The Shifting Tide, Part I

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“The tide has shifted, totally shifted,” says journalist Katie Herzog, describing recent press coverage of pediatric gender medicine. Finally, the news sources that liberals trust are shedding light on the dark side of puberty blockers, cross-sex hormones and sex-change surgeries for young people. We’ve reached a “reckoning,” says another reporter on the gender beat, Lisa Selin Davis. People on the left, she believes, now feel free to “object to a lot of what has happened.” What has happened includes the great medical scandal resulting from the belief that each human being has something called a “gender identity,” a subjective sense of self that take precedence over the biological reality of sex. DIAG would like nothing more than to celebrate a shifting tide in press reporting of the issue, a real reckoning with the damage done. We’re not reaching for the champagne yet.

Yes, it was heartening to see the Washington Post editorial board commend the evidence review commissioned by the Department of Health and Human Services. It found “very weak evidence” that hormones and surgeries benefit gender-distressed young people and concluded that the interventions for minors are neither empirically nor ethically justified. The Post editorial tells readers to get past the inflammatory language of President Trump’s executive order mandating the review. The HHS report itself, it says, makes a legitimate case for caution. Bravo to the Post for publishing an op-ed by one of the report’s authors, philosopher Alex Byrne. He assures readers of his own liberal bona fides and states that he and his collaborators felt no political pressure from the Trump administration.

So yes, the tide may have shifted and started to go out. But the waters have not receded far enough to reveal the mudflats of ideological muck under the ocean of disinformation in which we’ve been swimming. Unfortunately, the journalists behind the six-part New York Times podcast, “The Protocol,” seem to be trying to hold the waters back. Yes, the series casts doubt on the mantra chanted by practitioners and their Democratic party boosters — “gender-affirming care is evidence-based and life-saving.” Hopefully, this will spur some questioning among the podcast audience, which skews younger than the Times readership at large. However, reporter Azeen Ghorayshi and producer Austin Mitchell fail to address fundamental issues of safety and ethics, as well as the ideological underpinning for gender medicine. This is frustrating, since the journalists spoke with the biggest names in the field and the series ran more than four and a half hours.

The podcast went live at a politically charged moment, just before the Supreme Court, in US v. Skrmetti, upheld Tennessee’s ban on gender interventions for minors. Though the “The Protocol” promises to tell the history of pediatric gender medicine beyond politics (it does), it retains the familiar left/right partisan frame. Episode One opens with Trump proclaiming, “With the stroke of my pen, on day one, we are going to stop the transgender lunacy.” Then a voice chimes in, “I am so hated for just existing and being who I am.”

The podcasters introduce psychologist Peggy Cohen-Kettenis and psychiatrist Annalou de Vries — pioneers of the medical protocol in the Netherlands from which the podcast takes its name. Their goal was to stop the pubertal development of gender non-conforming children who wanted to live as the opposite sex, to help them “pass” more convincingly when they grew up. The clinicians saw failure to pass as the reason for adult transsexuals’ poor mental health. De Vries acknowledges their study’s small patient sample — 70, of whom 15 dropped out and one died of sepsis after surgery. She also admits selection bias could have led to the conclusion that medicalization improved the subjects’ psychological functioning. Other researchers have found more methodological shortcomings in the Dutch study.

In a glaring omission, the podcast fails to mention that 62 of the original 70 Dutch patients were same-sex attracted. We hear only in passing that de Vries had gay patients who hoped transition would bring greater social acceptance. Left unsaid: children who defy gender stereotypes and yearn to be the opposite sex often grow up to be homosexual. In most cases, gender dysphoria resolves after puberty. Ghorayshi did not ask the Dutch researchers, “Were you not, in effect, practicing a kind of conversion therapy on young people uncomfortable with their emerging sexuality?” That question might have shifted the tide for some liberal podcast listeners.

In episode three we learn how US clinicians abandoned the supposedly careful, measured Dutch approach and put children in the lead. Laura Edwards-Leeper, a psychologist who helped import the Dutch protocol, is dismayed that her colleagues have dispensed with extensive psychological assessment before sending patients off for puberty blockers, hormones and surgeries. She notes the soaring numbers of deeply troubled teen girls with with late onset gender dysphoria; they don’t fit the Dutch study’s patient profile. She worries about young people getting ideas on the internet.

