You know those IDIOT REPUBLICANS who think that SCIENCE hasn’t TOTALLY PROVEN that puberty blockers and hormones are AWESOME????? And TOTALLY REVERSIBLE????? Well two MOUTH-BREATHING IDIOTS who probably also HATE CRT and PUPPIES are so BIGOTED they don’t even ACCEPT the MEDICAL CONSENSUS.

(Show notes a bit longer and more in-depth than usual this week to help everyone follow along, double-check stuff, etc.)

Show notes/Links:

Carole hooven DESTROYS jon stewart

The state laws

https://www.kff.org/other/issue-brief/youth-access-to-gender-affirming-care-the-federal-and-state-policy-landscape/

Jesse on the state laws in 2020

The vote went down after the episode was recorded, but Florida has now banned yuth gender medicine, with exceptions for those already receiving it and future research projects

https://www.nytimes.com/2022/11/04/health/florida-gender-care-minors-medical-board.html

The full episode of Stewart’s show: https://tv.apple.com/us/episode/the-war-over-gender/umc.cmc.1jj39s607lehulo4k0iscsarp

“I don’t send someone to a therapist when I’m going to start them on insulin.”

https://www.theatlantic.com/magazine/archive/2018/07/when-a-child-says-shes-trans/561749/

“Historically, mental health professionals have been charged with ensuring ‘readiness’ [she puts that in scare quotes] for phenotypic transition, along with establishing a therapeutic relationship that will help young people navigate this very same transition. These 2 tasks are at odds with each other because establishing a therapeutic relationship entails honesty and a sense of safety that can be compromised if young people believe that what they need and deserve (potentially blockers, hormones, or surgery) can be denied them according to the information they provide to the therapist.” This excerpt strongly suggests she doesn’t believe in the traditional gatekeeping role a mental-health clinician might play in a situation like this, helping to determine if a young person will benefit from transitioning.

https://jamanetwork.com/journals/jamapediatrics/article-abstract/2504256

Kids — sorry, sorry — “adolescents” — getting double mastectomies at 13 or 14

https://pubmed.ncbi.nlm.nih.gov/29507933/

“Suicide Attempts among Transgender and Gender Non-Conforming Adults: Findings of the Naitonal Transgender Discrimination Survey.”

https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-GNC-Suicide-Attempts-Jan-2014.pdf

n.b.: “Without such probes, we were unable to determine the extent to which the 41 percent of NTDS participants who reported ever attempting suicide may overestimate the actual prevalence of attempts in the sample.”

And:

Finally, it should be emphasized that the NTDS, like all similar surveys, captured information about suicide attempts, not completed suicide. Lacking any information about completed suicide among transgender people (due primarily to decedents not being identified by gender identity or transgender status), it may be tempting to consider suicide attempt data to be the best available proxy measure of suicide death. Data from the U.S. population at large, however, show clear demographic differences between suicide attempters and those who die by suicide. While almost 80 percent of all suicide deaths occur among males, about 75 percent of suicide attempts are made by females. Adolescents, who overall have a relatively low suicide rate of about 7 per 100,000 people, account for a substantial proportion of suicide attempts, making perhaps 100 or more attempts for every suicide death.

13 suicides per 100,000 in a GIDS sample

https://link.springer.com/article/10.1007/s10508-022-02287-7

Insanely high rate of 2.8% in a Belgian clinical sample

https://biblio.ugent.be/publication/8706800/file/8707586.pdf

T H E G U I D E L I N E S

Stewart: So these, the guidelines that you wrote, because you were responsible with the endocrine board for writing guidelines of care for endocrinology.

Safer: The Endocrine Society, yes

Stewart: The endocrine society.

Yes.

Stewart: And that was based on, uh, research papers, data, the things that you saw. Intervening with gender affirming care which may be just being respectful or, as they get older some of these other things. You’ve seen that have a reduction in depression, a reduction in suicide — that’s what you’ve studied.

Safer: Absolutely.

