#settled science

Morgan Keller: On April 26, my friend Prisha testified in favor of this bill. Representative Beth Liston asked her if she was affirmed in her trans identity and medicalised in the state of Ohio. Prisha responded perfectly. "If you wait until you have a detransitioner from Ohio, someone is already hurt and you have failed."

My name is Morgan. I am the Ohio detransitioner that Prisha warned you about.

I’m 26 years old and was trans Identified for five years. In March of this year, after trying to ignore the doubt and regret that began to build around my transition, I woke up one morning with the realization that my trans identity was never about becoming my most genuine self or living my life authentically. Instead, it was a desperate, last-ditch attempt to become someone else to escape my unidentified trauma and body and mental health issues.

When I started exploring gender ideology, my life was in shambles. I was in an emotionally manipulative lesbian relationship, I was isolating myself in my apartment and drinking regularly. I wasn’t attending my classes or socialising normally, I had become captivated by the idea that my female body was fundamentally wrong and seduced by the prospect that there was something that I could do about it.

When I sought out help for my complicated feelings towards my female sex, I was affirmed, which is to say I was put on life altering cross-sex hormones with minimal questioning or treatment of my underlying issues. At 21, a license practitioner in the state of Ohio wrote me a prescription for medically unnecessary synthetic testosterone, and just one month after my 22nd birthday, I went under the knife for a double mastectomy based on the recommendation letter from a therapist who still holds an active license in the state. I sat with these practitioners for hours, describing how uncomfortable I was in my body, how disconnected I felt from myself and how hard it was to walk through the world as a masculine woman.

The nurse practitioner who prescribed me testosterone told me that I would transition beautifully and that no one would ever be able to tell that I had been born as a female. After a lifetime of body-image issues and an increasing desperation to become anybody but myself, that was like music to my ears.

I don’t believe that not transitioning was ever considered by my practitioners. I feel like once I walked into that gender clinic, medicalisation was the only option. I needed the practitioners that I trust it to help me make peace with my body, not firm my delusion that hormones and a cosmetic mastectomy might make me feel better. I needed them to just say no.

This week is the fifth anniversary of my first testosterone shot. I was told that this experimental medicalisation would save my life. My parents were made to believe that this was the only way to keep their daughter alive, healthy and happy. No practitioner bothered to dig deeper with me on why felt so disconnected from my female body, and why I thought giving myself an endocrine imbalance, amputating my healthy breasts and masquerading as a member of the opposite sex was such an appealing treatment plan. I can say with 100% certainty that this medicalisation only gave me new health problems and mental distress. I will never, ever legitimatise these experimental treatments as anything based on love or care for an individual.

Under the euphemistic guise of "life-saving gender affirming care," practitioners in our state have become enablers with their prescription pads. At its highest point, my testosterone levels were 11 times the maximum range for a female body. Is this really the standard of care that we want for our Ohioans?

When I realised that my medication was nothing more than a very elaborate placebo endorsed by multiple medical professionals, I made the immediate decision to detransition. It was all over. I quit testosterone cold turkey and endured four of the most brutal months of my life. I had no energy, I didn’t shower for almost 2 weeks, I would cry upwards of 10 times a day, shocked at what I’d been allowed to do to my body in such a vulnerable state with an underdeveloped brain.

I would lay in bed all day, sitting with the realisation that I would never be able to breastfeed children that I didn’t even know that I wanted at the time when I got my mastectomy. I didn’t know if those feelings would ever go away, so I started to make plans to commit suicide. My family was so worried that my parents made me go home, so they could make sure I was eating, bathing and sleeping.

I sent a letter to my prescribing practitioner detailing how much regret I felt, and all of the things I wish were different about the treatment I received, and she never replied. I had been working with that same therapist for seven years by the time I called her with my realisations about the issues underlying my decision to transition. I sent her list of everything that should have been treated instead of getting hormones and a mastectomy, and I will never forget hearing her tell me, "I failed you."

She told me that this was such a new field of psychology that modern medicine is still at the forefront of learning how to treat gender dysphoria. But isn’t that funny, because the current narrative says that this medicalisation is "settled science."

I couldn’t give informed consent at 21, so why are we pretending that children can do that? With this bill we can ensure that children in Ohio are protected from ever waking up and finding themselves in my position. I wish I never opened the Pandora’s box of gender ideology. I wish I’d been told by the practitioners that I trusted. I wish I could say that I’m the exception to the rule, but everybody in this room knows that that is false.

I come to you wearing the scars of this medical scandal asking you to please vote and support of House Bill 68 to protect Ohio’s children.

Thank you for listening.

