Jesse Singal critiques a new Scientific American article on puberty blockers, calls the piece “potentially harmful” and “negligent science journalism”

May 8, 2023 • 9:15 am

I’ve read a lot of Jesse Singal‘s writings on transgender issues, both before and after he started his Substack column, “Singal Minded.”  I like to read him because he specializes in careful analysis of data to analyze (often erroneous) claims about sex and gender issues. That’s the subject of today’s post, in which he shows, as he often does, that a popular article shows little scientific support for the claims made about gender dysphoria and its treatment. You can read his latest column, about a May 1 piece in Scientific American, for free (I’m a subscriber, and recommend that you subscribe, too, if you read Singal often).

Click to read.

I’m not going to rail about the ideological bent of Scientific American, as I’ve mentioned that many times before, except to say that a once-admired magazine is now scientifically untrustworthy and ideologically motivated (the two are connected). Worse, because it’s a very popular magazine, on the issue of medical treatment for gender dysphoria its ideological bent, according to Singal, is implicitly harmful, for it purveys misleading information about drugs, behavior, and treatment of people that could lead to irreversible medical decisions.

The gist of the article is this, in my words: “The author accepts a number of bogus scientific claims buttressing ‘affirmative care’ that don’t have a good empirical basis. The magazine, its authors, and editors, are thus guilty of not only a failure to fact check, but of disseminating information that could lead people to make bad medical decisions.”

It’s a long article, but worth reading on two counts. First, it gives the most up-to-date information (with references) about puberty blockers, a hot topic. Second, it’s yet another indictment, and a serious one, of Scientific American, and links to a lot of evidence bearing on Singal’s dispute with the article.

The article Singal goes after appeared in Scientific American only a week ago. Both articles are free online, and you can read Singal’s critique by clicking the screenshot below. If it disappears, I found that it’s already been archived a number of times here. I’ve left off the author’s name because, as Singal says,

Here’s the article. I feel a little bad critiquing it because it was written by a SciAm intern. But it was published in one of the leading science outlets in the world, and it does have some major problems, so I don’t know what to say.

I blame the editors, for whom this is a pattern, far more than I blame the individual author. I’m not going to name her, because I’m not trying to cause long-lasting Google damage to a young journalist’s reputation, but obviously her name will not be hard to find. I promise you, notwithstanding any of the criticisms that follow, that when I was a young journalist I wrote far worse stuff than what she wrote here. She is in a difficult situation, attempting to write about an issue where there is so much spin and so much politicization that it is impossible not to step on landmines unless you are very, very careful. Her editors were not careful. Not at all.

Clearly you can find the author’s name, but out of respect for what Singal says above, I’ve left it out of the Sci Am screenshot below. Note that this is a full article in the “medicine” category, not an op-ed. But why on earth would they assign something like this to an intern?

Again, click screenshot or one of the many links archived at the link above.

Singal’s article is very long, but you owe it to yourself, if you’re engaged in debates about trans issues or simply follow them, to read it. What I will do is reproduce the bits of the article (most of it, it seems!) that the author got wrong (indented in Roman type), and give Singal’s responses (indented in italics), with my own words appearing in Roman type flush left.

We’ll start off with this Sci Am quote:

Hormonal medications called gonadotropin-releasing hormone agonists (GnRHas), often referred to as puberty blockers, temporarily halt the production of sex hormones testosterone, estrogen and progesterone with minimal side effects. They can pause puberty and buy transgender children and their caregivers time to consider their options.

Singal notes that the “time to think” line is disputable because virtually every child or adolescent who takes the blockers goes on to full hormone therapy, transitioning to the phenotype of their non-natal sex. Sci Am continues:

These medications are well studied and have been used safely since the late 1980s to pause puberty in adolescents with gender dysphoria. They have been used routinely for even longer in children who enter puberty too early and in adults with a range of other medical conditions.

