Moti Gorin
@GorinMoti
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New article from me, Jilles Smids, and John Lantos. One of our conclusions: "Given this state of knowledge, it is ethically problematic to view the routine use of hormonal or surgical interventions in youth with gender dysphoria as evidence-based.".
Moti Gorin, Jilles Smids, and @johnlantos discuss the need for clinicians to conduct thorough research on the risks and benefits of gender-affirming care.
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The most striking thing about the “What is a Woman” documentary is how Matt Walsh—Matt Walsh—is able to make highly educated “progressives” look stupid. And it’s not due to entrapment or selective editing. It’s because the ideas are fundamentally incoherent.
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People piling on Coates, but what he says reminds me of when Ehud Barak said that if he were Palestinian at the right age he would have joined a terror organization (though Coates seems less certain than Barak). It is a descriptive point about how humans respond to oppression.
Ta-Nehisi Coates suggests he's not above taking part in an October 7-style attack:."And I grow up under that oppression and that poverty and the wall comes down. Am I also strong enough or even constructed in such a way where I say this is too far, I don't know that I am."
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One of the letters to the editor responding to the recent NYT piece on the use of puberty blockers, written by one of the principal researchers of Lupron (puberty blocking drug).
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Sweden and Finland are more LGBT+ friendly than the US. They conducted systematic reviews of the evidence for gender-affirming care and concluded the risks outweigh the benefits.Have advocates of GAC explained anywhere why Sweden and Finland are wrong? I have seen no discussion.
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I believe this is the first US pediatric gender clinic employee who has publicly spoken out. She's not the last. Medical historians, start doing your research. There's an important story to be told here about how this area of medicine was captured.
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Whatever you think of the Trump EO on pediatric medical transition, it is important to keep in mind that it is a consequence of the abject failure of American medicine (including my colleagues in bioethics and other medicine-adjacent academic disciplines) to self-regulate.
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Jack Turban, a psychiatrist and leading "expert" in pediatric "gender medicine," has a piece out in the NYT. I think this paragraph exemplifies the utter confusion that permeates this field. A few points: 1/
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When Matt Walsh makes you look like a fool, it’s time to look inward.
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Old enough to remember when “male lesbian” was a kind of frat boy sexist joke.
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People who genuinely believe they will be harmed by ideas presented at an academic conference may have chosen the wrong profession. You cannot be a responsible researcher or teacher if you cannot tolerate ideas with which you expect you might disagree.
That thing that never happens in academia, happened again. Presidents of @AMericanAnthro and @CASCATweet deplatform a conference panel on biological sex in anthropology, on grounds of "harm to Trans and LGBTQI". An open letter from those deplatformed follows in next tweet.
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Lots of accusations of bigotry directed my way today. But I still haven't heard anyone claiming my views on pediatric gender medicine are bigoted explain what's happening in Sweden, Finland, England (with Norway recently moving in a similar direction.) This never gets addressed.
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An example of how reporters and clinicians distribute misinformation. One of the doctors here claims research shows reduction in suicidal ideation and attempts. The link goes to a NEJM study that did not even report on these measures. Also, two kids in the study committed suicide.
“There are some days that you look at everything going on and you are just paralyzed by fear of what's coming at your kid next.”. Parents, trans kids, & doctors talked w/me about Florida’s new ban on gender-affirming care. My latest for @NPR:.
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The Olson-Kennedy lawsuit by a struggling patient who was "provided" a double mastectomy at 14 after testosterone at 13 and blockers at 12 is a further reminder of how negligent my field of bioethics has been on this issue. Explanation by me and Alex Byrne in the next tweet.
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I wrote a short essay describing the very unusual and ethically troubling differences in clinical guidelines between the US and some other LGBT+ friendly countries in pediatric gender care. The US should commission systematic reviews of the evidence.
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In the not-too-distant future, it will become clear to all that the model adopted in the US for the treatment of kids with gender dysphoria has been misconceived. If only for political reasons, it would be better if more people on the left started speaking out before that happens.
