The lack of scientific rigor in gender medicine is just insane. Starting a kid on puberty blockers or cross-sex hormones seems a bit like a witch drowning trial. Let's find the real ones by drowning all suspects in dangerous hormones. Don't worry, we can always pull them out.
Currently the AAP is asking active members (those involved in writing, sections and councils) to give their private email address and not to use their institutional academic emails in correspondence with the AAP.
I’m guessing subpoena avoidance. I’m one of those people. Im a pediatrician appalled by the direction the AAP has taken on gender issues. My work with them is not at all related to this. The email thing made no sense.
I'm sure they anticipate being named in future law suits particularly if the medical professional or facility relies on their best practices advice. They'll want as little written trail that could be subject to civil discovery demands. Aren't they also supposedly conducting a systematic review of the current evidence? They probably want to make sure it will be difficult to question the impartiality of that review. In any event it's probably a good idea to maintain a repository of these emails in case they'd be helpful in the future.
The article mentions the "'gatekeeping' approach of the Dutch." I have been thinking a lot about this point to try to work out my own thoughts. What we refer to as the "Dutch protocol" does indeed on paper seem like it includes therapeutic gatekeeping. Compared to the current gender affirmative model as practiced across the West today, the original Dutch protocol seemingly did involve relatively extensive therapy to get into that initial step of medicalization (though exactly how extensive is unclear). But then there is the infamous de Vries et al. (2014) paper where they switched the target sex of the gender dysphoria scale to measure outcomes. When de Vries and Steensma appeared on the Gender: A Wider Lens podcast, they were questioned about this choice, and their explanation was essentially that once the child begins medicalization, total social transition is simply given. To their eyes, there is simply no other way to proceed. In trying to think through this, the questions that come up are vast, but seemingly very consequential for the debate. For one, exactly how much therapeutic gatekeeping was there in the original Dutch protocol? The way the practitioners tell it, it was rigorous and left open the paths to different outcomes. But even if we assume this is true, it means that the therapeutic model was either shut off or switched to full affirmation at the moment of medicalization. I suspect the truth is probably that some loose form of an affirmation model was already entrenched in the original Dutch therapy context, and therefore it probably predates or coincides with the Hidalgo et al. (2013) paper that explains the gender affirmative model. Basically, the question is whether this "new" gender affirmative model was actually shedding off the "gatekeeping" approach of the Dutch. Another question that comes up from this discussion (which may seem trivial but I think is important if we are going to get our terms straight) is the difference between gender affirmation and social transition. Are they the same thing? Is social transition a component of gender affirmation? Are they separate, such that one could experience one but not the other? Is gender affirmation only a useful label for the therapy context? I am unclear about what people mean when they discuss these terms.
I am curious, did the editorial say anything about "watchful waiting” as an approach? It seems to be there were already 3 approaches when GAC came on the scene: (1) normalizing therapy (discredited/banned), (2) "gatekeeping approach" of the Dutch and (3) "watchful waiting" in whichgender distressed children were carefully observed as they proceeded through puberty. A majority were boys and most turned out to be gay young men comfortable with their sex. Now out of favor. Your article doesn't mention this approach and I am wondering if the editorial simply ignored its existence.
Thank you Lisa. It is hard to believe how much changed in the 10 years since that relatively cautious editorial you brought to light, and I am sad to say that I can’t imagine a turnaround taking hold in less than a decade. The degree to which this is now culturally and pedagogically embedded in schools (based on my experience as a private school parent) is going to make change very difficult. You have boards, administrators and educators who are going to need their own off-ramps. The DEI (or DEI & Belonging as it seems to have become in schools these days) ship continues to chug along and if anything seems to be picking up more steam, at least in my daughter’s school, even as DEI has drawn more criticism in our national dialogue post Oct 7. We need change at all levels of the system from the politicians and institutions to social media influencers of tweens and teens.
Lisa, as you’re researching things, are you seeing other social contagions for male adolescents? I’m just curious if SM is influencing the younger generation z male cohort since they were on SM/ internet at a young age.
Right, or something more unique to males? What got me thinking about this was that I listened to an older podcast with a male who was trans at the time and has since detransitioned. He talked about how social contagion online was happening in the males with trans and AGP I know a lot of males are falsely identifying with other disorders. Mine says he is ASD and then I heard him later say he has ADHD, both of which aren't true.
@mamabearproud and Lisa, perhaps social contagions looks different in young males, maybe something like falling into extreme ideologies that focus less inward and more outward, llike Andrew Tate or incel subcultures? But after reading Joe Burgo's piece on AGP this morning and considering his view of what it is, I wonder how many distressed young males are going on the AskAGP Reddit and hearing the growing number of interviews with "self-aware AGPs" and becoming convinced their distress maps onto the ever-growing list of things that supposedly fit into the AGP experience, much in the same way the classic ROGD girl is experiencing social contagion? I also worry that if that's the case, at least for some vulnerable young men, if the AGP awareness campaign from some people in Genspect and individuals like Aaron Terrell and Phil Illy (the latter two who seem to see AGP everywhere) may be, despite what I believe are genuinely good intentions, actually contributing to a meal social contagion much in the same way that eating disorder awareness campaigns and suicide awareness campaigns can end up contributing to social contagions?
