In over 20 years of teaching in early childhood settings, 1996-2016, I encountered 4 students, 3 boys and 1 girl, who went through a period of cross-sex ideation. In the case of one boy, his parents were in the middle of a high conflict divorce, he was forced to spend time away from his mother, with his unpredictable and erratic father. He desisted after about 8 months, basically when Dad calmed down and started acting responsibly. The girl had a same sex twin, and it appeared she was trying to differentiate from her more talkative sister. Her cross-sex ideation lasted perhaps a month. The other two boys tested the idea for a week, as a ploy for attention. At that time, I knew from my divorce from a cross-sex ideating man that erratic, unpredictable, irrational and demanding behavior accompanies the landscape of "transsexualism." I'd be fired if I used the same kind and grandmotherly manner with those 4 children in today's Brooklyn atmosphere. Again, the best expert witness testimony is in several webpages by Dr. Stephen B. Levine, who states that even in adult "transitioners," this diagnosis is neither stable nor pervasive.
Thanks for another excellent piece, Lisa! The links and data will be useful in rebutting politicians & others who use the AMA as the basis for affirmation being the best policy.
The systematic reviews produced by other countries are published and out there. How long can US based clinicians and professional medical groups continue to ignore them??
Yes, funny how the Endocrine Society is pushing the hormone approach, psychotherapy doesn't do them any good (and yes, there are some therapists in WPATH, but it seems that looking to WPATH for advice about medical intervention is like looking to Purdue Pharma for advice about taking opioids).
Just when I think, what else can you possibly contribute, as you seem to have covered the waterfront, you up the ante once again with this superb piece of journalism. This is just one anecdote, but I think bears on what you are describing: I worked for many years with community health centers, all good people, but also swarmed by vendors, particularly Pharma folks. Sitting with the CEO of one of the centers, I observed that every item on her desk--staplers, mugs, pencils, you name it--bore the name of a medical/Pharma company. I picked one up and asked, where is the stapler that says exercise and eat right? She was a good soul, but seemed baffled. Of course the answer is, there is far less money to be made from jogging, walking, fruits, vegetables, and whole grains.
Lisa, I love and appreciate your work. In this piece, however, I have two bones to pick. First, naturopathy is not science-based. If someone has a serious illness and decides to watchfully wait while taking naturopathic substances ... well, that's not free of harm. More importantly for your argument, naturopathy may not make money for "mainstream" medicine but it sure as heck does for somebody.
So-called alternative medicine (of which naturopathy is a part) is a big money maker AND it has a powerful lobby and political backers. Second, European science advisory bodies have their own sacred cows, blind spots, and interest groups. The result is that they issue guidance that is not based on best science - GMOs are a great example. You may be right that where medicine is concerned, the incentives are much better aligned over there than in the US ... I guess what I am saying and calling upon all of us do - and I know you agree - is to examine every issue on a case-by-case basis. BTW, if anyone would like links, I'd be happy to provide.
These are really good bones to pick! I was using those as examples of thing that the AMA has tried to get rid of, but didn't mean to insinuate that they're above reproach. And the idea is not that European bodies are above reproach—but that they don't have financial incentive in these cases and have better data and came to opposite conclusions. Does it read as giving the full thumbs up to any of those things? I'd be curious how you'd want it to be reworded, if so. Thanks!
Thanks for asking. I would replace the sentence with something like “One can imagine that an approach relying on profitable medical interventions would be more appealing to an organization looking out for doctors’ interests than watchful waiting which reduces the likelihood of such interventions.” Maybe AMA opposes certain modalities because it cuts into their profit margins or maybe because they are protecting patients or maybe both.
I find it curious that you use labeling GMOs as an example of European countries issuing guidance not based on best science. It is quite the contrary. GMOs are restricted and labeled in Europe due to the Precautionary Principle, which says you must prove an intervention is safe prior to unleashing it on the public. Labeling GMOs, which have never been proven safe is a perfect example where the transparency of the label helps customers decide whether their consumption presents an acceptable risk. We don't follow the Precautionary Principle in the United States and justify many novel interventions with the faulty reasoning that because something has not been proven harmful, it must be safe. Of course if you don't study it, you will never even have proof. And so it goes.
