I agree the difference comes down to our health care system being for profit. It's so tragic. "In the end, perhaps what makes the Swedish and Finnish approaches so different from the American approach is that they have socialized medicine, not the consumer model here, where gender surgeons have a great financial incentive to ignore risk, and some doctors advertise surgeries directly to children on TikTok." The reality of a healthcare system that is fueled by profit rather than actual concern for children's health makes the media influence the ONLY way to change the trajectory in the US. Please get a paid subscription to this important Substack if you can. Lisa, I hope you will still get this published in the other publication too!
Unfortunately Canada's approach mirrors the American one despite our socialized medicine. Is it because we are so closely tied to the US and often pride ourselves on being more progressive than our neighbour to the south? I don't know but it is a huge problem here and our media doesn't cover it either.
Well, that's a really good point, and fodder for another piece. Why has Canada gone the way of the US and not followed in the footsteps of other countries, especially when they have some evidence of the ROGD phenomenon?
Good point about Canada Lavender. Your theory sounds plausible. I used to live in Canada, and it's long been a big part of the story Canadians tell themselves that they need to be more progressive than crude, right-wing, gun-slinging Americans. Canadians seem to resent Americans but also enjoy feeling superior to us. It might be part of the "nice" thing too, the TRA agenda slid early into policies and laws with no resistance.
Yes, yes, and yes to all the above. As a Canadian parent of a gender-questioning kid, I am terrified of living in this "nice and progressive" country. Lisa, please consider writing about this. I am fighting as much as I can against this, but it's hard to do when my fellow parents are so tired and demoralized and I have to keep my activities on the down low so as not to worsen my relationship with my child. It seems even worse here than in the US because even the "right" is meekly accepting the non-existing "consensus".
Who are the major players in Canada? Who's pushing the affirmative model, and who's pushing back? Are there people who stand to make a profit (pharma companies)? Would love to know more. Are they trying to out-progressive American progressives because that's always been part of their identity, but now American progressives have veered toward censoriousness and against science, so they're pushing harder on the same stuff?
Cantor and Zucker are big names in the "gender-critical" or at least cautious approach, for sure. I imagine things are different based on the province, just like they are in the US, but at least in Ontario the Green party and the New Democratic Party are pushing for quicker and easier transitioning. And the Liberals are definitely saying "all the right things". The Progressive Conservatives are just not saying much... There are two new "fringe" parties, both of which are anti-woke, but they didn't get much support because people are afraid of a Trump-style populism taking hold in Canada. It boggles my mind that "Trump-style" or "full-woke" seem to be the only two options - I am certain that a huge majority of the population in Canada and the US want neither.
The Canadian Gender Report (genderreport.ca) is a source of news and some activism, but it's not as prominent as Genspect or Transgendertrend. Yet.
Cantor is Canadian, yes? Or at least works there? And Zucker's clinic was located in Toronto? If you are in contact with them, I bet they could steer you. Certainly they've both been part of the pushback on both sides of the 49th.
While I’m sure money and decentralized medical care play a massive part in why the US is ignoring the lack of evidence, you cannot ignore that powerful, wealthy TIMs are very much involved. The desire to destigmatize and legitimize their life choices would be a significant bonus on top of the profits they will rake in. These are not people who are concerned about the welfare of our children.
Yes, good point. There are many more factors at play, especially the ideological buy in. Why haven't Swedish and Finnish clinicians been captured in the same way? Why are they still demanding evidence-based care? I have some theories but would love to know more about that if I can do a follow-up.
Yes! Clinician capture is fascinating and horrifying. The clinicians I have spoken to seem patently unhinged, or they have the trans = gay confusion or really believe they’re saving people, both of which require an excruciatingly surface-level thought process. The number of clinicians who themselves are GNC also raises its own set of questions. The lack of larger-context learning in the medical community really needs to be examined. To come off of the opioid epidemic and jump right into this is dumbfounding. And never in the history of medicine has a wrongheaded movement been so completely documented, which has huge impacts in terms of dissecting it’s evolution.
Articles like this are why I decided to subscribe about a month ago. You're making it well worthwhile, and have been for quite some time. Thanks, Lisa.
