What the Left and Mainstream Media Won't Report About Gender-Affirming Medicine

None of this should be politicized

If you are reading the free version of this newsletter, well, thank you for reading it! Please consider subscribing so I can spend more time on it. As a full-time freelancer, I have had to be very careful about what I’ve written to make sure I stay employable, but reporting that way has left many important things unsaid, and I can no longer abide that. More on that below.

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Earlier this summer, in an attempt to educate the public (I guess?), The New York Times ran an article about puberty blockers. It noted that Republicans are targeting these drugs, but such framing contributes to the politicization of treatment for gender dysphoria (GD), rather than taking the reader beyond that idea. Supporting or cautioning against the use of these drugs has nothing to do with politics, even if it’s playing out that way in this country.

Some Republicans and conservatives have trans or gender dysphoric kids (and we should stop assuming that’s the same thing, but that’s for another post) and embrace blockers and what often comes after them: cross-sex hormones and sometimes surgeries. Some Democrats and liberals reject blockers or worry about them and what can come after them. The practice of pausing puberty—and the host of other changes in bodies and brain development that come with puberty—should not be politicized. It should be based on evidence. And the media has a responsibility to properly report on that evidence.

The article noted that Arkansas conservatives have argued that “the risks of gender transition procedures far outweigh any benefit at this stage of clinical study on these procedures,” and that “medical experts say that’s not the case.”

But which medical experts? The author quotes some leaders in gender-affirming care, but fails to talk to critics of it from within the medical and mental health fields, or to mention two very basic facts.

The first is that several other countries, or major medical centers in those countries, are also banning or limiting the use of blockers, cross-sex hormones and surgeries in children (the youngest child I’ve heard of getting a double-mastectomy or “top surgery,” along with testosterone injections, was 12; by 13, my source told me, she regretted it, though of course I have talked to and read about plenty of young people who are very happy they transitioned). Finland has severely restricted the practice, and in at least one pediatric gender clinic in Western Australia a patient now needs a court order to medically transition. Sweden’s Karolinska Hospital and several other Swedish hospitals that provided pediatric medical gender transition have stopped providing gender-affirming treatment for kids under 18, except in clinical trials.

In others words, if kids are medically transitioning in those places, doctors, therapists and researchers are watching carefully to make sure the protocol is working as intended (alleviating dysphoria with bodily changes). Per this article on Medscape, the outlet that I think is the best source if you want honest, nuanced discussion of and debate around this topic, “This decision comes amid growing unease in some quarters regarding the speed at which hormonal treatment of children with gender dysphoria has become accepted as the norm in many countries, despite what critics say is a lack of evidence of any benefit, plus known harms, of treatment.”

These places aren’t slowing down or stopping these medical treatments because of hatred against trans people, nor is this known as “anti-transgender legislation.” The medical community itself is pressing pause not because of social values or politics, but because both the quantity and quality of evidence was found to be flimsy.

Weird that the Times didn’t mention that, right? It’s almost as if they have decided to affirm the evidence without question, much as many therapists and doctors are doing with gender dysphoric kids.

But that affirmation medical model, while clearly working for many people, sometimes backfires. Earlier this year, the UK’s National Institute for Health and Care Excellence (NICE) reviewed the evidence after a young woman named Keira Bell sued the NIH for facilitating the transition she came to regret.

What did NICE find? Sometimes puberty blockers and other treatments were helpful, alleviating some depression while not affecting anger or anxiety levels. Sometimes they improved global or psychological functioning. This is no surprise. For the kids I’ve talked to who were severely dysphoric at puberty, the idea of pausing was so appealing, such a relief. It put off the thing they dreaded.

But sometimes these drugs and other treatments made no impact. And sometimes they made things worse. Ten times NICE printed the phrase, “no conclusions could be drawn,” and when they rated the quality or certainty of evidence of most of the studies used to justify treatments, they often used the phrase “VERY LOW.” (The journal Pediatrics published an oft-cited study that correlated use of blockers with lowered lifetime suicidal ideation, but almost every expert I’ve talked to has debunked its methodology and conclusions.)

Wouldn’t anyone reporting about puberty blockers, and about pediatric gender dysphoria and gender transition in general, want to mention this? How is it not relevant, both to readers who know nothing about this and to parents and dysphoric kids desperately searching for impartial information, that other countries are reconsidering this approach?

The second thing the center and left media consistently fails to report on is the host of new groups that have sprung up to provide alternatives to and urge caution about the fast-tracked medicalization of gender-dysphoric youth. These groups, like the Society for Evidence-Based Gender Medicine (SEGM) or Genspect, are sometimes dismissed by activists as hateful or anti-trans, even though some adult trans people are involved in them. While some of them don’t believe that any kids under 25 can properly evaluate the risks of transition, what they advocate for is leading with therapy, examining the source and type of dysphoria, and not predetermining the treatment based on self-diagnosis. They spend a lot of time poring over the evidence and they want to offer a counter-argument to the affirmation model. The media should let them.