I had been wondering for a long time about the new brand of authoritarian and ideological “liberals” as well as about the apparent capitulation of the elites to the whims of the “woke.” I think a big piece of the puzzle has to do with the pertinent information from the recent article for Tablet by Jacob Siegel titled A Guide to Understanding the Hoax of the Century—Thirteen ways of looking at disinformation. I think this information—the merging of interests of big tech, media, academia and what used to be the military-industrial complex—has much to do with this new erroneous understanding of “science” and the undermining of diverse perspectives and the role they play in the pursuit of truth. This, in turn, is also crucial to understand the source of the intolerance and demonization of dissenting voices on the topic of transitioning minors and has much to do—in my opinion—with why other countries have been able to look at this topic more objectively and are calling out US medical associations for their ideological bias.
“But when children are socially transitioned, it seems they are both much more likely to persist in a trans identity, and much more likely to medicate.” Trans activists would challenge the first part of this sentence noting, “there is nothing wrong with being trans” without acknowledging the second part--- lifelong medication, infertility, and often inorgasmia. Those potential consequences are fine for an adult to make for their own bodies and future. Children are not capable to consenting to those outcomes. Many people say, depression, anxiety, and other conditions are the result of being part of a marginalized group, while also saying the increase in those identifying as trans is the result of increased acceptance. I think most of us (at least on the left) are pro-trans. We are for all civil protections, access to medical care – and transition, and full social acceptance--even celebration. We just want open discussion about medicalization of children, fairness in female sports, and sex segregated spaces for vulnerable women.
As I've written before: Yea, one cause of organization/practitioner support for "gender affirming" medical care is that medicalized transgender care makes them money mental health services doesn't.
But focus on 'the money motive' overlooks - and even, in today's cynical-hopeless political environment, directly prevents thinking about - other causes. In particular, political causes:
1/ US liberal Democratic culture has historically supported minority rights before the law (14th Amendment) in the face of Republican attacks. Now, I AGREE the civil rights of Blacks and gays 'isn't the same as' medicalizing kids...except that, politico-culturally, with victimization of trans people, and Republican culture wars...it FEELS the same. Defending persecuted minorities - who surely exist - is a politically instinctive liberal reaction. And not a bad one - liberals should care about minority rights.
2/ Political liberals are proud of supporting the Black-driven Civil Rights Movement of the 1950s/60s that ended the unequal, segregated South. But today, Republicans' use of cultural politics to hide greater attacks on the New Deal and 1960s social safety net...has a Democratic counterpart:
The right-liberal Democratic machine that supported Clinton STRATEGICALLY invoked equal civil rights of women and Blacks - vilifying Sanders as racist - to reject medicare for all. Likewise, Biden's defense of civil rights and warmongering both miss the mark of the great suffering body of US citizenry.
Upshot: Anti-medicalization forces are not just up against 'trans activist' propaganda: rather, trans issues sit comfortably in the liberal history of defending minority rights; and a right-leaning Democratic Party today exploits that history to bury a populist agenda which would help all citizens.
Yes, I should probably include more about how they're pressured, how this is everywhere, how there's no way to back it up because they've literally testified under oath about this stuff, and testified to the church of public opinion. I don't mean to say it's all about money. I mean to say that the endorsement of these associations doesn't really mean anything. We need to have some mechanism here for creating evidence-based guidelines.
Lisa, I am a retired pediatric pulmonologist and have been opposed to the American Academy of Pediatrics for decades. They are an advocacy group that has no interest and spends no money (of which they have a lot) on determining what their members really think. This started, as I remember, in the 1970s when they supported the "emancipation" of many teenagers from parental authority on the basis of sexual activity. This naturally led to the "right to abortion" for the pregnant teenage girl with specters of brutal parents demanding that their daughters carry these unwanted babies to term in harsh judgmental punishment. I regard the current practice in transgender clinics to be the single greatest medical malfeasance of my 40+ year career. The contrasting approach by our European colleagues could not be more revolting clearer.
The medical advocacy groups want to continue the tradition of allowing physicians to make the medical decisions, like abortion and early medical and surgical therapies for gender-confused youth. These are NOT just private medical choices. They have profound societal impact as the contagion of gender dysphoria proves. Sadly, too many pediatricians just line up with the AAP and take offense at anyone questioning "our organization". You would think that the disastrous consequences of the COVID-induced lockdowns on the emotional and academic lives of our young children would convince my fellow pediatricians to rise up against the AAP. I hear nothing but crickets!
It is beyond high time that all physicians understand that they need to be informed and engaged in key public health issues. The transgender clinics are the greatest medical malfeasance of my 40 year career. Each pediatric practice has few affected families which does NOT relieve the physicians from their social responsibilities. It is morally unacceptable to hide behind being busy.