I'm sorry to say it's unlikely anyone will regard the Florida study as nonpartisan. Mostly that's because nothing gets to be nonpartisan in this country anymore. It's all tribalism, all the way down.
But also, Quentin Van Meter - their key pediatric expert - is the head of the American College of Pediatricians (ACP). And his political commitments are troubling to anyone who cares about the LGB. It's worth visiting the ACP About page. The organization continues to insist that being gay is hazardous in and of itself, and that children raised by gay parents are at a disadvantage compared to kids of straight parents. These points have both been thoroughly debunked. Leaning on him as an expert made the Florida review instantly appear partisan even if the content of it is completely dispassionate. (I haven't read it carefully, only skimmed it, so I can't offer my informed opinion on whether the review itself is solid or shoddy. Just reading backward from the bibliography, it seems unlikely the review steelmanned the evidence for transition. I'd need to look into the Appendices, because that's where the expert opinions are located, and they're not in the copy of the main report that I downloaded.)
It's also important to note that the Florida review was conducted specifically to address the question of whether Medicaid should cover transition-related medical expenses - a policy that we can assume DeSantis opposes, which again casts some doubt on whether the review was conducted in an open-ended fashion. It's not limited to youth transition care, either, although it does address it separately. Given that the U.S. public is broadly more supportive of adult transition, the review is more likely to be seen as politicized by moderates and liberals insofar as it recommends against public funding for adults too.
To date, the most compelling North American critique of pediatric gender affirmation is the dissection of the AAP position on youth transition by James Cantor, which I *have* read carefully and consider extremely well-founded. I'd expect his contribution to this review to be equally rigorous and fair - but also undermined for a liberal reader who's familiar with the stances taken by ACP and Van Meter regarding gays and lesbians.
There's no easy solution here as the AAP has totally abandoned ship. Plus, any doctor, academic, or journalist who raises even the most reasonable questions about youth transition immediately gets tarred as a bigot and 'phobe - as you know all too well.
(Anyone who hasn't read Cantor's takedown of the AAP position should - it's super-accessible and concise, albeit detail-oriented. It is not peer-reviewed but since what he's doing is mainly showing how the AAP position statement is founded on misrepresentations, it meets my standards for solid scholarship. I'm not a doctor but much of my research is in the social history of medicine. Here's Cantor: http://www.sexologytoday.org/2018/10/american-academy-of-pediatrics-policy.html)
(Edit: While the above-linked version of Cantor's critique of the AAP position is not peer-reviewed, it did go through peer review and was published here - behind a paywall, unfortunately: https://www.tandfonline.com/doi/full/10.1080/0092623X.2019.1698481 I can't vouch for whether any substantive changes were made.)
Yes, the Florida review isn’t quite in the same class as the UK reviews (or seemingly the Swedish and Finnish reviews). Cantor’s submission for Florida is better than the actual review.
Had to dredge through tons of guilt-by-association smear stories about him - one of the criticisms being from a judge complaining that he hadn’t treated young transgender people, which may be correct but doesn’t mean he isn’t in a position to assess the evidence base. In light of the pressure towards affirmation-only treatment it may wind up difficult to find anyone who has treated young people with GD who is in any way critical of the affirmation track, which I guess is the point.
Yes, your final point is a really important one. I absolutely agree that Cantor is well-placed to evaluate the evidence; he has all the requisite scientific skills, is deeply familiar with the literature, and has worked extensively with transgender adults. I've started to look at Cantor's report for the Florida review and so far it looks very solid, as I'd expect. But it's the length of a master's thesis and I'm trying to deal with some of the chaos in my life, so I may not get through it soon ...
My Mom was a dissident in Cuba, had colleagues imprisoned and one was even executed without trial. She also had her best friend, a gay man, thrown into jail for being gay. And, she's been quite liberal for decades while happily living in NYC., & strongly in favor of gay rights (she hosted a large group of lesbians at our house when they emigrated out of Cuba).
