformity encompasses preferences, behaviors, and physical traits that deviate from what is considered typical for males and females. Today, "transgender" is widely used as an umbrella term that is conflated with common gender nonconformity. Ideologically-motivated researchers and clinicians typically use biological evidence for gender nonconformity as a stand-in for evidence of gender identity.

For such a "large body of evidence," as Turban claims throughout the book, I expected more than the same two studies on twins and genome sequencing that he referenced in his 2021 CNN op-ed, “Attacks on trans people are also attacks on science itself.”

The twins study, a 2011 review of older research, revealed only a 40% concordance rate among twins, which is considered low for such studies. Additionally, many of the twins were same-sex attracted, a factor often associated with gender nonconformity and potentially leading to the adoption of a transgender identity—especially when gender nonconformity is now viewed as synonymous with being transgender.

The paper concludes, "These findings suggest a role for genetic factors in the development of GID" (emphasis added). Contrary to Turban’s claim, this does not provide strong evidence for an innate gender identity. Rather, it suggests that genetic factors may contribute to gender nonconformity, which can cause distress and a desire to be the opposite sex, previously diagnosed as gender identity disorder (GID).

The second study Turban cites is a 2019 genome sequencing study. Recent research in this field has increasingly leaned towards activism, either explicitly or implicitly. The authors of this study consider the lack of biological understanding of transgender identity as an obstacle to individuals obtaining medical interventions.

This study's methodology is questionable due to a small sample size and lack of a control group, as well as missing data on sexual orientation. Among the 30 participants (13 transgender men and 17 transgender women), no single gene variant was found in all or most of them. Most variants were unique to individuals, with a few shared by small groups of 2-4 people. This is typical in genetic research of complex traits, where no single gene determines the trait.

Turban claims that although no "transgender gene" was found, the study provides evidence for a biological basis of gender identities. However, this is dubious because the broad definition of transgender includes gender nonconformity, making it more likely that gender nonconforming people identify as transgender. Thus, Turban's interpretation might better be seen as evidence for a genetic basis of gender nonconformity.

The genes identified are linked to pathways that affect sexually dimorphic brain development and behavior, relating to gender expression and behavior—essentially gender nonconformity. The study may be identifying genetic variants common in transgender individuals, but these traits are not exclusive to or definitive of transgender identity. In a culture equating gender nonconformity with being transgender, it may appear that way.

So that’s the best Turban’s got. 

In Chapter 3, Turban gives an honorable mention to the brain sex studies, which were once hailed as proof that transgender people have brains matching their gender identity. However, these studies were refuted when researchers controlled for confounding variables and found that sexual orientation was responsible for the observed brain differences. All Turban can muster is “the results have been inconsistent.”

It's important to highlight this failure because “brain sex” conjecture was baked into clinical guidelines for medical transition and legislation for employment, healthcare, and education. The narrative that transgender people have brains matching the opposite sex, explaining their condition, was pervasive in the media and even appeared in the influential 2014 children's book "I Am Jazz," where Jazz states, "I have a girl brain but a boy body. This is called transgender. I was born this way!" When the brain sex studies were debunked, activists shifted their narrative.

Nowhere in this chapter are the body perception neuroscience studies mentioned, which I believe have merit and are worth exploring. The “own-body perception” theory proposes that reduced structural and functional connectivity between certain brain networks is responsible for gender dysphoria. However, these studies show only an association, not a causal link. Abnormalities in body perception networks in the brain are not unique to those with gender dysphoria; they are also associated with many other conditions, including body dysmorphic disorder, anorexia, body integrity identity disorder, schizophrenia, and autism.

Perhaps this theory was omitted because it isn't useful to advocates trying to disassociate the psychiatric condition of gender dysphoria from being transgender. "It’s important to acknowledge that gender dysphoria and being transgender are not the same thing," Turban says. The "ultimate goal" stated on the American Psychiatric Association page is to categorize it under an "endocrine/medical diagnosis." The WHO's new ICD-10 diagnosis, gender incongruence, classified as a "condition related to sexual health," is a step towards that aim, explicitly done to reduce stigma.

The concept of a fixed, innate, and unchanging gender identity is refuted by a substantial body of desistance research in children and a growing population of detransitioners. Their existence is a major inconvenience to proponents of the innate gender identity narrative, who often downplay their presence.

Nothing I am saying contradicts the view that transgender people exist and deserve dignity and respect. My definition of a transgender person is someone who has taken social or medical steps to be perceived as the opposite sex, usually to alleviate what they experience as gender dysphoria. I say this not to discount their experience—there is genuine distress involved—but to acknowledge that this distress can sometimes be misattributed. In my conversations with detransitioners, some have said that they did not have gender dysphoria and were misdiagnosed, while others have said that they did have gender dysphoria, but it later resolved.

In conclusion, biological factors are associated with being transgender, but being transgender itself is not an inherent condition one is born with. The studies seeking to discover biological factors associated with transgender identity are most likely evidence of gender nonconformity, and misinterpreted as evidence of innate gender identity.

A more appropriate title for Jack Turban’s book would be “Free to Believe” because gender identity only exists for those who believe in it, and claiming that scientific studies support its existence is gender pseudoscience.

Update 6/15/24: In response to questions about their recent study on whether young people in Germany maintain their gender-related diagnoses throughout the transitioning process, the study authors were contacted for more information.

They confirmed that in Germany, individuals typically keep their medical diagnosis for an extended period as they navigate transitioning. This may include lifelong hormone treatments and other ongoing healthcare services such as speech therapy. They also shared new insights, noting that while changing one's gender marker on identification documents is a common step during transitioning, the study found that less than 0.5% of those diagnosed with gender identity disorders actually changed their marker during the time they were studied.

Additionally, the authors mentioned that surgeries for children and teenagers, tracked by a specific German coding system (OPS code), are quite rare. They observed that the stability of these diagnoses varies by age and sex, with older individuals generally having more stable diagnoses compared to adolescent girls.

The authors were confident in their interpretation of the data, emphasizing that their study findings align with past desistance research: “The proportion of unstable diagnoses is within the range of previously published international figures, which makes our results plausible.”

The results of this study are a significant finding—there is very little desistance data on the newer cohort of young people under the gender-affirming model of care, and this study adds to growing evidence that for many young people, a trans-identity can be a temporary phase.

A new long-term study from Germany suggests that the majority of young people diagnosed with gender identity disorders do not continue to identify as such over time. The study examined insurance data over five years, revealing that more than half of young people aged 5-24 across every age subgroup diagnosed with "gender identity disorder" no longer had the diagnosis after five years. Specifically, the desistance rate was 72.7% in 15- to 19-year-old females and 50.3% in 20- to 24-year-old males. Among the whole group of 5- to 24-year-olds, only about 36.4% of those diagnosed in 2017 still had the diagnosis five years later, indicating that more than 63% desisted. 

One of the strengths of this study is its comprehensive collection of outpatient billing data for all legally insured persons in Germany, providing a large and representative sample. Additionally, the long observation period from 2013 to 2022 offers valuable insights into long-term trends and changes in diagnosis rates.

The research also noted a dramatic rise in the number of young people being diagnosed with gender identity disorders. In 2013, there were 22.5 cases per 100,000 insured young people, but by 2022, this had increased to 175.7 cases per 100,000, representing an increase of nearly 681%. The study highlighted that, in almost all years, the highest prevalence of gender identity disorder diagnoses was found in 15- to 19-year-old females. In 2022, this age group had a prevalence rate of 452.6 cases per 100,000.

The study also found that a large majority of those diagnosed with gender identity disorders had other mental health conditions. In 2022, 72.4% of individuals with a gender identity disorder diagnosis had at least one other psychiatric diagnosis. The most common co-occurring mental health issues included depressive disorders (affecting about 57.5% of females and 49.3% of males), anxiety disorders (34% of females and 23.5% of males), and borderline personality disorders (17.6% of females and 12.1% of males). Other frequent conditions were attention deficit/hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD).

The researchers highlighted the "fluid" nature of gender identity during childhood and adolescence as a likely reason for the high desistance rates. Citing the U.K.’s Cass Review, the authors suggested the need for a comprehensive, standardized diagnostic procedure for youth experiencing gender-related distress.

The study suggests that many young people might resolve their gender incongruence without needing long-term medical treatment. The authors recommend that diagnostic stability and the high prevalence of concurrent mental disorders be considered when starting “gender-adjusting therapy” in adolescence.

They call for more research into cases of "low persistent diagnosis," confirming that “the diagnostic persistence of less than 50% in all age groups in the 5-year follow-up corresponds to the literature.” This supports a growing body of research showing that gender dissatisfaction during adolescence is often temporary and tends to decline with age. This study aligns with recent findings from a long-term Dutch study, which found that most adolescents who expressed a desire to be the opposite sex no longer felt that way in adulthood.

h/t: OurDuty Group

A newly published review in a prestigious medical journal has found that many studies on hormonal treatments for children with gender dysphoria have exaggerated their benefits. The analysis, led by Kathleen McDeavitt from the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, revealed that many studies presented positive conclusions about hormonal interventions even when the findings were insignificant, small, or even negative.

Proponents of early medical transition argue it can reduce suicide risk, often describing hormonal interventions as “life-saving care.” However, McDeavitt's review of 14 long-term studies reveals that the majority did not find improvements in depression or suicidality. In fact, the largest study included in the review reported

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A new study has found that trans-identified female patients on testosterone face an increased risk of lacerations and vaginal bleeding after undergoing a “minimally invasive hysterectomy.” The study follows another report from just one month earlier, which found that trans-identified females on testosterone have a high incidence of pelvic floor dysfunction.

Researchers at the Medical College of Wisconsin conducted a study analyzing past data from surgical and medical records at a single, large academic center. They reviewed phone calls, emergency room visits, and clinic visits over 90 days post-surgery. The aim was to compare complications in trans-identified female patients on testosterone with those not on testosterone.

The study included patients aged 18 to 55 who had a minimally invasive hysterectomy, with or without the removal of ovaries, between January 2014 and December 2022. This procedure, which involves removing the uterus through small incisions, is often offered to transgender patients as a “gender-affirming hysterectomy.”

The study group included 88 patients on testosterone who identified as male, transgender male, genderqueer, or nonbinary. The control group included 242 patients who identified as female, genderqueer, or nonbinary and were not using testosterone. Patients using testosterone were generally younger, had lower body weight, better overall health, and were more likely to have never given birth, with a median of 2.5 years on testosterone.