For what it's worth, it seems about 1/4 of the psychogenic tics influenced by social media described in this study occurred in males, but since there are other sources that acknowledge a significant overlap between the kids who have TikTok tics and a trans gender identity (I think I saw one article that cited up to 40%, but don't quote me on that) it's hard to tell if some of the "males" cited in this statistic or actually teenage girls identifying as boys and having two social contagions affecting them
"The majority of these new presentations occurred in female patients (75.6%)"
I've done a lot of reading on "AGP" and listening to podcasts. I'm skeptical about a lot of it. I quoted Bailey's tweet to Jesse Singal that he should discuss AGP, saying that we should and look for other experts with a differing opinion because not all these young males are AGP. But today, I had the thought. If you define these males as either HSTS or AGP, how can one be different than either of those two Blanchard categorizations? Secondly, as for the contagion part there is a similarity with psychosomatic disorders in that once something is named, the person focuses on that and looks for signs that they have that thing. This is a looping effect as defined by Ian Hacking. Eliza Mondegreen mentioned a book, "Sleeping Beauties" by Suzanne O'Sullivan which the looping effect is discussed. Thirdly, the whole issue with "Trans" is a disorder of assumption as Dr. Paul McHugh states. This is similar to those who believe they are overweight when they are underweight (anorexia nervosa). In his opinion piece in the WSJ, Dr. McHugh seems to notice the ROGD in adolescents (Dr. Lisa Pittman may not have published her study by then) and states "that they are persuaded in online chat groups that a change in their appearance will solve their psycho-somatic issues." Off my soapbox. :-)
Thanks Lisa.
The lack of scientific rigor in gender medicine is just insane. Starting a kid on puberty blockers or cross-sex hormones seems a bit like a witch drowning trial. Let's find the real ones by drowning all suspects in dangerous hormones. Don't worry, we can always pull them out.
Whatever happened to Coy Mathis?
Can't find any information at all!
I can’t either, which I find very interesting considering how happy the mom was to be in the limelight in the past.
Wish this piece was in the NYT!
I sent several versions of this, with much more history and reporting, to pretty much every mainstream/liberal outlet, including NYT.
Thank you for your tireless efforts!
It will pay off one day.
Currently the AAP is asking active members (those involved in writing, sections and councils) to give their private email address and not to use their institutional academic emails in correspondence with the AAP.
For FOIA evasion?
I’m guessing subpoena avoidance. I’m one of those people. Im a pediatrician appalled by the direction the AAP has taken on gender issues. My work with them is not at all related to this. The email thing made no sense.
Can you send me their request asking you to do that?
Let me locate it. I will send it to another email and snd to you. What email address?
My full name at gmail!
Thx!
I'm sure they anticipate being named in future law suits particularly if the medical professional or facility relies on their best practices advice. They'll want as little written trail that could be subject to civil discovery demands. Aren't they also supposedly conducting a systematic review of the current evidence? They probably want to make sure it will be difficult to question the impartiality of that review. In any event it's probably a good idea to maintain a repository of these emails in case they'd be helpful in the future.
The fix was in at Social Services... because the moment the Rafferty Statement came into being, the State of CA was instantly "affirmation only."
Keep pushing Lisa!
The article mentions the "'gatekeeping' approach of the Dutch." I have been thinking a lot about this point to try to work out my own thoughts. What we refer to as the "Dutch protocol" does indeed on paper seem like it includes therapeutic gatekeeping. Compared to the current gender affirmative model as practiced across the West today, the original Dutch protocol seemingly did involve relatively extensive therapy to get into that initial step of medicalization (though exactly how extensive is unclear). But then there is the infamous de Vries et al. (2014) paper where they switched the target sex of the gender dysphoria scale to measure outcomes. When de Vries and Steensma appeared on the Gender: A Wider Lens podcast, they were questioned about this choice, and their explanation was essentially that once the child begins medicalization, total social transition is simply given. To their eyes, there is simply no other way to proceed. In trying to think through this, the questions that come up are vast, but seemingly very consequential for the debate. For one, exactly how much therapeutic gatekeeping was there in the original Dutch protocol? The way the practitioners tell it, it was rigorous and left open the paths to different outcomes. But even if we assume this is true, it means that the therapeutic model was either shut off or switched to full affirmation at the moment of medicalization. I suspect the truth is probably that some loose form of an affirmation model was already entrenched in the original Dutch therapy context, and therefore it probably predates or coincides with the Hidalgo et al. (2013) paper that explains the gender affirmative model. Basically, the question is whether this "new" gender affirmative model was actually shedding off the "gatekeeping" approach of the Dutch. Another question that comes up from this discussion (which may seem trivial but I think is important if we are going to get our terms straight) is the difference between gender affirmation and social transition. Are they the same thing? Is social transition a component of gender affirmation? Are they separate, such that one could experience one but not the other? Is gender affirmation only a useful label for the therapy context? I am unclear about what people mean when they discuss these terms.
