“Progressives” appear to whitewash female genital mutilation

December 17, 2025 • 10:20 am

This is an example of how horrible cultural practices are excused—or made to seem less harmful—by “progressives” (read “the woke”) when they’re characteristic of minority groups. In this case the practice is one of the cruelest and most misogynistic forms of behavior around—female genital mutilation (FGM), especially in its most damaging form, infibulation (there are three forms of FGM; see below). I

This issue came to my mind when I saw this tweet:

The ‘decolonising’ of FGM continues apace

“we adopt the more neutral expression ‘female genital practices’ throughout this paper. This term allows us to refer inclusively and descriptively to a diverse set of practices without prejudging their ethical, medical or cultural…

— Róisín Michaux (@RoisinMichaux) December 13, 2025

Here’s the article in the Times of London referred to in the tweet; click to read.

And that led me to an essay in the Journal of Medical Ethics (below) highlighted in the above article.

The Times article above seems toi me a pretty accurate characterization of the Journal of Medical Ethics (JME) article, though a bit hyperbolic:

Laws that ban female genital mutilation (FGM) are harmful and “stigmatising” towards migrant communities, academics have claimed in a British Medical Journal publication.

The essay argues that criticism of FGM, which involves cutting or removing females’ genitals for non-medical reasons, is “sensationalist” and based on “racialised stereotypes”.

It draws an equivalence between FGM in Africa and a trend for cosmetic genital procedures in the UK and US whereby women undergo surgery to create a “designer vagina”.

The article was published in the BMJ’s Journal of Medical Ethics, and its 25 co-authors include academics at the University of Cambridge, the University of Bristol and Brighton and Sussex Medical School.

FGM has been illegal in the UK since 1985, but remains commonplace in areas of Africa, Asia and the Middle East, with the highest prevalence in Somalia.

It can cause severe pain, harm and long-term health problems, and organisations including the United Nations support bans and recognise it as a violation of women and girls’ human rights.

However, the article suggests that laws that ban FGM, including in the UK, are “causing harms to people” and can “objectify girls and women as passive victims”.

It says: “Laws against ‘FGM’ in Western countries have resulted in the marginalisation of migrant communities, reinforcing exclusionary practices and contributing to their social stigmatisation. While intended to protect, such legislation can serve as a tool of exclusion, deepening the divide between these communities and the broader society.”

The article claims that critics of FGM “ignore similar practices that have long been customary in powerful countries of the Global North”. It compares FGM to a rare type of cosmetic surgery called labiaplasty, which is offered by surgeons in Western nations.

Now if you read the original article below, you’ll see that though the authors admit here and there that female genital mutilation is harmful, their purpose is really to rename it, as “female genital modification as well as to reduce bigotry against cultures that practice FGM.

This authors argue that conflating FGM with other forms of genital surgery, such as that performed on transgender males or females in the “Global North” causes confusion and confused social policy. They also say it leads to discrimination against people who practice it in their native countries in the “Global South”, like Somalia, but after those people immigrate to the “Global North”. Yes, they do say FGM is harmful, but so are these other surgeries, including circumcision. But the article’s real result, I think, is to de-stigmatize the practice as a whole when the authors try reduce discrimination against cultures that practice FGM in their native lands.

A few quotes from the essay above:

One might also point to the tyranny of ‘types’ promulgated by the standard tale. Despite being the least common, infibulation (the sewing together of the outer labia, type 3) has come to stand for all forms of female genital practices in the popular imagination. Thus, communities that practise other forms, such as some Shia Muslims, who reportedly excise a small amount of skin from a girl’s prepuce, the so-called clitoral hood, as a religious duty and rite of inclusion, are immediately deemed ‘mutilators’.35 While some Shia and some Sunni Muslims argue that a notion of gender equality underlies the practice—in communities where both boys and girls undergo ritual circumcision—the use of the term ‘mutilation’ shuts down meaningful dialogue.

In contrast, boys who undergo circumcision, whether performed by so-called traditional operators or medically trained personnel, are rarely considered victims of mutilation, and the various forms of male genital practices—some as altering as infibulation—elude equivalent scrutiny.

. . . . Recent quantitative and qualitative research reveals that affected migrants who expect a permanent future in the Global North overwhelmingly opt to stop their cultural or religious female genital practices. Nevertheless, the belief persists that migrants are committed to preserving these traditions, and stories of ‘FGM’ practices after immigration abound in public discourse and news reporting, despite a lack of evidence, and indeed evidence to the contrary. Such misrepresentation and stereotyping fuel suspicion towards minority communities and families, resulting in harmful consequences for the girls and families involved.

, , ,We have written this critique to expand that conversation. Over the past four decades, great damage has been done to the process of rational policy formation by misleading and sensational media coverage of affected women from practising communities in the Global South. In concert with anti-FGM activist organisations, mainstream newspapers in North America, Europe and Australia have firmly fixed in the minds of their readers a typifying ‘dark continent’ ‘female genital mutilation’ image based on the atypical practice of infibulation, which should not be confused with the far more common forms of female genital practices that continue to prevail in many African and South-East Asian societies, and which are gaining in popularity among cosmetic surgeons and majority populations in North America and Europe (although never under the label ‘genital mutilation’—the expression ‘designer vagina’ is sometimes used).

Additionally, while reading the mainstream media coverage of ‘FGM’, one would never know that the custom does not selectively pick on women. Almost without exception, wherever there are female genital modifications, the local social norms regarding genital alteration are gender inclusive or gender equal and approvingly call for male genital modifications as well. Political patriarchy may have rather little to do with it.

Now FGM is illegal everywhere in the “Global North”, and this article says that the practice here is very rare. There are actually three main types of FGM as classified by WHO. All are harmful, and I list them below. First, though, is the practice really rare in the “Global North”? It’s very hard to find data as cases are, for obvious reasons, not often reported. I first consulted ChatGPT, whose data must of course be taken with a grain of salt. But it does give references, a few of which I’ve checked to see if they say what they’re alleged to say; the ones I’ve checked do. I also add below a link from Ayaan Hirsi Ali, who has founded an anti-FGM organization (she was a victim) and she gives statistics as well.

First, from the bot, when I asked it “how common is female genital mutilation in the West”?

Female genital mutilation/cutting (FGM/C) is much less common in Western countries than in the regions where the practice has traditionally been concentrated (mainly parts of Africa, the Middle East, and some countries in Asia), but it does occur in the West — largely within migrant and diaspora communities from countries where FGM is prevalent. World Health Organization+1

Here’s an overview of how common it is in the West:

📊 General Western Prevalence

Overall Western prevalence is low compared with high-prevalence countries in Africa or the Middle East. In most Western populations, FGM is very rare or nearly absent overall, and national prevalence rates are typically well below 2 % of the general female population. However, estimates can vary based on methods and data limitations. Political Islam Center

🇪🇺 Europe

At least ~600,000 women and girls residing in European countries are estimated to have undergone FGM, with an additional ~130,000–190,000 girls and women at risk in some European Union countries. FGM/C Research Initiative

The largest numbers of FGM survivors in Europe are found in the UK, France, Italy, Spain, Germany, the Netherlands, and Sweden. FGM/C Research Initiative

Because most European countries do not collect comprehensive health data on FGM, these figures are estimates drawn from community surveys, health systems data, and extrapolations. End FGM

🇺🇸 United States

Estimates suggest that hundreds of thousands of women and girls in the U.S. either have undergone FGM or are at risk, mostly because they or their parents come from countries where the practice is common. PRB

For example, one estimate identified over 500,000 women and girls at risk or already cut based on countries of origin with high FGM prevalence. Political Islam Center

🇨🇦 Canada and Other Western Countries

Canada and other Western nations also report thousands of women and girls who have undergone FGM, again primarily within immigrant communities. For example, the CSPII FGM Index estimated Canadian prevalence at around 0.47 % of the female population — substantially lower than in high-prevalence countries. Political Islam Center

🧠 What This Means

In the general Western population, FGM prevalence is very low because the practice is not part of mainstream Western culture or norms.

Most cases in Western countries occur in migrant communities from regions where FGM is traditionally practiced.

Due to legal bans and active public health and human rights efforts, Western countries also focus heavily on prevention and protection to reduce incidence.

In the Anchorage Daily News, Ayaan Hirsi Ali writes what’s indented blow, making claims about people living with FGM in the U.S. It’s not clear how often the mutilation was done before immigration, but I suspect that a lot of it is done in America, especially because you don’t have to have it done by a doctor. See below.