The study found that patients on testosterone had a higher risk of experiencing

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The prominent science journal Nature has launched a new opinion article series on sex and gender. One paper in this series explores research attempting to search for a biological basis for trans-identity, arguing that such research could “pathologize” and “harm” the trans community. The authors discourage “investigations into the underlying bases of transgender identity” and propose various steps for researchers to incorporate transgender activism into their work to influence research outcomes — signaling the end of Nature’s commitment to pursuing scientific truth over ideology.

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The world is reacting to the U.K.'s Cass Review and associated systematic evidence reviews, which found "remarkably weak" evidence supporting medical interventions for gender transition in minors. Released on April 9, 2024, the final report from the national gender clinic service for those under 18 — following four years of meta-analyses of the available literature — dealt a major blow to the gender-affirming model of care and marked its termination in England.

England’s National Health Service, which commissioned the report, expressed gratitude to Dr. Hilary Cass and committed to implementing her recommendations. These advocate for primarily relying on psychotherapy to address gender-related distress in minors and discontinuing the use of puberty blockers. The NHS predicted the landmark review would have "major international importance and significance" — a prediction that has proven correct.

In the last several years, we saw the U.K., Sweden, Finland, and Denmark adopt a more cautious approach by placing restrictions on medical interventions for treating gender dysphoria in minors. Norway has also signaled intentions to follow a similar path.

Now, the Cass review has mobilized other countries to begin reevaluating their practices — with the exception of the United States. The following is an overview of recent updates in the two months since the Cass review was published, followed by a comprehensive review of all updates in recent years from countries that offer pediatric gender clinic services.

What’s New

Germany and Switzerland

On June 6, 2024, two major medical societies, DGPNN in Germany and SGKJPP in Switzerland, announced their rejection of the new "gender-affirming" German guidelines for minors. The primary issues are the guidelines' failure to review evidence post-2020 and their reliance on WPATH. DGPPN, Germany's largest mental health association, stated they would reject the current draft if finalized, supporting medical interventions only for a limited number of cases within clinical studies.

On May 22, 2024, fifteen chairs and senior members of Germany's Child and Adolescent Psychiatry Association published a rebuttal to the draft of German guidelines for gender-dysphoric youth.

In early May 2024, the German Medical Assembly, a pivotal body representing medical professionals across the country, passed a resolution that calls for the restriction of puberty blockers, cross-sex hormones, and surgeries for gender dysphoric youth to strictly controlled research settings. Another resolution passed that stated minors should not be permitted to "self-identify" into a chosen sex without first undergoing a specialist child and adolescent psychiatric evaluation and consultation.

Chile

On June 7, 2024, Chile's Health Minister ordered the public health system to stop providing puberty blockers or cross-sex hormones to new patients, according to a report by . Existing patients will continue treatment on a case-by-case basis. An official policy statement reflecting the change is expected soon. This decision follows a similar restriction by the private UC Christus health network on June 5, both acknowledging the weak scientific evidence for pediatric gender medicine and the need to review England’s Cass report.

The Netherlands

On June 6, 2024, the Dutch Minister of Health addressed the Dutch Parliament, acknowledging the Cass Report and formally requesting the Dutch Health Council to advise on the use of the Dutch protocol for transgender care. The Health Council is expected to begin the advisory process this year. The Minister's information package to Parliament also included brief responses from the three gender clinics in Amsterdam, Groningen, and Nijmegen.

France

On May 28, 2024, the French Senate voted to pass a draft law to restrict puberty blockers and prohibit cross-sex hormones and transgender surgery for minors. Under the bill, a minor seeking puberty blockers must visit a specialized multidisciplinary center, undergo an assessment for contraindications and capacity to consent, and wait at least two years from the first appointment at the center before starting treatment.

United Kingdom

On May 29, 2024, the United Kingdom government passed legislation to ban the private practice prescription of puberty blockers, including those sourced from abroad. Previously, in March 2024, the National Health Service (NHS) had restricted puberty blockers to trials. This new legislation means that no minor in England, Scotland, or Wales can receive a prescription for puberty blockers unless participating in strictly controlled research settings. The emergency measures will last for three months, requiring further action to become permanent.

Scotland and Wales

In April 2024, in response to the Cass Review, Wales and Scotland have joined England in halting new prescriptions of puberty blockers for minors under 18 diagnosed with gender dysphoria. Additionally, in Scotland, cross-sex hormones will not be available to those under 18.

Belgium

On April 9, 2024, leading physicians in Belgium published a report advocating for significant reforms in the treatment protocols for gender dysphoria in children and adolescents. The report emphasized the need to follow the precedents set by Sweden and Finland, where hormones are regarded as a last resort. Their findings and recommendations were published in a prestigious medical journal associated with Dutch-speaking medical faculties in Belgium and their alumni associations.

International Bodies

International bodies such as the United Nations (UN) have also responded to the Cass Review. On April 24, 2024, the United Nations Special Rapporteur on violence against women and girls, Reem Alsalem, issued a statement on the UN’s website declaring that the Review’s recommendations are essential for protecting children, especially girls, from harm.

In addition, the European Society of Child and Adolescent Psychiatry (ESCAP), a prominent umbrella association of 36 Child and Adolescent Psychiatry societies worldwide, issued a policy statement on April 27, 2024. They urged healthcare providers to "not to promote experimental and unnecessarily invasive treatments with unproven psycho-social effects and, therefore, to adhere to the ‘primum-nil-nocere’ (first, do no harm) principle."

These responses stand in stark contrast to that of World Professional Association for Transgender Health (WPATH), a body-modification advocacy organization. WPATH emailed a statement to its subscribers in response to the Cass Review, vehemently rejecting its findings and adhering to its ideological beliefs. WPATH criticized the Cass Report as “harmful” and "rooted in a false premise" that suggests distressed children can be helped without "medical pathways.”

United States

In response to the Cass Review, the American Academy of Pediatrics (AAP) and the Endocrine Society (ES) provided statements to WBUR on May 8, 2024, doubling down on their endorsement of the gender-affirming model of care and medical interventions for minors. Both blamed “politics” for spreading “misinformation.” Meanwhile, prominent gender clinicians have expressed to WBUR that they are “perplexed and concerned” by these organizations’ statements, given the Cass Review’s findings.

AAP President Dr. Ben Hoffman responded to Dr. Cass's statement in a New York Times article on May 13, 2024, where Dr. Cass claimed that American medical organizations are misleading the public by overstating the strength of evidence supporting youth transition. Dr. Hoffman stated, "Any suggestion that the American Academy of Pediatrics is misleading families is false."

WPATH, AAP, and ES continue to mislead the public by claiming that the gender-affirming model of care adheres to the principles of evidence-based medicine (EBM), despite clear evidence to the contrary. Their recommendations for medical interventions are not grounded in robust evidence but rather rely on "circular referencing" of each other’s guidelines, effectively creating a citation cartel.

On June 5, 2024, the American College of Pediatricians (ACPeds) launched a new initiative called the Doctors Protecting Children Declaration, urging U.S. medical organizations to stop promoting medical interventions for children with gender dysphoria and instead recommend comprehensive evaluations and therapies for underlying psychological conditions and neurodiversity.

Comprehensive Overview of the International Debate On Youth Transition by Country

In recent years, there has been an ongoing debate about the best approach for treating gender-distressed youth, addressing the global increase in young people, primarily adolescent females, seeking services from gender clinics. Countries with pediatric gender clinic services have shown varied responses, ranging from highly medicalized treatment pathways to approaches that prioritize psychotherapy.

Nations such as the UK, Sweden, Finland, and Denmark have taken unified steps to heavily restrict medical transitions for minors, aligning their guidance with the results of systematic evidence reviews, with Norway similarly indicating moves in this direction. Elsewhere, medical and health authorities remain divided on best practices, although there are signs of some reevaluating their positions on the medical transition of minors. This guide will highlight significant updates and changes observed in these practices over recent years.

The Netherlands

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A new systematic review of international clinical guidelines for children and adolescents with gender dysphoria has exposed deceptive practices by respected medical authorities who recommend medical transitions for minors. These guidelines are often cited as uncontroversial and scientifically robust. However, the review reveals that these organizations have misled the public by basing their recommendations on insufficient evidence and inaccurately labeling their approach as “evidence-based.” Furthermore, they have engaged in a corrupt practice known as “circular referencing.” Instead of conducting independent evaluations, they have relied on endorsements of sex-trait modification for minors from other medical bodies, artificially creating a consensus on the issue.

Commissioned by NHS England and chaired by Dr. Hilary Cass, the University of York’s research team evaluated 23 international guidelines using the Appraisal of Guidelines for Research and Evaluation tool to assess their quality. The study specifically examined how evidence informed recommendations, the development and agreement processes for these recommendations, the stakeholders involved, and how the guidelines referenced each other during their development.

Insufficient Evidence

The findings of the review were deeply concerning. It concluded that clinical guidelines globally used to treat gender-questioning children and adolescents were crafted in violation of international standards for guideline development. These guidelines recommended medical interventions for minors despite insufficient evidence, particularly regarding long-term treatment outcomes in adolescents. Additionally, they relied on other guidelines that recommended medical treatments as the basis for making similar recommendations.

Circular Referencing

The Endocrine Society (ES) and the World Professional Association for Transgender Health (WPATH) published initial guidelines recommending youth medical transition in 2009 and 2012, respectively. These guidelines became foundational for many subsequent guidelines, shaping their content and recommendations despite the lack of evidence and rigor. In the Cass Review, Dr. Hilary Cass highlighted the ways in which WPATH and ES were closely interlinked, noting their mutual co-sponsorship and input into each other’s drafts. This coordinated effort suggests that WPATH and ES were colluding to grant undue credibility to their guidelines.

The corruption persisted in the formulation of national and regional guidelines by prominent organizations such as the American Psychological Association, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Society for Adolescent Health and Medicine. It also extended to international guidelines from countries like Australia, Spain, Italy, and regions including Asia and the Pacific. Rather than grounding their recommendations in robust evidence, these guidelines deferred to the endorsements from the initial guidelines of WPATH and ES.

Years later, when WPATH and ES updated their guidelines, they referenced the same national and regional guidelines that had initially drawn from their recommendations. This perpetuated a cycle in which each iteration reinforced the others, each time without sufficient evidence to support the recommendations. Dr. Cass highlighted the problematic nature of this circular referencing, stating, “The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.”