It would have been valuable to hear the thoughtful, seemingly moderate Edwards-Leeper answer some truly probing questions. For example:

• Is it ethical to lead a child to believe he can change sex, when that is not possible?

• Is it ever ethical to address psychological distress by disrupting the healthy endocrine function and removing the healthy body parts of any young person?

• Is puberty a disease to be treated?

• Puberty is the time when humans forge their adult identity. Does it make sense to medically cement the child’s pre-pubertal sense of self?

• Puberty is a time of crucial psycho-sexual and cognitive development. What are the costs of depriving a child of this birthright?

• Can a minor truly understand and consent to procedures that can lead to sterility, sexual dysfunction, heightened risk of disease and potential psycho-cognitive deficits?

• What is “gender identity’?

• What is a “trans child”? Is a child who claims to have been “born in the wrong body” not like an anorexic teen who says she is fat?

Did ideological blinders keep Ghorayshi and Mitchell from even seeing these avenues to explore?

The podcast’s face of gender medicine run amok is Johanna Olson-Kennedy, a physician who pushed more than a thousand gender distressed young people onto the medical conveyor belt at Children’s Hospital Los Angeles. She sees no need for lengthy psychological assessment before hormones and surgeries because, she admits no one has figured out how to determine which children will persist in their trans identity into adulthood. Say what? That should have stopped the show. Olson-Kennedy takes children at their word when they declare a “gender identity” different from the reality of their sex. Ghorayshi does not ask, “In what other cases do doctors prescribe life-altering medications and surgeries for minors based on self-diagnosis?” The podcast spares listeners the recording of Olson-Kennedy’s flippant advice concerning young detransitioners who regret mastectomies, “If you want breasts at a later point in your life, you can go and get them.” One young woman detransitioner is suing Olson-Kennedy, another fact “The Protocol” fails to mention.

We do hear Olson-Kennedy explaining how she coerces parents to consent to medical procedures with the ominous line, ‘Would you rather have a dead son or an alive daughter?” The podcasters should have informed the audience, right then and there, that the myth of trans suicide has been thoroughly debunked. Trans-identified young people are no more likely to take their own lives than others with the same psychological co-morbidities. (See the Cass review.) We never hear this correction. Only in the last episode does Mitchell say, “The data doesn’t clearly show that puberty blockers or hormones cause the risk of suicide to decrease in kids.”

In Episode 4, “The Protocol” introduces another foil to Olson-Kennedy — Jamie Reed, a former case manager at Washington University’s gender clinic in St Louis. In an affidavit filed with Missouri’s attorney general, Reed alleged that clinicians hastily prescribed hormones and surgeries for patients suffering from severe mental illness, including schizophrenia. Ghorayshi tells Reed she’s heard from angry parents who insist their kids were thriving under the clinic’s care. The whistleblower responds with an important question the podcasters seems not to have considered before: Should doctors base medical treatment on patient satisfaction or evidence of safety and efficacy? Ghorayshi recorded this interview two years ago. Why did Ghorayshi use this old tape, instead of going back to Reed, whose warnings about shoddy care have been increasingly vindicated?

“The Protocol’s” narrative reaches a climax in Episode 5 with Hilary Cass, the British pediatrician whose four-year review found “remarkably weak” evidence for any mental health benefits of pediatric gender interventions. Her report led the UK to shut down its main children’s gender clinic and to limit puberty blockers to clinical trials. US Supreme Court justices cited the report as they deliberated in the Skrmetti case. Cass explains how her team rated research and notes the lack of long-term follow-up studies. She observes “I can’t think of any other situation where we do give life altering treatments, and we just don’t have enough understanding about what’s happening to those young people in adulthood.”

We know what’s happening to some of them -- the detransitioners who have come forward to testify before state legislatures in support of bans on pediatric gender interventions. They recount how gender clinicians quickly affirmed their delusional thinking and rushed to refer them for hormones and surgeries. The podcast acknowledges the detransitioners’ testimony and their presence on “right-wing media,” but disappointingly doesn’t include an interview with any of these young adults, who are coping with medically induced physical and psychological pain. They are also part of the Dutch protocol’s legacy, just as surely as are the two Dutch patients we hear in early episodes who express no regrets. The podcast devotes virtually no airtime to the medical risks and serious harms that have led Republican states to restrict gender interventions for minors.