Nothing about mental health improvement, lotta assessment-talk, “low evidence” at best

https://academic.oup.com/jcem/article/102/11/3869/4157558?login=false#99603239

The Ibuprofen System For Evidence Assessment

https://www.ncbi.nlm.nih.gov/books/NBK470778/table/app2.t2/

Erica Anderson and Laura Edwards-Leeper take their concerns to the Washington Post

https://www.washingtonpost.com/outlook/2021/11/24/trans-kids-therapy-psychologist/

Jesse’s interview with Anderson on BARPod

Rutledge: We don't have enough data, we don't have enough to show that these drugs are effective and that these children are better off. And that we should encourage…

Stewart: You don't have enough, or it's not enough for you? I've got some bad news for ya. Parents with children who have gender dysphoria, have lost children, to suicide, and depression.

Rutledge : They absolutely have.

Stewart: —because it's acute. And so these mainstream medical organizations have developed guidelines through peer reviewed data, and studies. And through those guidelines, they've improved mental health outcomes.

Rutledge’s read on the evidence is perfectly reasonable

Here’s Sweden’s National Board of Health and Welfare:

For adolescents with gender incongruence, the [National Board of Health and Welfare] deems that the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases. … To minimize the risk that a young person with gender incongruence later will regret a gender-affirming treatment, the NBHW deems that the criteria for offering GnRH-analogue and gender-affirming hormones should link more closely to those used in the Dutch protocol, where the duration of gender incongruence over time is emphasized.

https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf

And here’s Finlands’ Council for Choices in Health Care, via an unofficial translation

In light of available evidence, gender reassignment of minors is an experimental practice. Based on studies examining gender identity in minors, hormonal interventions may be considered before reaching adulthood in those with firmly established transgender identities, but it must be done with a great deal of caution, and no irreversible treatment should be initiated. Information about the potential harms of hormone therapies is accumulating slowly and is not systematically reported. It is critical to obtain information on the benefits and risks of these treatments in rigorous research settings.

https://segm.org/sites/default/files/Finnish_Guidelines_2020_Minors_Unofficial%20Translation.pdf

NHS headed same way

https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/user_uploads/b1937-ii-specialist-service-for-children-and-young-people-with-gender-dysphoria-1.pdf

Dutch stuff

https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2121238

https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221

Depression and suicidality linked to blockers, perhaps rarely

https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019732s042,020517s038lbl.pdf

T

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693622/

“Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database”

https://www.sciencedirect.com/science/article/abs/pii/S1743609522012449#:~:text=Testosterone%20use%20was%20independently%20associated,testosterone%20deficient%20sub%2Dgroup%20analysis

The book to read on T

https://www.amazon.com/Story-Testosterone-Hormone-Dominates-Divides/dp/1250236061

The desistane literature is by no means “debunked,” and if you actually read the studies, no, the clinicians who wrote them did not confuse a bunch of merely gender nonconforming kids for genuinely gender dysphoric ones

These studies aren’t perfect and come from different contexts, but they consistently tell the same story

http://www.sexologytoday.org/2016/01/do-trans-kids-stay-trans-when-they-grow_99.html

That story probably doesn’t apply to kids who socially transition at a young age

https://www.nytimes.com/2022/05/04/health/transgender-children-identity.html

https://publications.aap.org/pediatrics/article/150/2/e2021056082/186992/Gender-Identity-5-Years-After-Social-Transition?autologincheck=redirected%3fnfToken%3d00000000-0000-0000-0000-000000000000

Even at the bigger clinics that do take a multidisciplinary approach, and where kids could theoretically get comprehensive, holistic care, that isn’t always happening

https://www.reuters.com/investigates/special-report/usa-transyouth-care/

In interviews with Reuters, doctors and other staff at 18 gender clinics across the country described their processes for evaluating patients. None described anything like the months-long assessments de Vries and her colleagues adopted in their research. At most of the clinics, a team of professionals – typically a social worker, a psychologist and a doctor specializing in adolescent medicine or endocrinology – initially meets with the parents and child for two hours or more to get to know the family, their medical history and their goals for treatment. They also discuss the benefits and risks of treatment options. Seven of the clinics said that if they don’t see any red flags and the child and parents are in agreement, they are comfortable prescribing puberty blockers or hormones based on the first visit, depending on the age of the child. “For those kids, there’s not a value of stretching it out for six months to do assessments,” said Dr Eric Meininger, senior physician for the gender health program at Riley Hospital for Children in Indianapolis. “They’ve done their research, and they truly understand the risk.”