Sooo, one would think she'd be in favor of "trans" issues, but this is her take:
State actors in China/Russia/etc. are always looking for ways to undermine America. They have found a great one in TikTok and social media, where they are pushing/promoting/brain-washing kids into "trans care" in order to make a percentage of the American population infertile and hooked on life-long drugs, and suffering from physical ailments such as decreased bone-density, etc.
She's convinced family members to ban TikTok and social media in general for the minors in the family. Kids were given pretty dumb cell phones, no ipads and computer time is limited to home work research. They're following the Michelle Obama method for raising kids (lots of sports, limited screen time, etc.).
Make of this what you will -- but, Mom knows a thing or two from her gun-running from Varadero to Santa Clara days.
thank you _again_ lisa, this is an excellent article. this is a good one for sharing with ppl who are open to listening but don’t have a big picture yet.
“ In the end, perhaps what makes the Swedish and Finnish approaches so different from the American approach is that they have socialized medicine, not the consumer model here, where gender surgeons have a great financial incentive to ignore risk, and some doctors advertise surgeries directly to children on TikTok.”
For folks interested in how the who "trans" issue is affecting politics in America, I suggest looking up a Paola Ramos' report on MSNBC about voting Latinos in Florida. Paola, in the hour-long program, detailed how Latino voters, even formerly liberal ones, are now Republicans specifically due to the whole "trans rights for minors" push.
They are supporting DeSantis for higher office, in the hopes that if he is elected President he will pass a national ban on all sorts of "trans" things.
Latinos make up nearly 18% of the U.S. population, without a large chunk of Latino votes, Democrats cannot win.
For whatever reason, the "trans" issue is freaking Latinos out -- even though they are generally ok with gay rights.
It will affect elections, despite trans people making up a tiny percentage of the population. There will be a huge back-lash. Unfortunately for us Dems, this issue is very much helping Republicans.
Dear Lisa! Great article. Could you please tell me where you got your quotes from on social transition refering to Finland? "Social transition for young people is not recommended". I can't find it in Finish guidelines.
Curious, in the United States are "top surgery" and "bottom surgery" and puberty blockers for under 18 people covered by medical insurance of parents, etc?
I had heard that much of transitioning is cash basis....
Depends on the insurance and the state. Vastly different depending on those things, which is partly what Finland and Sweden didn't want to have happen there; uniformity is important and making sure there's equality of access. When I think about it now, it's really like they were saying, "Let's not be America."
Point taken. Any suggestions for how to word it better? I shifted it for now but would be open to hearing other ways to fundraise so I can keep doing this, my full time job. I used to get paid by other media outlets to write about these things, until I wanted to tell a more complex and intellectually honest story. And then, huh, the mainstream media work vanished. So now I am asking other people to fund me so I can keep going. It's not fun or comfortable but it's what I have to do for now. And point taken about not examining the origin of the culture war itself, though Helen Joyce's book is the best source for that! What I will be writing about soon is why it goes beyond the funding, beyond the capture, to the point where much of the left is actively participating in this fervor. And that's I think because it fills a need for a kind of religion. Another time for that!
Just a brief comment to say that I personally thought Kathleen Stock's discussion about definitions in her book Material Girls to be very compelling. She gives a few possibilities, including the gametes one, and then proposes something similiar to the Wittgenstein family resemblances one (or perhaps that same one?) - basically saying that a woman can be thought of as a person with a sufficient number of certain characteristics: large gametes, secondary sex characteristics, XX chromosomes, etc., and that not all of those have to be present, but a sufficient number (though I don't believe she gives a number). Hers is a philosophical exploration of concepts and why we need words to distinguish women and trans-women, so she doesn't aim to come to a definition so much as to say that we can and need definitions for all these different words that came into being in that last while. A very compelling and intelligent read, in my opinion.
I agree the difference comes down to our health care system being for profit. It's so tragic. "In the end, perhaps what makes the Swedish and Finnish approaches so different from the American approach is that they have socialized medicine, not the consumer model here, where gender surgeons have a great financial incentive to ignore risk, and some doctors advertise surgeries directly to children on TikTok." The reality of a healthcare system that is fueled by profit rather than actual concern for children's health makes the media influence the ONLY way to change the trajectory in the US. Please get a paid subscription to this important Substack if you can. Lisa, I hope you will still get this published in the other publication too!