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I have not finished reading the final Cass Report. But one thing Dr. Cass says in this recent interview struck me as worth posting. It's about how the familiar tactics of the most aggressive activists and the cowardice of the rest of us have undermined science and harmed children
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This is what happens when academics and researchers fail miserably at defining our terms, and when the lessons of second-wave feminism are forgotten. Conforming to gender norms becomes "gender affirming care," on a par with cross sex hormones and double mastectomies for teenagers.
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@pschofie79 Also odd because if you want to hurt someone in a tug a war, what you do is drop the rope. I remember playing as a kid and sometimes one team conspired to do this and then the other team would fall down. Seems like they should go with "don't pick up the rope" but it's less catchy.
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@PhilipMertz1 @BrianLeiter @SandisBertaitis This understates things a bit. She was ostracized by her department, emails calling her a bigot were circulated, she lost the TA she relied on to help teach her course, and Harvard refused to defend her academic freedom.
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Gretchen Felker-Martin has repeatedly and publicly fantasized about the grisly sexualized murder of journalists and authors. She is a signatory to the letter to the NYT. When will the other signatories distance themselves from The Gretchen Felker-Martin letter?.
Sorry -- make that *NYT Letter Signatory Gretchen Felker Martin*!! Congrats to all involved.
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One of the odd implications of construing sexual orientation in terms of gender identity rather than sex is that one's sexual orientation is determined by other people's mental states.
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What does it mean to "feel male" or "feel female"? Maybe it's just the feeling of being alive as a male or female. But then how could a female feel male or vice versa? 2/.
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Surprisingly strong (and accurate) piece from the Washington Post’s editorial board. This, from a center/left of center outlet, is quite significant, and it means the censorious crowd continues to lose influence. Link in next tweet.
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And no one seems interested in the recent BMJ piece that included interviews with leading experts in evidence grading, who looked at US guidelines (WPATH and Endocrine Society) and concluded they aren't evidence based. Why no interest?.
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In this article, Burns claims that "dozens" of studies on adolescents show improvements in "mental health and life outcomes" "resulting from" gender affirming care. This is demonstrably false. Where are these dozens? How does this get published?.
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Why are other clinicians and health authorities deferring to these "experts," who openly tell us without embarrassment, that the most "basic sense" of arguably the most important variable in their field (gender identity) is ineffable and transcendent? Not everyone goes to church.
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To be clear, his comment was that he’s a father to two little girls and he worries about them playing against male athletes, and that Democrats make it difficult to express this kind of concern, despite its being quite widely shared by voters.
Interesting: Tufts is breaking ties with Rep. Seth Moulton’s office over his comments on trans athletes, telling the office not to contact Tufts about future internships, per person familiar with the matter. The call came from David Art, chair of poli sci department.
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What are the kids drawing? Are they drawing themselves with genitals they don't have? If so, the representations are inaccurate. Are they drawing themselves as being nonconforming in dress or hairstyle? If so, what does this have to do with their sex? 3/.
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No, your four year old didn’t say that. This entire article is amazing. Would have been silly even in 2010 but in 2024 it’s journalistic malpractice.
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Finland’s top adolescent psychiatrist on what’s gone wrong in the world of pediatric gender medicine. Compare her clear and accurate language to the kind of talk we get from US authorities, which has been distorted by the activist capture of the field.
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After years of watching various institutions--media outlets, professional societies, universities, medical orgs, etc.--buckle under the slightest pressure from the most unhinged activists, it's refreshing to see this kind of commitment to a core mission. It will spread.
Memo from Joe Kahn to NYT staff responding to yesterday's letter re: trans coverage. Times leadership says the paper "will not tolerate, participation by Times journalists in protests organized by advocacy groups or attacks on colleagues on social media and other public forums."
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Publisher of a book on (ironically enough) how to discuss/debate controversial ideas in a constructive manner refuses to publish the chapter on sex/gender because they disagree with the content on political grounds. Can't make this stuff up.
Turning to p. 99, Chapter 5 (or what’s left of it) begins: “This is where, in the original manuscript of this book, readers would have found Chapter 5, ‘Defining Sex/Gender: Beyond Trans Ideology.’ Here’s the story of why it’s not here.”