It will take legal action against the AMA and AAP to produce any progress. I am very much against plaintiff's lawyers in general but, as I said before, this is the greatest medical malfeasance of our lifetimes. Too many physicians want to hide behind the principle that we should let physicians "do medicine", quite parallel to the abortion argument. The fact is that there are many issues where legal and moral considerations demand that we put restrictions on medical care decisions. I applaud your activism. Keep us posted.
The same medical associations that supported school closures, toddler & child mask & vaccine mandates.
It should be patently clear by now that they are just pharma & medical lobby groups, not trusted partners in our children’s health. In fact, in all of the highlighted examples, they are actually our adversaries.
Thanks for this great article. Does anyone know if the American Association of Naturopathic Physicians has taken a stand supporting "gender affirming care"? I have been trying to communicate with my own naturopath for the past few years on this topic, as she specializes in pediatric care. I did find a link to a talk at their upcoming conference in July from a presenter who supports GAC. It is troubling that her definition of "do no harm" pretty much means embracing this ideology, learning to "combat misconceptions of gender within yourself." Presumably it also includes socially and medically transitioning kids.
I was just informed that they're offering naturapathic versions of puberty suppressing. Haven't investigated yet. If you have any intel, please send to me! That would be a good piece.
In WA most insurance companies cover naturopathy. It is not covered by Medicare anywhere (yet). It really depends on the naturopath, just like other docs. Mine doesn't use homeopathic remedies much if at all and works closely with MDs. What I like is the emphasis on the whole person, as bodies are complex. Especially for people with chronic illnesses not easily addressed, they can be helpful. Like nurse practitioners, they have a different kind of training that can be more wholistic.
But I fear that in this moment concerning "gender affirming care," naturopaths are just gearing up to get in on the grift.
In over 20 years of teaching in early childhood settings, 1996-2016, I encountered 4 students, 3 boys and 1 girl, who went through a period of cross-sex ideation. In the case of one boy, his parents were in the middle of a high conflict divorce, he was forced to spend time away from his mother, with his unpredictable and erratic father. He desisted after about 8 months, basically when Dad calmed down and started acting responsibly. The girl had a same sex twin, and it appeared she was trying to differentiate from her more talkative sister. Her cross-sex ideation lasted perhaps a month. The other two boys tested the idea for a week, as a ploy for attention. At that time, I knew from my divorce from a cross-sex ideating man that erratic, unpredictable, irrational and demanding behavior accompanies the landscape of "transsexualism." I'd be fired if I used the same kind and grandmotherly manner with those 4 children in today's Brooklyn atmosphere. Again, the best expert witness testimony is in several webpages by Dr. Stephen B. Levine, who states that even in adult "transitioners," this diagnosis is neither stable nor pervasive.
Thanks for another excellent piece, Lisa! The links and data will be useful in rebutting politicians & others who use the AMA as the basis for affirmation being the best policy.
How long can the charade continue is my question
The systematic reviews produced by other countries are published and out there. How long can US based clinicians and professional medical groups continue to ignore them??
Thank you for arming us with more evidence!
Yes, funny how the Endocrine Society is pushing the hormone approach, psychotherapy doesn't do them any good (and yes, there are some therapists in WPATH, but it seems that looking to WPATH for advice about medical intervention is like looking to Purdue Pharma for advice about taking opioids).
Just when I think, what else can you possibly contribute, as you seem to have covered the waterfront, you up the ante once again with this superb piece of journalism. This is just one anecdote, but I think bears on what you are describing: I worked for many years with community health centers, all good people, but also swarmed by vendors, particularly Pharma folks. Sitting with the CEO of one of the centers, I observed that every item on her desk--staplers, mugs, pencils, you name it--bore the name of a medical/Pharma company. I picked one up and asked, where is the stapler that says exercise and eat right? She was a good soul, but seemed baffled. Of course the answer is, there is far less money to be made from jogging, walking, fruits, vegetables, and whole grains.
Lisa, I love and appreciate your work. In this piece, however, I have two bones to pick. First, naturopathy is not science-based. If someone has a serious illness and decides to watchfully wait while taking naturopathic substances ... well, that's not free of harm. More importantly for your argument, naturopathy may not make money for "mainstream" medicine but it sure as heck does for somebody.