Even tyros like me know that this statement is wildly misguided. Singal notes that although the first use of blockers was in 1987, they did not come into widespread use until much later. More important, as Singal has pointed out repeatedly in his writings, using blockers to stall precocious puberty and then allow it to proceed is a very different situation from pausing puberty and then giving the young person gender-altering hormones.  Further, they aren’t well studied in either situation. Although the former use been studied more thoroughly than the latter, as Singal says:

“Can cross-sex hormones provide an equivalent-enough form of development, without any negative consequences to the teenager’s physical or cognitive development?The answer is simply that we don’t know yet, because we have hardly any medium-term data and no long-term data following young people who have gone through this protocol. That’s why you can’t conflate these two use cases. On top of all of that, there are questions about the safety of using puberty blockers to buy time for kids with precocious puberty, too. This goes unmentioned by Scientific American.

Every government-sponsored investigation of the evidence base for puberty blockers has come to the same conclusion: the quality of extant literature is so weak that no one really knows whether they are safe and effective for gender dysphoric youth. The healthcare systems of Finland and Norway have gone so far as to call these treatments “experimental,” as did the Swedish team behind a major, just-published systematic review. The UK’s National Health Service hasn’t quite gone that far, but late last year it proposed new guidelines, based in part on this realization about the evidence base, that would call for a significantly more conservative approach to administering blockers and hormones (again, see Barnes’ book for more background on this).

You would know none of this reading Scientific American’s article about puberty blockers. And frankly, that makes the piece negligent science journalism. Of course the existence of these reviews doesn’t, on its own, resolve the question of exactly what our feelings should be toward these medications, let alone what national or state-level policies toward them should be. Sometimes you have to make healthcare decisions for a vulnerable young person under conditions of scientific uncertainty. But that uncertainty is an absolutely crucial part of the story — a major detail that has to be communicated by journalists writing about this subject.

It’s baffling and frustrating that, in 2023, the magazine’s editors are comfortable allowing their publication to claim both that there’s solid evidence puberty blockers help gender dysphoric kids, and to conflate two such different uses for this medicine. This is an extremely misleading, potentially harmful claim to disseminate to parents trying to work through an extremely fraught medical decision.

This is the conclusion reached not just by Singal, but by the medical establishments of several European nations. The unwarranted claim that puberty blockers are safe over the long term is one reason why Singal calls the article “negligent science journalism.”

Singal finds another misleading claim in the article’s assertion that children who don’t receive “gender-affirming care” are at a significantly higher risk of killing themselves.

Gender-affirming hormone therapy can decrease this risk. A recent study in the New England Journal of Medicine, for example, showed that hormone therapy significantly decreased symptoms of depression and anxiety in transgender youth. Another study found that transgender teenagers who received gender-affirming care were 73 percent less likely to self-harm or have suicidal thoughts than those who didn’t.

He first responds this way, and then analyzes the data:

Imagine a pillar of frowny faces ten thousand light-years high. 

It is really, really frustrating that SciAm is spreading these messages. Remarkably, not only do neither of the linked-to articles in this passage demonstrate a reduction in suicidality (which is distinct from depression and anxiety) among kids who went on blockers or hormones, but there’s a case to be made that both findings offer some evidence these treatments don’t reduce suicidality.

Singal has analyzed this claim many times, and you can look at the data for yourself.   He goes over a lot more of the article, but I’ll just give one or two more of its claims and Singal’s response. Sci Am:

This host of beneficial clinical uses and data, stretching back to the 1960s, shows that puberty blockers are not an experimental treatment, as they are sometimes mischaracterized, says Simona Giordano, a bioethicist at the University of Manchester in England. Among patients who have received the treatment, studies have documented vanishingly small regret rates and minimal side effects, as well as benefits to mental and social health.

Singal says the timeline is way off, and takes issue with every other claim in this paragraph, including the “minimal side effects” and “vanishingly small regret rates”.  He’s not saying those claims are flat wrong, but that there are simply not enough data to support them, which makes the Scientific American claims misleading.