“Experts” often say the effects of blockers are fully reversible. By that they mean that if you go off them and go through puberty as intended, you’ll probably be fertile. But the truth is, we’re not doing good enough research and follow-up to know the real effects, on bone density and brain development and whatever else might be affected by blockers and cross-sex hormones, and thus we can’t fully help families understand if the risks are worth the reward. If you get far enough in the Times article, you get to the caveats. “But while puberty blockers are commonly referred to as ‘fully reversible,’ more research is needed to fully understand the impact they may have on certain patients’ fertility. There is also little known about the drugs’ lasting effects on brain development and bone mineral density.”

Here’s another thing the Times piece ignored: Many in the field of gender-affirming care talk about blockers as a way of “hitting the pause button” on secondary sex characteristics, to give kids and families more time to decide if they want to proceed with a medical transition and cross-sex hormones, but from whatever little bit of evidence we have, it seems most kids who start blockers do go on to cross-sex hormones. Many believe it is not the ole harmless pause button but rather the laying of groundwork for lifetime medicalization. In one (small) study, 98% of kids went from blockers to cross-sex hormones.

Now, it’s possible that this study was from Before Times, when kids were properly assessed before they went on them. But since we are largely not tracking kids who medically transition in this country, we have very little sense of outcomes. Let’s demand high-quality, long-term research, tracking every child who goes through this process, to make sure we’re getting this as close to right as we can. If activists are right that desistance and regret are virtually non-existent, then their assertions will be confirmed, and the debate will end. If they’re not, we’re going to need to talk about it.

More research is needed. More discussion. More debate. Thesis, antithesis, synthesis.

Medical experts do not all agree. There are a heterodox group, and parents deserve to hear multiple perspectives when trying to help their suffering children. If parents aren’t getting the full picture, they can’t make good decisions. We should expect the media and the medical community to present diverse opinions, to show us all the evidence, and help us develop the literacy to evaluate that evidence—not to push a political agenda, but to serve the needs of children. But instead, the medical community, activist groups and the media have all spread the narrative that there is one approach to treating GD, and it should never be questioned.

We don’t know enough to pronounce things safe when we actively ignore evidence. When groups claim medical consensus by silencing or ignoring dissent, we in the media should report that. The American Academy of Pediatrics recently booted SEGM from its national conference, but you probably didn’t hear about that, right?

Why are some people and groups, including the ACLU and the AAP, so invested in shutting down research, debate and discussion? My guess is that a) they truly believe they are saving lives, but have also bought the bogus argument that this is the only path forward, despite the lack of evidence; b) they’re afraid to be labeled transphobic; and c) some of them are amassing a lot of power. The more you silence dissent, the more power you have.

From my experience talking to many doctors and therapists, many are seeing kids improve from gender affirming care and they are terrified of having it taken away. Most of the people who are very concerned about these treatments don’t think bans are the answer. The reform should come from within the medical and mental health communities, by listening to both those who have been harmed and helped by transition.

I’m baffled (okay, maybe distraught is the better word) by the left media’s decision to present puberty blockers as harmless. The medical community had to work so hard to teach parents how dangerous Tylenol can be; kids are killed by it every year, and when we understood that the problem was how the drug was marketed, and lack of parental education, consumer protection activists made a big stink about it. When six people out of 6.8 million took sick after the Johnson and Johnson vaccine, we paused, did more research, and worked to ensure that a drug intended to make people well didn’t make them sick. Isn’t it our duty in the media to report the basic facts?

But Davis, you might be thinking, aren’t you a member of this left/center media which you are disparaging?

Well, kind of. I’m a freelancer, and I’ve been at this for almost two decades. I’ve had the good fortune (fortune is really the wrong word) to write for many of the most prestigious publications, but it’s all hanging by a thread and nothing is stable. I have no power or sway. (What I have is this Substack, and if you subscribe I’ll hopefully have more time to devote to this and get some sway). It has pained me to force myself to report in ways that I don’t think are intellectually or factually honest, though I have done my best to include broad research and ideas and arguments, often against pushback from editors. And as you know if you read last week’s entry, doing so eventually led to my deplatforming.

Many adult trans people who had to work their butts off to transition and go through what they felt was a humiliating process to prove the reality of their lived experience want to spare kids the pain they went through, and that’s understandable. But with the exponential rise in kids with gender dysphoria, we have to carefully evaluate, and not bat away evidence that disrupts our own narrative. It’s really hard to do.

It’s a brilliant marketing move to label anyone who has concerns about the safety of these medical approaches as hateful, because it prevents us from listening to them. But we’ve got to put politics aside here. The media has to do a better job.