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.
It’s heartening to see the media from the left giving space for these arguments. Helen Lewis’ article on Atlantic, NYT’s podcast series The Protocol, Some good reporting from Azeen Ghorayshi and now Singal’s piece – All good signs… and of course, they make the “progressives” mad about the center-left media. The silencing of healthy skepticism is what led to this mess. It was APA’s unscientific BS arguments that made me first notice this mess. In my opinion, APA has done significant harm to many minors and, in general, regarding people’s trust in public health and science.
I expect the lawsuits by detransitioners and the lawsuits involving major medical organizations such as the World Professional Association for Transgender Health (WPATH), the American Academy of Pediatrics (AAP), and the Endocrine Society are going to shed more light on the horrific medical malpractice involving these young victims. This social contagion has run its course, but the damaging societal effects will persist for many years.
I would add that those effects will be lifelong for many who have transitioned. Imagine, if we as a society come to our collective senses, how they will feel. No longer admired and praised for being “stunning and brave,” they will run the risk of being thought of as foolish freaks, and perhaps the best they can hope for is pity. This may ruin their lives more than the physical and sexual disabilities inflicted upon them.
One reason that I won’t hold my breath about things changing too too much, at least in the short term, is because, even when faced with facts that a person (or even more so, a self-reinforcing group) knows to be true, changing course requires that person to say three simple but extremely difficult words: “I was wrong.” We saw this vividly with people swearing up and down that President Biden’s cognition was A-OK right up the end, and we see this with the MAGA crowd refusing to see Trumps own present journey down that same road. Saying “I was wrong” means (1) “you were right”, and oftentimes people would rather see their opposition fail than see their own side benefit from a u-turn; (2) it means “I’ve been wasting my time, energy, and money this whole time”, and (3) it says “maybe you can’t trust me next time”. Doubling down prevents these horrors, at least for a while.
This is EXACTLY the subject of today’s Jesus and Mo cartoon, coming up in the next post. But I am more optimistic than you given that two important societies have changed their stand in the last few months.
“Singal has […] been branded a “transphobe,” shunned and blocked on social media. There was even a petition to ban him from the site Bluesky.”
Like you, I am optimistic that things will change eventually, but I agree with Jon that it’s very hard for people to admit “I was wrong”, and I think they won’t ever admit they were wrong. They will just lie.
In a few years, when the real facts come out, everyone who called Singal names or tried to ban him will deny they did that and announce that they have always supported him. We are already seeing people like that crawl out of the woodwork.
I couldn’t have said it better, Jon. My thoughts on this, too. Thanks.
Yes to all. And, in the case of medical organizations that recognize that, by being wrong, they helped change, beyond medical repair, the futures of some of their still unhappy patients and their detransitioning patients, the desire to hide from this truth must be exceptionally strong. Plus, being wrong may come with significant monetary consequences for some of their members, a sobering reality to contemplate.
I agree that the fact that the NYT published this is very important. I wonder if there will be any backlash from its employees?
“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.”
It’s bad enough that this claim is not true. Perhaps as bad is how claims like this corrode public confidence in evidence-based medicine and other areas of science. Do folks remember this astonishing performance by the godfather of evidence-based medicine Gordon Guyatt?
“I would never use the term ‘medically necessary'” [to describe medicalization of gender dysphoria in children]
Signs a letter calling such treatment “medically necessary.”
https://x.com/_CryMiaRiver/status/1965153846868824477
The publisher must have thought “.. Fad Psychology ..” is a comfortable idea for the reader. Gives the practice a whimsical silliness, as if it came from nowhere.
Tracing back to the centuries-old Gnostic cult religious alchemy of gender is unsettling, and too much to expect :
Gender in Mystical and Occult Thought – Behmenism and its Development in England
Brian J. Gibbons
Cambridge University Press
1996
Some copies printed with this 18th century engraving :
https://www.gettyimages.com/detail/news-photo/albert-the-great-indicates-a-symbolic-hermaphrodite-who-news-photo/559575049
The amount of federal and state money spent on “gender-affirming healthcare” for minors is absolutely staggering: https://x.com/benryanwriter/status/2026385681606430784
Good information. Are you aware of a similar compilation of spending by private insurance companies?
My hope is that soon insurance companies will stop paying for these procedures (for both adults and children)?
I’m sure they’d love to. But for now, setting premiums high enough to cover it increases their gross receipts, giving them more money to invest until it is time to pay out the claims so they’re happy to go with the flow. It’s not what it costs, it’s what it makes, as Warren Beatty’s character the tuna company CEO said in Heaven Can Wait. (Not what you think. He was a good guy.)