Here’s one of Singal’s responses:

Whether puberty blockers are an “experimental treatment” for other conditions is a completely different question from whether they are an “experimental treatment” for youth gender dysphoria. The fact is we havealmost no quality evidence addressing puberty blockers’ safety and efficacy in the latter setting. Why is Scientific American hiding all of this from its readers?

Why? We can only guess, but my own interpretation is that this is a rah-rah article written and approved because it buys into gender activists’ claim that puberty blockers are a perfectly safe aspect of “affirmative care”.

Speaking of “affirmative care”, please realize that it is NOT defined as patients simply being evaluated by empathic therapists and doctors. Affirmative care, as practiced in the U.S., means immediate affirmation of the patient’s self diagnosis of gender dysphoria, only a cursory exploration of their feelings, and then the almost instantaneous prescription of puberty blockers, soon to be followed by hormone therapy and, perhaps later, surgery.  This is in strong contrast to the way the Dutch do it, which, I think, is the way it should be done.  Here is the “traditional” Dutch procedure, quoted by Singal:

Under this protocol, kids were seen for months, and carefully evaluated for psychological comorbidities, before they were allowed to go on blockers or hormones, or to (later on) get surgery. 

I don’t know if things have since loosened up a little over there, but traditionally, kids simply were not allowed to transition if their other mental health issues weren’t under control, if they didn’t have supportive parents, or if they didn’t have a long-standing history of childhood gender dysphoria. Some of the only decent research we have comes from this very specific clinical context, though even that research isn’t as straightforward as many (myself included) have previously assumed, at least according to this article by Oxford sociologist Michael Biggs and this critique by E. Abbruzzese, Stephen Levine, and Julia Mason.

Contrast that with the American procedure, “affirmative care”. Note that children can get a prescription for puberty blockers at the very first visit:

In interviews with Reuters, doctors and other staff at 18 gender clinics across the country [the U.S.] described their processes for evaluating patients. None described anything like the months-long assessments [leading Dutch clinician Annelou] de Vries and her colleagues adopted in their research.

At most of the clinics, a team of professionals — typically a social worker, a psychologist and a doctor specializing in adolescent medicine or endocrinology — initially meets with the parents and child for two hours or more to get to know the family, their medical history and their goals for treatment. They also discuss the benefits and risks of treatment options. Seven of the clinics said that if they don’t see any red flags and the child and parents are in agreement, they are comfortable prescribing puberty blockers or hormones based on the first visit, depending on the age of the child.

Now that is dreadful treatment, but it’s “affirmative therapy”. Two hours or so of discussion, and it’s on to the hormones!

Altogether, Singal makes a good case (with references) that the Scientific American article has misled readers about the history of puberty blockers, whether they are safe, whether they have long-term side effects, whether they (and “affirmative care”) reduce suicide rates and increase well being, and so on.

If you read the whole thing, you’ll sense that there’s an almost complete lack of fact-checking in the Sci Am article. Why?  It could be, I suppose, that the editors are lazy, that the reporter was naive, or didn’t do her homework (yes, “her” is the author’s preferred pronoun), or that the article’s message—that “affirmative care”, including the use of puberty blockers, is the way to go—plays into the “authoritarian progressive” bias of Scientific American, a bias it’s evinced many times before. Or, most likely, it could be all of these things. (To be fair, let me point out, as does Singal, that Sci Am made one small correction at the end about one organization’s recommended age minimum for gender-affirming surgery.)  Note again the article’s subtitle:

Even a cursory acquaintance with the data show that this claim is wrong.  And if the magazine does realize that the data are being used to “weigh important medical decisions,” then it is irresponsible to give outdated, misleading, or flatly wrong conclusions.  I’ll give Singal’s ending:

The Scientific American article also talks about some bone health stuff I’m less familiar with, so I can’t speak to its quality without doing some reporting I don’t have time to do right now, but in light of the above. . . let’s just say that my default stance would be skepticism. I would not take anything in this article at face value, without vigorous fact-checking — the fact-checking that should have occurred before the article was published.