. . . . Alaska is one of nine states without a specific FGM ban, and the costs of that inaction are real. According to a groundbreaking study published by AHA Foundation in 2023, 10,020 women and girls in the Western United States have ancestral ties to countries where FGM is practiced. Of these, approximately 2,780 are at high risk of being cut or already living with FGM and 750 are living with Type III FGM, the most severe form, in which the genital area is sewn almost completely closed. A significant percentage (23.2%) of the Type III FGM population is living in Alaska. These survivors face chronic pain, complications during childbirth and lifelong trauma — often without access to medical care or emotional support.

Perhaps I should have put what follows up first, but here are the four types of FGM classified by The World Health Organization (WHO). Hirsi Ali refers above to three forms; she’s talking about the first three.

The World Health Organization (WHO) classified FGM into four broad categories in 1995 and again in 2007:

Type I: Partial or total removal of the clitoris and/or the prepuce.

Type II: Partial or total removal of the clitoris and labia minora, with or without excision of the labia majora.

Type III: Narrowing of the vaginal orifice by cutting and bringing together the labia minora and/or the labia majora to create a type of seal, with or without excision of the clitoris. In most instances, the cut edges of the labia are stitched together, which is referred to as ‘infibulation’.

Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.

FGM is condemned by a number of international treaties and conventions, as well as by national legislation in many countries. Article 25 of the Universal Declaration of Human Rights states that “everyone has the right to a standard of living adequate for health and well-being,” and this statement has been used to argue that FGM violates the right to health and bodily integrity. With FGM considered as a form of violence against women, the UN Convention on the Elimination of All Forms of Discrimination against Women can be invoked. Similarly, defining it as a form of torture brings it under the rubric of the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment. Moreover, since FGM is regarded as a traditional practice prejudicial to the health of children and is, in most cases, performed on minors, it violates the Convention on the Rights of the Child. An interagency statement on FGM, issued by 10 UN organizations, was issued in 2008.

Now all are harmful, and the first two either completely remove or considerably diminish the possibility of any sexual pleasure, which is one of the reasons they’re done. So all three are harmful.

What about circumcision? I’ll leave that aside for this post as it’s not as harmful as these forms of FGM, and isn’t banned. But many readers feel that that, too, is genital mutilation, and one can make the case that it shouldn’t be done until the prospective circumcisee is old enough to give permission. If people want to discuss that, please do so in the comments.

Now onto one form, infibulation, which I hadn’t read about in detail before. The details came from the following tweet:

I just read in more detail about female genital mutilation, which Somalis perform on 99% of girls in their country.

It’s possibly the worst thing I’ve ever read.

Here it is below so you can read it too; although I would advise you not to.

But it is important to understand how…

— Jonatan Pallesen (@jonatanpallesen) December 4, 2025

Here are the details from that tweet. NOTE: THE BIT IN ITALICS IS DISTURBING AND YOU MAY NOT WANT THE DETAILS:

I just read in more detail about female genital mutilation, which Somalis perform on 99% of girls in their country.

It’s possibly the worst thing I’ve ever read.

Here it is below so you can read it too; although I would advise you not to.

But it is important to understand how alien and horrible Somali culture is.

These are acts such that if they happened to a single Danish girl in Denmark, they would be rightfully seen as the most gruesome and grotesque mistreatment ever. It would be a news story running for decades, and the perpetrator would be the most hated man in the country.

This is what every family in Somalia inflicts on their daughters.

Not 5000 years ago in the bronze age. Right now. The Somali immigrant that came here last week had this done to his daughter.

“The process begins with the girl being forcibly restrained; often held down by several female relatives, including her mother or aunts, to prevent movement amid her screams and struggles. The excisor, using crude tools like a razor blade, knife, or broken glass, starts by slicing off the clitoral glans (the sensitive tip of the clitoris) and the surrounding clitoral hood, exposing raw nerve endings and causing profuse bleeding as blood spurts from the severed arteries. Next, the labia minora (the inner vaginal lips) are completely excised, followed by the labia majora (the outer lips), with chunks of flesh being cut away in jagged, imprecise strokes, leaving behind a mangled, bloody wound where the vulva once was. Shock sets in from the excruciating pain, described by survivors as feeling like being torn apart alive, with waves of burning sensation radiating through the body.

Once the removals are complete, the excisor repositions the raw edges of the remaining labia majora and stitches them together over the vaginal opening using thorns, acacia needles, or coarse thread, creating a tight seal. This narrows the opening to the size of a matchstick or pinhole, just large enough for urine and menstrual blood to trickle out slowly, often leading to immediate complications like urinary retention, where the girl strains in agony to pass even a few drops. The stitching is done without regard for hygiene, increasing the risk of tetanus or other infections as pus forms in the festering wound. If the girl faints from blood loss or pain, she’s revived with slaps to continue the ordeal.

Immediately after, the girl’s legs are bound tightly together from hips to ankles with ropes or cloth strips to immobilize her and allow scar tissue to form over the next 40 days, during which she lies in excruciating discomfort, unable to move without tearing the stitches. Swelling balloons the genital area into a throbbing, inflamed mass, and fever often spikes as infection takes hold. Hemorrhage can be fatal if not stemmed, sometimes by packing the wound with herbs, animal dung, or ash, which only exacerbates the sepsis. Survivors recount nights of unrelenting torment, with the pain so intense it induces vomiting, hallucinations, or loss of consciousness.

The aftermath is a lifetime of suffering: the scarred seal must often be cut open (deinfibulation) for intercourse or childbirth, reopening old wounds and risking further tearing, excessive bleeding, or even death during delivery. Menstrual blood pools behind the barrier, causing chronic infections and foul odors; urination becomes a drawn-out, burning process; and sexual activity turns into a source of dread, with friction against the rigid scar tissue feeling like sandpaper on raw skin. Psychological scars run deep, manifesting as PTSD, depression, or a profound sense of bodily violation.”

Again, this is the most brutal form of FGM. Presumably most readers know why FGM is performed. It is “cultural,” but the cultural reasons are often explicit. It’s done to preserve virginity for marriage, as in some cultures you have to be a proven virgin to be married. It’s also done to control women’s sexuality so they don’t experience too much (or any) sexual pleasure; presumably this keeps them from wanting sex.

At any rate, although I’m not implying that the authors above are justifying FGM, I think they are minimizing its harms by saying that it leads to bigotry against people from cultures that practice FGM, even when they’re immigrants. Read the paper if you wish and see if you agree. But for sure people must agree that FGM has to stop; it’s the medical equivalent of wearing burqas, but much, much worse. The WHO is doing what it can to stop the practice, but it’s still very common in some places.

Everyone, and not just feminists, should be aware of it and speak out against it at appropriate times. No, we shouldn’t demonize, say, the Somalis in America just because FGM is common in Somalia. But I think it does no good at all to try to change the words to “female genital modification.”

Somebody asked Grok about the frequency of FGM in the U.S. and I have put the answer below the fold Again, it is hard to estimate numbers or frequenies.

Click “Continue reading” to see what Grok says:

Continue reading ““Progressives” appear to whitewash female genital mutilation” →

Proprietor’s miscellany

November 1, 2025 • 8:25 am

Here is some information about my sleep test and a few miscellaneous photos from Chicago. Readers’ wildlife photos will return tomorrow, so keep sending them in!

First, wish me luck; next Tuesday I am taking a home sleep test, which involves the items shown below (you also need the right app on your phone). It used to be that to take a sleep test you’d have to spend the night in the hospital, all wired up to various devices. How can you sleep normally under such conditions? But things have changed for the better. After all, it’s much better to sleep in your own bed, which is what you can do with the equipment below.

Here’s the kit:

A watchlike device that apparently transmits data to the hospital through your phone. You wear it on your non-dominant hand.
The data come from the tubular device fastened to one of your fingers, as well as an electrode that you tape (using the medical tape provided) to the little hollow at the base of the front of your neck. You can use any finger on your non-dominant hand save the thumb.
Your cellphone, which has to be within fifteen feet of the watch.

So, you put the battery in the watch, put the watch on your wrist, put the finger device on your finger, put the electrode on your throat, and then press “begin” on your app. Then you go to sleep—or try to. You have to record for seven hours at the minimum. At the end you press “stop recording” on the phone app, and wait while the data (presumably mostly indicating your breathing) is transmitted to the hospital. In a few seconds it should be over, and you can discard the whole kit.

It appears to be designed to detect sleep apnea, but there is no sign I have the condition, as nobody has ever reported me snoring or waking up gasping for breath, and sometimes I’m up all night not able to sleep, with no breathing problems at all. But the doctors tell me you can have sleep apnea without knowing it (I find this nearly impossible to believe when I’m awake all night breathing normally), but they won’t treat me further unless I take this test. So be it: my own view is that the cause of my insomnia is pure anxiety.