2020 Finnish study

https://pubmed.ncbi.nlm.nih.gov/31762394/

Those who did well in terms of psychiatric symptoms and functioning before cross-sex hormones mainly did well during real-life. Those who had psychiatric treatment needs or problems in school, peer relationships and managing everyday matters outside of home continued to have problems during real-life. … Medical gender reassignment is not enough to improve functioning and relieve psychiatric comorbidities among adolescents with gender dysphoria. Appropriate interventions are warranted for psychiatric comorbidities and problems in adolescent development.

Jack Turban misinterpreting it:

https://archive.ph/wip/x6LGW

GIDS study comparing a group of kids with serious mental health problems who were delayed access to youth gender medicine to a group of kids who were able to start sooner because their mental health was solid enough

https://pubmed.ncbi.nlm.nih.gov/26556015/

Severely distorted UW study also found no improvement among kids who went on youth gender medicine

Yet another study out of GIDS, on kids from 12 to 15 years old who went on blockers, found no mental-health improvements, full-stop

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243894

Littman defends Littman’s research methods

https://link.springer.com/article/10.1007/s10508-020-01631-z

That dumb chart

We also have charts

https://www.newscientist.com/article/mg21929361-000-multiple-personalities-takedown-of-a-diagnosis/

http://www.fmsfonline.org/?ginterest=RecoveredMemoriesInTheCourts

“Another significant issue raised with us is one of diagnostic overshadowing – many of the children and young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be overlooked.”

https://cass.independent-review.uk/wp-content/uploads/2022/03/Cass-Review-Interim-Report-Final-Web-Accessible.pdf

NHS changes course on the safety/reversibility of blockers in 2020

https://www.transgendertrend.com/nhs-no-longer-puberty-blockers-reversible/

[Michael Hobbes got mad at me for posting this because he doesn’t like Transgender Trend, but holy hell is that stupid: They are simply summing up and putting into writing a change to the NHS website, and they’re citing a BBC report on the same subject. -Jesse]

OLD LANGUAGE: The effects of treatment with GnRH analogues are considered to be fully reversible, so treatment can usually be stopped at any time after a discussion between you, your child and your [multidisciplinary team]

NEW LANGUAGE: Little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria. Although the Gender Identity Development Service (GIDS) advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be. It’s also not known whether hormone blockers affect the development of the teenage brain or children’s bones. Side effects may also include hot flushes, fatigue and mood alterations.

Serious Lupron side effects

https://www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/

For years, Sharissa Derricott, 30, had no idea why her body seemed to be failing. At 21, a surgeon replaced her deteriorated jaw joint. She’s been diagnosed with degenerative disc disease and fibromyalgia, a chronic pain condition. Her teeth are shedding enamel and cracking. None of it made sense to her until she discovered a community of women online who describe similar symptoms and have one thing in common: All had taken a drug called Lupron. Thousands of parents chose to inject their daughters with the drug, which was approved to shut down puberty in young girls but also is commonly used off-label to help short kids grow taller. The drug’s pediatric version comes with few warnings about long-term side effects. It is also used in adults to fight prostate cancer or relieve uterine pain and the Food and Drug Administration has warnings on the drug’s adult labels about a variety of side effects. More than 10,000 adverse event reports filed with the FDA reflect the experiences of women who’ve taken Lupron. The reports describe everything from brittle bones to faulty joints. In interviews and in online forums, women who took the drug as young girls or initiated a daughter’s treatment described harsh side effects that have been well-documented in adults.