I am curious, did the editorial say anything about "watchful waiting” as an approach? It seems to be there were already 3 approaches when GAC came on the scene: (1) normalizing therapy (discredited/banned), (2) "gatekeeping approach" of the Dutch and (3) "watchful waiting" in whichgender distressed children were carefully observed as they proceeded through puberty. A majority were boys and most turned out to be gay young men comfortable with their sex. Now out of favor. Your article doesn't mention this approach and I am wondering if the editorial simply ignored its existence.
Thank you Lisa. It is hard to believe how much changed in the 10 years since that relatively cautious editorial you brought to light, and I am sad to say that I can’t imagine a turnaround taking hold in less than a decade. The degree to which this is now culturally and pedagogically embedded in schools (based on my experience as a private school parent) is going to make change very difficult. You have boards, administrators and educators who are going to need their own off-ramps. The DEI (or DEI & Belonging as it seems to have become in schools these days) ship continues to chug along and if anything seems to be picking up more steam, at least in my daughter’s school, even as DEI has drawn more criticism in our national dialogue post Oct 7. We need change at all levels of the system from the politicians and institutions to social media influencers of tweens and teens.
Also @lisaselindavis, I could not get the link to Colin Wright’s piece to work.
Thank you Lisa. This is such critically important work.
Lisa, as you’re researching things, are you seeing other social contagions for male adolescents? I’m just curious if SM is influencing the younger generation z male cohort since they were on SM/ internet at a young age.
Oh, that's an interesting question. Are young males developing tics and DID? I don't know.
Right, or something more unique to males? What got me thinking about this was that I listened to an older podcast with a male who was trans at the time and has since detransitioned. He talked about how social contagion online was happening in the males with trans and AGP I know a lot of males are falsely identifying with other disorders. Mine says he is ASD and then I heard him later say he has ADHD, both of which aren't true.
@mamabearproud and Lisa, perhaps social contagions looks different in young males, maybe something like falling into extreme ideologies that focus less inward and more outward, llike Andrew Tate or incel subcultures? But after reading Joe Burgo's piece on AGP this morning and considering his view of what it is, I wonder how many distressed young males are going on the AskAGP Reddit and hearing the growing number of interviews with "self-aware AGPs" and becoming convinced their distress maps onto the ever-growing list of things that supposedly fit into the AGP experience, much in the same way the classic ROGD girl is experiencing social contagion? I also worry that if that's the case, at least for some vulnerable young men, if the AGP awareness campaign from some people in Genspect and individuals like Aaron Terrell and Phil Illy (the latter two who seem to see AGP everywhere) may be, despite what I believe are genuinely good intentions, actually contributing to a meal social contagion much in the same way that eating disorder awareness campaigns and suicide awareness campaigns can end up contributing to social contagions?
https://www.realityslaststand.com/p/sympathy-for-the-devil-autogynephilia
For what it's worth, it seems about 1/4 of the psychogenic tics influenced by social media described in this study occurred in males, but since there are other sources that acknowledge a significant overlap between the kids who have TikTok tics and a trans gender identity (I think I saw one article that cited up to 40%, but don't quote me on that) it's hard to tell if some of the "males" cited in this statistic or actually teenage girls identifying as boys and having two social contagions affecting them
"The majority of these new presentations occurred in female patients (75.6%)"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733629/
I'll look at that. Thanks.
Yes. See my comment above.
I've done a lot of reading on "AGP" and listening to podcasts. I'm skeptical about a lot of it. I quoted Bailey's tweet to Jesse Singal that he should discuss AGP, saying that we should and look for other experts with a differing opinion because not all these young males are AGP. But today, I had the thought. If you define these males as either HSTS or AGP, how can one be different than either of those two Blanchard categorizations? Secondly, as for the contagion part there is a similarity with psychosomatic disorders in that once something is named, the person focuses on that and looks for signs that they have that thing. This is a looping effect as defined by Ian Hacking. Eliza Mondegreen mentioned a book, "Sleeping Beauties" by Suzanne O'Sullivan which the looping effect is discussed. Thirdly, the whole issue with "Trans" is a disorder of assumption as Dr. Paul McHugh states. This is similar to those who believe they are overweight when they are underweight (anorexia nervosa). In his opinion piece in the WSJ, Dr. McHugh seems to notice the ROGD in adolescents (Dr. Lisa Pittman may not have published her study by then) and states "that they are persuaded in online chat groups that a change in their appearance will solve their psycho-somatic issues." Off my soapbox. :-)
"suggested improved psychological functioning ". Only for ftm!
And we don't know if the two kids who committed suicide were mtf or ftm.
What happened to Jack Drescher??
Question worth asking!