So I’ll leave things here. It seems an appropriate note to end on: a major science magazine makes a very serious claim about suicide — that a specific intervention is “well established” as reducing it. That phrase links to write-ups of two studies, neither of which even measured completed suicide, let alone proved that the intervention in question reduces its likelihood. That’s where mainstream science reporting is on all this. 

It’s pretty bad, guys. The good news is that since it’s very clear what has gone wrong, there’s no reason these outlets can’t do better.


Wrong, Jesse. It’s not that they can’t do better but that this magazine, at least, apparently doesn’t want to do better.  So long as Scientific American is wedded to its woke ideology, we can’t expect honest reporting of any issue that bears on “Social Justice.”

If I were Scientific American‘s editor, I’d take down this article immediately or else issue multiple corrections. Don’t they realize that, as Singal said, this kind of loosey-goosey reporting can actually be harmful? Remember, many kids with gender dysphoria not given “affirmative treatment” and hormones eventually lose their dysphoria, often coming out as homosexuals.  Once you start taking hormones after puberty blockers, your body undergoes changes that cannot be reversed. This makes medical decisions especially important. Sadly, this article is not useful in helping parents make them.

I will add one reader’s comment from the roughly 50 comments responding to Singal’s piece. I think it’s unfair in accusing Singal of  “naïve optimism”; he’s simply giving a data-based critique of the magazine’s article. I have no idea if he’s followed the magazine’s wokeism, but I do think reader “Apunaja” is correct in saying that the Sci Am article reflects its ideological agenda, which appears to be aligned with that of extreme gender activism.

43 thoughts on “Jesse Singal critiques a new Scientific American article on puberty blockers, calls the piece “potentially harmful” and “negligent science journalism”

  1. What’s the betting that Laura Helmuth reads Singal’s article, and thinks: “In the interests of truth and open discussion I must commission him to write a rebuttal article, after all, we are a science journal”?

  2. I appreciate this post – lots of work to make ideas clear.

    I add my new thought here :

    I think a peculiar aspect of this general topic is perhaps obvious to point out, but as Hitch said, never ignore the obvious :

    The ages discussed rarely Include adults who, at advanced ages (e.g. not adolescent, so post-gender dysphoria), suddenly decide to change their sex or gender – as if it is like changing out the seasonal decorations.

    The material I gather is predominantly regarding adolescents. Yes, that might be bias, but if changing sex or gender is so important and unlimited in benefits, I’d expect to see it showing up on the covers of magazines in the checkout aisle in the grocery store, akin to homeopathic remedies.

    1. “The ages discussed rarely Include adults who, at advanced ages (e.g. not adolescent, so post-gender dysphoria), suddenly decide to change their sex or gender – as if it is like changing out the seasonal decorations.”

      You apparently care about this. But why? Have they ever done anything to you? Or, perhaps, you may conclude that it is none of your business that some people as adults come out as transgender with the hope that it may makes their lives a little bit happier despite the fact that just as gay people, they will be subject to abuse by those that find it intolerable that there are those in society that do not conform to the so-called norm.

      1. Counting how many mature adults transition (now that society generally accepts that) is very relevant to ascertaining how much gender-dysphoria in adolescents is due to social factors and how much of it would resolve itself with time. And that is very relevant to the issue of whether we should medicalise gender-dysphoric adolescents.

      2. “You apparently care about this. ”

        So do you – you read this whole article as well.

        “But why?”

        Why not?

        “Have they ever done anything to you? ”

        No. Nor have I to them.

        So what, precisely does that have to do with knowing all the facts about human biology? And how and sex, gender develop over any given age range?

      3. Some time ago, I had a quarrel with a friend after I had opined that trans women should not compete in women’s sport, be housed in women’s prisons or get jobs in women’s refuges. I was taken aback by the ferocity of my friend’s reaction; and I noticed that he kept returning, aggressively, to the question ‘Why do you care about this, anyway?’

