Gender Medicine Monthly

June - July

This is the 4rd edition of my new 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.

Here are some headlines in gender medicine from the month of June (and the first week of July) covered in this edition of Gender Medicine Monthly.

1. The American Academy of Pediatrics sidelines formal proposal to revise pediatric medical transition policy for the 4th consecutive year

2. Endocrine Society president responds to criticism in WSJ, fails to disclose affiliation with a gender clinic 

3. The American Medical Association, Endocrine Society double down on affirming model of care

4. New paper confirms increasing number of gender dysphoria diagnoses, decreasing age and sex ratio flip

5. GLAAD pushes for censorship of pediatric medical transition debate in celebrity-backed letter 

6. Norway set to release new guidelines restricting pediatric medical transition 

7. Ireland to review use of puberty blockers following U.K.’s lead

8. Three important new articles on detransitioners

9. Genspect launches new Think Tank to develop alternative to WPATH Standards of Care

1. The American Academy of Pediatrics sidelines formal proposal to revise pediatric medical transition policy for the 4th consecutive year

Source: buttonslives.news 7/9/23

The AAP has once again disregarded a member-drafted proposal aimed at aligning its stance on pediatric medical transitions with systematic evidence reviews — for the fourth year in a row — and has implemented new rules to stifle discussion.

Resolution #37, co-authored by 24 AAP member pediatricians, states that the AAP is proceeding with an update to their 2018 policy endorsing the “gender-affirming” model of care without conducting a systematic review of the evidence — the gold standard of evidence-based medicine.

In 2022, AAP leadership imposed a rule barring pediatricians from discussing "unsponsored" resolutions, unlike in 2021. Back then, a resolution seeking a revision of the pediatric gender care policy gained substantial backing from pediatricians through votes and comments.

Reacting to these restrictions, dozens of AAP members took an unprecedented step by voicing their concerns in the comments section of a separate resolution on the AAP's website. Despite these efforts, it failed to progress at the leadership meeting.

Last month the AAP announced a new set of resolutions that were ready for member review and commentary for the annual conference in August. However, Resolution #37 remains barred from receiving comments, as no chapter or committee was willing to sponsor.

In an attempt to dissuade members from commenting on Resolution #37 within the comment sections of other resolutions, as was done the previous year, the AAP included a proviso stating:

"Members should focus their comments on the content of the resolution itself. Submitted comments will be reviewed before public posting. The comments contained in the report are for members only and should not be shared outside the AAP."

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Significance: The U.S. is quickly becoming an outlier in pediatric gender medicine, as more countries have adopted a more cautious approach after conducting systematic evidence reviews and finding the risks outweigh purported benefits.

If U.S. medical organizations like the AAP continue to take politically-driven rather than science-based positions, they risk damaging their credibility and inflicting serious harm on the children they have a duty to care for.

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2. Endocrine Society president responds to criticism in WSJ, fails to disclose affiliation with a gender clinic 

Source: Leor Sapir’s Twitter 7/7/23

Do No Harm, an association of doctors that opposes political influence in medicine, penned an op-ed [archive] in the Wall Street Journal on June 28th. They criticized the Endocrine Society for deviating from the best available research on gender medicine and disregarding the views of its members, following their attendance at the Endocrine Society conference in June. In response, Dr. Stephen Hammes, the newly appointed president of the Endocrine Society, authored a counter-opinion [archive] in the same publication, in which he dismissed and downplayed the concerns raised.

Leor Sapir, a researcher and Manhattan Institute fellow, weighed in on Twitter, suggesting that Dr. Hammes either lacks understanding or intentionally disregards evidence-based medicine (EBM) principles in the Endocrine Society guidelines. Sapir recently published an article in The Hill, discussing why the U.S. differs from some European countries in gender medicine due to a departure from EBM principles by U.S. medical authorities.

Sapir further highlighted that Dr. Hammes failed to disclose his affiliation as the co-director of the University of Rochester's transgender clinic and is involved in the medical transition of minors at Golisano Children's Hospital. This omission raises concerns about potential conflicts of interest and bias in his approach to pediatric gender medicine and adherence to evidence-based medicine.

Also of interest: A doctor from Redlands, California, submitted a letter to the editor [archive] of the WSJ in response to the Do No Harm article. In her letter, she expressed agreement with the position presented in the article and emphasized that pediatricians she consulted with shared the view that the American Academy of Pediatrics' stance on pediatric medical transition is "repugnant and destructive to their patients, but they were afraid to speak up for fear of retaliation."

Significance: The Endocrine Society, the American Academy of Pediatrics (AAP), and the World Professional Association for Transgender Health (WPATH) are the three main organizations in the United States that have issued guidelines on pediatric medical transition. Other organizations, such as the American Medical Association (AMA), have expressed support for "affirming" medicine without providing evidence or have relied on the expertise of these three organizations.

It's important to note that none of these organizations have conducted systematic reviews of the evidence. Systematic reviews are rigorous evaluations specifically designed to prevent the selective inclusion of studies and biased analysis.

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3. The American Medical Association, Endocrine Society double down on affirming model of care

Source: Jesse Singal’s substack 6/15/23 Benjamin Ryan’s twitter 6/13/23

In a controversial move, the American Medical Association (AMA) recently reaffirmed its commitment to the “gender-affirming” model of care, despite ongoing criticism. Announcing that its House of Delegates had approved the Endocrine Society's resolution, the AMA aimed to protect access to what it inaccurately describes as "evidence-based gender-affirming care."

This decision drew the attention of journalists Jesse Singal and Benjamin Ryan, who debunked the claims made on Substack and Twitter, respectively. The AMA's claim that their endorsement was supported by "more than 2,000 scientific studies… since 1975” is misleading as most of these studies pertain to adults, not children. Pediatric gender-affirming care, specifically the 'Dutch model' of puberty blockers and hormones, only began being studied in the late '90s and was not widely applied until around 2015. 

Singal pointed out their assertion that gender-related medical interventions are primarily intended for "older adolescents and adults," is demonstrably untrue, contradicted by the Endocrine Society’s own past statements that “puberty blocking medications could be considered once an experienced clinician confirms the start of puberty.”

Singal refutes the AMA's statement that “pediatric gender-affirming care is designed to take a conservative approach,” citing a Reuters investigation on gender clinics that recommended puberty blockers and hormones during the first consultation.

Ryan, meanwhile, casts doubt on the validity of the evidence referred to by the AMA. The existing research on gender-affirming care for children lacks the quality to be labeled definitively as "evidence-based," as the pioneers of the evidence-based medicine movement recently said that the guidelines for adolescent gender medicine were “untrustworthy” and should not be considered evidence-based.