Britain Is Leaving the U.S. Gender-Medicine Debate Behind: The Cass report challenges the scientific basis of medical transition for minors. (Helen Lewis, 4/14/24, The Atlantic)

The report drew on extensive interviews with doctors, parents, and young people, as well as on a series of new, systematic literature reviews. Its publication marks a decisive turn away from the affirmative model of treatment, in line with similar moves in other European countries. What Cass’s final document finds, largely, is an absence. “The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Cass writes. We also don’t have strong evidence that social transitioning, such as changing names or pronouns, affects adolescents’ mental-health outcomes (either positively or negatively). We don’t have strong evidence that puberty blockers are merely a pause button, or that their benefits outweigh their downsides, or that they are lifesaving care in the sense that they prevent suicides. We don’t know why the number of children turning up at gender clinics rose so dramatically during the 2010s, or why the demographics of those children changed from a majority of biological males to a majority of biological females. Neither “born that way” nor “it’s all social contagion” captures the complexity of the picture, Cass writes.

What Cass does feel confident in saying is this: When it comes to alleviating gender-related distress, “for the majority of young people, a medical pathway may not be the best way to achieve this.”


How a cult captured the NHS Society fails when it treats children like adults (Kathleen Stock, APRIL 12, 2024, UnHerd)

Pity poor Dr Hilary Cass, the eminent paediatrician charged with managing an independent review of NHS gender services for young people, whose final report was published this week. Given the hair-trigger sensibilities of interested parties, she seems to have been unable to state unambiguously that now-popular treatments for young people confused or distressed by their sexed bodies are blatant quackery: keeping pre-pubescent kids in suspended chemical animation on the basis of a single, discredited study; dosing teenagers liberally with opposite-sex hormones; or — when a child reaches the tender age of 18, though even earlier in other countries — empowering her to have major body parts cut off.

Instead, time and again in Cass’s report she is forced back into the conceit that the most pressing problem for contemporary gender medicine is the lack of good evidence for such interventions either way. It is as if a modern-day medic had been tasked with reviewing the efficacy of trepanning, and then ordered to defend her findings in front of fanatical fifth-century devotees. “It’s not that drilling a hole in a child’s skull to release demons is necessarily harmful, you understand — indeed, it may be the best outcome in some cases. The main issue is the lack of long-term follow up.”

Alongside Cass’s cumulatively devastating account of reckless decision-making, poor evidential standards, and patchy record-keeping at Gids and elsewhere, a whole section of the report gently attempts to educate its readership about “the components of evidence-based medicine” — complete with basic explainers about randomised controlled trials, blinding processes, and the possibility of bias. She might as well be addressing an archaic people who have just emerged blinking from a time capsule, still convinced that disease is God’s punishment for insufficient acts of propitiation.

In a sense, though, this is indeed very like one group to whom the report is addressed: those clinicians, parents and patients immersed in bubbles of identity affirmation, and cognitively isolated from any reasoning or evidence that would confound their worldview. Perhaps unusually for a medical review, it is clear from Cass’s overtly respectful tone and at times still-euphemistic language that her aim is not just to inform these readers but also to deprogram them.


Development of Gender Non-Contentedness During Adolescence and Early Adulthood (Pien Rawee, Judith G. M. Rosmalen, Luuk Kalverdijk & Sarah M. Burke, 2/27/24, Archives of Sexual Behavior)

Adolescence is an important period for the development of gender identity. We studied the development of gender non-contentedness, i.e., unhappiness with being the gender aligned with one’s sex, from early adolescence to young adulthood, and its association with self-concept, behavioral and emotional problems, and adult sexual orientation. Participants were 2772 adolescents (53% male) from the Tracking Adolescents’ Individual Lives Survey population and clinical cohort. Data from six waves were included (ages 11–26). Gender non-contentedness was assessed with the item “I wish to be of the opposite sex” from the Youth and Adult Self-Report at all six waves. Behavioral and emotional problems were measured by total scores of these scales at all six waves. Self-concept was assessed at age 11 using the Global Self-Worth and Physical Appearance subscales of the Self-Perception Profile for Children. Sexual orientation was assessed at age 22 by self-report. In early adolescence, 11% of participants reported gender non-contentedness. The prevalence decreased with age and was 4% at the last follow-up (around age 26). Three developmental trajectories of gender non-contentedness were identified: no gender non-contentedness (78%), decreasing gender non-contentedness (19%), and increasing gender non-contentedness (2%). Individuals with an increasing gender non-contentedness more often were female and both an increasing and decreasing trajectory were associated with a lower global self-worth, more behavioral and emotional problems, and a non-heterosexual sexual orientation. Gender non-contentedness, while being relatively common during early adolescence, in general decreases with age and appears to be associated with a poorer self-concept and mental health throughout development.