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In order to accommodate the (confused) views of a tiny sliver of Western activists, Amnesty International outright denies the basis of sexist oppression in Afghanistan (and everywhere else). Women and girls are discriminated against because they are female. Talk about "erasure.".
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How can "feeling male or female" be "manifested" by the good/bad feelings kids have when they are "gendered" via pronouns? We are told that gender and sex are distinct and that pronouns refer to gender, not sex. So what do transcendent sex-feelings have to do with pronouns? 4/.
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Yes, this is an incredibly callous comment. But it’s also a concession that medical transition can “screw up” someone’s life. And this is supposed to be impossible because as affirming clinicians tell us, kids “know who they are.”.
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@benryanwriter Might be worth noting that the systematic reviews on which the Cass Review was largely based are in fact peer-reviewed. The Cass Review itself is a policy document, never intended for submission peer review.
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An understated point re the chemotherapy discourse. Chemotherapy is prescribed normally for kids with certain cancers. And yet sadly there are those who oppose prescribing chemotherapy to kids without cancer. Such an understated point.
An understated point re the puberty blocker discourse:. Puberty blockers are prescribed normally for kids who go through puberty early. They're available, for *cis* kids. They've been deemed safe, for *cis* kids.
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I've said it before and I'll say it again: the extent of disregard for the truth in the field of pediatric gender medicine among proponents is simply remarkable. Look at this bald lie. Link in next tweet.
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Exactly right. The reason people don't focus on cases of trans men in men's sport is because the issue has never been about being trans. It's always been about males in women's spaces, including sports. "TERFs" aren't actually trans-exclusionary. They're male-exclusionary.
ooooOOOPs, we accidentally undercut the narrative that people are targeting trans-identifying folks! Yet again! Every time!. It's about *biological sex*. Namely, male puberty. Not people's attitudes toward masculinity and femininity (i.e. "gender identity").
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The best reason to take Jamie Reed's testimony seriously isn't that she gave it in a sworn affidavit. The best reason is that she is simply describing the approach that's openly endorsed by many US gender clinicians themselves: Gatekeeping is bad, "affirm" ASAP-it's their model.
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It should be easy, then, for people to attend and clearly show the falsehoods, the “unethical research practices” etc. But no, instead they advance vague and unsubstantiated claims of “harm.” It’s ok to hate academic freedom. There are other jobs out there.
it is not “ideas” that are harmful, it is the well-documented pattern of falsehoods being legitimized by an academic organization platforming faulty and unethical research methods, which is then cited in legislation that harms, disenfranchises, and discriminates in tangible ways
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@runthinkwrite What I find so odd about such cases is that the “winners” seem genuinely proud. Like they really believe it.
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Whatever you think of the AAP’s position on pediatric gender medicine, having security remove detransitioners who are peacefully working a booth is just stupid as a public relations matter. The pressure is getting to them.
BREAKING: The @AmerAcadPeds has kicked out a detrans group that included Chloe Cole, Abel Garcia, Soren Aldaco, and Nicolas Flowers from their annual conference. Why is the AAP preventing doctors from hearing these stories?
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@jessesingal @christapeterso Typical behavior from this one. Just machine gun-style spray of massively uncharitable and misleading Tweets aiming to tar perceived enemies. The speculation on privacy law minutia does add a comedic element this time around.
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@MattWalshBlog If wives leave their husbands when they start to earn more, maybe this suggests that economic precarity plays some role in explaining why some women stay bound to their husbands, rather than because they want nothing more than to cook and clean for their men. Ever consider this?.
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Sweden and Finland are very low on the list of religiosity worldwide. Their decisions cannot be understood through the US prism of religious conservatism. Often, liberals look to those countries as models. And yet here we are supposed to believe they are genocidal against LGBT?.
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"A surprising percentage of their patients with the TikTok tics identified as transgender or nonbinary. But without hard data in hand, multiple attendees said, the doctors worried about publicly linking transgender identity and mental illness.".