Caroline Jemsby

https://www.journalismfund.eu/journalists/carolina-jemsby

GULDSPADEN

https://archive.ph/wip/GFury

Clip in question

https://drive.google.com/file/d/1bL4WWMCs46dCKweZzz0gBj1AqE62k3oj/view?usp=sharing

Full unlocked interview with Jesse

GLAAD is glad journalists are falling in line

https://www.glaad.org/blog/jon-stewart-sets-record-straight-gender-affirming-care

https://www.glaad.org/blog/john-oliver-explains-why-gender-affirming-care-is-so-important

But sometimes not

https://www.glaad.org/gap/jesse-singal

Jesse’s response to the original version of his page (he hasn’t yet responded to the new one, which went up after this, because life is short):

The TikTok Doc yeets some teets

https://www.nytimes.com/2022/09/26/health/top-surgery-transgender-teenagers.html

Whoops:

Dr. Gallagher of Miami said that she follows up with patients for up to a year. “I can say this honestly: I don’t know of a single case of regret,” Dr. Gallagher said in May, adding that regret was much more common with cosmetic procedures. But one of her former top surgery patients, Grace Lidinsky-Smith, has been vocal about her detransition on social media and in news reports. “I slowly came to terms with the fact that it had been a mistake born out of a mental health crisis,” Ms. Lidinsky-Smith, 28, said in an interview.

So basically, these clinicians are claiming top surgery has incredibly low regret rates, but they’re simply not bothering to keep in touch with their patients. And one year is not very long for followup on this — if you give a kid top surgery at 15 or 16, one of the questions is whether, as their peers sexually develop and start families, they’ll at some point wish they had breasts. It’s a totally natural, important question, and you can’t answer it if your patients are disappearing into the void just one year after you perform surgery on them.

Age guidelines

https://www.cdc.gov/hiv/policies/law/states/minors.html

Oliver: So the benefits of providing care are immense and the risks of withholding it are dire. A survey of around 28,000 trans people found that of those who wanted hormone therapy and didn't receive it 58% reported suicidal thoughts in a given year, which is why the three major professional associations of Child and Adolescent doctors, psychologists and psychiatrists have endorsed gender affirming care and condemned efforts to deny it.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261039

This study is ridiculous and doesn’t even show any correlation between access to hormones and improvement on the more serious suicide measures anyway

Oliver: You may have seen or heard from a small subset of people who D transitioned but it is worth noting such cases are rare and highly individualized. Studies show an average of just 2% of people who transition expressed regret. And the vast majority of those who have opted to detransition did so not because of changes in their gender identity but due to external factors such as stigma and lack of social support.

Supposedly 1% - 2% regret rate

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/

Lost to follow data

https://docs.google.com/spreadsheets/d/1Yog0cUgVufxoTY64q-ll1wr7XcBhuqKD/edit?usp=sharing&ouid=102378063559486309340&rtpof=true&sd=true

Oliver is relying not on a study of detransitioners, but on individuals who currently identify as trans

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213007/

Littman study of detransitioners

https://pubmed.ncbi.nlm.nih.gov/34665380/

Reasons for detransitioning were varied and included: experiencing discrimination (23.0%); becoming more comfortable identifying as their natal sex (60.0%); having concerns about potential medical complications from transitioning (49.0%); and coming to the view that their gender dysphoria was caused by something specific such as trauma, abuse, or a mental health condition (38.0%). Homophobia or difficulty accepting themselves as lesbian, gay, or bisexual was expressed by 23.0% as a reason for transition and subsequent detransition. The majority (55.0%) felt that they did not receive an adequate evaluation from a doctor or mental health professional before starting transition and only 24.0% of respondents informed their clinicians that they had detransitioned.

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Episode 138: Jon Stewart And John Oliver Are Wrong About The Evidence For Puberty Blockers And Hormones

Blocked and Reported