Part 1 of the systematic review includes Figure 3, pictured above, which illustrates the various ways in which guidelines reference or influence each other. It shows how guidelines draw on the initial Endocrine Society (2009) and WPATH (2012) guidelines, which have influenced nearly all the national and regional guidelines identified. Additionally, it demonstrates how these subsequent guidelines cite and rely on each other, and how the latest Endocrine Society (2017) and WPATH (2022) guidelines have cited and drawn on the national and regional guidelines.

The systematic review highlights an example of this circular referencing: WPATH Version 8, published in 2022, identifies numerous national and regional guidelines published as early as 2012 as potentially valuable resources. It cites guidelines from the APA (2015), Australia (2018), New Zealand (2018), and University California, San Francisco (2016) multiple times to support their recommendations. Importantly, all of these guidelines were themselves significantly influenced by WPATH Version 7 (2012).

Broader Context

In the research world, such circular referencing is sometimes referred to as a citation cartel. This occurs when a group of academic authors collude to excessively cite each other's publications to artificially inflate their citation counts. However, what has occurred here differs slightly; their aim wasn’t to boost citation counts, but rather to enhance their own credibility through mutual referencing in the eyes of the public and other medical professionals. Nonetheless, this practice is highly unethical. By engaging in circular referencing, these medical bodies have actively deceived healthcare professionals and the public, leading them to believe in the validity and reliability of recommendations founded on weak evidence. 

Unfortunately, much of the transgender rights movement has advanced through an approach that heavily relies on appeals to authority. Organizations that once focused on Gay and Civil Rights, now pivoting to champion transgender rights, are deferred to as authoritative bodies by news outlets, schools, teachers' unions, and even the Biden administration, which seeks their guidance on transgender issues. Within academia, idea laundering has bestowed Queer Theory and Gender Theory, foundational to modern gender ideology, with the illusion of legitimacy.

Moreover, significant changes in federal regulations under Title IX, granting biological males (who identify as women) access to female-only spaces and sport categories, have occurred through a process known as institutional leapfrogging. In this process, judges and administrators take incremental steps, each citing the authority of the other, ultimately leading to the expansion of federal mandates.

Not Evidence-Based

WPATH, whose stated mission is to “promote evidence-based care,” and ES, who refers to their approach as “evidence-based transgender medicine,” along with any organization advocating for medical transition for minors, are misleading the public by portraying themselves as being “evidence-based.”

In an investigative report for the British Medical Journal (BMJ), Dr. Gordon Guyatt, a highly respected figure in the field of medical research methods and evidence evaluation, and who pioneered the evidence-based medicine (EBM) movement, stated that the current guidelines in the United States for managing gender dysphoria in adolescents should not be considered evidence-based. He emphasized that these guidelines fail to offer cautious and conditional recommendations appropriate for such low-quality evidence. Guyatt further underscored his concerns in a social media post, labeling these guidelines as "untrustworthy."

Similarly, the systematic review team arrived at the same conclusion: 

Most clinical guidance lacks an evidence-based approach and provides limited information about how recommendations were developed. The WPATH and Endocrine Society international guidelines, which like other guidance lack developmental rigour and transparency have, until recently, dominated the development of other guidelines. Healthcare professionals should consider the lack of quality and independence of available guidance when utilising this for practice.

In the end, the team was only able to recommend two guidelines for practice: the Finnish guideline published in 2020, and the Swedish guideline published in 2022. Both guidelines conducted their own systematic evidence reviews, concluding that the risks of medical transition outweigh any purported benefits. As a result, they do not recommend medical transition treatments for minors but instead prioritize mental health support.

WPATH, ES, and any medical authority that misrepresents guidelines recommending medical transition for minors as “evidence-based” betray public trust and fail those seeking reliable guidance. Healthcare professionals and regulatory bodies must hold guideline developers accountable for these deceptive practices and ensure transparency in the basis of future recommendations.

The National Health Service England issued a statement in response to the Cass Report and new systematic reviews, asserting that their findings "will not only shape the future of healthcare in this country for children and young people experiencing gender distress but will also be of major international importance and significance."

I am an independent journalist with a forthcoming report on the connection between autism and gender dysphoria, as well as a detransition survey awaiting publication. I am also developing a website that will feature the latest data, studies, and fact-checks that will debunk activist arguments related to gender medicine. If you would like to support my work, please consider making a donation:

In a groundbreaking study from the Mayo Clinic, a globally recognized leader in medical research and patient care, researchers examined the effects of puberty blockers on testicular development in gender dysphoric male children. Their investigation revealed evidence of mild to severe atrophy in the sex glands of these children, leading the authors to express doubt in the claims of “reversibility” often made about puberty blockers.

The authors assert, “We provide unprecedented histological evidence revealing detrimental pediatric testicular sex gland responses to [puberty blockers].”

This preprint study, not yet peer-reviewed, presents evidence that puberty blockers induce significant cellular changes, impacting testicular development and sperm production in ways that are not fully reversible, with potentially permanent effects on testicular function and fertility. It challenges the longstanding view of puberty blockers as a reversible "pause button" on puberty.

As noted by the researchers of this study, no long-term studies exist for the use of puberty blockers in the context of stopping puberty for gender dysphoric children, and many potential health consequences remain unknown. In particular, the long-term impact on reproductive health is uncertain, making this study critical for filling this knowledge gap.

To address these unknowns, the Mayo Clinic has established the largest collection of testicular samples for patients aged 0-17 years, including those with gender dysphoria who have and have not yet received puberty blocker treatment, creating a database of over 130,000 individual cells for analysis.

Using a novel approach, the research team meticulously analyzed testicular tissue samples from youths undergoing puberty blocker treatment, with those not on puberty blocker treatment serving as controls. This comparison provides important insights into the potential cellular and molecular changes induced by these drugs.

Key Findings

The study utilized the Mayo Clinic's Pediatric Testicular Biobank for Fertility Preservation, which has been recruiting patients primarily from pediatric urology departments since 2015. Researchers analyzed testicular specimens from 87 young individuals (ages 0-17) undergoing fertility preservation surgery for various health reasons. Among these, 16 were gender dysphoric boys between the ages of 10 and 16, all of whom began identifying as transgender girls between the ages of 2 and 15. At the time of surgery, 9 patients (56%) were already on puberty blockers, with exposure ranging from 3 to 52 months. The authors noted that 100% of the 16 children would eventually go on to take them, highlighting “the widespread nature of PB intervention in this demographic.”

Among nine patients treated with puberty blockers, two exhibited unusual features in their testicles upon physical examination. One patient had abnormalities in both testicles, including incomplete development of the tunica albuginea, which is a protective covering around the testicles. The other patient had a right testicle that was difficult to detect.

In one part of the tissue-level analysis, over 400 testicular biopsy samples were analyzed and stained to examine the differences between those treated with puberty blockers and those who were not. Comparisons showed that testicular development in those treated with puberty blockers was abnormal compared to non-treated individuals. There was variability in how individuals responded to puberty blockers, leading to different outcomes in testicular development, including the degeneration of testicular tissues.

The study authors presented a case of a 12-year-old patient who underwent treatment with puberty blockers for 14 months. In this individual, 59% of the sex glands showed complete atrophy, along with the presence of microlithiasis—a condition where small clusters of calcium form in the testicles. This insight suggests that puberty blockers could lead to lasting structural changes. Additionally, research has shown a link between testicular microlithiasis and testicular cancer.

This study also utilized single-cell analysis to investigate the effects of puberty blockers and aging on testicular cell composition. It took a very detailed look at individual cells from the testicles of a 14-year-old who had been on puberty blockers for over 4 years. The study analyzed a total of 130,100 cells, including 11,199 cells from the juvenile puberty blocker-treated patient.

The study observed that over 90% of the cells responsible for sperm production in this patient were stunted at an early developmental stage, unable to progress further. Additionally, it found "pathologically" higher and lower levels of two types of support cells (Sertoli cells) necessary for healthy sperm development. These findings suggest that puberty blockers can disrupt the normal maturation process of cells critical for sperm production.

In another part of the analysis, the authors found distinct cell-specific changes, including altered expression patterns of puberty-associated genes in endothelial cells, due to puberty blocker treatment. The authors believe that these drugs might induce juvenile testicular atrophy in part by disrupting the normal function of testicular endothelial cells.

Another aspect of the study focused on examining the effects of puberty blockers on the genetic activity of early-stage sperm cells, revealing significant changes that could potentially influence their development and fertility. By analyzing the activity of specific genes within these cells, the researchers found that puberty blockers may have caused alterations in gene expression, affecting processes crucial for the normal growth and function of these cells. This analysis suggests that the use of puberty blockers in gender dysphoric youth could have lasting implications for their reproductive health, particularly by impacting the ability of these early-stage sperm cells to mature properly.

Study Impact

Puberty blockers are increasingly used as a treatment for gender dysphoric youth to halt the development of secondary sex characteristics, such as breast development and widening of hips in females, or the growth of facial hair and deepening of the voice in males. Thousands of children in the United States are placed on this medical pathway as part of the gender-affirming model of care, under the presumption that these drugs are safe and fully reversible.

However, many aspects of the long-term consequences of puberty blockers, which have been administered to children off-label in an experimental manner, remain unknown. This study contributes valuable insights into the potential irreversible harm these treatments can cause to bodily and reproductive functions. 

Arguably, the most critical finding is the evidence of mild to severe sex gland atrophy in children treated with puberty blockers. This atrophy signifies potential damage or impairment to the structures essential for sperm production, raising serious concerns about the long-term fertility impacts of these drugs for these individuals. 

Given the Mayo Clinic's esteemed reputation in the medical and research communities, should the study pass peer review without any issues, its findings will carry significant weight.

Broader Implications

Puberty blockers belong to a group of synthetic gonadotropin-releasing hormone

(GnRH) analogues. These drugs act on the pituitary gland to hinder the release of chemical signals that typically trigger the production of estrogen and testosterone. Historically GnRH analogues were used to treat conditions such as prostate cancer, fibroids, and endometriosis and, in some cases, as a measure to chemically castrate sex offenders.

In children, puberty blockers prevent the natural changes of puberty driven by sex hormones and have been used to treat central precocious puberty, a condition where a child begins to sexually mature much earlier than usual. In gender dysphoria, puberty blockers are administered experimentally, lacking long-term testing.

Notably, the U.S. Food and Drug Administration (FDA) has not approved puberty blockers and sex hormones for use in pediatric gender care. No clinical trials have substantiated the safety of these drugs for such non-approved applications and manufacturers of puberty blockers have repeatedly declined to conduct safety trials for their use on this cohort.