        I thought then and I think now that this is a strange and irrelevant question. Perhaps I don’t care all that much, just enough to have an opinion. Perhaps I care a lot because I want to protect women’s hard-won rights. Perhaps I think that’s why I care, but my view is motivated by unconscious transphobia. Perhaps I am a transphobe and I know it and I’m pretending not to be. What of it? Whatever my motives (which, like most motives, may well be mixed and partly unknown to me) the arguments I advance are what need to be answered – aren’t they?

        Since then I’ve heard and read this riposte (‘Why do *you* care?’) a lot. It seems to be part of an armoury of set responses to counter gender- critical views. But I do not think it’s actually an argument.

        My friend later apologised for getting so hostile about it. But an unfortunate side-effect of this ad hominem response is that I have not felt like broaching the topic with him ever again. (Maybe that’s the point of it?)

        1. That’s pretty thoughtful on your part. One should care to protect the rights and safety of biological women. Or at least to want to keep an open discussion on it.

          1. Yes. If someone posted against FGM, and a Islamic scholar responded with an aggressive “why do you care?”, suggesting that it is irrelevant to non-Muslim non-girls, wouldn’t we think he was being a tad defensive?

          2. This “curiosity” about adult transgender people is a redux of the right-wing propaganda against gay people: let’s learn about their biology, they are predators, they are abnormal, they will attack biological women in prisons, they are “groomers” and people feel uncomfortable around them. The attack on gay people served the right wing for many years until it didn’t. Now the right wing hopes to make political capital attacking transgenders. The overwhelming number of transgender people simply want to live their lives without being harassed. Yes, you can find exceptions where transgender people do bad things, but I hardly detect a similar concern about male rapists. Yes, I think transgender women should not participate in women’s sports. But, in most cases, “why do you care” is a valid question. Leave adult transgender people alone!

            1. The right wing hopes to make political capital by catching a heavy bipartisan issue the left wing threw right at them. The argument that gay people are perversions of nature does not resemble the argument that male people are men.

            2. Historian, the idea that trans rights concern only trans people is false.
              If you don’t understand why that is so, I recommend these articles:
              Eliza Mondegreen: The falsehood at the heart of the trans movement. Oct 21, 2022

              So why do civil liberties violations and calls for further clampdowns follow trans activism wherever it goes?
              The short answer is that the trans movement threatens civil liberties because the movement is not what it claims to be and thus is threatened by free and open enquiry. If a movement cannot withstand scrutiny, it will create and enforce taboos—and undermine civil liberties in the process. One of the trans movement’s central claims is that there is no conflict between its claims and demands and the rights of any other group. Stonewall, a leading trans rights organisation in the United Kingdom, states upfront that ‘we do not and will not acknowledge a conflict between trans rights and “sex based women’s rights”.’ Merely ‘claiming [that] there is a conflict between trans people’s human rights and those of any other group’—such as women, children, religious minorities, or lesbian and gay people—is defined as transphobic hate speech that governments and private corporations alike should censor.
              Unfortunately—for the trans movement and the rest of us—the conflict exists, whether we are free to acknowledge it or not.

              Julie Bindel: It’s dangerous to conflate the gay and trans rights struggles. The Telegraph, Jan 20, 2023
              Far from being a repeat of the fight to repeal Section 28, the activists’ demands actually reduce the rights of gays and lesbians

              Meghan Murphy: Christina Ellingsen is facing prison time for saying that men can’t be women

              1. You are confusing whatever a particular organization of unknown strength is advocating and the mass of people that may be similar to the members of the organization in certain ways. In other words, there is no evidence that the mass of transgendered people share the political goals of the organization you have referenced. This is like calling everyone on the left of the political spectrum as communists because people on the left may share a few of the goals of communists. To reiterate my basic point: transgendered people do not want to be discriminated for a life choice they have made. Let them live their lives in peace without having to suffer torment from radical rightists that are trying to use them for their own ends.

                On this I have no doubt: the right wing’s goal is to create moral panic amongst the citizenry. Attacks on gay people have fizzled out; transgendered people make the next convenient target. The right wing’s claim that the tiny minority of transgendered people somehow represents a dire threat to western civilization because their goal is to create a Marxist state is truly laughable. But, we’ll see how many people fall for the con job.