The sadness of Sceptical Man (Victoria Smith, 28 March, 2024, The Critic)

As a topic, sex and gender causes particular problems for the man who views himself as a lofty, rational observer of other people’s madnesses. This is because in order to pass as occupying “the middle ground”, you still have to give a free pass to lots of insane things, as opposed to lots and lots of them. Instead of going full-on Long Chu — which would of course be too far! — you have to ignore plenty of stuff which, deep down, you know to be total bollocks. This probably makes you quite cross, only not with yourself. It’s the people who keep pointing it out who are the problem.

If it wasn’t for all those bigots who keep reminding you that human can’t change sex, no one’s born in the wrong body, and a twelve-year-old autistic girl who’s terrified of puberty is in no way comparable to a middle-aged man who gets off on wearing his wife’s tights, you’d be fine. Sure, these people are saying things that you, too, would have said six or seven years ago, but they’re the ones who have gone insane. It’s definitely not you who’s been radicalised. It’s the people who lack the nuance, curiosity and intellectual ingenuity to have started saying a few mad things and ignoring a few medical scandals on the basis that most people in their social circle are saying and ignoring them, too.

For those whose brand values — rationality! curiosity! scepticism! — are quite incompatible with any serious engagement with what has been happening, it has been necessary to portray it as a “culture war” between two equally extremist sides. There are the people who think sex isn’t binary, male people should be welcome in female-only spaces and sports, it’s fine to experiment on the bodies of children, JK Rowling is a terrorist, and then there are the people who think that sex is immutable, women are definable as a class of human beings and that biological sex is socially and politically salient. Both sides have to be treated as though they are equally irrational, in order to make it possible for self-styled voices of reason to shake their heads and performatively muse on what drives perfectly ordinary people to adopt such ludicrously polarised positions. Can’t they find some middle ground? Like, experiment on half the number of kids? Let uterus havers and bleeders call themselves adult human females every other Tuesday?

An alternative reading of the current situation —- one which acknowledges those who can still be bothered to speak the truth as whistleblowers, rather participants in an ever-increasing exchange of crazy ideas and violent threats — is not permissible.


Why did it take so long to ban puberty blockers? (Patrick West, 22nd March 2024, spiked)

For too long, these drugs were handed out to mentally troubled youths, to confused young gay people caught up in vortices of social contagion and to children pressured into potentially life-ruining decisions by ideologically driven adults.

For this ban, we must thank Lucy Bannerman and Janice Turner of The Times, author Helen Joyce and the many other gender-critical feminists who campaigned tenaciously against the use of puberty blockers. But a troubling question remains: how on Earth was the practice allowed to continue for so long?

An intriguing answer comes from Helen Joyce herself. As she explains in a recent article for the Critic, the trick the radical trans movement played was to persuade people that according blanket rights to trans people was simply the next step in a narrative of liberation. The thinking among many has been that, ever since the Enlightenment, we have been on an emancipatory trajectory in the West. It began with religious toleration, then came the campaign for racial equality, moving on to women’s liberation and then, by the 1960s, gay liberation. With these goals achieved, the next step was surely liberation for the trans community. As Joyce explains: ‘During the past decade, the trans lobby has been stunningly successful in selling false analogies… [such as] that separate toilets for men and women are like racial segregation and that insisting people can change sex is “gay rights 2.0”.’ […]

The recent craze for mutilating children will most likely one day be put in that same category of warped, weird thinking. As will Butler’s belief, that both gender and biological sex are socially constructed.

The ‘Detransition’ Time Bomb (WILFRED REILLY, March 14, 2024, National Review)

More striking than the total numbers involved, to me, was their mappable rate of increase. The summed year-over-year increase rate, during only my five-year window of analysis, was 119.6 percent for the use of puberty blockers and 122.1 percent for hormone use. Conservatively applying the rate for the last year that I have on record to the next two, we would expect prescriptions for puberty-blocking drugs to keep rising to above 2,000 in 2023, and for hormone prescriptions to over 7,000 in 2023, with hundreds more mastectomies for teen girls across the same two years. Our 2017–23 totals would then indicate tens of thousands of minors were given some combination of puberty blockers, human sex hormones, and top surgeries.


Barbie and the Franken-Feminists: The recent films Barbie and Poor Things try to reinvent the woman—and fail. (Noah Millman, January 26, 2024, Modern Age)

There’s a lot of gleeful mockery of the overtly retrograde sexism of the manosphere, as well as the general idiocy of men, all deserving targets. But what was most striking to me about this vision of the corruption of Barbieland is not its sexism but its sexlessness. The Kens may have taken over, but they and the Barbies still don’t have the foggiest idea what they might have to do with one another. Ken still wants Barbie’s attention—but why? The corrupted Barbies now want to fawn over the Kens—but why? Ken’s transformation doesn’t transform the Barbies into sex slaves; it transforms them into simulacra of them, forms without content.