While puberty-blocking drugs are often promoted as “safe,” "reversible" and a "pause button" on puberty, these characterizations seem to stem from their approved use for treating central precocious puberty in younger children, not their burgeoning off-label use for managing gender dysphoria in adolescents. 

Past studies have indicated possible negative effects on bone density and brain health. There is also a concern that these drugs might solidify gender dysphoria in adolescents, potentially leading them down a lifelong road of biomedical interventions. Following reports in 2016 of suicidal ideation in children administered puberty blockers, the FDA instructed drug manufacturers to include a warning about potential psychiatric issues on the drugs' labels.

Puberty blockers are increasingly administered to adolescents at Tanner Stage 2, the first signs of puberty. Research shows administering puberty blockers at this stage, followed by cross-sex hormones, may result in infertility, sterility, and sexual dysfunction. Furthermore, they inhibit the development of mature male genitalia, making it difficult to create a pseudovagina in the event of a later vaginoplasty due to a lack of sufficient tissue.

The National Health Service England recently announced it would no longer prescribe puberty blockers to youth outside of research settings and closed down its only national clinical service for pediatric gender medicine, following a review that deemed the service "not safe.”

Several European countries, including Sweden, Finland, the UK, Denmark, and Norway have updated their guidelines for youth transition to align with systematic evidence reviews, the gold standard in evidence-based medicine. These reviews concluded that the risks associated with youth transition outweigh any purported benefits. Consequently, these countries have implemented restrictions on medical interventions, prioritizing psychotherapy as a first-line response for minors experiencing gender-related distress.

A new Dutch study relying on long-term data found that the majority of adolescents expressing a desire to be the opposite sex no longer felt that way in adulthood. This adds to a growing body of research showing that gender dissatisfaction in adolescence is often temporary and declines with age.

Research on youth experiencing gender dysphoria often lacks long-term data, leading to significant disagreement about the most ethical ways to support these individuals. The authors drew attention to this research gap, observing that most studies focused on clinical samples from specialized gender clinics with only one follow-up assessment.

Their objective was to investigate the development of gender dissatisfaction in a sample comprising both clinical (youth psychiatric care) and general populations. They sought to explore associated factors such as sex, sexual orientation, self-concept, and mental health.

Their study included 2772 participants, with 53% being male, and provided a rare view of long-term data on dissatisfaction with one’s sex among youth. Spanning over 15 years, it followed individuals from late childhood to early adulthood, covering ages 11 to 26.

The study introduced the concept of “gender non-contentedness,” defining it as feeling unhappy with one's sex. The authors explained that this might be observed in a young adolescent girl who prefers activities typically associated with boys and feels discomfort with the physical changes of puberty.

To measure gender non-contentedness, the study relied on responses to the statement: "I wish to be of the opposite sex.” This question was part of a self-report survey provided by TRAILS, a long-term research project in the Netherlands tracking the development of adolescents and young adults through regular assessments. Data from this question was collected and analyzed from participants at six different time points between 2001 and 2020.

Additionally, the researchers measured behavioral and emotional problems using various survey instruments. Global self-concept, an assessment that measures self-esteem, self-confidence, and self-value, was evaluated at age 11, and sexual orientation was assessed at age 22 through self-report.

Key Findings

Findings revealed that approximately 11% of participants reported gender non-contentedness in early adolescence, with the prevalence decreasing to 4% by the last follow-up around age 26. Only 3 individuals, representing 0.1% of the total sample, consistently reported gender non-contentedness throughout adolescence and adulthood.

A majority of adolescents surveyed conformed to three identifiable trajectories: those who consistently reported never experiencing any gender non-contentedness (78%), those who reported gender non-contentedness in early adolescence that did not persist into adulthood (19%), and those who demonstrated the opposite pattern, with reports of gender non-contentedness increasing with age (2%).

Gender non-contentedness was most prevalent around age 11, and girls were more likely than boys to report it at ages 13 and 16. By approximately age 25, individuals on the decreasing gender non-contentedness trajectory no longer reported experiencing these feelings.

The authors posit that the large percentage of individuals with “temporary, declining gender dissatisfaction” may be attributed to the extended duration of the study, unlike typical research in this field, which often involves short-term follow-ups. Consequently, the study found “a clear declining trend in gender non-contentedness with age.” This was consistent with other studies, like a study from Taiwan, which found 8% (of 1806 children) who experienced gender dissatisfaction around age 13 no longer did by around age 22. 

The study showed that individuals with both an increasing and decreasing trajectory of gender non-contentedness had lower global self-worth, more behavioral and emotional problems, and more often had a homosexual or bisexual sexual orientation compared to individuals without gender non-contentedness.

The authors find it noteworthy that both groups experiencing increasing and decreasing gender non-contentedness had lower self-esteem at age 11 compared to those who did not indicate gender non-contentedness, aligning with findings from previous studies. They suggest a connection between feeling dissatisfied with one's sex and having a negative self-perception applies not only to children seeking help at gender clinics, but also to the general population.

Acknowledgements of research on ROGD and desistance

The authors of this study made several important acknowledgements regarding research that is often overlooked or disregarded by activist researchers and clinicians. They identified a group that began reporting gender non-contentedness in mid to late adolescence, confirming that these feelings may emerge after puberty, supporting late-onset gender dysphoria or rapid-onset gender dysphoria (ROGD).

The authors also acknowledged research indicating that children who socially transitioned in early childhood were more likely to have persisting feelings of gender dysphoria. Socially transitioning children can have significant iatrogenic effects that solidify a child’s transgender identity, increasing the likelihood of seeking medical interventions. A review by the National Health Service England stated that social transition is not a “neutral act” and could have significant effects on psychological functioning.

The authors recognized the existing longitudinal studies in gender clinics showing that the vast majority (61-98%) of individuals who experienced early childhood gender dysphoric feelings did not have those feelings persist into adolescence and adulthood. They also recognized clinical research indicating that childhood gender dysphoria is linked to a homosexual orientation in adulthood, and that studies on childhood gender nonconformity tended to show a bisexual or homosexual sexual orientation later in life. Their new study corroborated these findings, showing that a decreasing trajectory of gender non-contentedness was a significant predictor of a homosexual or bisexual identification in adulthood.

Study Impact

The authors acknowledge that general population studies are scarce, and much of the existing research relies on clinical samples with only one follow-up assessment. Because this study draws from both clinical and general population groups over an extended period of time, it offers "more reliable epidemiological knowledge" about how prevalent feelings of dissatisfaction with one’s sex are among adolescents, as well as new insights into the association with mental health problems.

The researchers conclude that their study results should reassure teenagers who feel unsure about their identity and desire to be the opposite sex during adolescence, that this is a normal and common experience. Additionally, they hope their findings will “provide some perspective” to clinicians who mainly treat teenagers with “intense gender dysphoric feelings.” This understanding could give them a broader view of how common it is for young people, both in the general population and those receiving mental health care, to question their sex.

Broader Implications

Importantly, the findings from this study challenge commonly held beliefs promoted

Read more

The Arizona Mirror published an article earlier this month titled "The latest GOP anti-trans strategy: Requiring ‘detransition’ services," arguing that legislation aimed at providing healthcare and insurance coverage for detransitioners is unnecessary—it is merely a tactic by Republicans to hassle people who currently identify as transgender. The article was republished under the same title in the Phoenix New Times.

The article focuses on an Arizona senate bill that would make the pathway of detransition easier for those who are struggling to get the healthcare they need. Currently, there are no billing codes for detransitioning, nor is there anything resembling a standard of care for this growing population. Additionally, some insurance companies explicitly exclude gender-reversal procedures.

But you wouldn’t learn any of this from reading the Arizona Mirror. It appears that the author, Gloria Gomez, only writes about the bill in an attempt to discredit it. The articles’ premise is that detransitioners face no difficulties in accessing healthcare and this bill is merely a scheme designed to inconvenience people who currently identify as transgender.

Gomez does not speak to a single detransitioner, opting instead to quote gender activists who argue the bill is “unnecessary” and not a “real issue” because detransitioners’ “medical needs are already covered by insurance.”

The first half of this article will debunk these misleading claims and clarify the purpose and necessity of detransition healthcare bills, offering a new contribution to the discourse. The latter half will counter several common misleading claims about detransition and "gender-affirming care" made by Gomez. For those familiar with my work, I often address these claims, so some of the content may be drawn from earlier writings.

Gomez quotes two representatives from the Human Rights Campaign (HRC), the largest LGBTQ political lobbying organization in the United States, which received $50 million in donations in 2023. The HRC regularly protests the New York Times' coverage of detransitioners and the inadequacies of the "gender affirming" model of care.

Misleading Claim #1: Detransitioners’ medical needs are “already covered by health insurance”

An emailed statement by Cathryn Oakley, the senior director of legal policy for the Human Rights Campaign (HRC) said:

“This bill is an unnecessary and gratuitous excuse to talk about detransition in an effort to shift the focus from the actual health care that transgender people receive, which is supported by every mainstream American medical health organization, to the care of a very small number of folks whose medical needs are already covered by health insurance.”

For many detransitioners, this is false.

There is significant variability among insurance policies regarding what is covered, leading to disparities in access to care. While some insurers may cover detransition care under certain conditions, others may not, deeming the care not medically necessary.

Had Gomez done any research she’d know some insurance companies explicitly exclude detransition healthcare—like Capital Blue, which has a stipulation in its plans stating gender-reversal surgery is “considered not medically necessary and, therefore, not covered.” 

…or United Healthcare Community Plan, which excludes “reversal of genital surgery or reversal of surgery to revise secondary sex characteristics.”

Others evaluate on a case-by-case basis (California Health & Wellness) or if certain criteria are met (Wellmark), and thankfully, some health insurance companies do cover detransition healthcare (Aetna). These are just a few examples and by no means an exhaustive list. I plan to conduct a much larger overview of insurance providers’ coverage of detransition care in a future investigative article.

Misleading Claim #2: Detransitioners receive the same care as those seeking to transition

Bridget Sharpe, the director of HRC's Arizona branch, who responded to the Arizona Mirror's request for comment, said:

“The care for people who detransition is the same as the care for transgender people. Any medical service that affirms someone’s gender includes someone who decides to detransition. If they decide to detransition they are affirming their gender.” 

This is not accurate.