Gender-affirming healthcare is a goose that lays golden eggs. That is why so many “activists” vehemently oppose any legal restrictions and criticism. It is pure opportunism; they do not want to lose their income.
Wow! I just read that tweet. Call me naive, I had no idea Medicaid would cover that stuff. I’m very curious if it was funnelled through mental health. Brainwashed parents certain their kids would commit suicide if they couldn’t transition. Damn.
There has been little notice of the Russian branch of fad psychology. This is Vladimir Vladimirovich Putin’s discovery that all Ukrainians were born in the wrong body—the body they should have been born in being Russian. My own group, the World Political Association for Trans-Russians, asserts that Vladimir Vladimirovich’s Special Military Operation to correct the anomaly should really be labelled “Affirmative Care a la Russe”.
Reminds me of the core Islamic belief that everyone is born Muslim. In that context the “affirmative care” includes threats of beheading if one refuses to “revert” to their “true self”.
I know you’re being facetious (or at least I think you are), but I had a gay friend (male) who wholeheartedly believed that all humans are either gay or bisexual. His theory was that well-mannered society had shut us down and cut us off from our true desires.
As a 100% heterosexual male, let me assure you that your friend’s assertion is utterly false, and perhaps reflects wishful thinking. Not that there’s anything wrong with that! (Seinfeld reference)
That’s pretty much what I said to him, “You wish!”
I admire Singal’s essay. I hope his book will go where the essay stops short, and address the fact that none of the claims about gender or transgenderism are true. Humans don’t have a gendered soul and can’t be born in the wrong body, humans can’t change sex, a male who says he “feels like a woman” has no idea what that feels like because he’s not female, and no amount of medicalization of his feelings can make him female.
Singal’s writing – including in this essay – has an excellent clear focus on the evidence supporting the medicalization of such feelings in children (or its absence). But his writing is also suffused with the idea that there is objective evidence that some true “trans” people benefit from medicalization (not just subjective self-reported claims to be “happy with the outcomes of their treatments”).
I used to share that idea, but the more I read about “trans” people the less confident I am that it’s true, and the more likely it seems that the whole “trans” phenomenon is a terrible mix of the consequences of sexual fetishes, homophobia, misogyny, and mental illness, all facilitated by social media, smart phones, and the breakdown of trust in institutions and experts.
And the danger of conceding that this might be true is that one would be looking at happy “survivors” of a dangerous treatment as evidence that the treatment was beneficial, and that the doctors were able to artfully predict before starting treatment that the happy survivor we now see in front of us was one of the ones who would benefit. For all we (and he) knows, he did OK despite the treatment, not because of it.
I agree with most of that, but not the bit about a breakdown of trust in experts. As PCCE’s post points out, the medical establishment lined up in support of youth gender medicine despite the lack of evidence. “Experts” were precisely the problem – the call was coming from inside the house.
NYTimes has begun a careful climb-down from its former stance as largely being a stenographer, not always but usually, for trans movement.
I think there are two factors that are bringing about a change. The first is the emerging crack in the “consensus.” The second—which might be the more impactful—is lawsuits. When lawsuits threaten loss of income, loss of career, and even loss of freedom, one’s attention becomes focused. This fad is mercifully coming to an end.
Years ago, when I first heard the phrase “evidence-based medicine,” I was a bit puzzled. My maternal grandfather was a physician, and I had always regarded medicine as an offshoot of science. Of course it was evidence based, so why did we need a term that seemed redundant. Well, it wasn’t redundant. Lots of medicine is tradition based, not evidence based and some, it seems, is even prejudice based—“affirmative care” being an excellent example.
The UK PATHWAYS Trial investigating the benefits of immediate vs. delayed puberty blockers has been paused, as of last week:
https://www.gov.uk/government/news/pathways-clinical-trial-paused-following-new-mhra-advice
Says the Dept. of Health and Social Care:
It’s astonishing that the concerns raised by the Medicines and Healthcare products Regulatory Agency (MHRA) hadn’t already been addressed BEFORE the trial got approval. There is also a law case pending brought by therapist and campaigner James Esses (spokesman for Thoughtful Therapists) and detransitioner Keira Bell seeking a judicial review of the decision to approve the PATHWAYS study. I can’t see the trial going ahead, thankfully.
My thoughts exactly and I’m gratified to hear a British person say it first.