And some miscellaneous photos taken on my walk home and to work. First, fall is here (don’t forget to set your clocks back tomorrow):

Given the number of immigrants in Chicago, with many surely undocumented, ICE is a big deal. There have been attempted apprehensions in Hyde Park, which have led to signs like the one below, on the door of a local bakery that employs Hispanics. There are also other signs taped to lightposts that aren’t so polite, saying “F-ck ICE” and saying that ICE are Nazis. Note that in the sign below, ICE is depicted as a hungry alligator.

And good news for lovers of Botany Pond: Yesterday afternoon three of the five turtles put back in the pond (they were removed when the pond was drained several years ago), were sunning themselves on a warm rock yesterday afternoon. I haven’t seen them sunning themselves for a couple of weeks, so I think they’re getting used to the pond. They look healthy, no? I suspect the other two were either swimming around or were ensconced in their “turtle dens” on the pond bottom.

The Atlantic criticizes youth gender medicine

October 17, 2025 • 10:30 am

The exaggerated or false assertions of extreme gender activists are starting to wane—thanks to scientific research. The fact that the article below appeared in a liberal magazine, The Atlantic, is a sign that these activists can no longer bully the public into accepting bogus arguments and claims (e.g., “would you rather have a dead son or a live daughter?”), for research shows otherwise. The article below concentrates on two especially distressing antiscientific phenomena:

1.) The persistence of “zombie” facts: false assertions that nevertheless hang on because they suit a liberal, virtue-signaling ideology. One of them is the supposed increase in suicide among youth who aren’t given “affirmative care” for gender dysphoria.

2.) The reluctance of organizations like WPATH and the U.S. government to publish research that goes against the accepted ideology.

Both of these can lead not only to public ignorance, but also to real harm of children and adolescents pushed into transitioning genders without complete information (or with false information). I am not saying, of course, that changing genders, or having surgery, or taking hormones to do so, should never be permitted. In many cases those allowed to transition report that they are happier for having done so. (One must nevertheless be wary of such self-reporting after the fact.) But while I don’t believe in bans on medically changing gender, I do object to affirmative care and to unscientific assertions, which can lead young people to make poorly informed decisions. (Older people, say over 21, should have the ability to weigh the facts and make their own decisions.)

The fact that MSM like the New York Times and The Atlantic can now get away with publishing articles like these is a sign that the times are a-changin’. And I’m glad that they are changing because the change is coming from science.

The Atlantic article below was published here, but unless you subscribe it will be paywalled. However, you can find it archived here, and clicking the headline below will take you to the archived version.

The article begins with an anecdote about the ACLU attorney and deputy director for transgender justice Chase Strangio, whom we’ve met before. Strangio, a trans-identified woman, is the lawyer who advocated the banning of Abigail Shrier’s book on social causes of gender dysphoria Irreversible Damage: The Transgender Craze Seducing Our Daughters. Few reasonable people now doubt that Shrier was right: some transitions are promoted by social pressure.

Strangio later removed these tweets, which incorrectly characterize Shrier’s book. And the ACLU was arguing for banning books? Oy!

Strangio argued, and lost, a case in the Supreme Court, one of the reasons being he adduced a false “zombie fact” (all quotes below are from Lewis’s Atlantic article, and are indented):

“We often ask parents, ‘Would you rather have a dead son than a live daughter?’” Johanna Olson-Kennedy of Children’s Hospital Los Angeles once explained to ABC News. Variations on the phrase crop up in innumerable media articles and public statements by influencers, activists, and LGBTQ groups. The same idea—that the choice is transition or death—appeared in the arguments made by Elizabeth Prelogar, the Biden administration’s solicitor general, before the Supreme Court last year. Tennessee’s law prohibiting the use of puberty blockers and cross-sex hormones to treat minors with gender dysphoria would, she said, “increase the risk of suicide.”

But there is a huge problem with this emotive formulation: It isn’t true. When Justice Samuel Alito challenged the ACLU lawyer Chase Strangio on such claims during oral arguments, Strangio made a startling admission. He conceded that there is no evidence to support the idea that medical transition reduces adolescent suicide rates.

At first, Strangio dodged the question, saying that research shows that blockers and hormones reduce “depression, anxiety, and suicidality”—that is, suicidal thoughts. (Even that is debatable, according to reviews of the research literature.) But when Alito referenced a systematic review conducted for the Cass report in England, Strangio conceded the point. “There is no evidence in some—in the studies that this treatment reduces completed suicide,” he said. “And the reason for that is completed suicide, thankfully and admittedly, is rare, and we’re talking about a very small population of individuals with studies that don’t necessarily have completed suicides within them.”

Here was the trans-rights movement’s greatest legal brain, speaking in front of the nation’s highest court. And what he was saying was that the strongest argument for a hotly debated treatment was, in fact, not supported by the evidence.

Even then, his admission did not register with the liberal justices. When the court voted 6–3 to uphold the Tennessee law, Sonia Sotomayor claimed in her dissent that “access to care can be a question of life or death.” If she meant any kind of therapeutic support, that might be defensible. But claiming that this is true of medical transition specifically—the type of care being debated in the Skrmetti case—is not supported by the current research.

Here Strangio and the ACLU lost out because they adduced a “zombie fact”. Yes, thought of “suicidality” might increase if blockers aren’t given, but the data are inconclusive, and we should always remember that the great majority of children and adolescents with gender dysphoria who don’t transition turn out to be cis, gay or bisexual, outcomes that doesn’t lead to more dysphoria, much less sterility, medical complications, bone problems, and so on.

Zombie facts, like zombies themselves, are hard to kill, not least because people who adduce them are ideologues who are resistant to facts. In this respect they resemble creationists.

Marci Bowers, the former head of the World Professional Association for Transgender Health (WPATH), the most prominent organization for gender-medicine providers, has likened skepticism of child gender medicine to Holocaust denial. “There are not two sides to this issue,” she once said, according to a recent episode of The Protocol, a New York Times podcast.

Here’s one result of those zombie facts:

When red-state bans are discussed, you will also hear liberals say that conservative fears about the medical-transition pathway are overwrought—because all children get extensive, personalized assessments before being prescribed blockers or hormones. This, too, is untrue. Although the official standards of care recommend thorough assessment over several months, many American clinics say they will prescribe blockers on a first visit.

This isn’t just a matter of U.S. health providers skimping on talk therapy to keep costs down; some practitioners view long evaluations as unnecessary and even patronizing. “I don’t send someone to a therapist when I’m going to start them on insulin,” Olson-Kennedy told The Atlantic in 2018. Her published research shows that she has referred girls as young as 13 for double mastectomies. And what if these children later regret their decision? “Adolescents actually have the capacity to make a reasoned logical decision,” she once told an industry seminar, adding: “If you want breasts at a later point in your life, you can go and get them.”

Yes, you can go and get them. “Two new breasts, please.” Of course those breasts will have no sensation, sexual or otherwise.

Finally, the organization that perhaps promulgates the most zombie facts is The World Professional Association for Transgender Health (WPATH), which has spread the false rumor that Britain’s 2020 Cass Review, was shoddy and wrong. That report concluded that “the evidence base and rationale for early puberty suppression was unclear, which led to a UK ban on prescribing puberty blockers to those under 18 experiencing gender dysphoria (with the exception of existing patients or those in a clinical trial).” This led to the closure of the UK’s main Gender Identity Center (GIDS) and a revision of the way patients are referred for treatment. But WPATH, firmly wedded to affirmative care and the transitioning of those not of age to make such decisions, opposed the report, spreading misinformation about it:

The reliance on elite consensus over evidence helps make sense of WPATH’s flatly hostile response to the Cass report in England, which commissioned systematic reviews and recommended extreme caution over the use of blockers and hormones. The review was a direct challenge to WPATH’s ability to position itself as the final arbiter of these treatments—something that became more obvious when the conservative justices referenced the British document in their questions and opinions in Skrmetti. One of WPATH’s main charges against Hilary Cass, the senior pediatrician who led the review, was that she was not a gender specialist—in other words, that she was not part of the charmed circle who already agreed that these treatments were beneficial.