Under the current system, when someone transitions, they receive a diagnosis code indicating gender dysphoria. When someone detransitions, they no longer meet the criteria for a gender dysphoria diagnosis. Without a specific diagnosis like gender dysphoria to justify “medical necessity,” obtaining coverage for detransition procedures can be complicated, demonstrating the need for legislation that ensures detransition is covered.

Legislation like SB 1511, which mandates that doctors, health care institutions, or any other licensed health care providers in Arizona offering gender transition procedures must also provide gender detransition procedures. Furthermore, if an insurance policy covers gender transition, it will be required to "provide or pay" for detransition procedures.

A third provision aims to collect information on how many people are requesting detransition procedures by requiring insurance companies to submit a report. Currently, there is no method for tracking detransition, so we don't know how many people are detransitioning.

Gathering more data on detransitioners would aid in the process of acquiring new billing codes from coding authorities. Nine months ago, FAIR in Medicine submitted an application to the Centers for Disease Control and Prevention (CDC) for International Classification of Disease (ICD) diagnosis codes specific to detransition. This application is currently under review. The process to review and approve new ICD diagnosis codes can take over a year and involves several steps, including gathering data, public comment, and revision.

The absence of dedicated medical billing codes for detransition procedures creates a significant barrier for healthcare providers seeking reimbursement for these services. Consequently, they may resort to using inaccurate billing codes.

In practice, healthcare professionals apply their discretion to navigate these challenges. For example, a detransitioned woman who underwent a hysterectomy as part of her transgender experience might be classified similarly to a postmenopausal woman for the purposes of accessing hormone replacement therapy.

An important article by Drs. Aida Cerundolo and Carrie Mendoza on detransition billing codes highlights a case like this: A woman named Katie began taking testosterone at 19, underwent a double mastectomy at 20, and had a hysterectomy at 24. Shortly after, she realized transitioning was a mistake.

Now at 25, Katie is experiencing early menopause and has had significant difficulty obtaining the correct hormone dosage. Even after numerous phone calls, she was prescribed estrogen at a dose typically given to males seeking to become transgender women, which was not suitable for her needs. For obvious reasons, this is not a sustainable solution. We need detransition billing codes.

Misleading Claim #3: Detransition healthcare is not a “real issue”

The director of HRC's Arizona branch, Bridget Sharpe, continued her statement by saying:

Instead of resolving a real issue, Sharpe said, the Republican legislation instead seeks to weaponize detransitioning against transgender health care.

It is insulting to dismiss detransitioners’ healthcare needs as not a “real issue.”

Had Gomez interviewed any detransitioners or reviewed research on them, she would understand that many encounter challenges in finding information on detransition or healthcare professionals equipped to address their specific needs.

• A 2021 international survey of 237 detransitioners found the support available to detransitioners to meet their medical needs is currently inadequate.

  • 49% seek accurate information on stopping or changing hormonal treatment.

  • 24% require assistance for complications from surgeries or hormonal treatments.

  • 15% need information on and access to reversal surgeries or procedures.

  • 7% provided other responses not listed, such as the need for tests to assess current reproductive health, information on the long-term effects of cross-sex hormones, the health consequences of undergoing a full hysterectomy, and issues related to pain from chest binding.

• My preliminary survey of 94 detransitioners and desisters (pending publication) revealed that 72% of those seeking medical assistance faced significant challenges, and 78% of those who sought insurance coverage for detransition services had difficulty accessing it.

• I've interviewed several detransitioners who have had immense difficulty in getting insurance coverage for detransition-related needs. One male detransitioner had to wait a full year to have his breast implants removed. Others have turned to crowdfunding to finance their detransition-related procedures.

  • However, one detransitioner I recently spoke with had no issues in getting insurance coverage for breast reconstruction surgery, which I believe is due to a growing awareness of detransitioners' needs in the last year.

Activist-journalism

In the last decade, influential activist organizations, including HRC, GLAAD, ACLU, and SPLC, have collaborated closely to shape the narrative on transgender issues. They provide news outlets with a range of media reference guides, stylebooks, fact sheets, and other resources, equipping mainstream journalists—most of whom are not well-informed on the debate surrounding youth medical transition—with the materials needed to present a biased perspective and label any valid concerns as bigotry. This approach effectively transforms journalists into activists.

Activists rely on propaganda tactics like the illusory truth effect—the tendency for people to believe things that are false after repeated exposure. This strategy of creating a semblance of public agreement benefits from the support of progressive platforms like the Arizona Mirror, which claims to be “an independent, nonprofit news organization” yet serves as an example of political activism masquerading as journalism. Their reporting standards neglect objectivity and thorough research, delivering a skewed narrative that deceives the public.

It seems ironic that progressives who champion “healthcare for all” would try to undermine bills aimed at ensuring a vulnerable group has access to healthcare. And like Pamela Paul pointed out in her recent New York Times op-ed, “These are people who were once the trans-identified kids that so many organizations say they’re trying to protect.”

Activist organizations frequently ignore or downplay the experiences of individuals who have detransitioned, despite these being the same individuals they pledge to support. This neglect is a significant departure from their stated principles. For many, a transgender identity is not a lifelong experience — they need support too.

Additional reading:

Misleading Claim #4: Detransition is rare

Read more

This is the 10th edition of my newsletter Gender Medicine Monthly, dedicated to sharing updates related to gender medicine with a particular focus on pediatric gender medicine and the affirmative model of care, for paying subscribers. 

If you find the content of this newsletter valuable, please consider becoming a paid subscriber. Your support helps me dedicate my time and energy to producing quality content. Free subscriptions are available for detransitioners — please send me a message on X.

Here are some important headlines in gender medicine from January and the first few days of February 2024 covered in this edition of Gender Medicine Monthly.

1. The WHO acknowledges limited evidence for youth medical transition, proceeds with adult guidelines

2. The New York Times publishes boldest trans coverage yet that systematically debunks gender activists’ claims 

3. Alberta becomes the first Canadian province to restrict youth medical transition and enact common sense trans policies

4. A new documentary spotlights male detransitioners

5. An open letter opposing the American Psychiatric Association’s radical new gender-affirming textbook now seeks public signatures 

6. New organization helps fund detransitioner lawsuits 

7. Democrats from 4 states have voted against youth medical transition policies

8. Richard Dawkins defends the sex binary

1. The WHO acknowledges limited evidence for youth medical transition, proceeds with adult guidelines  

Source: SEGM 2/1/23 

On January 15, 2024, the World Health Organization (WHO) updated its announcement on developing healthcare guidelines for “trans and gender diverse (TGD) people.” The initial announcement in late December 2023 sparked widespread concern, including a petition garnering nearly 12,000 signatures, coverage in the British Medicine Journal (BMJ), and even a powerful letter addressed to the WHO Director from Reem Alsalem, the U.N.'s Special Rapporteur on Violence Against Women and Girls.

In response to the criticism, WHO extended the public comment period to February 2, removed a particularly outspoken activist from their Guideline Development Group (GDG), and stated in an FAQ that it would not be making recommendations that impact minors. 

Importantly, they made the following admission: "[O]n review, the evidence base for children and adolescents is limited and variable regarding the longer-term outcomes of gender affirming care for children and adolescents" (January, 2024).

Despite these changes, major issues with the planned guidelines persist, as laid out by the Society for Evidence-based Gender Medicine (SEGM). The concern is that the WHO is advancing recommendations based on unproven assumptions instead of solid evidence that could potentially endanger many vulnerable adults.

SEGM has reviewed WHO documents and previous guidelines relevant to transgender individuals, notably the 2022 self-care and HIV guidelines. SEGM discovered that these guidelines assert the need for widespread hormone availability and legal gender self-identification without adequate evidence support. These assertions are not grounded in thorough reviews or human rights analyses but rather in circular referencing. Additionally, the composition of the GDG remains biased — riddled with conflicts of interest.

Significance: WHO's acknowledgment of the insufficient and inconsistent evidence for transitioning minors highlights a significant divergence between the U.S. and a growing international consensus that has begun heavily restricting youth medical transitions. This acknowledgment is a critical admission, suggesting that the agreement among many U.S. medical groups may reflect the stance of the U.S. medical industry rather than scientific consensus. The decision by WHO not to develop guidelines for minors represents a significant victory; however, vulnerable adults remain at risk.

The term “vulnerable adults” broadly refers to individuals, especially those aged 18-25, and particularly those on the autism spectrum or with psychiatric comorbidities, who have not previously experienced gender-related distress but come to identify with an “underlying trans-identity” after encountering gender ideology. This contrasts with persistent, lifelong gender dysphoria. Careful and individualized assessments, grounded in the best available evidence and scientific rationale, are crucial to help prevent adults from making potentially regrettable long-term decisions. By facilitating easier access to hormones, WHO risks leading vulnerable adults towards harmful outcomes.

2. The New York Times publishes boldest trans coverage yet that systematically debunks gender activists’ claims  

Source: New York Times 2/2/24

The New York Times has released its most courageous article yet on the controversy surrounding youth gender transition, titled "As Kids, They Thought They Were Trans. They No Longer Do," an op-ed by Pamela Paul. This piece shines a light on detransitioners, health professionals speaking out against the gender-affirming care model, and the faulty science supporting it, which Paul meticulously dismantles.

The NYT took its time to start covering this topic, beginning in June 2022, and has since published several significant articles. These articles have adopted a cautious, objective stance on youth transition, but were too often conciliatory towards the activist viewpoint — likely in an effort to avoid provoking gender activists (who ended up being provoked anyway).

What distinguishes this op-ed from previous coverage is its unapologetic tone. It employs assertive language previously unseen in the NYT and systematically counters activist claims with solid scientific evidence. Here are some highlights from the article that set it apart from others:

• Paul says that transgender activists have “pushed their own ideological extremism” and “describe any opposition as transphobic.” She notes that individuals raising concerns are often “attacked as anti-trans and intimidated into silencing their concerns.”

• She characterizes gender activist assertions as a “narrative” and an “ideology.”

• She details how young people encounter transgender influencers on platforms like TikTok and YouTube, and in schools through “curriculums supplied by trans rights organizations.”

• Paul describes the coercive tactic of presenting parents with a choice between a dead child or a trans child as “emotional blackmail.”

• She discredits numerous activist claims with studies that directly challenge their assertions.

• Paul addresses the challenges faced by detransitioners, who “face ostracism and silencing because of the toxic politics around transgender issues,” and observes that “only conservative media outlets seem interested in telling their stories.” She poignantly states: “These are people who were once the trans-identified kids that so many organizations say they’re trying to protect — but when they change their minds, they say, they feel abandoned.”