Senator Kristina Roegner: Thank you for your testimony. Are there any questions? I do have one. You mentioned when you were 21 years old, you went in for the first time to a medical practitioner, and then started the treatments at that point. What was that... how many visits did it take, what was the discussion like, Was it really that quick or what did they ask you? What was that like?

Keller: I actually was the one to push back on them. I went in and they had such a long waiting list, you could just go in and see somebody below the main practitioner who is writing things at this clinic, you know, directing the program. And one of the doctors on the staff just said, "why don’t you start testosterone and see how you feel" And I was like, "no way." I wanted someone that I trust a little bit more to really help me discern if this was correct for me or not.

And I went to the clinic for the first time, I believe it was in June, and then six months later I was on hormones, and I think I went to the clinic three times.

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The thing that never happens keeps never happening.

Everyday I listen to the champions of the clot shot talking about consensus.

First of all, no real consensus exists except among government officials, and we all know how fucking shady they are.

By: Leor Sapir

Published: Jun 28, 2023

A growing number of countries, including some of the most progressive in Europe, are rejecting the U.S. “gender-affirming” model of care for transgender-identified youth. These countries have adopted a far more restrictive and cautious approach, one that prioritizes psychotherapy and reserves hormonal interventions for extreme cases.  

In stark contrast to groups like the American Academy of Pediatrics (AAP), which urges clinicians to “affirm” their patient’s identity irrespective of circumstance and regards alternatives to an affirm-early/affirm-only approach “conversion therapy,” European health authorities are recommending exploratory therapy to discern why teens are rejecting their bodies and whether less invasive treatments may help.  

If implemented in American clinics, the European approach would effectively deny puberty blockers and cross-sex hormones to most adolescents who are receiving these drugs today. Unlike in the U.S., in Europe surgeries are generally off the table before adulthood.  

Why are more countries turning their backs on what American medical associations, most Democrats and the American Civil Liberties Union call “medically necessary” and “life-saving” care? The answer is that Europeans are following principles of evidence-based medicine (EBM), while Americans are not.

A bedrock principle of EBM is that medical recommendations should be grounded in the best available research. EBM recognizes a hierarchy of information. The expert opinion of doctors, for example, even when based on extensive clinical experience, furnishes the lowest quality — meaning, least reliable — information. Slightly higher on the information pyramid are observational studies. Systematic reviews of evidence, meanwhile, furnish the highest quality evidence. They follow a rigorously developed, reproducible methodology. They do not cherry-pick studies with convenient results, but instead consider all the available research.  

Most importantly, systematic reviews don’t merely summarize the conclusions of available studies on a question of interest. Instead, they assess the strengths and weaknesses of these studies to determine the reliability of their findings. To do this, systematic reviews typically use the GRADE system (Grading of Recommendations, Assessment, Development and Evaluations) and rank the quality of evidence as “high,” “moderate,” “low” or “very low.”  

Systematic reviews by EBM experts in Scandinavia and the United Kingdom have concluded that there are serious gaps in the evidence base for sex modification in minors. The U.K. systematic reviews found the available research to be of “very low” quality — meaning that there is very low certainty that an observed effect, like reduced suicidality, is due to the intervention, and therefore the studies’ claimed results are unlikely to represent the truth.  

Importantly, even the famous Dutch study that is said to be the “gold standard” of research in this area received a rating of “very low” due to serious methodological problems. Sweden’s National Board of Health and Welfare has said that the risks of treating gender dysphoric minors with hormonal interventions “currently outweigh the possible benefits.”  

Last year, Florida’s health authorities commissioned what is known as an “umbrella review,” or a systematic overview of systematic reviews, from independent experts at McMaster University, home of EBM. Unsurprisingly, that overview came to the same conclusion: There is no reliable evidence that youth transition improves mental health outcomes.  

Because U.S. medical groups don’t always use EBM, their conclusions can be based on studies whose fatal flaws are overlooked or ignored. Consider, as an example, a study done at Seattle Children’s Hospital and published last year. The study’s authors reported that use of puberty blockers and cross-sex hormones was associated with 60 percent lower odds of depression and 73 percent lower odds of suicidality. Leading mainstream publications, including Scientific American and Psychology Today, celebrated the findings. More recently, major U.S. medical associations cited the study in federal court proceedings.  

But a careful look at the study’s data shows that the kids who received hormonal interventions did no better by the end of the study than at the beginning. The researchers’ claim about improvement was based on the fact that the kids in the control group, who received psychotherapy but not hormones, got worse relative to the hormone group. But even this isn’t accurate, as 80 percent of the control group dropped out by the end of the study, and a likely reason for this dramatic loss to follow-up is that many or perhaps all of the non-hormone-treated kids improved without “gender-affirming” drugs. It’s quite possible that if the researchers had followed up with all the participants, we’d see this study become Exhibit A in the case against pediatric sex changes.