Another: the Biden Administration’s Rachel Levine, a trans-identified man who was the Assistant Secretary for Health and Human Servies, even tried to completely get rid of any age minimums for “affirmative care”. She said in emails that having age limits would make it harder for people to allow youths to transition. But what’s wrong with that given we have age limits for decisions (like driving or drinking) with health import? As far as I know, Levine failed,

But to me as a scientist, the worst part of the whole mess is when scientists get data showing that the claims of gender activists are wrong, and then the data are withheld or delayed. This is exactly the kind of ideological distortion of science that Luana and I described in our Skeptical Inquirer article. But it’s even worse, because distorting medical issues not only misrepresents the facts, but also leads to uninformed medical practice, something far more harmful to people than, say, attacking evolutionary psychology on ideological grounds. Here are two examples of data being withheld or delayed because it didn’t support “accepted” gender medicine (words are from The Atlantic):

A) The Alabama litigation also confirmed that WPATH had commissioned systematic reviews of the evidence for the Dutch protocol. [The Dutch Protocol, developed in the Netherlands, is pretty much what we call “affirmative care” in the U.S., involving blockers followed by hormone treatment and perhaps surgery.] However, close to publication, the Johns Hopkins University researcher involved was told that her findings needed to be “scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender health care.” This is not how evidence-based medicine is supposed to work. You don’t start with a treatment and then ensure that only studies that support that treatment are published. In a legal filing in the Alabama case, Coleman insisted “it is not true” that the WPATH guidelines “turned on any ideological or political considerations” and that the group’s dispute with the Johns Hopkins researcher concerned only the timing of publication. Yet the Times has reported that at least one manuscript she sought to publish “never saw the light of day.”

B) The Alabama disclosures are not the only example of this reluctance to acknowledge contrary evidence. Last year, Olson-Kennedy said that she had not published her own broad study on mental-health outcomes for youth with gender dysphoria, because she worried about its results being “weaponized.” That raised suspicions that she had found only sketchy evidence to support the treatments that she has been prescribing—and publicly advocating for—over many years.

Last month, her study finally appeared as a preprint, a form of scientific publication where the evidence has not yet been peer-reviewed or finalized. Its participants “demonstrated no significant changes in reported anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, aggressive behavior, internalizing problems or externalizing problems” in the two years after starting puberty blockers. (I have requested comment from Olson-Kennedy via Children’s Hospital Los Angeles but have not yet heard back.)

Clearly this study was delayed because it showed that puberty blockers did not relieve symptoms of gender dysphoria—a claim that is part of the “dead son or live daughter” trope. Author Lewis’s quote about how evidence-based medicine is supposed to work is absolutely appropriate here. Two studies didn’t show what they should have, so people didn’t want them published.

Now Lewis, like me, is not in favor of total bans on young people getting transitions. But given the fact that the bulk of young people who don’t get affirmative care wind up as gay is, to me, a powerful argument for making it very hard to undergo medical gender transitions. Even Lewis has changed her mind a bit in view of the fact that puberty blockers are not (as everyone thinks) always completely reversible, and also we lack good long-term studies of their effects. As Lewis notes:

However, the revelations from Skrmetti and the Alabama case have made me more sympathetic to commentators such as Leor Sapir, of the conservative Manhattan Institute, who supports the bans because American medicine cannot be trusted to police itself. “Are these bans the perfect solution? Probably not,” he told me in 2023. “But at the end of the day, if it’s between banning gender-affirming care and leaving it unregulated, I think we can minimize the amount of harm by banning it.” Once you know that WPATH wanted to publish a review only if it came to the group’s preferred conclusion, Sapir’s case becomes more compelling.

Lewis concludes that it shouldn’t be embarrassing to revise one’s views in light of scientific data. That, in fact, is how science works. But when it comes up against ideologues—particularly the diehard advocates of gender ideology—many people don’t want to change their minds. This is a palpably unscientific attitude, and one harmful to young people.

Despite the concerted efforts to suppress the evidence, however, the picture on youth gender medicine has become clearer over the past decade. It’s no humiliation to update our beliefs as a result: I regularly used to write that medical transition was “lifesaving,” before I saw how limited the evidence on suicide was. And it took another court case, brought by the British detransitioner Keira Bell, for me to realize fully that puberty blockers were not what they were sold as—a “safe and reversible” treatment that gave patients “time to think”—but instead a one-way ticket to full transition, with physical changes that cannot be undone.

Lewis’s conclusion seems sound, at least until we have more data:

We can support civil-rights protections for transgender people without having to endorse an experimental and unproven set of medical treatments—or having to repeat emotionally manipulative and now discredited claims about suicide.

I’m not sure why this one issue has evoked so much rancor and attempt to distort science, but somehow permissiveness to undergo “affirmative care,” combined with the sacralization of those who change gender, has turned this into an argument about virtue rather than science. In the end, though, you can’t decide what is virtuous unless you have the data. As Richard Feynman said, referring to the Challenger disaster, “For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.”

h/t: Norman

American Humanist vigorously endorses “affirmative care” with no lower age limit

September 4, 2025 • 10:30 am

The American Humanist Association (AHA) is among the most prominent humanist/atheist/skeptical organizations in America, but it’s been getting increasingly “progressive” (read “woke”). You may remember that in 2021 the AHA revoked its “Humanist of the Year” award given to Richard Dawkins 15 years earlier, saying this:

Regrettably, Richard Dawkins has over the past several years accumulated a history of making statements that use the guise of scientific discourse to demean marginalized groups, an approach antithetical to humanist values. His latest statement implies that the identities of transgender individuals are fraudulent, while also simultaneously attacking Black identity as one that can be assumed when convenient. His subsequent attempts at clarification are inadequate and convey neither sensitivity nor sincerity.

This is an arrant mischaracterization of Dawkins’s views, which were most famously expressed in this tweet in 2021 (note the coincidence with the year of revocation):

It didn’t matter to the AHA that Dawkins tried to explain what he meant by that tweet: it was a question intended to provoke discussion:

It didn’t matter that the Rachel Dolezal “transracial” issue is certainly worth discussing, and the first tweet above surely did not mean that Richard thinks the “identities of transgender individuals are fraudulent, while also simultaneously attacking Black identity as one that can be assumed when convenient.” That can be said only if you want to attack Dawkins to begin with or are flautning virtue at the expense of truth.

This shows two things relevant to this post: that the AHA has become overly woke, and, more relevant for today, the organization waving the banner of gender activism (here the issue of transgenderism) beyond reason, ignoring the facts. Both of these conclusions can be seen in the article below by Kavita Narayan, identified by the AHA as “a humanist writer and researcher based in LA.”.

Even though the piece is long for many people’s attention spans, I suggest you read the whole thing to check whether my assertions are correct and to see where the AHA probably stands on this issue. I assume that the AHA agrees with Narayan’s views, as she repeatedly invokes what the AHA believes to justify her conclusions, and the organization allowed her to publish the long article.

Here are some of the AHA’s assertions I’ve gleaned from the article. Bold headings are mine, Narayan’s quotes are indented, and my comments are flush left:

1.) Denying “affirmative care” to anyone (including adolescents) who wants it, with that care including hormones and surgery, is unethical.

Transmasculine and nonbinary individuals report invasive gatekeeping, as well: Jordan, 22 and nonbinary, remembers undergoing humiliating questioning before a hysterectomy consultation, a stark reflection of a system built only for cis bodies.

A humanist framework grounded in reason, equality, and bodily autonomy holds that denying care based on gender identity is not only a practical failure, but an ethical breach. “To deny someone care… is not just unethical, it’s inhuman,” says ethicist Casey Ruhl.

. . . This is where humanism can make a unique impact. Unlike traditional religions that may treat gender diversity as a moral debate, humanism begins from a different premise: that every individual has inherent worth, and that self-determination is not a privilege, but a right. “Humanism allows us to honor people without pretending to know them better than they know themselves,” says Elan, a queer humanist chaplain.

Note that they give no age limit here: any child or adolescent who claims to be of the sex different from their natal sex has a right not just to be believed, but also given affirmative care. I would add here that unless you’re “of age” (I’ll take it to be the age of 18, the legal age at which a person can make their own healthcare decisions), I would not be so quick to say that a person “knows themselves,” particularly when it comes to “knowing” that they’re really of their non-natal sex. “Self-determination” for medical issues is not a right for anyone under 18, and may not be warranted if someone wants to transition when they have other psychological issues when over age 18. Often gender dysphoria is part of a complex of other, unrelated psychological problems, problems that are often confused with gender dysphoria itself (see below). It can also be exacerbated by social pressure–the “affirmation” from peers, which is often very strong.

Finally, remember that doctors are not obligated legally to do anything that a patient wants, even if it’s harmless. If someone goes to a doctor with a viral infection and demands antibiotics, doctors are perfectly within their rights to refuse, for antibiotics are not only useless against viruses, but their wanton use can increase antibiotic resistance in bacteria. If you ask someone to cut off your arm because you think it’s superfluous (yes, there are such people), doctors can and will refuse, and will not suffer for it. And no doctor is obligated to give children or adolescents puberty blockers or hormones just because they ask for it. (A good doctor will refer such people to competent specialists.) This doesn’t mean that if someone has an easily treatable ailment or injury, it is ETHICAL for a doctor to refuse treatment, but gender transitioning does not fall into this category. It takes a specialist in pediatric gender transitioning, objective rather than affirmative therapy, and above all what we don’t have: evidence that it’s safe to use puberty blockers. After puberty is over, of course, a gender-specialist doctor can help transitioning by giving hormones and other things, though surgery is something that requires careful thought, and perhaps many surgeons won’t agree to go snipping off breasts or genitals.