• She references research indicating that most children who identify as transgender do not maintain that identification into adulthood, and she highlights a comprehensive review on youth detransition, noting: “Studies show that around eight in 10 cases of childhood gender dysphoria resolve themselves by puberty and 30 percent of people on hormone therapy discontinue its use within four years, though the effects, including infertility, are often irreversible.”

• Paul critiques the Dutch studies for being “falsely presented to the public as settled science” and highlights their “methodological flaws and weaknesses,” stating they provide “no evidence that any intervention was lifesaving.”

• She discusses the tactics by trans activists to “suppress any discussion of rapid onset gender dysphoria, despite evidence that the condition is real.”

• Paul calls out activist groups like GLAAD and the Human Rights Campaign for their efforts to pressure the media into silence.

• She highlights how many countries have now reconsidered their stance on medical transition for youth and asserts that the American medical community is clinging to an “outdated model of gender affirmation.”

Significance: The significance of this article is apparent from the responses it has generated, especially from comments like this:

The intense reaction from gender activists, who have tried to dismiss the piece as merely an opinion that supposedly bypassed rigorous fact-checking, also highlights its impact. Despite the NYT opinion editor Kathleen Kingsbury publishing a letter in an attempt to temper the criticism, it has not calmed the activists.

The New York Times has previously navigated the topic of youth medical transition with caution, yet its role in shaping the discourse is significant, given its wide-reaching, predominantly left-leaning audience and esteemed reputation. This op-ed represents a pivotal shift, indicating a movement in the right direction as it brings to light the controversies surrounding pediatric gender medicine that challenge activist narratives.

3. Alberta becomes the first Canadian province to restrict youth medical transition and enact common sense trans policies

Read more

This is a brief primer on woke antisemitism, inspired by the book Woke Antisemitism by David Bernstein, founder of the Jewish Institute for Liberal Values (JILV). Most people are familiar with antisemitism associated with the far right. JILV was established to confront a specific ideology emerging on the left.

Woke antisemitism, or ideologically-motivated antisemitism from the left, is a progressive dogma that portrays Jewish people as white, privileged, and complicit in white supremacy, thus viewing them inherently as oppressors. Initially an obscure set of academic concepts, the underlying ideology has gained widespread acceptance among the far left.

What is woke?

Wokeism, or Critical Social Justice (CSJ), is a specific ideological approach to addressing perceived injustices between identity groups. It originates from a flawed academic field of study driven by political agendas rather than a commitment to the pursuit of truth.

Woke ideology is concerned with power dynamics. It posits an overly simplistic model of society that categorizes people by their group identity and ranks them as either “oppressors” or “oppressed” in a winner-takes-all conflict. Critics often refer to this obsession with group identity as “identity politics.”

The term woke originates from the idea of being awakened or “woken up” to an awareness of these alleged oppressive power structures that they claim have been set up by the powerful to maintain control. 

These systems are called white supremacy, patriarchy, colonialism, cisnormativity, heteronormativity, ableism and fatphobia.

The expression “stay woke” implies using a “critical lens” to recognize unjust power dynamics, which are believed to permeate all aspects of life and shape every social interaction.

How does the ideology impact the Jewish community?

In their race-obsessed view, Jews are perceived as white and thus possessing privilege and power. Some progressive activists believe any success Jewish people have achieved is not due to merit, but acquired through their complicity in white supremacy. 

Woke ideology implicates Jews in the oppression of other minorities due to their perceived group advantage. It feeds the antisemitic trope about Jewish power. Jews are presumed to be powerful and cause the suffering of those who are presumed to be powerless. 

This ideology does not tolerate dissent or debate. It corrupts Jewish values, and spawns a virulent new strain of antisemitism.

What is Decolonization?

In university Humanities departments, the various identity-based “studies” fields, influenced by postmodernism and Marxist-inspired Critical Theory, produce activist scholarship that favors personal perspectives over objectivity and empirical evidence. Because of its unrigorous nature, it has been subject to ridicule and the target of numerous hoaxes.

One of its offshoots, Postcolonial Theory, pioneered by Palestinian-American Edward Said, is often used to rewrite history by “reenvisoning” history from the “perspective of the oppressed.” 

Palestine Studies, a branch of Postcolonial Theory, equates Zionism with colonialism and white supremacy. It casts Israelis as oppressors and Palestinians as helpless victims without agency. It permits and even encourages violence against perceived oppressors through decolonization.

Where is Woke Antisemitism?

Social media has propelled what was once an obscure academic field mostly confined to college campuses into an international post-colonialist movement disguised as “Social Justice.”

Through corporate diversity programs, it has now become a dominant ideology in mainstream institutions, including many Jewish organizations. As a result, woke antisemitism is now a prominent feature in far-left and progressive circles.

Although postcolonial activists claim to oppose “settler-colonialism,” their disproportionate focus on Israel, compared to other nations, suggests an underlying antisemitic bias.

Learn more

Read Woke Antisemitism by David Bernstein, available on Amazon and Audible. Visit www.JILV.org and follow @JILVorg on Instagram, Twitter and Facebook for more educational materials.

This is the 9th edition of my newsletter Gender Medicine Monthly, dedicated to the latest updates, international news, new research, and debunking of pseudoscience related to gender medicine and detransition — for paying subscribers. 

March’s inaugural issue is free, as well as a preview of the first part of each issue. If you find the content of this newsletter valuable, please consider becoming a paid subscriber. Your support helps me dedicate my time and energy to producing quality content.

Here are some important headlines in gender medicine from November to December 2023 covered in this edition of Gender Medicine Monthly.

1. A new petition challenges the World Health Organization’s (WHO) expedited plans to develop transgender health guidelines

2. New analysis of transgender survey data backs ROGD hypothesis

3. Media outlets promote adult gender surgery publication in the debate over restricting youth transitions

4. Three new publications on detransitioners

5. A new scientific report in Germany sparks debate about youth gender transition

6. SPLC releases sloppy hit piece on groups advocating for evidence-based approach to gender medicine

7. New psychiatry publication likens gender transition to teen rebellion 

8. New study on detransition launches, poised to be the largest to date

1. A new petition challenges the World Health Organization’s (WHO) expedited plans to develop transgender health guidelines

Source: SEGM 12/26/23 WHO-decides.org 12/30/23

A new petition, "WHO Decides?", launched on December 30th, contests the biased panel composition and rushed development process of the World Health Organization's (WHO) transgender health guidelines, planned for February 2024.

The WHO announced on December 18, 2023, the formation of the Guideline Development Group (GDG), tasked with writing the guidelines. The Society for Evidence-based Gender Medicine (SEGM) and the WHO Decides? petition have highlighted conflicts of interest within the GDG.

As Manhattan Institute fellow Leor Sapir points out: three-quarters of the 21 panel members are trans-identified individuals, members of “affirmative” advocacy groups, or members of WPATH, an activist organization that presents itself as a professional medical association. The petition argues that this composition violates WHO’s conflict of interest policies and could lead to biased recommendations.

Additionally, there are concerns about the brief three-week public comment period that ends on January 8, 2024, occurring over a holiday period, which is unusually short for such a guideline development process. The rapid and "unprecedented" pace of the guidelines' development, with the GDG meeting scheduled for February 2024, has also raised red flags.

The petition calls on WHO to appoint individuals with a range of perspectives, extend the public comment period, prolong the guideline development process, and commit to full transparency and adherence to evidence-based guidelines.

Significance: For obvious reasons, we don’t need yet another unscientific, ideologically-driven set of guidelines on trans healthcare, which might contribute to the false perception of “scientific consensus” among US-based medical organizations’ endorsements of the gender-affirming model of care. (See Leor Sapir’s primer on the misinterpretation of science by these organizations.) 

But also, as SEGM points out, while the nations that have demonstrated a commitment to evidence-based medicine in youth gender medicine (England, Sweden, Finland, etc.) may disregard biased WHO guidelines, countries with fewer resources or those new to the international debate might struggle with guidelines that seem evidence-based but could endorse non-beneficial or harmful practices for gender-dysphoric youth.

People are encouraged to submit public comments by January 8, 2024 to the email provided by WHO: hiv-aids@who.int

The petition is available for anyone to electronically sign, but signatures from medical and mental health professionals are especially needed.

NEW! Shareable social media graphics:

2. New analysis of large scale transgender survey data finds support for ROGD hypothesis

Source: Archives of Sexual Behavior 12/18/23

In a recent Letter to the Editor in Archives of Sexual Behavior, Manhattan Institute fellow Leor Sapir, public health researcher Dr. Lisa Littman, and Professor Michael Biggs critique a recent article by Jack Turban and colleagues. Turban's article, which used data from the 2015 US Transgender Survey, aimed to disprove the Rapid Onset Gender Dysphoria (ROGD) hypothesis.

Sapir and colleagues argue that the 2015 US Transgender Survey data actually supports, rather than refutes, the ROGD hypothesis, contrary to what Turban's paper suggested. They point out a key limitation in Turban’s analysis: it focuses on adults who currently identify as transgender, thus excluding those who may have experienced a sudden and transient identification as transgender during adolescence.

Sapir and his co-authors assert that to accurately assess the ROGD phenomenon, the analysis should have concentrated on respondents aged 18 to 24. This demographic is crucial because they were adolescents during the period when trans-identification rapidly expanded, especially among young girls. Analyzing this age group in the 2015 survey, Sapir and his colleagues found that the majority had a "late realization" of “being trans,” typically at age 11 or older, with a median of 3 years passing before they disclosed their transgender identity. This finding, they argue, is consistent with the ROGD hypothesis.

Significance: Dr. Jack Turban is an assistant professor of child and adolescent psychiatry at the UCSF and is known for his activism promoting youth gender transition and for producing deeply flawed research. His latest attempt to debunk the ROGD hypothesis backfired spectacularly due to his failure to properly understand the criteria in Lisa Littman’s original paper on ROGD. 

In contrast to Turban's bad faith approach, Sapir and Littman actively engage with the discourse and have addressed five points raised by critics in a new article on Reality’s Last Stand, illustrating their commitment to transparency and rigorous debate.

3. Media outlets promote adult gender surgery publication in the debate over restricting youth transitions

Source: JAMA Surgery 12/27/23

A new publication that claims to find a low rate of regret for gender-affirming surgeries is being used to argue against restricting youth medical transition. Some outlets have referred to the publication as a “new study.” In reality, it's just a letter reiterating two earlier studies with minimal relevance to youth under the new gender-affirming model of care.

