Jesse Singal’s op-ed in the NYT: A turning point in “affirmative care”?

For two reasons I think that Jesse Singal‘s long op-ed (really a “guest essay”) in today’s NYT will mark a turning point in public and professional attitudes towards “affirmative care.”  First, the NYT saw fit to publish a piece showing that many American medical associations have promoted “affirmative care” of gender-dysphoric adolescents, despite those associations knowing that there was little or no evidence for the efficacy of such care.  Indeed, it seems that some of those associations lied or dissimulated about it, all in the interest of pushing a “progressive” ideology. As we know, left-wing “progressives” have been in favor of immediately accepting a child’s self-identification as belonging to its non-natal gender, so that teachers, parents, therapists, and doctors have united to start such children on puberty blockers and, later, surgery and hormones.

The NYT, while it has published pieces questioning the evidence for affirmative care, has been reluctant to come out as strongly as Singal does in the essay. That America’s Paper of Record deems this worthy of publication is news in itself.

For a number of reasons, most concerned with recent evidence (e.g., the Cass Review), the rah-rah affirmative therapy treadmill is grinding to a halt.  As Singal relates, recently two American medical associations—the American Society of Plastic Surgeons (ASPS) and now the powerful American Medical Association (AMA)—have admitted that we don’t know whether a gender-dyphoric child will “resolve” as gay or non-trans without medical intervention, and also that there should be no surgical intervention aimed at altering the gender of minors.

Singal has long called attention to these problems, and for his troubles he’s been branded a “transphobe,” shunned and blocked on social media.  There was even a petition to ban him from the site Bluesky, though, thank Ceiling Cat, it didn’t work.  Now, at long last, his views are getting a respectful airing, and society is coming to realize that the American zeal for “affirmative care”—not shared so much in Europe—is not only misguided but harmful.

The second reason is that the author ID says this about Singal:

Jesse Singal is writing a book about the debate over youth gender medicine in the United States and writes the newsletter Singal-Minded.

Although he’s already written one book. The Quick Fix: Why Fad Psychology Can’t Cure Our Social Ills, this is his first book on gender medicine, and if it expands on the theme of this article, it will be a landmark work with the potential to create big changes in gender medicine and how we view it.  Yes, it’s true that gender ideologues will oppose the article and upcoming book, but they have long put ideology over science, a strategy that is a loser, as we know from the failures of creationism and intelligent design.

Click on the headlines to read the article at the NYT, or find it archived for free at this site.

A few excerpts:

It didn’t matter that the number of kids showing up at gender clinics had soared and that they were more likely to have complex mental health conditions than those who had come to clinics in years earlier, complicating diagnosis. Advocates and health care organizations just dug in. As a billboard truck used by the L.G.B.T.Q. advocacy group GLAAD proclaimed in 2023, “The science is settled.” The Human Rights Campaign says on its website that “the safety and efficacy of gender-affirming care for transgender and nonbinary youth and adults is clear.” Elsewhere, these and other groups, like the American Civil Liberties Union, referred to these treatme

. . .The science doesn’t seem so settled after all, and it’s important to understand what happened here. The approach of left-of-center Americans and our institutions — to assume that when a scientific organization releases a policy statement on a hot-button issue, that the policy statement must be accurate — is a deeply naïve understanding of science, human nature and politics, and how they intersect.

At a time when more and more Americans are turning away from expert authority in favor of YouTube quacks and their ilk — and when our own government is pushing scientifically baseless policies on childhood vaccination and climate change — it’s vital that the organizations that represent mainstream science be open, honest and transparent about politically charged issues. If they aren’t, there’s simply no good reason to trust them.