So-called alternative medicine (of which naturopathy is a part) is a big money maker AND it has a powerful lobby and political backers. Second, European science advisory bodies have their own sacred cows, blind spots, and interest groups. The result is that they issue guidance that is not based on best science - GMOs are a great example. You may be right that where medicine is concerned, the incentives are much better aligned over there than in the US ... I guess what I am saying and calling upon all of us do - and I know you agree - is to examine every issue on a case-by-case basis. BTW, if anyone would like links, I'd be happy to provide.
These are really good bones to pick! I was using those as examples of thing that the AMA has tried to get rid of, but didn't mean to insinuate that they're above reproach. And the idea is not that European bodies are above reproach—but that they don't have financial incentive in these cases and have better data and came to opposite conclusions. Does it read as giving the full thumbs up to any of those things? I'd be curious how you'd want it to be reworded, if so. Thanks!
Thanks for asking. I would replace the sentence with something like “One can imagine that an approach relying on profitable medical interventions would be more appealing to an organization looking out for doctors’ interests than watchful waiting which reduces the likelihood of such interventions.” Maybe AMA opposes certain modalities because it cuts into their profit margins or maybe because they are protecting patients or maybe both.
On second read, I think your point about European bodies is solid. You are not making an overarching statement about all European institutions.
I find it curious that you use labeling GMOs as an example of European countries issuing guidance not based on best science. It is quite the contrary. GMOs are restricted and labeled in Europe due to the Precautionary Principle, which says you must prove an intervention is safe prior to unleashing it on the public. Labeling GMOs, which have never been proven safe is a perfect example where the transparency of the label helps customers decide whether their consumption presents an acceptable risk. We don't follow the Precautionary Principle in the United States and justify many novel interventions with the faulty reasoning that because something has not been proven harmful, it must be safe. Of course if you don't study it, you will never even have proof. And so it goes.
Natalya, with respect, I disagree. To my understanding and reading, GMOs have been proven safe. But let’s not hijack this thread 😀
Thank you, Lisa, as always. I'm wondering if there are AAP members, in addition to Dr Julia Mason (https://www.wsj.com/articles/the-american-academy-of-pediatrics-dubious-transgender-science-jack-turban-research-social-contagion-gender-dysphoria-puberty-blockers-uk-11660732791) who have pushed back openly?
I had been wondering for a long time about the new brand of authoritarian and ideological “liberals” as well as about the apparent capitulation of the elites to the whims of the “woke.” I think a big piece of the puzzle has to do with the pertinent information from the recent article for Tablet by Jacob Siegel titled A Guide to Understanding the Hoax of the Century—Thirteen ways of looking at disinformation. I think this information—the merging of interests of big tech, media, academia and what used to be the military-industrial complex—has much to do with this new erroneous understanding of “science” and the undermining of diverse perspectives and the role they play in the pursuit of truth. This, in turn, is also crucial to understand the source of the intolerance and demonization of dissenting voices on the topic of transitioning minors and has much to do—in my opinion—with why other countries have been able to look at this topic more objectively and are calling out US medical associations for their ideological bias.
“But when children are socially transitioned, it seems they are both much more likely to persist in a trans identity, and much more likely to medicate.” Trans activists would challenge the first part of this sentence noting, “there is nothing wrong with being trans” without acknowledging the second part--- lifelong medication, infertility, and often inorgasmia. Those potential consequences are fine for an adult to make for their own bodies and future. Children are not capable to consenting to those outcomes. Many people say, depression, anxiety, and other conditions are the result of being part of a marginalized group, while also saying the increase in those identifying as trans is the result of increased acceptance. I think most of us (at least on the left) are pro-trans. We are for all civil protections, access to medical care – and transition, and full social acceptance--even celebration. We just want open discussion about medicalization of children, fairness in female sports, and sex segregated spaces for vulnerable women.
As I've written before: Yea, one cause of organization/practitioner support for "gender affirming" medical care is that medicalized transgender care makes them money mental health services doesn't.
But focus on 'the money motive' overlooks - and even, in today's cynical-hopeless political environment, directly prevents thinking about - other causes. In particular, political causes:
1/ US liberal Democratic culture has historically supported minority rights before the law (14th Amendment) in the face of Republican attacks. Now, I AGREE the civil rights of Blacks and gays 'isn't the same as' medicalizing kids...except that, politico-culturally, with victimization of trans people, and Republican culture wars...it FEELS the same. Defending persecuted minorities - who surely exist - is a politically instinctive liberal reaction. And not a bad one - liberals should care about minority rights.