The lead author is social scientist Harry Barbee (“they/them”), whose profile on the John Hopkins website says his research concerns “the emotional burdens of living in a society that assumes a gender binary.” The co-authors are plastic surgeons at the Center for Transgender and Gender Expansive Health at John Hopkins.

Barbee et al. appears to be influenced by political agendas, evident from their references to legislative endeavors concerning minor surgeries. They cherry-picked two studies that found a low rate of regret and use them to argue for “policymakers to abandon policy initiatives that deny TGD people access to GAC…”

Studies that find low rates of regret are primarily derived from adults who transitioned under very different circumstances from today's youth. They have considerable methodological flaws and a substantial loss to follow-up. Researchers have already thoroughly debunked the two studies cited, Bustos et al. and Bruce et al., and highlighted why they are not applicable to today’s youth.

Missing from the Barbee et al. letter is consideration of studies actually relevant to the younger cohort that find 29-30% of minors change their minds with regards to "gender-affirming" medical interventions after several years.

Significance:  Of course, media outlets have already picked up the Barbee et al. article and have begun generating new headlines touting it as more evidence against restricting medical interventions for minors.

The fact that the authors of this article refer to gender-affirming care as "evidence-based" is comical. US-based medical organizations have repeatedly refused calls to align their guidelines with the best available evidence.

The European countries that have aligned their guidelines with systematic evidence reviews, which are the gold standard of evidence-based medicine (EBM), have heavily restricted youth medical transition.

4. Three new publications on detransitioners

Read more

This is the 8th edition of my newsletter Gender Medicine Monthly, dedicated to sharing updates related to gender medicine with a particular focus on pediatric gender medicine and the affirmative model of care, for paying subscribers. 

March’s inaugural issue is free, as well as a preview of the first part of this issue. If you find the content of this newsletter valuable, please consider becoming a paid subscriber. Your support helps me dedicate my time and energy to producing quality content.

Here are some important headlines in gender medicine from October to November covered in this edition of Gender Medicine Monthly.

1. Deposition of prominent gender clinician reveals his profound ignorance of evidence-based medicine principles

2. The Netherlands begins to debate pediatric medical transition

3. Three new detransitioner lawsuits, 2 name American Academy of Pediatric as defendant

4. Finland’s leading gender clinician warns of U.S. medical scandal 

5. Medical watch-dog releases model legislation for detransitioners

6. New investigative article offers rare balanced reporting on pediatric gender medicine for left-leaning audiences

7. Genspect releases model framework for a non-medicalized approach to gender-distress

8. Summary of new studies and policy updates

1. Deposition of prominent gender clinician reveals his profound ignorance of evidence-based medicine principles

Source: City Journal 11/13/23

Dr. Jack Turban is an assistant professor of child and adolescent psychiatry at the University of California, San Francisco and one of the most vocal supporters of pediatric gender medicine. He is known to many of us critical of gender medicine for producing deeply flawed research.

The ACLU recently hired Turban as an expert witness against an Idaho law that restricts medical transition services to adults only. In a seven-hour deposition led by lawyers representing Idaho, Turban was questioned about his low-quality research and how he misled the public about scientific findings. 

Manhattan Institute fellow Leor Sapir went through the 177 page testimony for City Journal. Turban’s deposition revealed his general ignorance of evidence-based medicine principles. He failed to correctly define a systematic evidence review and, among other embarrassing admissions, revealed that he did not read the overview of systematic reviews on gender-related treatments commissioned by Florida because he "didn't have the time."

Sapir consulted Gordan Guyatt, the foremost expert and founder of the Evidence-Based Medicine (EBM) movement, who said Turban "does not understand what [EBM] is all about." His approach to evidence assessment "shows no respect for, or understanding of, science.”

Significance: Leor Sapir highlights that the research in gender medicine is often conducted by those with conflicts of interest, including professional, intellectual and financial stakes. They tend to overstate positive results, underreport negatives, misuse causal language, and avoid studying potential harms. This bias leads to a situation where gender clinicians, seen as “experts” by judges, appear more credible the more they are personally and professionally invested, despite this being a conflict of interest.

Dr. Jack Turban's deposition highlights this issue, showing that gender clinicians may be the least familiar or concerned with applying rigorous scientific scrutiny to their views. They often exhibit confirmation bias, a lack of interest in the scientific method, and a disregard for evidence-based medicine.

2. The Netherlands begins to debate pediatric medical transition

Source: SEGM  11/11/23

The Netherlands, the birthplace of pediatric medical transition (AKA the Dutch protocol), has seen a significant rise in young people, particularly adolescent females, seeking gender transition – which was not widely acknowledged in the country until now. Recently this issue has come to the forefront in the Netherlands due to three key developments:

1. A medical article in a leading Dutch medical journal

2. A legal analysis in a Dutch legal journal

3. A two-part documentary by a Dutch public broadcaster 

These events have sparked a debate in the Netherlands about the practice of gender transition in minors, aligning it with broader international discussions on this topic. The Society for Evidence-based Gender Medicine (SEGM) has highlighted the main points of this debate, examining the contributing factors and considering its significance both within the Netherlands and in the context of global practices concerning youth gender transition.

Significance: The Netherlands joins public health authorities in other countries like France, Ireland, Italy, Australia, and New Zealand to have begun raising concerns or reevaluating their stances on pediatric gender medicine. 

Denmark, Finland, Sweden, and England have aligned their guidelines with systematic reviews of evidence (the gold standard of evidence-based medicine) and restricted youth medical transition, emphasizing psychotherapy as a frontline response. Norway announced that it would be taking these steps soon. 

The United States is quickly becoming a global outlier for their reluctance to align their guidelines with the best available evidence.

3. Finland’s leading gender clinician warns of U.S. medical scandal 

Read more

This explainer is adapted from an infographic slideshow I created for Instagram and offers an intentionally oversimplified perspective to give a quick overview of the topics. It's not designed to be comprehensive, but the links interspersed within the article will be helpful for those seeking more information.

It covers how modern “Social Justice” is a Trojan Horse for a Marxist-inspired radical belief system, where this pernicious ideology has taken root: in university Humanities departments through the application of Postmodernism and Critical Theory, and why this type of scholarship is frivolous and unrigorous. Also, how Hamas’s allies use one of its offshoots, Palestine Studies, and online activism to promote a pseudohistorical narrative to hundreds of thousands of people, that ultimately benefits Hamas terrorists.

I was a Social Justice Warrior

Some background first: I voted for the Democratic party in every presidential election since turning 18, but my active involvement in politics began in 2020. During the pandemic, I fell for the moral panic pushed by “anti-racist educators” on Instagram that insisted the U.S. was simultaneously experiencing a “racism pandemic.”

For 8 months, I found myself swept up in the online Social Justice community, genuinely believing that I was helping move the country towards progress. This led to my involvement with a progressive Instagram account with 750,000+ followers, where I took on the role of creating and curating content for them. However, it didn’t take long for me to discover that modern “Social Justice” is not what it seems.

Like many other old-fashioned liberals, I had mistakenly perceived "Social Justice" as a continuation of the Civil Rights movement. But this is a deception crafted by far-left academics who leverage a postmodernist framework with the intent to ignite a cultural revolution against Western values.

What is Postmodernism?

The philosophical movement of Postmodernism originated in the 1960s in the Humanities as a way to challenge traditional power structures. It holds that empirical knowledge used to describe objective reality is a social construct used to oppress people.

Postmodernism’s brazen rejection of empirical science and liberalism as “tools of the oppressor,” (because of their origins with white men), has led to an academic culture ripe for ridicule and hoaxes due to its lack of intellectual rigor.

The purpose of this postmodern academic discipline is to produce leftist activists with a specific theoretical approach to addressing perceived injustices between identity groups.

Peer-reviewed Humanities journals attempt to make postmodern scholarship appear legitimate, but this is another deception. It is not empirical or evidence-based like the hard sciences. It is leftist activism peer-reviewed by other leftist activists.

Hoaxes such as the Grievance studies affair and the Sokal affair have helped to expose their unrigorous practice. In the 2018 Grievance studies hoax, three academics (James Lindsay, Helen Pluckrose and Peter Boghossion) submitted deliberately absurd and fake academic papers to respected peer-reviewed journals in the Humanities and Social Sciences, many of which were accepted and at least one won an award!

Their objective was to reveal that these journals were accepting papers not based on research quality but on their alignment with specific ideological beliefs, influenced by postmodernist thought. One of the faux papers accepted in a peer-reviewed Humanities journal was a chapter from Hitler's "Mein Kampf" with the phrases "our movement" or "party" replaced by "intersectional feminism."

What is Critical Theory?

Postmodernism is closely aligned with Critical Theory, a Marxist-derived social philosophy which hoped to explain why liberal orders were so effectively resistant to Marxist revolutions by analyzing power dynamics between social classes.

Adherents of Critical Theory posit an overly simplistic model of society that categorizes people by their identity traits and ranks them as either “oppressors" or “oppressed” in a zero-sum conflict for power. (This is where “identity politics” comes from.)

Within this “Critical” framework, they have attempted to redefine the Israel-Palestine conflict.

An entire frivolous body of postmodern scholarship dedicated to Palestine Studies (influenced by Postcolonial theory - another offshoot of Critical Theory), portrays Israel as an all-powerful aggressor and Palestinians as helpless victims without agency.

According to this ideology, instead of a conventional moral compass, they see the “oppressed” as inherently virtuous and the “oppressors” as deserving of any consequence. They advocate for “decolonization” - even by violent means.

Palestine Studies attempts to legitimize an alternative pseudohistory and rationalize every terrorist attack by Palestinians against Jews, all while insisting that Israel simply existing is “inherently the initiator of violence.”

When in fact, an accurate reading of history reveals that Palestinians have started (and lost) every war, rejected every offer for a two-state solution, and elected Jihadi terrorists into power - who have kept 80% of Gazans in poverty and whose foundational document (the 1988 Hamas Charter) makes explicit their genocidal intentions of killing all Jews. Hamas leaders have vowed to repeat the mass murders of October 7 until that goal is achieved.

What is Critical Social Justice?

Modern “Social Justice,” informed by postmodernism and Critical Theory, which some have called Critical Social Justice (CSJ), is the vehicle used to spread their ideology. It is a trojan horse for an illiberal and radical, Marxist-inspired belief system.