And then Singal documents how organizations representing mainstream science and medicine haven’t been so trustworthy. The American Academy of Pediatrics (AAP) has been particularly  vocal—and clueless—in relentlessly pushing affirmative care:

A 2018 policy statement by the American Academy of Pediatrics provides a useful example of how these documents can go wrong. At one point, it argues that children who say they are trans “know their gender as clearly and as consistently as their developmentally equivalent peers,” an extreme exaggeration of what we know about this population. (A single study is cited.) The document also criticizes the “outdated approach in which a child’s gender-diverse assertions are held as ‘possibly true’ until an arbitrary age” — the A.A.P. was instructing clinicians to take 4- and 5-year-olds’ claims about their gender identities as certainly true. It’s understandable why the Cass reviewers scored this policy statement so abysmally, giving it 12 out of 100 possible points on “rigor of development” and six out of 100 on “applicability.”

Policy statements like this one can reflect the complex and opaque internal politics of an organization, rather than dispassionate scientific analysis. The journalist Aaron Sibarium’s reporting strongly suggests that a small group of A.A.P. members, many of whom were themselves youth gender medicine providers, played a disproportionate role in developing these guidelines.

Dr. Julia Mason, a 30-year member of the organization, wrote in The Wall Street Journal, with the Manhattan Institute’s Leor Sapir, that the A.A.P. deferred to activist-clinicians and stonewalled the critics’ demands for a more rigorous approach. Dr. Sarah Palmer, an Indiana-based pediatrician, told me she recently left the A.A.P. after nearly 30 years because of this issue. “I’ve tried to engage and be a member and pay that huge fee every year,” she said. “They just stopped answering any questions.” This is unfortunate given that, as critics have noted, in many cases the A.A.P. document’s footnotes don’t even support the claims being made in the text.

In the face of a lack of studies supporting their preferred ideology, organizations like the American Psychological Association (APA) have waffled, weaseled, and dissimulated, sometimes making contradictory statements.  Here’s one example (the AMA has also changed its stand but wouldn’t give Singal an interview). Bolding is mine:

The A.P.A. presents a particularly striking case of why transparency is important. In 2024 it published what it hailed as a “groundbreaking policy supporting transgender, gender diverse, nonbinary individuals” that was specifically geared at fighting “misinformation” on that subject. But when I reached out to the group this month, it pointed me to a different document, a letter written by the group’s chief advocacy officer, Katherine McGuire, in September in response to a Federal Trade Commission request for comment on youth gender medicine.

The documents, separated by about a year and a half (and, perhaps as significantly, one presidential election), straightforwardly contradict each other. The A.P.A. in 2024 argued that there is a “comprehensive body of psychological and medical research supporting the positive impact of gender-affirming treatments” for individuals “across the life span.” But in 2025, the group argued that “psychologists do not make broad claims about treatment effectiveness.”

In 2024 the A.P.A. criticized those “mischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence.” In 2025 it cautioned that gender dysphoria diagnoses could be the result of “trauma-related presentations” rather than a trans identity and that “co-occurring mental health or neurodevelopmental conditions (e.g., depression, anxiety, autism spectrum disorder) … may complicate or be mistaken for gender dysphoria.” It seems undeniable that the 2025 A.P.A. published what the 2024 A.P. A. considered to be “misinformation.” (“The 2024 policy statement and the 2025 F.T.C. letter are consistent,” said Ms. McGuire in an email, and “both documents reflect A.P.A.’s consistent commitment to evidence-based psychological care.”)

Behavior like this should anger anyone wedded to evidence-based medicine and science, especially because the APA simply lies when it says that its stand has been consistent all along. And the APA is not alone in its bad behavior.  Other organizations are digging in their heels, maintaining unsupportable positions in the face of counterevidence—all because of the ideology that people can change sex and we should believe them when they say they are really of a different sex than their natal one. This is wedded to the view that surgery and hormones designed to change gender have been proven to be safe.

I should add here that many adults who have transitioned are nevertheless happy with the outcomes of their treatments. But note that Singal’s forthcoming book is about youth gender medicine. This is the focus of the controversy, and few people (certainly not me) would deny adults the right to go ahead with surgery and hormones, though perhaps the public shouldn’t have to pay for it.

Singal’s conclusion, which I hope is the theme of his book, is short and sweet:

Should we trust the science? Sure, in theory — but only when the science in question has earned our trust through transparency and rigor.

  It looks like most medical organizations should not be trusted until they start speaking the truth.