Unfortunately Canada's approach mirrors the American one despite our socialized medicine. Is it because we are so closely tied to the US and often pride ourselves on being more progressive than our neighbour to the south? I don't know but it is a huge problem here and our media doesn't cover it either.
Well, that's a really good point, and fodder for another piece. Why has Canada gone the way of the US and not followed in the footsteps of other countries, especially when they have some evidence of the ROGD phenomenon?
Good point about Canada Lavender. Your theory sounds plausible. I used to live in Canada, and it's long been a big part of the story Canadians tell themselves that they need to be more progressive than crude, right-wing, gun-slinging Americans. Canadians seem to resent Americans but also enjoy feeling superior to us. It might be part of the "nice" thing too, the TRA agenda slid early into policies and laws with no resistance.
Yes, yes, and yes to all the above. As a Canadian parent of a gender-questioning kid, I am terrified of living in this "nice and progressive" country. Lisa, please consider writing about this. I am fighting as much as I can against this, but it's hard to do when my fellow parents are so tired and demoralized and I have to keep my activities on the down low so as not to worsen my relationship with my child. It seems even worse here than in the US because even the "right" is meekly accepting the non-existing "consensus".
Who are the major players in Canada? Who's pushing the affirmative model, and who's pushing back? Are there people who stand to make a profit (pharma companies)? Would love to know more. Are they trying to out-progressive American progressives because that's always been part of their identity, but now American progressives have veered toward censoriousness and against science, so they're pushing harder on the same stuff?
Cantor and Zucker are big names in the "gender-critical" or at least cautious approach, for sure. I imagine things are different based on the province, just like they are in the US, but at least in Ontario the Green party and the New Democratic Party are pushing for quicker and easier transitioning. And the Liberals are definitely saying "all the right things". The Progressive Conservatives are just not saying much... There are two new "fringe" parties, both of which are anti-woke, but they didn't get much support because people are afraid of a Trump-style populism taking hold in Canada. It boggles my mind that "Trump-style" or "full-woke" seem to be the only two options - I am certain that a huge majority of the population in Canada and the US want neither.
The Canadian Gender Report (genderreport.ca) is a source of news and some activism, but it's not as prominent as Genspect or Transgendertrend. Yet.
Might be good to get in touch with Mia Ashton on Twitter, who is a brilliant writer and Canadian activist.
Cantor is Canadian, yes? Or at least works there? And Zucker's clinic was located in Toronto? If you are in contact with them, I bet they could steer you. Certainly they've both been part of the pushback on both sides of the 49th.
The class action lawsuit route is another but getting the media to report the facts on this would be a start.
Fantastic and important piece, thank you for writing!
This is an excellent summary of the different places and their approaches, I will share!!!
Thank you!
While I’m sure money and decentralized medical care play a massive part in why the US is ignoring the lack of evidence, you cannot ignore that powerful, wealthy TIMs are very much involved. The desire to destigmatize and legitimize their life choices would be a significant bonus on top of the profits they will rake in. These are not people who are concerned about the welfare of our children.
Yes, good point. There are many more factors at play, especially the ideological buy in. Why haven't Swedish and Finnish clinicians been captured in the same way? Why are they still demanding evidence-based care? I have some theories but would love to know more about that if I can do a follow-up.
Yes! Clinician capture is fascinating and horrifying. The clinicians I have spoken to seem patently unhinged, or they have the trans = gay confusion or really believe they’re saving people, both of which require an excruciatingly surface-level thought process. The number of clinicians who themselves are GNC also raises its own set of questions. The lack of larger-context learning in the medical community really needs to be examined. To come off of the opioid epidemic and jump right into this is dumbfounding. And never in the history of medicine has a wrongheaded movement been so completely documented, which has huge impacts in terms of dissecting it’s evolution.
Articles like this are why I decided to subscribe about a month ago. You're making it well worthwhile, and have been for quite some time. Thanks, Lisa.
I'm sorry to say it's unlikely anyone will regard the Florida study as nonpartisan. Mostly that's because nothing gets to be nonpartisan in this country anymore. It's all tribalism, all the way down.