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@kittypurrzog Drink his water while maintaining eye contact. Full alpha, the machine is yours.
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Denmark follows England, Sweden, Finland, Norway in stepping back from the medically aggressive model endorsed by US clinics and American major medical organizations. The former countries are practicing evidence-based medicine, grounded in systematic reviews. The latter is not.
The journal of the Danish Medical Association Ugeskrift for Læger has confirmed that Denmark is restricting medical transition of gender-dysphoric minors. Only 6% of the gender clinic referrals were approved for transition in 2022, down from 65% in 2018./1.
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Not everyone knows this but if you go around collecting small dog turds, and you collect a bunch of them, and you put them in a big pile, you actually end up with a delicious, nutritious meal.
This right here. Another principle being ignored is that at a certain point, a mountain of lower quality evidence that nevertheless all shows the same results combines to create a larger picture.
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A deep oddity confronting anyone who starts thinking about these issues is that if "gender affirming care" affirms gender, then gender must be directly related to one's sexed body, but it's also an axiom of the pro-affirmation view that one's gender is independent of one's body.
I am once again reminding us that in order to know whether these surgeries affirm someone's "gender," we'd have to first know what a gender is. And, embarrassingly, nobody seems to know that.
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Ok, good. A simple empirical claim. Easy to assess. Where are the dozens of studies showing that adolescents’ mental health and life outcomes improve as a result of gender affirming care?.
I wrote that there are dozens of studies showing this because there are dozens of studies showing this.
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@jessesingal Wait a minute. Are you telling me Lewis—a journalist—just flat out asked someone if they wanted to talk about a story?. Literally shitting my pants in vicarious terror.
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The most important thing here aren't the findings, but rather the prior fact that our institutions have proven so vulnerable to activist capture and the insertion of their pseudo-intellectual bullshit that academics have to waste their time doing studies like this.
Which is more important sex or gender identity?. In a study published today we used data on non-binary athletes' performance in road races to compare the power of gender-identity theory and gender-critical theory.
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Regarding the Roald Dahl "sensitivity readers" changes: it's unclear to me how this can be done without violating obvious authorship and publication norms. Dahl did not write those words; how can the publisher represent him as having done so when the books come out?.
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@jessesingal It's weird that in 2023 there are still people who are nominally smart and informed and who speak publicly on this issue but who seem completely in the dark about the developments in the field. The US has to be way down on the list when it comes to elite competency in this area.
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One of the criticisms of the Cass Review is that Cass is not an expert in pediatric gender medicine. Here is a leading expert in that field explaining how they approach things. I find this pretty troubling. This field has gone off the rails in pretty spectacular fashion.
“I’ll turn to the child and be like, so yeah what gender identity do you have?” . Dr. Robert Garofalo of @LurieChildrens hospital proudly admits the horrible truth behind the process of transitioning children.
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If I ever despair over the state of philosophy I read a tweet by Sally Hines and feel better.
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Cass does discuss the long wait lists in several places. Easy to verify. Cass does not view transition as an "inherently bad outcome." She says "for some, the best outcome will be transition." Easy to verify. How these people call themselves "journalists" is beyond me.
Someone directed my attention to material on the listening sessions the Cass Review held with trans youth and their families, and it's just heartbreaking. These kids openly begged Cass not to view transition as an inherently bad outcome, and that was one of the main conclusions.
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Twitter “communists” may not like this, but what they say here about sex and gender and capitalism is true.
Well, this throws a spanner in the works of the GC Nazi narrative. The British Communist party coming out as TERFs. (Actually, just reaffirming true socialist materialism). Can someone ping Owen Jones?.
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Isn’t it just awful how those greedy and ethnocentric Arabs want all the land from the river to the sea? Why can’t they be more like the modern, secular, democratic Israelis, who just want to live in peace with their neighbors?.
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"Will the trans activists ever accept they lost?" .The answer is "no." But it shouldn't matter. The problem isn't that some people will continue to cling to false beliefs. The question is whether they will continue have influence over practice and policy.