2.) There is no lower age limit to begin “affirmative treatment”, and treatment that includes puberty blockers is reversible. While the article argues that gender-affirming care is safe and efficacious “when providce with informed consent”, what does that mean? If parents assent that it’s okay to inject a child or adolescent with hormones or cut off bits of their body, does that mean that a child of any age has a right to do that, so long as they find a compliant doctor? Look at the title of this section:

The Myth of “Too Young” and the Data That Debunks It

Opponents of gender-affirming care often argue that children are too young to make life-altering decisions. But this talking point misunderstands both the process and the people it affects.

Gender-affirming care for minors doesn’t begin with surgery. It starts with listening. It involves long conversations with therapists, pediatricians, and families. Puberty blockers, often the first clinical step, are fully reversible and give young people time to explore their identity without the permanent effects of endogenous puberty.

Narayan’s “myth of too young” is invidious. First, it’s not uncommon for children to be referred to doctors for affvirmative therapy or even hormones after just one or a few visits, lacking those “long conversations.”

Second, talk therapy that supports and verifies the conclusion of a young person that they are transgender should be, but is not invariably, objective. What if the therapist fails to affirm the child’s assertion, concluding that the child is too young or is caught in a morass of psychological confusion? Is that unethical?

And is “too young” really a myth? Children as young as 11 (e.g., Jazz Jennings) have taken puberty blockers, and, at 17, Jennings had the difficult and complex “bottom surgery”. Other papers report girls as young as 13 getting double mastectomies. In 2022, the organization WPATH, a villain in this narrative, recommended these things:

The World Professional Association for Transgender Health said hormones could be started at age 14, two years earlier than the group’s previous advice, and some surgeries done at age 15 or 17, a year or so earlier than previous guidance. The group acknowledged potential risks but said it is unethical and harmful to withhold early treatment.

Surgery at 15 and hormones at 14?

Note the “unethical” trope, as raised by Narayan above. As for “harmful to withhold early treatment,” it’s important to realize that the majority of adolescents and children who are not given affirmative treatment eventually come out as gay, so that neither surgery or hormone treatment needs to be done.

As I’ll mention in a minute, those treatments might damage people’s health, despite Narayan’s assertion, and we don’t know their long-term effects, except that post-puberty hormone treatment, as well as bottom surgery, can leave people without the ability to have a sex life that includes orgasms. Simply affirming a child’s self-diagnosis and giving them whatever hormones they want is bad practice without careful vetting, and certainly there are ages that are “too young” for that. (I’ve suggested a lower limit of 18, but even 21 may be okay.)

At any rate, there are a variety of studies showing the proportion of children with gender dysphoria who do not receive affirmative care and wind up deciding they’re gay. This varies from 39% to 80% among boys. Data from girls are sparser, but several studies of small samples say that untreated gender-dysphoric girls usually become lesbian or cisgender women. Given this, and the possible dangers of hormone treatment and demonstrated dangers of surgery, saying that no child is too young to be treated, and that they have a right to be treated the way they want, is, to me, both unethical and harmful. To foster the idea that there is no such thing as “too young” is pushing children to make decisions that they’re not ready to make—decisions that will change their lives and bodies forever.

As for the harm of puberty blockers when they are stopped, there is insufficient evidence about the long-term effects of puberty blockers on several traits, and some evidence that there are irreversible effects on bone density and height. As the Cass Report states:

There were no high-quality studies identified that used an appropriate study design to assess the outcomes of puberty suppression in adolescents experiencing gender dysphoria or incongruence. There is insufficient and/or inconsistent evidence about the effects of puberty suppression on gender dysphoria, mental and psychosocial health, cognitive development, cardio-metabolic risk, and fertility. There is consistent moderate-quality evidence, albeit from mainly pre-post studies, that bone density and height may be compromised during treatment.

There is a lack of high-quality research assessing the outcomes of hormones for masculinisation or feminisation in adolescents with gender dysphoria or incongruence and few studies that undertake long-term follow-up. There is little evidence regarding gender dysphoria, body satisfaction, psychosocial and cognitive outcomes, and fertility. There is moderate-quality evidence from mainly pre-post studies that hormone treatment may in the short-term improve some aspects of psychological health. There is inconsistent evidence about the effect of hormones on height/growth, bone health and cardiometabolic effects.

There is certainly not enough evidence to say that the effects of puberty blockers on the body are safe and fully reversible, although some of the phenotypic effects may be. The lack of firm evidence that blockers are irreversible and safe is one reason the puberty blockers (not approved, by the way by the FDA for blocking puberty, and always prescribed “off label”) are considered “experimental treatment” in the UK under 18, and are severely restricted in quite a few other countries like Sweden. Almost nowhere are they permitted to be given willy-nilly to children or adolescents at their request, as Narayan seems to feel.

3). Withholding affirmative care increases depression and suicidality. Affirmation is, as the article says, “life-saving”. Note that the AHA is very canny here, repeatedly using the word “suicidality” rather than “suicide”, although the general claim among gender activists is that withholding affirmative care increases suicide itself. But the American Psychological Association defines “suicidality” as “the risk of suicide, usually indicated by suicidal ideation or intent, especially as evident in the presence of a well-elaborated suicidal plan.”

The AHA says this:

Affirmation isn’t just emotional. It directly correlates with better mental health outcomes. A 2022 study in JAMA Network Open found that transgender youth who received gender-affirming care had significantly lower rates of depression and suicidality than those who did not. These effects persist into adulthood, with gender-affirming hormones and surgeries linked to improved quality of life and reduced psychological distress.

The link given doesn’t go to an article I can find, but I do know of one good study that seems to me the gold standard of the relation between gender dysphoria and suicide itself. And it shows that, when you disentangle the effects of psychiatric problems not related to gender dysphoria from the data, there is no difference in the suicide rates of adolescents without gender dysphoria compared to those either presenting for treatment for gender dysphoria or going on to gender reassignment via surgery and hormones. That is, dysphoria and its affirmative treatment doesn’t increase suicidality or suicide itself. You can find this 2024 study below, published last year in the BMJ [British Medical Journal] Mental Health; click on screenshot to read. If you’re blocked, click here to see the full text or here to get the pdf:

The study is the best because it had a large sample, lasted over 23 years into adulthood, and, moreover, was conducted in Finland, where every individual is numbered and their doctor and psychiatric visits tallied. The sample was of 2,083 adolescents who sought gender-identity assessments and/ir desired gender reassignment (GR). For each of these target individuals, EIGHT control individuals were assigned, matched by age and sex. The results were that, without multivariate analysis, there was a slight but nonsignificantly higher rate of suicide among the 2,083 “GR” (gender-referred) children, some of which went on to full transition. But that difference completely disappeared when the authors controlled for other psychiatric issues. As the paper says (my bolding):

Most importantly, when psychiatric treatment needs, sex, birth year and differences in follow-up times were accounted for, the suicide mortality of both those who proceeded and did not proceed to GR did not statistically significantly differ from that of controls. This does not support the claims that GR is necessary in order to prevent suicide. GR has also not been shown to reduce even suicidal ideation, and suicidal ideation is not equal to actual suicide risk. To the best of our knowledge, the impact of GR on suicide mortality among gender-referred adolescents has not been reported in earlier studies. In an earlier study by Dhejne et al,¹¹ even when psychiatric morbidity was controlled for, participants diagnosed as transsexual in adulthood who had undergone both hormonal and surgical GR displayed increased suicide mortality compared with matched population controls. Nonetheless, these authors focused on patients treated before 2002. More recent cohorts, particularly adolescents, may differ from those in earlier decades, and stress related to gender identity itself may be lower presently because of decreasing prejudice.

In other words, gender-dysphoric youth who sought help but did not proceed to gender reassignment did not differ in suicidality from those who went on to gender reassignment. Further, when psychiatric difficulties were taken into account (number of visits to psychiatrists), neither of these differed in either suicidality or suicidal rates from controls. The finding that there was a difference in earlier studies may have been due to the conflating effects of psychiatric difficulties, since those seeking help for gender dysphoria, or proceeding to gender reassignment, apparently have more such difficulties (unconnected to dysphoria) than those who don’t, and psychiatric difficulties greatly increase the rate of suicide.