            3. Again, the idea that trans rights concern only trans people is false. What do radical trans activists (like, e.g., the ACLU’s Chase Strangio) want? Two things:
              1. A self-ID law. Anybody should have the right to self-identify as woman or man, whether they are male or female – with no questions asked, and with no preconditions. In other words, trans women are women in every respect, and should have access to all traditionally-women-only spaces (prisons, rape shelters, women’s sports, etc.).

              This, of course, would amount to the erasure of biological sex from public life.

              2. A law that criminalizes calling trans women biological males, and criminalizes statements like “You can’t change your sex.”
              Here I recommend that familiarize yourself with the Maya Forstater case in the UK and the Amy Hamm case in Canada.

              Gender-critical views are a protected belief, appeal tribunal rules

              Nurse May Lose License for Believing in Biological Sex, with Amy Hamm (interviewed by Megyn Kelly). Feb 3, 2023, 14 mins

              Eva Kurilova: A Canadian Nurse Understood Biology… Now She Risks Losing Her License. Jan 18, 2023

              And there are other cases like this.

              Radical trans activists fight for a radical remake of our culture. You don’t have to be a religious conservative to think that this concerns you.

            4. I didn’t think that being a woman concerned about men in woman only spaces automatically made you right wing. That’s super silly really.

              Women know that a very small subset of men are predatory and or violent and the only way to ensure our safety and privacy is to ban ALL men. The nasty ones are not always obvious so the best outcome for women is a universal exclusion.

              Thanks for supporting women

              1. You are describing the utopia of Saudi Arabia, whose social system should be adopted everywhere. There women have no fear of predatory and violent men except perhaps for close relatives. I did not know that women support universal exclusion of men. Thanks for supporting women.

              2. Historian, should we take it that you believe bathrooms, locker rooms, rape shelters, prisons, and all other spaces should be open to all genders? Because the logical conclusion of your non sequitur about Saudi Arabia suggests exactly that: that any sex segregation is tantamount to the Saudi Arabian system.

                As soon as it’s pointed out that you paint your ideological opponents with the broad brush you accuse others of, you resort to non sequitur attacks. Not a great look, especially when the logical conclusion of your non sequitur is so blatantly absurd.

                And regardless, women have even more to fear in SA, as they are predated on by men even more often, and authorities don’t even bother taking it seriously. But I think you knew that.

        2. I care because of long fought for women’s rights and a concern on how science is being ignored for ideology. I had a mother, I have four sisters, a wife, a daughter, a daughter in law, a grand daughter, that is enough reason for me.

      4. I care about this because the transwomen I know who came out in midlife made a mess out of the lives of their wives and children by doing so.

        1. People screw up their lives and families for a multitude of reasons. So, based on your anecdote, what would you have done? Forcibly prevented the person from transitioning because there was a chance other people could have been hurt? What about the millions of families screwed up because a member is an alcoholic? Hey, I know the solution – let’s bring back Prohibition.

          1. I’m not advocating forcible anything. I agree with you alcoholism is bad too. You’re obviously a smart well-informed person, and your comments here are often useful. I don’t even disagree with your general live-and-let-live point here. But this kind of whataboutery seems beneath you.

    2. An edit : “unlimited in benefits”

      I meant more to draw a parallel with homeopathy, inconsequential – or “mostly harmless”.

    3. What sets off an alarm in your comment is to say that an adult chooses to transition like “changing out the seasonal decorations.” Many of us have sympathy for people who suffer from gender dysphoria. I have read their stories. It is disparaging and dismissive, and absolutely false, to describe their path in that manner.
      I am concerned about child and adolescent treatment in the US and the extremists pushing for transwomen to compete in sports against women. I am very much in favor of human rights and civil rights for transgendered folks. I would not participate in this forum if I did not believe our host held compassionate views towards transgendered people.