Leor Sapir, who is mentioned in Singal’s opinion piece, makes a good point about the NYT’s coverage of sex/gender: https://x.com/LeorSapir/status/2026296433901465872
My greatest concern about public health right now is the decrease in people getting their children (and themselves) vaccinated. The ideological basis of the AAP’s gender affirmation for children undermines their authority on any topic, including vaccines. This adds to the dangerous anti-science wave we are experiencing in the US. I assume they will not make a statement such as “upon further investigation into the data, we are changing our position. Our commitment is to the health of children…” because they wish to avoid lawsuits. I would like to think that these organizations will take a good look at their failures and change their processes. Otherwise, they make a good argument for those people listening to charlatans and claiming they are just “doing my own research”.
During the pandemic, I encountered several antivaxxers (against vaccines in general, not only those against COVID vaccines). When confronted with facts about the safety and efficacy of vaccines, a great many dismissed the studies that supported these facts with the response “I have done my own research”. The ignorance and stupidity of such people was easily shown when, in response to their claims of “doing my own research” are met with simple questions such as:
“So what is the difference between the T cells and the B cells in response to vaccination?”
Of course, most of these yo-yos wouldn’t know a T cell from a toad, or a B cell from a bowling ball, much less understand their different roles in the immune system or their responses to vaccination. While exceptions to this ignorance doubtless exist, my experience is that anyone who develops their opinions on medical/scientific issues by “doing my own research” (as opposed to actual critical reading of the medical/scientific literature) may as well wear a pin stating:
“Proud Ignoramus—
Knowledge is not necessary for opinion”
Perhaps there is nothing quite like a successful multimillion dollar lawsuit judgment to concentrate one’s thinking.
On the other hand, I suspect quite a few organizations will simply play a more sophisticated form of defense against a currently hostile federal Administration until their team can go back on offense from the White House and Congress. And I predict that will be the case on an array of “progressive” causes: gender, DEI, free speech, among others.
Why the skepticism? Because deeply-contested notions such as “gender identity” arose from ideological convictions, beg for evidence, and still capture the progressive (and liberal) imagination. Because an ethics of “harm” avoidance permeates left-wing politics and habitually overrides other legitimate concerns such as reason, evidence, fairness, due process, and free speech. Because issues of identity and harm avoidance pass through the funnel of oppressor/oppressed distinctions. Because of the conviction that “moderation” in the pursuit of power is no vice, but moderation once one has power is.
And because I trust nobody who cannot sincerely utter the phrases “I am sorry” and “I was wrong.”
As I understand it, Jessie Singal is being absolutely flayed over on BlueSky. Of course, people there have made death threats against him before. I don’t speak with first-hand knowledge, as you couldn’t pay me to go on BlueSky.
At the end of the day (Wednesday) only 712 comments on that NYT piece and comments are now closed. But many thousands of likes (“Recommended”), and the top recommended comments are all like this one (#4 at >1500 likes),
“My daughter told me she was a boy in Nov 2020 when she was 13. Our family was put through a living hell bcs these medical associations all kept backing each other up and censoring common sense questioning. Let the world be on notice that we, the parents, aren’t forgetting that this happened and we will be holding accountable those who hurt our children and our families.”
Totally normal responses to Singal’s piece over on BlueSky: https://x.com/benryanwriter/status/2026658541612761594/photo/1
It’s unmanly for men to throw such catty, colourful hissy fits. What man, even a high-camp homosexual man, would ever come up with a curse that a man should have hot coffee poured over his testicles every day? Even the death threats have a kind of feminine implausibility attached to them. Maybe these guys really are women after all, just as they say.
I am inclined to agree. The fact that the NYT has published an Op-Ed by Jesse Singal is a real turning point. The public has opposed males in female sports and opposed mutilating minors for some time. Trump’s most effective ad stated “Kamala is for they/them, Trump is for you”. The NYT has presented both sides of this issue for some time. Indeed, in 2023 LGBTQ+ activists protested the NYT, using a billboard truck for daring to present both side of an issue. I typed a few keywords into Google are got
“What specific NYT articles about trans issues sparked GLAAD’s protest?”
“In February 2023, GLAAD and various organizations protested The New York Times over coverage they argued used biased language and pseudoscience regarding transgender issues. Specifically cited articles included Emily Bazelon’s “The Battle Over Gender Therapy,” Azeen Ghorayshi’s piece on gender-affirming care, Katie Baker’s report on school gender policies, and opinion pieces by Ross Douthat and Pamela Paul. For further details on the criticisms, visit GLAAD.”
For some reason, English speaking countries (the US, the UK, etc.) have typically been the worst offenders. I don’t know why.