But also, Quentin Van Meter - their key pediatric expert - is the head of the American College of Pediatricians (ACP). And his political commitments are troubling to anyone who cares about the LGB. It's worth visiting the ACP About page. The organization continues to insist that being gay is hazardous in and of itself, and that children raised by gay parents are at a disadvantage compared to kids of straight parents. These points have both been thoroughly debunked. Leaning on him as an expert made the Florida review instantly appear partisan even if the content of it is completely dispassionate. (I haven't read it carefully, only skimmed it, so I can't offer my informed opinion on whether the review itself is solid or shoddy. Just reading backward from the bibliography, it seems unlikely the review steelmanned the evidence for transition. I'd need to look into the Appendices, because that's where the expert opinions are located, and they're not in the copy of the main report that I downloaded.)
It's also important to note that the Florida review was conducted specifically to address the question of whether Medicaid should cover transition-related medical expenses - a policy that we can assume DeSantis opposes, which again casts some doubt on whether the review was conducted in an open-ended fashion. It's not limited to youth transition care, either, although it does address it separately. Given that the U.S. public is broadly more supportive of adult transition, the review is more likely to be seen as politicized by moderates and liberals insofar as it recommends against public funding for adults too.
To date, the most compelling North American critique of pediatric gender affirmation is the dissection of the AAP position on youth transition by James Cantor, which I *have* read carefully and consider extremely well-founded. I'd expect his contribution to this review to be equally rigorous and fair - but also undermined for a liberal reader who's familiar with the stances taken by ACP and Van Meter regarding gays and lesbians.
There's no easy solution here as the AAP has totally abandoned ship. Plus, any doctor, academic, or journalist who raises even the most reasonable questions about youth transition immediately gets tarred as a bigot and 'phobe - as you know all too well.
(Anyone who hasn't read Cantor's takedown of the AAP position should - it's super-accessible and concise, albeit detail-oriented. It is not peer-reviewed but since what he's doing is mainly showing how the AAP position statement is founded on misrepresentations, it meets my standards for solid scholarship. I'm not a doctor but much of my research is in the social history of medicine. Here's Cantor: http://www.sexologytoday.org/2018/10/american-academy-of-pediatrics-policy.html)
(Edit: While the above-linked version of Cantor's critique of the AAP position is not peer-reviewed, it did go through peer review and was published here - behind a paywall, unfortunately: https://www.tandfonline.com/doi/full/10.1080/0092623X.2019.1698481 I can't vouch for whether any substantive changes were made.)
Yes, the Florida review isn’t quite in the same class as the UK reviews (or seemingly the Swedish and Finnish reviews). Cantor’s submission for Florida is better than the actual review.
Edit to add link to Cantor’s submission:
https://www.ahca.myflorida.com/letkidsbekids/docs/AHCA_GAPMS_June_2022_Attachment_D.pdf
Had to dredge through tons of guilt-by-association smear stories about him - one of the criticisms being from a judge complaining that he hadn’t treated young transgender people, which may be correct but doesn’t mean he isn’t in a position to assess the evidence base. In light of the pressure towards affirmation-only treatment it may wind up difficult to find anyone who has treated young people with GD who is in any way critical of the affirmation track, which I guess is the point.
Yes, your final point is a really important one. I absolutely agree that Cantor is well-placed to evaluate the evidence; he has all the requisite scientific skills, is deeply familiar with the literature, and has worked extensively with transgender adults. I've started to look at Cantor's report for the Florida review and so far it looks very solid, as I'd expect. But it's the length of a master's thesis and I'm trying to deal with some of the chaos in my life, so I may not get through it soon ...
My Mom was a dissident in Cuba, had colleagues imprisoned and one was even executed without trial. She also had her best friend, a gay man, thrown into jail for being gay. And, she's been quite liberal for decades while happily living in NYC., & strongly in favor of gay rights (she hosted a large group of lesbians at our house when they emigrated out of Cuba).