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Authors argue strategies that minimize risk to “offspring” (babies, future people) are potentially harmful to trans people and society more generally. Forget morality: strategically, it’s probably a mistake to pitch one’s own interests as being in conflict with those of babies.
This new paper arguing that "precautionary" and "safety first" approaches during pregnancy to prevent developmental conditions in the fetus is "eugenicist" and "inscribe binarized notions of sex" needs to be seen to be believed. It's truly demented.
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I would think at least the more serious writers who signed that letter to the NYT would be curious about this. Ron DeSantis is not governor of Europe.
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@transscribe Do you mean to tell me that your claim that dozens of studies have shown improvements for adolescents, caused by GAC, is based on your simply counting the number of search engine results using queries that don't even include "adolescent"? I can't tell if you're serious.
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@jessesingal Hilary Cass kicking herself for wasting 4 years when it could have been done in a morning.
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There are other misleading claims, but this one is so easy to verify by spending just a few minutes actually checking sources. Of course the vast majority of people do not check sources. Then, when someone raises questions about this care, they get labeled anti-science, or worse.
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@jessesingal I hope normal people who don't follow this stuff closely but who care about the basic human element (children's welfare) read this story and then see some of the activist responses calling the NYT bigoted, genocide-adjacent, etc.
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Assisted suicide is a complicated issue. But one thing probably everyone agrees on is that in any case it is a response to a bad situation, and not something that should be presented as appropriate to ecstatically jump around about.
Who at @TfL thought it was remotely appropriate to promote assisted suicide on the London Underground?
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Norway joins Sweden, Finland, UK in rejecting the American/WPATH aggressive medicalization model, which is not supported by systematic reviews, in pediatric gender care. Informative thread:.
The Norwegian Healthcare Investigation Board, (NHIB/UKOM) has deemed puberty blockers, cross-sex-hormones & surgery for children & young people experimental, determining that the current “gender-affirmative” guidelines are not evidence-based and must be revised. /1.
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Here's an article from 2017 discussing some of the longer-term risks of puberty blockers. Nothing to do with the trans issue--these people got it for precocious puberty or off-label to add height--so hard to call it transphobic.
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I have to stop responding to the "cis" stuff because it gets really repetitive. But this is an important point: "cis" is not synonymous with "non-trans." People may use it that way, but if you look up how it's defined, it carries far more metaphysical baggage than "non-trans.".
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@jessesingal Scenes of Jews being rounded up, forced on trains. Old Jewish man getting beaten by Nazi soldier: “My lived experience sucks right now.”.
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@Docstockk It's far from obvious that we'd be reading about this now if you and others hadn't spoken out earlier and taken that flak. Perhaps there's not much solace in that for you but it's true, and important.
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If I were a parent of a patient, I would find this upsetting. Such nakedly cynical, anti-scientific, unethical maneuvering on the part of people who have an obligation to protect and promote the health of vulnerable patients. Children, in this case.
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@LeorSapir It’s virtually impossible to find an account of gender identity, beyond “a sense one has.” It is truly remarkable to see so much policy and law constructed on the basis of such an impoverished notion.
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@pschofie79 Not only should he not be fired, but he should receive an award for protecting his students.
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My language is “rhetorically aligned” with some other naughty language. This is two parts literary theory, three parts vague and careless accusations of bigotry, all delivered as a sermon.
This language is also rhetorically aligned with the language used by Moti Goran in the linked tweet below:.
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From a science integrity standpoint, I think this is the most damning story about WPATH (so far). It looks like WPATH commissioned systematic reviews from Johns Hopkins but then muzzled the researchers and squashed publication. Read the documents.
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Philosopher Alex Byrne @byrne_a wrote a review of Turban's new book. It's a very good review, fair-minded and charitable (which does not mean it's not critical).
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Recent Dutch public television report on the "Dutch model" of pediatric gender medicine, with English subtitles. Very important. We need this kind of reporting in the United States.