What all this means is that neither “suicidality” nor suicide itself differs in rate among control children lacking gender dysphoria, whether or not they go on to gender reassignment treatment. The argument for affirmative care that says, “you can have either a dead daughter or a live son” is not borne out, at least by this study. Have a look at it; I was impressed by the quality of the work, which would not be possible in countries where every individual is tracked for both medical and psychiatric care.

The AHA, then, is, to my mind, grossly distorting what we know about suicidality, affirmative care, and the risks of gender dysphoria. It is not known to be safe to give adolescents puberty blockers; there should be a lower age limit; and you are not preventing suicides by giving “affirmative care.” In this sense I consider the article misleading and irresponsible.

So many skeptical/humanist/atheist organizations lose their skepticism when it comes to gender issues! The only one I trust, because it’s published articles on gender like this and this, is the Center for Inquiry, which appears to be the only one that is strongly based on evidence.

But read for yourself, and, if you have time, do a scan of the literature, including the Cass Review.

Tomorrow I’ll publish a letter to the AHA from a disaffected member who took strong issue with the article above, and will say a few words about their response, which I won’t publish as I didn’t ask permission. Thanks to that reader for calling this article to my attention.

Let me finish by saying I have nothing against adolescents or children who feel that they are trapped in the wrong body, nor should there be discrimination (except in sports or things like jails) affecting transgender adults. I’m glad to call anybody whatever pronoun they want, and abhor those who really do dislike or denigrate trans individuals. All I ask for is rationality when it comes to treating young people, and that that treatment should always, like all medical treatment, be based on evidence.

The political erosion of American med schools

July 29, 2025 • 10:15 am

Sally Satel (a psychiatrist) and Thomas Huddle (an academic clinician) have an article in The Chronicle of Higher Education that you can read by clicking on the title below. If you’ve followed how med schools are changing their curricula to emphasize social justice (including rewriting the Hippocratic Oath that they must recite), this may not come to a surprise to you.

If you don’t have a free Chronicle subscription (you get a certain number of articles per month, you can find the same article on Glenn Loury’s Substack for free.

Some quotes:

Over the past decade, we’ve grown ever more concerned about dubious strains of social-justice advocacy infiltrating medicine. Following the murder of George Floyd in 2020, doctors’ pursuit of social reform coalesced, almost overnight, into a mission.

Within a week of Floyd’s death, for example, the Association of American Medical Colleges, which is a co-sponsor of a major accrediting body, announced that the nation’s 155 medical schools “must employ antiracist and unconscious bias training and engage in interracial dialogues.” A year later (and again in 2024), the American Medical Association released a Strategic Plan to Embed Racial Justice and Advance Health Equity that encouraged physicians to dismantle “white patriarchy and other systems of oppression.” Over two dozen medical schools issued their own similar plans.

. . . . Today, doctors perform political advocacy in myriad ways. State medical boards have added a requirement for training in “antiracism” in order to be eligible for a medical license, according to the Federation of State Medical Boards. The University of California at San Francisco (UCSF) created a document titled “Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators.”

Certain debates have become off-limits. Consider, for instance, a 2020 incident involving Norman C. Wang, a cardiologist with the University of Pittsburgh School of Medicine. After Wang published a peer-reviewed critique of affirmative action in a respected medical journal, his colleagues denounced him on social media for his “racist thinking” and condemned his paper as scientifically invalid and “racist.” The journal retracted his article and the school removed him as director of the electrophysiology program. (Wang sued for retaliation and discrimination, but was unsuccessful.)

Researchers are promoting unscientific modes of thinking about group-based disparities in health access and status. The University of Minnesota’s Center for Antiracism Research for Health Equity decrees “structural racism as a fundamental cause of health inequities,” despite the fact that this is at best an arguable thesis, not a fact. (The center was shut down last month.) The Kaiser Family Foundation states that health differentials “stem from broader social and economic inequities.”

In what borders on compelled speech, the State University of New York’s Upstate Medical University issued a 164-page report from a diversity task force insisting that “Health care professionals must explicitly acknowledge that race and racism are at the root of [Black-white] health disparities.” Other variables influencing the course of chronic disease, prominently the patient’s health literacy and self-care, receive scant attention.

But those disparities are far more complicated than that. This brings to mind the claim, promulgated in 2020, that black babies delivered by white physicians had over twice the mortality rate than when delivered by black physicians (see this PNAS paper). It got a lot of publicity, and cries of “racism” were loud and pervasive. But later analysis showed that racism was not a factor, but a difference among races in birth weight. As The Economist reported:

Now a new study seems to have debunked the finding, to much less fanfare. A paper by George Borjas and Robert VerBruggen, published last month in PNAS, looked at the same data set from 1.8m births in Florida between 1992 and 2015 and concluded that it was not the doctor’s skin colour that best explained the mortality gap between races, but rather the baby’s birth weight. Although the authors of the original 2020 study had controlled for various factors, they had not included very low birth weight (ie, babies born weighing less than 1,500 grams, who account for about half of infant mortality). Once this was also taken into consideration, there was no measurable difference in outcomes.

The new study is striking for three reasons. First, and most important, it suggests that the primary focus to save young (black) lives should be on preventing premature deliveries and underweight babies. Second, it raises questions about why this issue of controlling for birth weight was not picked up during the peer-review process. And third, the failure of its findings to attract much notice, at least so far, suggests that scholars, medical institutions and members of the media are applying double standards to such studies. Both studies show correlation rather than causation, meaning the implications of the findings should be treated with caution. Yet, whereas the first study was quickly accepted as “fact”, the new evidence has been largely ignored.

The reason why white doctors at first looked like such a “lethal” combination with black babies, say the authors of the recent paper, was that a disproportionately high share of underweight black babies were treated by white doctors, while a disproportionately high share of healthy-weight black babies were treated by black doctors. Being born severely underweight is one of the greatest predictors of infant death. Just over 1% of babies in America are born weighing less than 1,500 grams, but among black babies the rate is nearly 3%.

You can find the Borjas and VerBruggen paper here. Their finding, as The Economist wrote, got far less publicity than the original finding, clearly because the real reason didn’t play into the social-justice Zeitgeist.

But back to Satel and Huddle’s article. Note that the following caveat appears later in the essay, accepting the possibility that past racism is involved in health disparities but questioning whether current structural racism is causing present disparities:

. . . . .We do not deny that much of the health disadvantage suffered by minority groups is the cumulative product of legal, political, and social institutions that historically discriminated against them. But past discrimination is not necessarily a factor sustaining those problems now. We must address the discrete causes that operate today.

Back to their text, giving a few more examples of social-justice medicine:

In what borders on compelled speech, the State University of New York’s Upstate Medical University issued a 164-page report from a diversity task force insisting that “Health care professionals must explicitly acknowledge that race and racism are at the root of [Black-white] health disparities.” Other variables influencing the course of chronic disease, prominently the patient’s health literacy and self-care, receive scant attention.

Some medical professionals have even endorsed racial reparations in health care decision-making.At one point,the CDC vaccine advisory committee proposed prioritizing the anticipated Covid vaccine by race rather than age, solely because older cohorts disproportionately comprised whites. This plan would have delayed vaccination of the elderly—the highest risk group—and, according to the CDC’s own projections, resulted in more overall deaths. Other sponsors of health equity lobbied for a rationing scheme that prioritized the assignment of ventilators to Black patients, negating customary triage procedures.

These “reparations” are unethical because they would cause deaths than would occur otherwise. Nevertheless, people proposed them knowing this.

But wait! There’s more!

Perhaps the most dramatic recent display of ideological intrusion into the medical sphere took place last June at the UCSF Medical Center, where keffiyeh-draped doctors gathered on the grounds to demand that their institution call for a ceasefire in the war between Israel and Hamas. Their chants of “intifada, intifada, long live intifada!” echoed into patients’ rooms.

These doctors were not putting patients first—if anything, they were offending and intimidating patients. They were putting their notion of social justice first.

You can see a video along these lines from UCSF here, though I’m not sure it’s the demonstration referred to in the article.

The authors then propose three guidelines that “should advocate for policies that 1) directly help patients and 2) are rooted in professional expertise, while 3) ensuring that their advocacy does not interfere with their relationships with their colleagues, students, and patients”:

1.) First, the reform they promote must have a high likelihood of directly improving patient health. “Dismantling white patriarchy and other systems of oppression” is not an actionable goal. Our primary job is to diagnose and treat, and to do no harm in the process. We have no expertise in redistributing power and wealth. Even seasoned policy analysts cannot readily tease out strong causal links between health and economic and social factors that lie upstream.