Online CSJ activists use social media to recruit others into adopting this worldview. Their propaganda campaigns employ slogans, art and highly conjectural slideshows that reduce complex issues into bullet points and narratives that give people a false sense of being informed.

By copying the methods of other Critical Social Justice activist campaigns, Hamas’s allies have manufactured a faux-Social Justice movement.

They foster mistrust in conventional news outlets and specifically target American progressives on social media with anti-Israel propaganda, based on their “research” from the pseudohistorical, Critical Theory-derived Palestine Studies.

Hamas and its allies are winning over public sympathy by weaponizing this form of online activism. They have orchestrated the most significant propaganda offensive against the Jewish community since World War II.

While the liberal approach to Civil Rights has enjoyed many great successes, such as the Emancipation Proclamation, Women's Suffrage, the Civil Rights Act, and the Voting Rights Act, to name only a few, Critical Social Justice has yet to achieve any real justice. In fact, it aims to overturn many of liberalism's great Civil Rights achievements.

The Critical Social Justice approach conflicts with long-established research on decreasing prejudice and enhancing relations between groups. It does more harm to the groups they claim to support.

We should emphatically reject this form of divisive, leftist activism and instead champion the liberal values of the Enlightenment and support our democratic allies like Israel in their fight against Islamic terrorism.

Read my new investigation for Quillette into the well-funded anti-Israel groups that target American progressives with “Social Justice” themed content on Instagram:

This is the 7th edition of my newsletter Gender Medicine Monthly, dedicated to sharing updates related to gender medicine with a particular focus on pediatric gender medicine and the affirmative model of care, for paying subscribers. 

March’s inaugural issue is free, as well as a preview of the first part of each issue. If you find the content of this newsletter valuable, please consider becoming a paid subscriber. Your support helps me dedicate my time and energy to producing quality content.

In light of the recent terrorist attack on Israel, I found it important to delay the release of this newsletter, which was scheduled for publication two weeks ago, to make room for learning, understanding, and reflection on the current tragedy in the Middle East.

Without further ado, here are some important headlines in gender medicine from the month of September (and the first week of October) covered in this edition of Gender Medicine Monthly.

1. New analysis on puberty blockers found one-third of kids’ mental health deteriorated 

2. Two Missouri pediatric gender clinics cease transitioning minors 

3. Nebraska places age restrictions on surgery, limitations on hormones for youth

4. Detransitioner files 5th U.S. lawsuit against medical transition of minors

5. New report highlights Planned Parenthood’s lack of patient safeguarding for medical transition 

6. ACLU loses appeal to overturn age restrictions on youth medical transition in Tennessee and Kentucky

7. Genspect's 2nd 'The Bigger Picture' Conference: November 4-5 in Denver, Colorado

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1. New analysis on puberty blockers found one-third of kids’ mental health deteriorated

Source: BBC 9/19/23

A recent re-analysis of a prominent study on puberty blockers for gender dysphoric youth in England revealed significant impacts on mental health after 12 months.

In 2011, the Tavistock's Gender Identity Development Service (GIDS), the only NHS specialist gender clinic for children in England, collaborated with University College London Hospitals (UCLH) on the early intervention study. Over three years, they enrolled 44 children aged 12 to 15 to investigate the effects of puberty blockers.

The original study, published in 2021, claimed "no changes in psychological function" after puberty blocker use. However, this conclusion was based on a group average of scores collected at various times.

Professor Susan McPherson from the University of Essex and retired social scientist David Freedman re-analyzed the data, focusing on individual trajectories of the young participants. Their findings after 12 months of puberty blocker injections indicated that 34% of the children had reliably deteriorated, 29% had reliably improved, and 37% showed no change, as per their self-reported responses.

The authors of the original report welcomed this new evidence. Hannah Barnes, author of "Time to Think," reported on this for the BBC, and a related 10-minute feature is available to watch below.

Significance: This study had a significant impact on policy, leading to the lowering of the age at which puberty blockers could be used in England, even before results were known in 2014.

This study, like many others in the field, was small and uncontrolled. Consequently, systematic evidence reviews conducted in several countries across Europe and the U.S. state of Florida consistently rate the quality of evidence for transitioning children as "very low." These assessments have resulted in restrictions on medical transitions for minors in England, Sweden, Finland, Denmark, and soon Norway.

2. Two Missouri pediatric gender clinics cease transitioning minors 

Source: NYT  9/11/23

Two university-affiliated hospitals in Missouri have stopped providing medical transition services to gender-distressed children, going beyond the requirements of a new law. The Washington University Transgender Center at St. Louis Children’s Hospital and the University of Missouri Health Care have announced they will no longer prescribe puberty blockers or cross-sex hormones to minors for gender transition purposes. Instead, they will refer current patients to other providers while maintaining mental health services and other non-prohibited offerings.

The new law, SB 49, prohibits gender transition surgeries and the prescription of such medications for individuals under 18. However, this law does not affect minors who were already receiving treatment before its effective date. 

Additionally, the Washington University Transgender Center is under investigation following allegations from former case manager Jamie Reed, who blew the whistle on the "morally and medically appalling" treatment causing "permanent harm" to children.

Significance: Both institutions have cited a provision in the law that allows patients to sue their doctors for malpractice related to these services up to 15 years after treatment or turning 21. Additionally, the law presumes harm if the drugs result in infertility.

Despite their professed confidence in the evidence of benefit and the assertion of providing "lifesaving care," they have chosen to discontinue offering these treatments to those already undergoing them due to concerns about potential lawsuits.

3. Nebraska places age restrictions on surgery, limitations on hormones for youth

Read more

A fifth lawsuit involving childhood medical transition against a U.S. healthcare provider is underway.

Luka Hein, a 21-year-old woman from Nebraska, underwent medical transition as a teenager. The complaint, filed on her behalf, alleges that starting at age 16, she had a double mastectomy after only two doctor appointments and was subsequently placed on testosterone. The University of Nebraska Medical Center (UNMC) and the clinicians responsible for her transition are named as defendants. 

The Center for American Liberty, Nebraska malpractice attorney Jeff Downing, and the Thomas More Society are representing Hein. They claim medical malpractice, asserting that the interventions left Hein "physically and psychologically scarred." Additionally, a tort claim is being filed on Hein's behalf against the Board of Regents at the University of Nebraska by the Center for American Liberty and Jeff Downing.

“I was going through the darkest and most chaotic time in my life, and instead of being given the help I needed, these doctors affirmed that chaos into reality,” said Hein in a press release. “I was talked into medical interventions that I could not fully understand the long-term impacts and consequences of.”

The complaint chronicles Hein’s story, beginning in 2015 at age 13, when her parents got divorced. This upheaval took a toll on her school performance in 2016, as persistent anxiety and panic attacks disrupted her focus. Despite efforts like counseling and medication, Hein's mental well-being deteriorated, leading to self-harm and suicidal thoughts.

In 2017, her situation was further compounded when she was preyed upon online. This traumatizing episode not only deepened her existing mental struggles but also led her to re-evaluate her own identity. Hein came across transgender influencers online who praised the benefits of hormones and surgeries. Influenced by her online research and interactions, Hein began considering transitioning, thinking it might offer relief from her intense emotional and psychological distress.

At 15, during Hein's initial visit to a gender clinic in 2018, she was quickly recommended for breast removal surgery after hastily being diagnosed with “gender identity disorder.” Despite their reservations, Hein's parents felt pressured to consent due to concerns about potential suicide threats, even though Hein had shown no signs of suicidal ideation for nearly a year before the surgery. Ahead of the operation, concerns about its appropriateness for Hein's age and her multiple personal challenges were largely ignored or downplayed.

At 16, Hein underwent a double mastectomy to remove her healthy breasts. The complaint suggests that, given her young age and complex psycho-social situation, Hein wasn't equipped to provide informed consent for such a permanent procedure. A few months post-operation, she began a testosterone regimen. The suit posits that she wasn't adequately briefed on the prolonged side effects of cross-sex hormones.

A year into the testosterone treatment, her physician proposed a partial hysterectomy as the “next step in her transition.” Hein's parents vehemently opposed this idea and ultimately withheld permission for the surgery.

Hein remained on testosterone under her physician’s advice for four years, which resulted in “substantial damage to her mental and physical health.” By 2022, she discontinued testosterone due to its harmful effects. 

In 2023, during a telemedicine consultation, when Hein voiced her regret about the treatments, her physician's response was reportedly dismissive, suggesting, "I guess this is just part of your gender journey," with the only advice being to pursue mental health counseling.

The lawsuit claims the defendants acted negligently, did not adhere to professional standards, and failed to secure genuinely informed consent. It underscores that, given the rapid onset of Hein’s gender dysphoria and her known psychosocial challenges, there was no concrete proof her transgender identity would persist in the long-term.

Central to the complaint is the assertion that both Hein and her parents weren't provided complete information on the treatments, were manipulated during the consent process, and were unjustly pressured with implied suicide risks. The lawsuit stresses Hein's incapacity to consent, given her youth and mental health. It further asserts that any negligence by individual defendants associated with Nebraska Medicine is directly attributed to that entity. Hein is seeking damages for various physical, emotional, and financial hardships. She is requesting a jury trial and compensation for damages, legal fees, and related expenses.

Hein’s legal team is also charging that the defendants are in violation of the Nebraska Consumer Protection Act by their use of “deceptive descriptions to market their ‘services’ to impressionable teens.”

Hein's complaint represents the twelfth instance globally where a detransitioner has pursued legal action against their medical facilitators. In the U.S., she is the fifth individual to seek legal recourse for transitioning procedures that began while she was a minor.

The Center for American Liberty also represents Chloe Cole and Layla Jane, two other young detransitioned women seeking legal action against the same institutions and doctors for facilitating their transitions as minors. In April 2023, Campbell Miller Payne, PLLC, a newly-established firm, started representing detransitioners. Prisha Mosley and Soren Aldaco, both young women who began their transitions as minors, were among their first clients, each filing claims in July.

While the exact number of detransitioners is unknown, and more research is needed, cases appear to be steadily rising. Current data suggests that 10-30% of individuals detransition approximately 4-8 years after starting their transition. A recent US-based comprehensive review of medical records that found 30% of teens and young adults had discontinued “gender-affirming” hormones after 4 years. Another US study from this year that challenges the notion that detransition is rare found that 29% of youth changed their requests for hormone treatment, surgery, or both.