Sooo, one would think she'd be in favor of "trans" issues, but this is her take:
State actors in China/Russia/etc. are always looking for ways to undermine America. They have found a great one in TikTok and social media, where they are pushing/promoting/brain-washing kids into "trans care" in order to make a percentage of the American population infertile and hooked on life-long drugs, and suffering from physical ailments such as decreased bone-density, etc.
She's convinced family members to ban TikTok and social media in general for the minors in the family. Kids were given pretty dumb cell phones, no ipads and computer time is limited to home work research. They're following the Michelle Obama method for raising kids (lots of sports, limited screen time, etc.).
Make of this what you will -- but, Mom knows a thing or two from her gun-running from Varadero to Santa Clara days.
thank you _again_ lisa, this is an excellent article. this is a good one for sharing with ppl who are open to listening but don’t have a big picture yet.
“ In the end, perhaps what makes the Swedish and Finnish approaches so different from the American approach is that they have socialized medicine, not the consumer model here, where gender surgeons have a great financial incentive to ignore risk, and some doctors advertise surgeries directly to children on TikTok.”
Exactly!
I haven’t even finished this grand essay. Thx you. But a doctor friend sent me this and wanted to share. More evidence from the Swedes this is experimental https://medicalxpress.com/news/2023-04-systematic-outcomes-hormonal-treatment-youths.html
For folks interested in how the who "trans" issue is affecting politics in America, I suggest looking up a Paola Ramos' report on MSNBC about voting Latinos in Florida. Paola, in the hour-long program, detailed how Latino voters, even formerly liberal ones, are now Republicans specifically due to the whole "trans rights for minors" push.
They are supporting DeSantis for higher office, in the hopes that if he is elected President he will pass a national ban on all sorts of "trans" things.
Latinos make up nearly 18% of the U.S. population, without a large chunk of Latino votes, Democrats cannot win.
For whatever reason, the "trans" issue is freaking Latinos out -- even though they are generally ok with gay rights.
It will affect elections, despite trans people making up a tiny percentage of the population. There will be a huge back-lash. Unfortunately for us Dems, this issue is very much helping Republicans.
Great article. How do we give a tip?
venmo is lisa-davis-11 and paypal is lisa@lisaselindavis.com. Still figuring out this model of how to make a living this way!
Dear Lisa! Great article. Could you please tell me where you got your quotes from on social transition refering to Finland? "Social transition for young people is not recommended". I can't find it in Finish guidelines.
Curious, in the United States are "top surgery" and "bottom surgery" and puberty blockers for under 18 people covered by medical insurance of parents, etc?
I had heard that much of transitioning is cash basis....
Depends on the insurance and the state. Vastly different depending on those things, which is partly what Finland and Sweden didn't want to have happen there; uniformity is important and making sure there's equality of access. When I think about it now, it's really like they were saying, "Let's not be America."
it is covered by insurance, even by medicaid
Fantastic summary. Thank you.
Point taken. Any suggestions for how to word it better? I shifted it for now but would be open to hearing other ways to fundraise so I can keep doing this, my full time job. I used to get paid by other media outlets to write about these things, until I wanted to tell a more complex and intellectually honest story. And then, huh, the mainstream media work vanished. So now I am asking other people to fund me so I can keep going. It's not fun or comfortable but it's what I have to do for now. And point taken about not examining the origin of the culture war itself, though Helen Joyce's book is the best source for that! What I will be writing about soon is why it goes beyond the funding, beyond the capture, to the point where much of the left is actively participating in this fervor. And that's I think because it fills a need for a kind of religion. Another time for that!
Just a brief comment to say that I personally thought Kathleen Stock's discussion about definitions in her book Material Girls to be very compelling. She gives a few possibilities, including the gametes one, and then proposes something similiar to the Wittgenstein family resemblances one (or perhaps that same one?) - basically saying that a woman can be thought of as a person with a sufficient number of certain characteristics: large gametes, secondary sex characteristics, XX chromosomes, etc., and that not all of those have to be present, but a sufficient number (though I don't believe she gives a number). Hers is a philosophical exploration of concepts and why we need words to distinguish women and trans-women, so she doesn't aim to come to a definition so much as to say that we can and need definitions for all these different words that came into being in that last while. A very compelling and intelligent read, in my opinion.