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I've opposed legislative bans on pediatric medical transition. I think the approach can be counterproductive, for one. However, when I read what leading US clinicians in positions of real power say, I start to second guess myself. This article provides many examples. Here's one:
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@colwight For the same reason they ask for a ceasefire rather than asking Israel to surrender. A ceasefire is meant to stop bloodshed, to save civilian lives, without requiring any side to concede. It’s about humanity not victory.
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I’m gonna cut to the chase: I’m not leaving twitter, but it’s nevertheless vital for me to believe that you believe that I’m still a very good, principled person.
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We hear from activists that the problem with reporting on this issue is that it misses the perspectives of trans people.Getting those perspectives is important.But it's irrelevant in cases like this, where basic facts are (mis)reported.This is about literacy, not gender identity.
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@jessesingal It’s liberating knowing that I can have a gender that’s different from my sex but also different from my gender identity. I am glad the medical doctors figured this out.
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It’s not unusual, historically, for medical scandals to be brought to public attention not by clinicians or researchers but by journalists. What’s more unusual is to see this kind of response.
very tiny fraction of the folks telling me to kill myself the other night in the wake of the noah kulwin thing
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Dr. Guyatt is one of the world’s very top experts and authorities in the evaluation of medical evidence. He helped establish the criteria used to determine what counts as evidence-based care.
Current American guidelines for managing gender dysphoria in adolescents untrustworthy. Don’t acknowledge the very low certainty evidence regarding alternatives and do not make the very guarded weak/conditional recommendations appropriate for such evidence
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@LeorSapir @AmJSurgery Helpful primer on what a systematic review is. Appraisal of evidence is a necessary component. Otherwise SRs wouldn’t provide stronger evidence than the studies they evaluate, and would be largely epistemically pointless.
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Several years ago even very careless accusations of bigotry carried a certain weight. But since then we've gotten more evidence about the state of pediatric gender medicine (and related issues), and so this tactic of silencing discussion or criticism has become untenable.
@shengokai Thanks for the inspirational ethics lecture and suggestions on how to attain wisdom. My bosom is heaving.I'm very familiar with the first-order issues here, at least those pertaining to the reporting on pediatric gender care. So forgive me if I'm not convinced, despite the pathos.
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From new guidelines for pediatric gender care out of Sweden:. "For adolescents with gender incongruence, the NBHW deems that the risks of puberty suppressing treatment with GnRH-analogues.and gender-affirming hormonal treatment currently outweigh the.possible benefits." 1/.
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@elizamondegreen "It was really hard for me to reign in the emotions I was feeling, particularly feeling triggered (and angry - my inner "protector" very much wanted to lash out and be all 'I'm not going to let a fuckin 6yr old tell me how to live my life')" . Bizarre.
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If I were a clinician who believed that sex characteristics have nothing to do with gender I would think about how I am supposed to affirm a kid's gender by modifying their sex characteristics. I'd wonder about this sometimes, like when I prescribed hormones or did a mastectomy.
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A must-read. Fellow bioethicists: It's ok to join the discussion now. Hilary Cass has done the heavy lifting and you can talk about it. The scary activists can't hurt you anymore.
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This letter is amusing for many reasons. One is that it claims that even before its publication the Cass review was “comprehensively critiqued in a peer-reviewed journal.” If true, this would be very exciting indeed, as it would provide good evidence of time travel.
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This is one reason I think detransition/desistance/regret rates, while important, don’t get to the heart of the ethical matter here.
Dr Hilary Cass 'surprised by homophobia' during review of gender identity services. ➡
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With all the talk about DSDs/intersex due to the Olympics, this is the one time where "assigned sex at birth" actually has accurate and useful application. Ironically, it's being neglected in favor of hogwash like "born a woman." . I don't use "hogwash" much but it's warranted.
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Semenya has testes and went through male puberty. That is the reason people objected to her participation in women's sports. Laurel Hubbard also drew criticism, is white, and could very well have taken a spot in the Olympics that would otherwise have gone to a non-white lifter.
Transphobia doesn't just harm trans people. It hurts cisgender women who don’t conform to a narrow, Eurocentric vision of womanhood.
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