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!

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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.

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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?

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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.

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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".

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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?

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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.

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Might be good to get in touch with Mia Ashton on Twitter, who is a brilliant writer and Canadian activist.

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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.

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The class action lawsuit route is another but getting the media to report the facts on this would be a start.

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Fantastic and important piece, thank you for writing!

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Jul 22, 2022Liked by Lisa Selin Davis

This is an excellent summary of the different places and their approaches, I will share!!!

Thank you!

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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.

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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.

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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.

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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.)

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Jul 24, 2022·edited Jul 24, 2022

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:


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.

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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 ...

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Jul 25, 2022·edited Jul 25, 2022

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.

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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.

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“ 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.”


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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

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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.

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Great article. How do we give a tip?

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venmo is lisa-davis-11 and paypal is lisa@lisaselindavis.com. Still figuring out this model of how to make a living this way!

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I did a search and there's no indication that it's possible:


Though maybe other search terms might show that it is.

But I expect that subscribing for a month or so and then pausing the subscription - as I've often done - is probably the same as providing a tip.

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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.

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Lisa: "... it took a long time to research and write, so please consider a paid subscription or tip if you can ...."

I can sympathize - and can periodically contribute. But you might consider the plight of your commenters - and commenters in general - who often spend as much time in the trenches "to research and write" what are hopefully cogent and insightful comments ... 😉

But a fairly comprehensive and informative article hitting pretty much all of the high points - nice to see that some other countries walking back from what has been "conventional wisdom" for too long about "gender-affirming care".

However, not sure that the article addresses the roots of that "vicious culture war", though I think you've alluded to it in other articles. However, as I've argued in my recent Welcome post (link below), it seems that the biggest problem is that every man, woman, otherkin - and their cats, dogs, and gerbils - has different definitions for sex, gender, and gender identity. If everyone has different definitions for those terms - that many often take as gospel truth, as articles of faith - then it's rather risible to even suggest that there's any actual communication going on.

But for one example of dozens, Wikipedia has a decent definition for "female" as a sex but then snatches defeat from the jaws of victory by asserting it refers to a gender - without saying exactly what it is that a "female gender" consists of:

"Female (symbol: ♀) is the sex of an organism that produces the large non-motile ova (egg cells), the type of gamete (sex cell) that fuses with the male gamete during sexual reproduction. ....

In humans, the word female can also be used to refer to gender."


Mucking idiots - and "female can also be used to refer to plumbing and electrical connectors". 🙄

And then, as both Matt Walsh and Graham Linehan have noted, Merriam-Webster - in a classic case of circular definitions - defines the terms "male" and "female" as "gender identities". A portion of my comment at the latter's Substack:

"Merriam-Webster: 'female: having a gender identity that is the opposite of male.'

And if you look at their definition for 'male' it says this:

'male: having a gender identity that is the opposite of female.'

What a bunch of idiots; 'Circular definitions R Us'. ..."


There's generally some rhyme and reason to how and why we create definitions, and why some are better than others - about which honest people may disagree. But refusing to grapple with those issues just contributes to that transgender clusterfuck, and to the transloonie nutcases and thugs riding roughshod over reason and logic and foundational principles - not to mention over women's rights - that are absolutely essential to whatever we call our "scientific" and rational "civilization".


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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!

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Lisa: "... suggestions ... open to hearing other ways to fundraise ... full time job ..."

Didn't mean to be overly critical - even though I'm retired so don't have that particular devil on my tail I can well sympathize with your "challenges"; been there, done that, etc.

But I appreciate your detailed response as I have a few ideas that might help. So far I've ponied up some $600 (US) for editing services for several articles - one on Wikipedia's Lysenkoism, and one on Canada's "misguided" transgender policies, link to the first below - so I'm willing to consider similar contributions to some articles that we might collaborate on - topics to be determined:


As I think I've mentioned, in both an email to you and in post comments, I think your rather brilliant idea, your "urgent proposal" for what I've called a public "summit conference on sex and gender" is something that I think has - or should have - some serious "legs" that should be developed to the greatest extent possible. My comment thereon which addresses a small part of that:


But other people have also suggested similar public dialogs, even if only in comments on other Substack posts, including one by Skeptic Michael Shermer. Link and quote below is the first part of my comment to "Berkeley Busby". However, it's still possible that Shermer - who publishes the Skeptic magazine - might be open to either that "urgent proposal" or to publishing something along that line that we might collaborate on to develop the idea:

"Berkeley: 'Wish Michael Shermer and Dr. Steven Novella (New England Skeptical Society - NESS - Skeptics Guide to the Universe podcast) would discuss this subject' ..."