      1. I do not understand the scolding directed at me.

        My reading of the posts here especially about Tavistock or other news, and especially (outside this site) Shrier’s book, suggest to me that changing the sex or gender is not a trivial matter, and not for everyone, but has a place in society.

        That’s pretty much the opposite of the expression I used “changing the seasonal decorations”. I could have said “on a whim”, or something like that.

        1. Glad to see that I misinterpreted your comment. Surely you can read how it came across as dismissive. Glad to know that it was a matter of wordsmithing. I too have been pig piled due to what I assumed was misunderstanding. Not a joy.

    4. May I emphasize in this comment, I wrote “as if”.

      “As if” here means that no, changing sex or gender is NOT a trivial lifestyle choice as other things where you try them for a while and see how you like it – so it demands serious attention.

      Perhaps I could have done more proof-reading.

      But my point is I am not getting enough material about adults in this phenomenon, which seems to me would be important for understanding it.

      1. I think ThyroidPlanet’s interest in adult transitioners is perceptive and perfectly justified in the public interest. Truth is always important but further:

        The practice of medicine is self-regulated as a privilege granted by the state as long as such self-regulation serves the public interest. Medical decisions made jointly by a doctor and an adult patient with capacity to consent are never entirely private matters. Doctors cannot do just anything the patient wants. The standard of care, which changes from time to time and place to place and is largely determined by doctors must always be met. Is it appropriate to remove healthy breasts or give hormones that will irreversibly alter appearance? What good is that doing? The legal system decides if the standard was met in a specific disputed case and if a judge thinks the standard being adduced doesn’t adequately protect the public, she can write her own standard.

        Often the issue in malpractice cases and regulatory complaints is that,the patient alleges s/he was misled about the likely benefits of the treatment and would not have consented had s/he been better informed…by the doctor. (Not by the Internet). In other cases, evidence starts to accumulate that a treatment is not beneficial for purposes claimed and doctors should be more selective or stop doing it altogether. It seems to take forever but useless and harmful treatments do eventually go out of fashion. And let’s not forget that doctors earn money from doing all this while working with asymmetrical information.

        What I think TP is asking is, “Is there evidence that this process of evaluation, so necessary for the public interest, is occurring in gender affirmation in adults? This is an important, valid question even if patients were paying the cost out of their own pockets…which of course they often aren’t.

        We’ve got a couple of cases going in Canada so I don’t want to make any specific comments.

  3. ” But why on earth would they assign something like this to an intern?” Maybe they couldn’t find even an academic sociologist, let alone a licensed physician, to write a piece that follows the “affirmative care” party line. Developments in Norway, Finland, the UK, and the Netherlands show that medical establishments can pay attention to empirical data—why, that might even be starting to happen in the US.

  4. An excellent and detailed piece from Singal as always. One of the SciAm claims that he didn’t mention was that:

    Teens who had access to puberty blockers and hormone therapy require fewer gender-affirming surgeries as adults.

    My understanding is that males who have puberty blockers and then undergo genital surgery lack sufficient penile material and the alternative procedure that has to be used, using transplants from either the colon or small bowel, causes complications and repeated further corrective surgery in a high percentage of cases.

    According to UCSF Transgender Care:

    This technique has the advantages of diminished need for dilation, greater depth and is naturally self-lubricating. However, this approach requires abdominal surgery with a risk of serious or even life-threatening complications. The primary indication for an intestinal approach is the revision of prior penile-inversion vaginoplasties. Since the secretion is digestive there is a risk of malodor and frequent secretions, and secretions are constant rather than only with arousal. Wearing panty liners or pads may be necessary for the long term. Bacterial overgrowth (diversion colitis) is common and may present with a greenish discharge, treatment includes [sic – end of sentence missing in original] . The bowel lining is also not as durable as skin. Use of intestinal tissue also places the vagina at risk of diseases of the bowel including inflammatory bowel disease, arterio-venous malformations (AVM) or neoplasms; screening or diagnostic evaluations for these conditions should be performed as indicated.