2/ Political liberals are proud of supporting the Black-driven Civil Rights Movement of the 1950s/60s that ended the unequal, segregated South. But today, Republicans' use of cultural politics to hide greater attacks on the New Deal and 1960s social safety net...has a Democratic counterpart:
The right-liberal Democratic machine that supported Clinton STRATEGICALLY invoked equal civil rights of women and Blacks - vilifying Sanders as racist - to reject medicare for all. Likewise, Biden's defense of civil rights and warmongering both miss the mark of the great suffering body of US citizenry.
Upshot: Anti-medicalization forces are not just up against 'trans activist' propaganda: rather, trans issues sit comfortably in the liberal history of defending minority rights; and a right-leaning Democratic Party today exploits that history to bury a populist agenda which would help all citizens.
Yes, I should probably include more about how they're pressured, how this is everywhere, how there's no way to back it up because they've literally testified under oath about this stuff, and testified to the church of public opinion. I don't mean to say it's all about money. I mean to say that the endorsement of these associations doesn't really mean anything. We need to have some mechanism here for creating evidence-based guidelines.
Lisa, I am a retired pediatric pulmonologist and have been opposed to the American Academy of Pediatrics for decades. They are an advocacy group that has no interest and spends no money (of which they have a lot) on determining what their members really think. This started, as I remember, in the 1970s when they supported the "emancipation" of many teenagers from parental authority on the basis of sexual activity. This naturally led to the "right to abortion" for the pregnant teenage girl with specters of brutal parents demanding that their daughters carry these unwanted babies to term in harsh judgmental punishment. I regard the current practice in transgender clinics to be the single greatest medical malfeasance of my 40+ year career. The contrasting approach by our European colleagues could not be more revolting clearer.
The medical advocacy groups want to continue the tradition of allowing physicians to make the medical decisions, like abortion and early medical and surgical therapies for gender-confused youth. These are NOT just private medical choices. They have profound societal impact as the contagion of gender dysphoria proves. Sadly, too many pediatricians just line up with the AAP and take offense at anyone questioning "our organization". You would think that the disastrous consequences of the COVID-induced lockdowns on the emotional and academic lives of our young children would convince my fellow pediatricians to rise up against the AAP. I hear nothing but crickets!
It is beyond high time that all physicians understand that they need to be informed and engaged in key public health issues. The transgender clinics are the greatest medical malfeasance of my 40 year career. Each pediatric practice has few affected families which does NOT relieve the physicians from their social responsibilities. It is morally unacceptable to hide behind being busy.
It will take legal action against the AMA and AAP to produce any progress. I am very much against plaintiff's lawyers in general but, as I said before, this is the greatest medical malfeasance of our lifetimes. Too many physicians want to hide behind the principle that we should let physicians "do medicine", quite parallel to the abortion argument. The fact is that there are many issues where legal and moral considerations demand that we put restrictions on medical care decisions. I applaud your activism. Keep us posted.
Photo copying this and leaving copies in the waiting room at all future medical visits
One would have to wonder which US medical Association we’ll be backing down from puberty blockers first?
The same medical associations that supported school closures, toddler & child mask & vaccine mandates.
It should be patently clear by now that they are just pharma & medical lobby groups, not trusted partners in our children’s health. In fact, in all of the highlighted examples, they are actually our adversaries.
Thanks for this great article. Does anyone know if the American Association of Naturopathic Physicians has taken a stand supporting "gender affirming care"? I have been trying to communicate with my own naturopath for the past few years on this topic, as she specializes in pediatric care. I did find a link to a talk at their upcoming conference in July from a presenter who supports GAC. It is troubling that her definition of "do no harm" pretty much means embracing this ideology, learning to "combat misconceptions of gender within yourself." Presumably it also includes socially and medically transitioning kids.
https://naturopathic.org/page/SpeakerPage_Hightower
I was just informed that they're offering naturapathic versions of puberty suppressing. Haven't investigated yet. If you have any intel, please send to me! That would be a good piece.
Will do.
In WA most insurance companies cover naturopathy. It is not covered by Medicare anywhere (yet). It really depends on the naturopath, just like other docs. Mine doesn't use homeopathic remedies much if at all and works closely with MDs. What I like is the emphasis on the whole person, as bodies are complex. Especially for people with chronic illnesses not easily addressed, they can be helpful. Like nurse practitioners, they have a different kind of training that can be more wholistic.
But I fear that in this moment concerning "gender affirming care," naturopaths are just gearing up to get in on the grift.