But somewhat more broadly - important to take a broad a view as possible ... 🙂 - Shermer's post was an attempt to ground the definition for "woman" on some solid philosophical and logical principles, Wittgenstein's "family resemblances" in particular. While I think he's to be commended for that effort, I also think, as I've argued in another comment on his article, his definition rests what are called polythetic categories - a concept that has some solid logic and scientific weight behind it - that are quite antithetical to the biological definitions as monothetic categories:


But, more broadly still, that dichotomy between, and controversy over monothetic and polythetic principles in the definitions for both the sexes and the genders - "man" and "woman" as both sexes and as genders - is part and parcel of the whole transgender clusterfuck. As I've frequently argued, we can't possibly agree on policies if we can't even agree on our definitions - no wonder the "debate" looks more like "Is too! Is not!", like the feud between the Hatfields and the McCoys, like sectarian warfare over making the sign of the cross with two fingers or three:



Not quite sure how to proceed from there. You/we might create an article and pitch/Substack-publish it, send links to various "heavy hitters" and other journalists asking for comments, create a YouTube video of a debate on the topic, etc.

Suggestions include Shermer of course, and Helen Joyce likewise. Apropos of the latter, she had a rather brilliant essay at Quillette some 2 years ago where she basically endorsed, in no uncertain terms, what is basically the monothetic category definition for "female" - even if she's somewhat "reluctant" to follow the logical consequences of it:

“The problem is that ‘female’ is not something you can identify as. It’s a word with an objective definition that holds right across all of biology, and hardly any of the things it refers to are capable of identifying as anything. It means: ‘of or denoting the sex class that produces large gametes,’ ….”


And, since I think that "objective definition" is more or less the keystone in any number of over-arching principles, we might include Abigail Shrier and UK/US philosopher/lawyer Elizabeth Finne - who I've quoted in my Lysenkoism article - who have both made cogent arguments along the same line:

"The public space is different — the lies told there have real, even lethal, consequences. For our democracy to function, for a diverse public to be able to communicate and work together, we must speak in objective terms to which we all have access. We must make points plainly. We must strive toward accuracy so that we may clearly recognize the issues at stake. We must, each of us, give up some of the private beliefs embedded in our ways of thinking and speaking in order to be widely understood."


"The primacy of subjectivity is by no means limited to politics. It now permeates the framework through which we have traditionally mediated our competing narratives. Journalism, academia, science, and law are all affected. In short, any institution that exists to accommodate competing perspectives is being undermined by a new paradigm that privileges the subjective ‘lived experience.’ And, in the process, the meta-values which have traditionally enabled us to transcend our differing subjective experiences suffer. Foundational principles such as 'audi alteram partem' (listen to the other side), the presumption of innocence, proportionality, empiricism, and even the rule of law now must bow before the sovereignty of the subjective."


But there are some other ideas and suggestions along same line that we might profitably discuss by email or here if others want to weigh-in; think you're more likely to garner tips and subscriptions if readers see some opportunities for contributions and acknowledgment.

However, it seems those definitions and a debate on them is "Job One" - as the Ford Motor Company used to say 🙂; we can't possibly separate wheat and chaff without them. As Voltaire said, "If you wish to converse with me, define your terms."

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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.

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Thanks for a cogent comment and useful recommendation; gives further justification for getting Stock's book to see what sort of depth she goes into on that "family resemblances" idea.

Not sure whether you looked at Shermer's post in any detail, but he gives some further elaborations on that idea. Although I'm not sure that either he or Stock realize that applying that concept of "family resemblances" to both "woman" and to the individual sexes basically turns those categories into spectra. Something I elaborated on in some detail in one of my comments there (my previously linked comments here didn't do so - sorry about that Chief):


Of particular note in that comment of mine is a comparison of the "family resemblances" idea with the analogous but more precisely defined concept of "polythetic categories"; included is a source which justifies the interpretation of such as spectra. Stock herself had earlier argued for a "cluster of particular designated properties" in defining the sexes which again boils down into defining them as spectra. You might be interested in an older Medium post of mine which discusses her take and its consequences in some detail:


But entirely agree with you and Stock about the "need to distinguish women and transwomen", though there are more than a few devils in the details. As a way of grappling with them you might also be interested in an article at the Stanford Encyclopedia of Philosophy on "Natural Kinds", particularly for its discussion of "homeostatic property clusters":


It's quite an informative article that I'm still trying to chew through myself - somewhat heavy going, but provides something in the way of a useful framework or starting point.

Finally, somewhat in passing, of particular note is this portion of Shermer's post that you may not have seen:

"But Grzanka’s dodge is not uncommon in academia today, and in exasperation with Walsh’s persistent questioning in search of the truth, Grzanka pronounces on camera, 'Getting to the truth is deeply transphobic.' ...."

That "getting to the truth is deeply transphobic" may well serve as a fitting epitaph for much of Academia.

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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....

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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."

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it is covered by insurance, even by medicaid

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Fantastic summary. Thank you.

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