Nor do Ghorayshi and Mitchell interview any Republican lawmaker who’s pushing for restrictions. Rather, we hear psychiatrist Scott Leibowitz describe a “”a very well-oiled financial machine” behind a mission on the political right “to eliminate trans care and, basically, trans rights and trans people from existence.” Of course, as DIAG’s many supporters will attest, it’s not just right-wingers who see pediatric “gender-affirming care” as a medical scandal. Courageous Democratic representatives have crossed party lines on the issue. See scholar Leor Sapir’s excellent analysis of “The Protocol’s” political slant.

Ghorayshi and Mitchell’s colleague Nicholas Confessore makes a cleaner break with the left’s prevailing political narrative in his post-mortem of the Skrmetti case. His article in The New York Times Magazine, “How the Transgender Rights Movement Bet on the Supreme Court and Lost,” shines the spotlight on Chase Strangio, the ACLU lawyer who argued on behalf of the plaintiffs challenging Tennessee’s law. Confessore paints Strangio, a trans-identified woman, as revolutionary, a self-confessed “constitutional lawyer who doesn’t believe in the constitution.” This queer theory ideologue, chosen by activists to represent their cause in nation’s highest court, once declared, “A penis is not a male body part. It’s just an unusual body part for a woman.”

With refreshing directness, Confessore writes that “some of the central medical claims girding the legal case for pediatric gender treatments — that decades of thorough study had found them to be safe and effective — began to unravel amid growing scrutiny by other doctors and experts.” This led the UK, Finland and other European countries to restrict puberty blockers and hormones for young people. Meanwhile, Confessore reports (“The Protocol” does not), the US-dominated World Professional Association for Transgender Health suppressed a Johns Hopkins review which, like the Cass Review, failed to show credible evidence in support of the treatments.

Confessore gets to the heart of the matter. He explains how activists and psychiatrists promoted the notion of “gender identity,” a feeling that might shift week to week, even day to day. This, he says, informed the gender-affirming approach to medical transition, as clinicians were trained to accept without question a child’s word that he felt he was born in the wrong body. In effect, Confessore shows the reader that a nutty ideology, a belief system, rather than medical necessity, was behind irreversible interventions for gender-confused or indoctrinated young people.

Kudos also to Confessore for explaining the catalyst driving the dizzying legal and societal changes over the last half decade. The Biden administration, he writes, issued executive orders, federal regulations and legal threats, mandating that schools, prisons and other institutions recognize sex as including gender identity. Times readers who felt outage when President Trump wielded his sharpie to “erase trans people” may not have known he was following his predecessor’s playbook. Props go to Confessore for unambiguously calling out the suicide myth. He notes that ACLU lawyer Strangio conceded in Skrmetti oral arguments that completed suicides among trans-identified youth are “thankfully and admittedly rare.”

After Confessore’s article, the Times published an op-ed from conservative writer Andrew Sullivan, “How the Gay Rights Movement Radicalized and Lost its Way.” Sullivan, who is gay, explains that LGBT groups swelled their coffers after same sex marriage became the law of the land. They did not use the money to promote gay, lesbian and transgender rights “because almost all had already been won,” he writes. The activists’ goal, according to Sullivan, became a "new and radical gender revolution,” focused on ending the oppression of the sex binary. This perspective may be new to Times readers accustomed to seeing advocates quoted as experts.

In another sign of a shifting tide, The Atlantic published a piece by Helen Lewis: “The Liberal Misinformation Bubble About Youth Gender Medicine. How the Left Ended up Disbelieving the Science.” Hurrah for a headline that clearly names the problem DIAG is fighting! Lewis lays out the “zombie facts” that inform liberals’ views — the belief that there’s a solid evidence base for “gender affirming care” and the myth of trans suicide. She calls out trans advocates for shutting down debate. She credits the oral arguments in Skrmetti with producing “a clearer picture of how youth gender medicine has really been operating in the United States.” The court case, she writes, gave the public “an uncomfortable insight into how advocacy groups and medical associations have tamped down their own concerns about its evidence base.” As I’ll explain in Part II, Lewis fails to identify the party perhaps most responsible for the liberal public’s ignorance of the facts.

DIAG is a grassroots organization of liberals guiding our party back to reason and reality. Check us out at di-ag.org and show your support: JOIN US!