Is that true to the experience of prepubescent girls and boys? Perhaps. In our porn-saturated age, kids still don’t really understand what sex is, but they’ve usually seen quite a bit of it before they are ready to understand, and that does prompt a certain amount of confused playacting (playacting that can nonetheless become all too real). But it’s still deeply ironic that Barbie, a toy that was originally based on a German novelty sex doll named Lilli, not only doesn’t have any interest in sex but doesn’t seem to know what sex is.

What’s more notable, though, is that Gloria, who comes from the real world and has infected Barbie with her adult fears, doesn’t enlighten her either. Her much-quoted eleven o’clock number is a passionate rant about the impossibility of being a woman, which turns out to be the key to deprogramming the Barbies from their masculinist brainwashing. But it offers no explanation for why women might be vulnerable to male emotional demands, or, indeed, why Ken would be in Barbieland in the first place. It’s also striking in that regard that Gloria’s own husband is a completely useless appendage, that we have no view at all into the nature of her adult marriage. It’s more troubling still that Gloria’s daughter is largely an appendage as well; the director of Lady Bird surely knows how to portray a mother–daughter conflict, so the fact that Gerwig barely sketches one in here tells the audience something important about the nature of the project: that she’s primarily interested in peddling sentiments, ones that come prepackaged in a box just as surely as Barbie does.

Structurally, Barbie is a quest narrative. The hero’s quest, initially, is to save her home, but after accomplishing that Barbie questions whether it is truly home anymore. It turns out what she really needs is to become a real girl—or, since she’s fully grown, a real woman. That makes Barbie a variation on Pinocchio, but the wooden boy wanted to be real from the beginning (at least in Disney’s animated version of the tale) and had to earn that privilege by demonstrating courage, loyalty, and other virtues despite being easily distractible (as boys so often are). Barbie’s quest for most of the film has been the opposite: to avoid becoming real. It isn’t until the end of the film that she has her “aha” moment and reverses course. She gets her wish, symbolized by her first visit to a gynecologist—suggesting, for the first time, that being a woman has something to do with being embodied as one, that womanhood isn’t only a matter of either false or raised consciousness. But we never do find out what Barbieland’s enduring purpose might be or how Barbie’s journey toward real womanhood might connect with the journey that the entirely real girls who play with her must themselves undertake.

Hilariously, the quest ends with her receiving the capacity for sex.


Secret files show how international group pushes shocking experimental gender surgery for minors (Gerald Posner, March 4, 2024, NY Post)

Newly leaked files from the world’s leading transgender health-care organization reveal it is pushing hormonal and surgical transitions for minors, including stomach-wrenching experimental procedures designed to create sexless bodies that resemble department-store mannequins. […]

The files — jaw-dropping conversations from a WPATH internal messaging board and a video of an Identity Evolution Workshop panel — were provided to journalist Michael Shellenberger, who shared the documents with me.

Shellenberger’s nonprofit Environmental Progress will release a scathing summary report, comparing the WPATH promotion of “the pseudoscientific surgical destruction of healthy genitals in vulnerable people” to the mid-20th-century use of lobotomies, “the pseudoscientific surgical destruction of healthy brains.”

The comparison to one of history’s greatest medical scandals is not hyperbole.

It is particularly true, as the files show repeatedly, when it involves WPATH’s radical approach to minors.

When the organization adopted in 2022 its current Standards of Care — relied on by the National Institutes of Health, the World Health Organization and every major American medical and psychiatric association — it scrapped a draft chapter about ethics and removed minimum-age requirements for children starting puberty blockers or undergoing sexual-modification surgeries.

It had previously recommended 16 to start hormones and 17 for surgery.

Not surprisingly, age comes up frequently in the WPATH files, from concerns about whether a developmentally delayed 13-year-old can start on puberty blockers to whether the growth of a 10-year-old girl will be stunted by hormones.

During one conversation, a member asked for advice about a 14-year-old patient, a boy who identified as a girl and had begun transitioning at 4.

When treating transgender youth, how informed is informed consent? (Megan McArdle, March 8, 2024, Washington Post)

This is not a novel problem in medicine. As therapist Dianne Berg points out in that discussion, if children have diabetes, they are given insulin even if they haven’t learned how the pancreas works. If they have depression, they might be given drugs that could increase their risk of suicide or permanently alter their developing brains to help them toward happier futures. And if a kid has a pediatric cancer, doctors don’t wait for her to be old enough to give fully informed consent to amputation or infertility — because without treatment, she might never reach that age.

Youth gender medicine is increasingly treating puberty as though it were a life-threatening condition like cancer or diabetes, and natal sex organs as though they were potentially dangerous growths. This is, of course, entirely appropriate if they are threatening, and letting nature take its course will end in suicide or a lifetime of emotional agony. Of course, with that kind of diagnosis you want to be very sure — and unlike doctors treating cancer or diabetes, who can rely on blood tests and imaging, gender-medicine doctors ultimately have only the patient’s feelings to go by.