. . . . 2.) Second, physicians’ actions or their advice to policymakers should be rooted in expertise that is unique to their profession. Opining and advocating on behalf of general social issues exploits their moral authority, turns medicine into a vehicle for politics, and risks the trust of the public. Medical professionals will, of course, have their own views of the public good. They are free to take to the barricades as citizens—but not while wearing their white coats.

3.) Third, doctors must not lose sight of the impact of advocacy on patients and students. While advocating for one’s own patients is a basic obligation of being a doctor, advocating on behalf of societal change can work against those patients, drawing time and attention away from their care.

One action the authors suggest is that young physicians who are truly dedicated to helping the oppressed, poor, and those deprived of medical care, should work in rural areas that suffer from a shortage of doctors:

A new report in the Journal of the American Medical Association found that newly licensed clinicians from top-ranked medical institutions were half as likely to initially practice in socioeconomically deprived areas as graduates from other medical institutions. Specialists were also less likely to practice in deprived areas compared with primary-care clinicians.

Well, that sounds good, but do you really think that the entitled social-justice doctors are willing to leave the cities and work in rural areas with a shortage of medical care?

The Atlantic takes on “affirmative care”

July 2, 2025 • 11:02 am

One sign that there has been a sea change in America’s gung-ho enthusiasm for “affirmative care” of minors with gender dysphoria is the mainstream media’s recent critiques (or just objective analyses) of the problems with such care. These critiques have exposed the lies promulgated about such care, largely by the “progressive” Left. The new article in The Atlantic by staff writer Helen Lewis is one such journalistic corrective (read it by clicking on the screenshot below or by reading it archived here). And you should read it.

One of the factors prompting the article appears to have been the Supreme Court case The United States v. Skrmetti, which upheld a Tennessee law banning the use of hormones or puberty blockers for “gender affirming care” in cases of gender dysphoria in minors. Such care was allowed, however, if modification of sexual traits was necessary to allow an individual with a disorder of sex determination to “conform to their sex assigned at birth” (Wikipedia’s words, not mine). The case was decided along ideological lines by a 6-3 vote, but in general I agreed with the decision, having felt that medical treatment for transition should be permitted only if a person with gender dysphoria was old enough to have mental maturity to decide. (I waffle between 16 and 18 on this one, but it’s 18 in Tennessee).

Author Lewis, in fact, was willing to allow medical transitioning to begin in younger children with dysphoria, but changed her mind after seeing WPATH, progressives, doctors, and government officials repeatedly lie about the condition and how to fix it. To quote her (all the article’s quotes are indented):

I have always argued against straightforward bans on medical transition for adolescents. In practice, the way these have been enacted in red states has been uncaring and punitive. Parents are threatened with child-abuse investigations for pursuing treatments that medical professionals have assured them are safe. Children with severe mental-health troubles suddenly lose therapeutic support. Clinics nationwide, including Olson-Kennedy’s, are now abruptly closing because of the political atmosphere. Writing about the subject in 2023, I argued that the only way out of the culture war was for the American medical associations to commission reviews and carefully consider the evidence.

However, the revelations from Skrmetti and the Alabama case have made me more sympathetic to commentators such as Leor Sapir, of the conservative Manhattan Institute, who supports the bans because American medicine cannot be trusted to police itself. “Are these bans the perfect solution? Probably not,” he told me in 2023. “But at the end of the day, if it’s between banning gender-affirming care and leaving it unregulated, I think we can minimize the amount of harm by banning it.” Once you know that WPATH wanted to publish a review only if it came to the group’s preferred conclusion, Sapir’s case becomes more compelling.

Here are three of the issues that Lewis raises:

1.) Lying or misleading people about gender dysphoria and its treatment.

ACLU lawyer Chase Strangio was guilty of promulgating the lie that failure to effect gender transition in dysphoric children would lead to their suicide. He in fact made this statement when he argued Skrmetti before the Supreme Court, and had to admit under questioning that there was acxtuallyno evidence for this assertion:

“We often ask parents, ‘Would you rather have a dead son than a live daughter?’” Johanna Olson-Kennedy of Children’s Hospital Los Angeles once explained to ABC News. Variations on the phrase crop up in innumerable media articles and public statements by influencers, activists, and LGBTQ groups. The same idea—that the choice is transition or death—appeared in the arguments made by Elizabeth Prelogar, the Biden administration’s solicitor general, before the Supreme Court last year. Tennessee’s law prohibiting the use of puberty blockers and cross-sex hormones to treat minors with gender dysphoria would, she said, “increase the risk of suicide.”

. . . But there is a huge problem with this emotive formulation: It isn’t true. When Justice Samuel Alito challenged the ACLU lawyer Chase Strangio on such claims during oral arguments, Strangio made a startling admission. He conceded that there is no evidence to support the idea that medical transition reduces adolescent suicide rates.

At first, Strangio dodged the question, saying that research shows that blockers and hormones reduce “depression, anxiety, and suicidality”—that is, suicidal thoughts. (Even that is debatable, according to reviews of the research literature.) But when Alito referenced a systematic review conducted for the Cass report in England, Strangio conceded the point. “There is no evidence in some—in the studies that this treatment reduces completed suicide,” he said. “And the reason for that is completed suicide, thankfully and admittedly, is rare, and we’re talking about a very small population of individuals with studies that don’t necessarily have completed suicides within them.”

Here was the trans-rights movement’s greatest legal brain, speaking in front of the nation’s highest court. And what he was saying was that the strongest argument for a hotly debated treatment was, in fact, not supported by the evidence.

Strangio is one of the biggest proponents of affirmative care, and even took to Twitter advocating censoring Abigail Shrier’s book on gender dysphoria, Irreversible Damage. (Strangio is a trans-identified female.) Imagine an ACLU lawyer advocating censorship!

The “Dutch Protocol” (see below) was often cited by American organizations like the World Professional Association for Transgender Health (WPATH) or by physicians to justify affirmative care of minors. But the Dutch Protocol (affirmative care with medical intervention in children of younger ages) is basically without convincing clinical evidence:

Perhaps the greatest piece of misinformation believed by liberals, however, is that the American standards of care in this area are strongly evidence-based. In fact, at this point, the fairest thing to say about the evidence surrounding medical transition for adolescents—the so-called Dutch protocol, as opposed to talk therapy and other support—is that it is weak and inconclusive. (A further complication is that American child gender medicine has deviated significantly from this original protocol, in terms of length of assessments and the number and demographics of minors being treated.) Yes, as activists are keen to point out, most major American medical associations support the Dutch protocol. But consensus is not the same as evidence. And that consensus is politically influenced.

There’s an article at the site of Our Duty that discusses the shortcomings of the Dutch protocol, and is accompanied by a video of Dr. Patrick Hunter testifying before the Florida Board of Medicine; it’s a summary of the flaws of that protocol, which was applied to children much younger than 18. Here’s the video, which is short (9 minutes):

2.) Demoniziong those who question “affirmative care”.

There’s Strangio, of course, who tweeted this (and later removed it):

And this:

Marci Bowers, the former head of the World Professional Association for Transgender Health (WPATH), the most prominent organization for gender-medicine providers, has likened skepticism of child gender medicine to Holocaust denial. “There are not two sides to this issue,” she once said, according to a recent episode of The Protocol, a New York Times podcast.

Boasting about your unwillingness to listen to your opponents probably plays well in some crowds. But it left Strangio badly exposed in front of the Supreme Court, where it became clear that the conservative justices had read the most convincing critiques of hormones and blockers—and had some questions as a result.

. . .Trans-rights activists like to accuse skeptics of youth gender medicine—and publications that dare to report their views—of fomenting a “moral panic.” But the movement has spent the past decade telling gender-nonconforming children that anyone who tries to restrict access to puberty blockers and hormones is, effectively, trying to kill them. This was false, as Strangio’s answer tacitly conceded. It was also irresponsible.

Questioning affirmative care has been something that marks you as “transphobic” (I myself have been called that), but when all the facts are in, I suspect that this demonization of people who want to know the scientific and medical truth will be seen as oppressive and, given its medical results, even barbaric. As Lewis notes, the British Cass Review that resulted in closing all but one gender clinic in the UK has been falsely demonized as being discredited. It has not been discredited.

3.) Withholdiong research that doesn’t support “affirmative care”.

This is the other side of the Dutch Study coin. First you promulgate bad research that supports your side, then you are slow to publish better studies that do not support your side. The author notes that WPATH comissioned reviews of the flawed Dutch protocols and, apparently because the protocols were weak, tried to block their publication.

And then there’s the infamous study by Dr. Johanna Olson-Kennedy on the effect of puberty blockers on mental health (remember, blockers were touted as essential to prevent depression and suicide in children with gender dysphoria). Olson-Kennedy, a big proponent of affirmative care, didn’t find what she hoped for, and so withheld the study for several years!