Similar problems exist in studies purporting to show a rate of transition regret of less than 1 percent. The true rate of regret is not known and won’t be known for years to come. The claim that gender dysphoric teens are at high risk of suicide if not given access to “gender-affirming” drugs and surgeries is likewise baseless and irresponsible. In February, Finland’s top expert in gender medicine emphasized this point to the country’s liberal newspaper of record.

The American Academy of Pediatrics’ main statement on gender medicine, authored by a single doctor while still in his residency, is not a systematic review. The author himself has conceded as much. A later published peer-reviewed fact check found the AAP statement to be a textbook example of cherry-picking and mischaracterization of evidence.

The World Professional Association of Transgender Health (WPATH) says in its latest “standards of care” that a systematic review of evidence is “not possible.” Instead, WPATH used a “narrative review,” which has a high risk of bias according to EBM because it doesn’t utilize a reproducible methodology. England has broken from WPATH, and the director of Belgium’s Center for Evidence-Based Medicine has said he would “toss them [WPATH’s guidelines] in the bin.” In the U.S., WPATH’s standards are widely accepted as authoritative.

The U.S. Endocrine Society has relied on two systematic reviews in developing its own guideline. But these reviews were not for mental health benefits, and in any case the Endocrine Society ranks the quality of evidence behind its own recommendations as “low” or “very low.”

All other U.S. medical groups cite these three sources when assuring the public about “gender-affirming care,” thus creating an illusion of consensus around “settled science.”  

Earlier this year, an investigative report in the prestigious British Medical Journal concluded that although pediatric gender medicine in the U.S. is “consensus-based,” it is not “evidence-based.” Gordon Guyatt, distinguished professor in the Department of Health Research Methods, Evidence, and Impact at McMaster University, Ontario, and one of the founders of EBM, recently called American guidelines for managing youth gender dysphoria “untrustworthy.” 

Consensus can be produced by misguided empathy, ideological capture or political pressures. Consensus can also be manufactured. The new president of the American Medical Association (AMA) has said there should be “no debate” when it comes to offering kids “gender-affirming” drugs and surgeries.  

Yale School of Medicine’s Dr. Meredithe McNamara calls the questioning of the evidence behind pediatric sex changes “science denialism.” Her protest is ironic. Science is a process of ongoing inquiry and debate, not a set of predetermined conclusions. Science depends on skepticism, especially about sensitive subjects. True science denialism means restricting rational, evidence-based debate — exactly what McNamara and the AMA’s new president want to do.

Their calls are bearing fruit. Just this month, gender activists successfully pressured a medical journal to retract a paper whose conclusions they found inconvenient. The ongoing campaign to suppress scientific debate allows a pseudo-consensus to emerge around “gender-affirming care.”

Put simply, pediatric gender medicine in the U.S. is out of control. Medicalization of gender diversity in children is a fast-growing industry that shows no signs of self-correction. Doctors and therapists who practice “affirmative” medicine consistently demonstrate ignorance about EBM principles and deceive the public about the grim realities behind the euphemism “gender-affirming care.”  

A Reuters investigation last year interviewed providers at 18 pediatric gender clinics and found that none were doing comprehensive mental health assessments and differential diagnosis. Those who promote and practice “gender-affirming care” themselves tell us that their approach is child-led. “Gatekeeping” of medical transition, they insist, is pointless, even “dehumanizing.”

The author of the AAP’s position paper on gender medicine has said that a “child’s sense of reality” is the “navigational beacon to orient treatment around.” The director of the gender clinic at Boston Children’s Hospital has admitted that they give out puberty blockers “like candy.” Even the founding psychologist of that clinic has warned that kids are being inappropriately “rushed toward the medical model.”

Why the U.S. has become an outlier on pediatric transgender medicine is a complicated question, but at least part of the answer is that European welfare states have centralized health bureaucracies and public health insurance. Before medicines can be approved for state funding, their evidence base needs to be evaluated. The American health care system is more vulnerable to profit motives, activist doctors and political pressures. Medical associations claim to advocate for patient health but can have other motives as well.

The situation is so dire that when pediatric gender medicine experts in other countries want to defend their practices before a skeptical public, they sometimes say that at least they are not as bad as the Americans. That is one kind of American exceptionalism we can do without.

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[A] “child’s sense of reality” is the “navigational beacon to orient treatment around.”

Holy shit.

How can you claim that it's "settled science" and "consensus," and then leave everything up to the most immature, most depressed, most anxious, least experienced person in the room?

“The only way to test a hypothesis is to look for all the information that disagrees with it.” -Karl Popper Using this hypothesis, is science ever really settled? I think not.