  5. Scientific American is circling the drain. It’s a huge loss to all who are interested in science. It is journalistic malpractice to publish articles that are so uncritically vetted, if they are vetted at all. One can only hope that Singal’s and others’ criticisms reach medical providers and vulnerable teens in time.

  6. The operative question to the postmodernish activist is not “Is this article true?” but is, instead, “Is this article useful?”. The activist does not care about those of us who still operate within the “truth” paradigm. He need not convince us of his nonsense; he will browbeat us into submission. He seeks to “persuade” through a combination of coercion and sheer repetition, counting on the kindness, laziness, fear, tribalism, or ignorance of those around him. It is important and exhausting work to not cede the field to such activists; for whatever else they are, they are indefatigable. And they are increasingly everywhere.

    I have reached the point at which there is hardly a mainstream publication anymore that I can read and feel that I can put my guard down, confident that the author is knowledgeable and is not trying to exploit my lack of knowledge on a particular issue. As we lose truth, we also lose trust.

    1. Thanks, Chip. Yes, EPATH sounds dangerously unwilling to examine the data. As Mondegreen says:

      I keep turning over Motmans’ words: “We respect everyone’s freedom of speech, but we choose not to listen to it.”

      This is a remarkable admission for the president of a professional association, especially when you consider that the speech Motmans and EPATH are “choos[ing] not to listen to” includes mounting evidence of medical harm and regret. The accusations EPATH chooses not to listen to are serious and cut directly at the organization’s stated aims: “To promote mental, physical and social health of transgender people in Europe. To increase the quality of life among transgender people in Europe. To ensure transgender people’s rights for healthy development and well-being.”

      A remarkable admission indeed!

  7. Question for doctors in the house: is there any other condition for which a patient’s word is supposed to immediately be taken as a proper diagnosis, rather than the doctor evaluating the patient and making a diagnosis based on that evaluation?

      1. Haha fair enough. I meant psychological conditions that would normally involve going through a list of symptoms and seeing if the patient meets the criteria of a certain number, and/or physical conditions that require a good diagnostician.

    1. Well, no, in principle. There is always a history to be taken and a differential diagnosis to be considered, which must be provisional. The correct diagnosis may declare itself only with follow-up or as new information is available. (Viagra isn’t all you do for impotence and Viagra can be dangerous for some men with bad hearts.). I’m not saying this thinking isn’t done in patients who come in having already decided they want cross-sex hormones. I just don’t know how many people get talked out of it when the long-term permanent effects are discussed. If the patient is told, “Relax. You’re not a woman. You’re just gay,” he will never be counted as a transitioner. Do these patients who had a careful evaluation account for 1%, 30%, 90% of people who come in thinking they might be trans? Dunno. No one seems to want to talk about this. Neither the Canadian Paediatrics Society nor the Canadian Society for Endocrinogy and Reproduction have any published standards or guidelines for cross-sex care on their websites when I checked just now, nor does the Ontario self-regulator, other than the general expectations for diagnosis in all patients.

      Complicating this in Canada is that the foolish 2021 law banning “conversion therapy” (trying to straighten out gay people) also makes it illegal to try to talk people into being comfortable in the body they were born with. So the longer the doc spends trying to figure out if the patient is really trans before giving him the hormones he wants, the more likely he is to call the cops. Not giving people what they want can be hazardous.

        1. I feel like we would all have a lot of fun getting some beers together. Leslie has both a good sense of humor and a wide breadth of knowledge, as do you. I at least have a good sense of humor…I think. My knowledge is even more questionable.

        2. I think I knew you were joking, Doug. If we’d been talking in person I still would have given a nod to it rather than just dismissing you. And then you would have told me you were joking. D’oh!

  8. Here’s an interesting insider account from someone who benefited from the Dutch protocol. She also has a few things to say about what she sees as the ‘politicisation’ of the issue.

    “In my view, the ignorance that reigned until just five years ago has given way to something else: an obsession with transgenderism. And that does not always work in favor of those who actually suffer from gender dysphoria.”
    (Put the text in Google Translate.)

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