The Alabama disclosures are not the only example of this reluctance to acknowledge contrary evidence. Last year, Olson-Kennedy said that she had not published her own broad study on mental-health outcomes for youth with gender dysphoria, because she worried about its results being “weaponized.” That raised suspicions that she had found only sketchy evidence to support the treatments that she has been prescribing—and publicly advocating for—over many years.

Last month, her study finally appeared as a preprint, a form of scientific publication where the evidence has not yet been peer-reviewed or finalized. Its participants “demonstrated no significant changes in reported anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, aggressive behavior, internalizing problems or externalizing problems” in the two years after starting puberty blockers. (I have requested comment from Olson-Kennedy via Children’s Hospital Los Angeles but have not yet heard back.)

And note, this is in an unreviewed preprint.

Withholding evidence that doesn’t support your favored hypothesis is scientifically unethical, somewhat akin to falsifying data. That’s because doing this means you’re simply allowing false conclusions to persist when you have evidence for their falsity. And that means that medical practice based on those false conclusions also persists, and, in this case, children were being treated on the basis of untested ideas.

There’s a lot more in this article to chew on, but the important thing is that it was published in a reputable (and left-leaning) magazine. The NYT has had similar articles about the weak evidence for “gender affirming care.” (In my view, Pamela Paul’s 2024 critique of this care in the NYT was a big factor in her being let go by the paper. They thus lost one of their best heterodox writers.)

To paraphrase Walter Cronkite, an advocate of gender-affirming care might say, “When we’ve lost The Atlantic and the New York Times, we’ve lost America.”

I don’t oppose the use of hormones or blockers when the decision to use them is made by adolescents with sufficient mental maturity. If you’re 18 and want to change, well, go ahead and take the hormones and cut off pieces of your top or bottom. But not in minors—not until we have evidence that that this practice actually helps them—and we don’t. Lewis closes her piece this way:

Some advocates for the Dutch protocol, as it’s applied in the United States, have staked their entire career and reputation on its safety and effectiveness. They have strong incentives not to concede the weakness of the evidence. In 2023, the advocacy group GLAAD drove a truck around the offices of The New York Times to declare that the “science is settled.” Doctors such as Olson-Kennedy and activists such as Strangio are unlikely to revise their opinions.

For everyone else, however, the choice is still open. We can support civil-rights protections for transgender people without having to endorse an experimental and unproven set of medical treatments—or having to repeat emotionally manipulative and now discredited claims about suicide.

Gender-altering surgery raises the incidence of mental illness in those with gender dysphoria

March 3, 2025 • 11:00 am

Here’s a new article in the Journal of Sexual Medicine that investigated the effects of gender-changing surgery on both males and females (over 18) with a diagnosis of gender dysphoria. The results won’t make gender extremists happy, as in both cases rates of mental distress, including anxiety, and depression, were higher than those having surgery than those not having surgery after two years of monitoring. However, this doesn’t mean that the surgery shouldn’t be done, as the authors note that other studies show that people undergoing surgical treatment are, over the longer term, generally happy with the outcome. The main lesson of the paper is that people who do undergo such surgeries should be monitored carefully for post-surgical declines in mental health.

Click the headline below to read.

The authors note that there are earlier but much smaller studies that show no decline in mental health after surgery, but these are plagued not only by small sample size, but also by non-representative sampling reliance on self-report, and failure to diagnose other forms of mental illness beyond gender dysphoria before surgery. The present study, while remedying these problems, still has a few issues (see below).

The advantages of this study over earlier ones is that the samples of Lewis et al. are HUGE, based on the TriNetX database of over 113 million patients from 64 American healthcare organizations. Further, the patients were selected only because they had a diagnosis of gender dysphoria and no record of any other form of mental illness (of course, it could have been hidden). Patients were divided into four groups (actually six, but I’m omitting two since they lacked controls): natal males with gender dyphoria who had or didn’t have surgery, and natal females with and without surgery. Here are the four groups, and I’ve added the sample size to show how much data they have:

Cohort A: Patients documented as male (which may indicate natal sex or affirmed gender identity), aged ≥18 years, with a prior diagnosis of gender dysphoria, who had undergone gender-affirming surgery.
Cohort B: Male patients with the same diagnosis but without surgery. [Cohorts A and B had 2774 patients.]
Cohort C: Patients documented as female, aged ≥18 years, with a prior diagnosis of gender dysphoria, who had undergone gender-affirming surgery.
Cohort D: Female patients with the same diagnosis but without surgery. [Cohorts C and D each had 3358 patients.]

A and B are the experimental and control groups for men, as are C and D for women. Further, within each comparison patients were matched for sex, race, and age to provide further controls. And here are the kinds of surgeries they had:

To be included, all patients had to be 18 years or older with a diagnosis of gender dysphoria, as identified by the ICD-10 code F64. This criterion was chosen based on literature highlighting elevated mental health concerns for transgender and nonbinary patients with gender dysphoria [15, 16]. Gender-affirming surgery cohorts consisted of patients with a documented diagnosis of gender dysphoria who had undergone specific gender-affirming surgical procedures. For transmen, this primarily included mastectomy (chest masculinization surgery, CPT codes 19 303 and 19 304), while for transwomen, this encompassed a range of feminizing procedures such as tracheal shave (CPT code 31899), breast augmentation (CPT code 19325), and vaginoplasty (CPT codes 57 335 and 55 970). These surgeries were identified using clinician-verified CPT codes within the TriNetX database, allowing for precise classification.

Note that there were a lot more “bottom” surgeries for trans-identifying men (as the authors call them, “transwomen”) than for trans-identifying women (“transmen”). Men prefer to change their genitals more often than women, even though, if you know how vaginoplasties are done, you have to be hellbent on getting one. (I don’t know as much about the results of getting a confected penis.)

I’ll be brief with the results: in both comparisons, those patients who had surgery had a significantly higher postsurgical risk of depression, anxiety, suicidal ideation, and substance abuse. But surgery had no effect on body dysmorphia: the obsession with flaws in one’s appearance. Here are the tables and statistical comparisons of cohorts A vs. B and C vs. D, and the effect of surgery is substantial (results on women are similar though differences are smaller). Some of the differences are substantial: anxiety in men, for example, was nearly five times higher in those who had surgery than those who did not.

As you see, there are significant differences for everything save body dysmorphia, for which there are no differences at all. The authors conclude that yes, at least over the two-year measurement period (again, mental states were monitored by professionals, and were not due to self report). Given that surgery does seem to improve well being over the long term, as the authors note twice, they conclude that the results provide more caution about taking care of patients who have transitional surgery:

The findings of this study underscore a pressing need for enhanced mental health guidelines tailored to the needs of transgender individuals following gender-affirming surgery. Our analysis reveals a significantly elevated risk of mental health disorders—including depression, anxiety, suicidal ideation, and substance use disorder—post-surgery among individuals with a prior diagnosis of gender dysphoria. Importantly, however, our results indicate no increased risk of body dysmorphic disorder following surgery, suggesting that these individuals generally experience satisfaction with their body image and surgical outcomes. Notably, the heightened risk of mental health issues post-surgery was particularly pronounced among individuals undergoing feminizing transition compared to masculinizing transition, emphasizing the necessity for gender-sensitive approaches even after gender-affirming procedures.

Possible problems. There are two main limitations of the study noted by the authors. First, individuals electing surgery may have higher levels of distress to begin with than those who didn’t, so the elevated rate of mental disorders in the surgery group could be artifactual in that way. Second, patients who have had surgery may be wealthier or otherwise have more access to healthcare than those who didn’t, and so higher rates of mental distress could result simply from a difference in detectability.

Now I don’t know the literature on long-term effects of surgery on well-being, so I’ll accept the authors’ statement that they are positive, even though patients with greater well being could, I suppose, still suffer more depression and anxiety. But those who are looking to say that there should be no surgery for those with gender dysphoria will not find support for that in this paper. What they will find is the conclusion that gender-altering surgery comes with mental health risks, and those must be taken into account. It’s always better, when dealing with such stuff. to have more rather than less information so one can inform those contemplating surgery.

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Category: medicine and health

“Progressives” appear to whitewash female genital mutilation

📊 General Western Prevalence

🇪🇺 Europe

🇺🇸 United States

🇨🇦 Canada and Other Western Countries

🧠 What This Means

Proprietor’s miscellany

The Atlantic criticizes youth gender medicine

American Humanist vigorously endorses “affirmative care” with no lower age limit

The Atlantic takes on “affirmative care”

Gender-altering surgery raises the incidence of mental illness in those with gender dysphoria