Will Malone MD
@will_malone
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Endocrinologist. Opinions my own. Society for Evidence-Based Gender Medicine ().
United States
Joined November 2010
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Please read our “No One is Born in the Wrong Body” essay published today on
@Quillette
.
@SwipeWright
@JuliaDRobertson
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There are many, many of us concerned clinicians. Most are fearful of speaking publicly, but some have started: .
Many health professionals are concerned that young people struggling with their mental health are being shunted towards hormones and surgery when this may not be in their best interests. 4/11
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Testosterone is important for normal male brain maturation. Here is a report of an 11 y/o boy on puberty blockers: IQ dropped 11% (80 to 71) after 17 mo.
As the EIC of the BMJ has said, PB are being used in a state of “profound scientific ignorance.”
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Cass Review:
"...brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences."
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Important new Endocrine Society statement: biological sex is real, measurable & dichotomous (only 2 sexes, not a spectrum).
Considering Sex as a Biological Variable in Basic and Clinical Studies: An Endocrine Society Scientific Statement
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Dr. Thomas Steensma, who helped develop and implement the “Dutch Protocol” (the interventions of puberty blockers, followed by cross-sex-hormones), has made a series of public statements that under normal situations would be self-evident to most medical professionals:/1
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Puberty blocking drugs aren’t a pause button. They’re the first step in a hormonal and surgical protocol that is unproven to help gender dysphoric kids, and carries great risk (infertility, low bone density, heart disease, stroke).
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Time to fact-check
@jack_turban
's latest article. Spoiler alert—it’s full of misrepresentations and errors. Jack’s mistakes could be forgiven as he is in medical training (a first year-fellow) with much to learn, except that he positions himself as an expert. /1
A new book by
@AbigailShrier
has gained widespread internet popularity.
@TheEconomist
named it a top book of the year
The book is full of medical misinformation with the potential to harm
#trans
youth. I wrote about what you need to know for
@PsychToday
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There is no convincing evidence that hormones or surgeries improve the long term mental health of youth with gender dysphoria. There is evidence they cause physical harms. The UK, Finland & Sweden have acted appropriately, but the
@AmerAcadPeds
keeps its head in the sand.
A worldwide debate on pediatric gender medicine isn't happening in U.S. medical institutions.
American medical organizations are too busy muzzling it.
My piece in the
@WSJopinion
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He asks: “Where does the large flow of children come from who have suddenly registered for transgender care since 2013? And what is the quality of life like for this group long after sex change? There is no answer to those questions.” /2
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Sex is not a spectrum. Female brains don’t come in male bodies. When doctors and medical societies fail to recognize self-evident facts to the detriment of children and adolescents, legislative bodies have an obligation to intervene.
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Combined threads regarding gender dysphoria
1. If 80-90% of childhood gender dysphoria resolves after puberty, why are we treating all pubertal gender dysphoric adolescents with puberty blockers (PB), especially when PB almost always leads to xsex hormones use?
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Unbelievable. That’s not how science works. Abnormal bone densities don’t disappear simply because a new false “normal” reference range gets created. //
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He continues: “The research on the small group of people from before 2013 may not apply to the large group that there is now. We conduct structural research in the Netherlands. But the rest of the world is blindly adopting our research." /4
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"Every doctor or psychologist who engages in transgender care should feel the obligation to do a good before and after measurement."/5
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And: "We don't know whether studies we have done in the past can still be applied to this time. Many more children are applying[for transition], and also a different type [many more girls who apply]./3
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New article, Swedish Press:
"Changing gender does not reduce the risk of suicide. The National Board of Health and Welfare's new overview shows what many others have warned about: today's treatment of gender dysphoria can do more harm than good." >>
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She writes that given uncertainties about outcomes in late presenters with no childhood history of dysphoria, there should be a renewed focus on psychological support, as hormones and surgeries may not be appropriate. /8
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While Jack accuses
@AbigailShrier
of a political slant, he published his attack on a journalist under the “political minds” rubric. Jack’s entitled to a political view. But as a young researcher, Jack would be well-advised to steer clear of mixing politics with research. /18
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Contrary to Jack's claim, the rapid rise in numbers of girls wishing to change sex is not a “bizarre premise.” Every gender clinic in the world has documented this phenomenon. Kaltiala-Heino (Finland) describes it in her 2018 peer-reviewed publication /2
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Humans acquire more than half the bone density they will ever have during their teen years. This is the most critical time for long term bone/skeletal health. >>
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“The other way to explain JKR’s journey... is that she is an intelligent women who has taken a careful look at the issue and decided for herself that there is nothing progressive or kind or liberal about a movement that encourages autistic children to be given untested drugs.”
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This follows commentary by Dr. Annelou de Vries (part of the same Dutch Protocol collaborative), reminding us that adolescents with recent-onset gender dysphoria (no childhood history of dysphoria) were not part of their study protocol./7
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Europe is turning away from hormones & surgeries for gender dysphoric minors. In the US, it is still politically positioned as a left vs right issue, but safeguarding youth should be a universal focus for all. Thank you for speaking up
@AbigailShrier
.
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Finland, the home of one of the most prominent gender researchers in the world, Kaltiala-Heino, evaluated the evidence for hormones and surgeries in 2020 and found it lacking. Finland no longer follows the “affirmation” model for young people. /9
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The authors response to their finding of PB halting bone development? They recommended a change in the reference range of bone density for kids on PB, essentially changing a abnormal finding to a “normal” one.>>
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Jack is right about one thing. Medical societies in the US are indeed on the “affirmation” bandwagon. The US profit-driven healthcare system is easily swayed by market forces such as generous payouts and patient demand. But even in the US the tide on “affirmation” is turning. /17
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“The time for politeness on this issue has passed. Biologists and medical professionals need to stand up for the empirical reality of biological sex.”
Thanks
@SwipeWright
and
@FondOfBeetles
.
I am excited to share my op-ed in the
@WSJ
coauthored with the amazing
@FondOfBeetles
. The growing trend to deny the reality of biological sex is harmful to women, the LGB community, and children. It’s time to speak out against this toxic ideology.
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"Britain’s National Institute for Health and Care Excellence found that puberty blockers did little to dispel gender dysphoria or improve patients’ mental health."
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Yet again,
@jack_turban
accuses journalists of “agenda-driven propaganda” & “astounding misinformation.” Jack’s new target is the
@TheEconomist
‘s coverage of the UK High Court ruling re: experimental hormonal interventions for gender-dysphoric youth./1
The misinformation about
#trans
youth and
#mentalhealth
in this piece from
@TheEconomist
is astounding. Thread (1/9)
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Jack claims that “affirming” interventions for gender-dysphoria are not controversial outside of “a few fringe groups.” The “fringe” Jack is referring to must be the UK, Sweden, and Finland, who are backing away from "affirmative" hormones & surgeries. /8
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“The fact is, no child is actually born in the wrong body. Adults should expand their understanding of what normal male and female behavior and preferences look like—which would lead them to appreciate that being male or female comes with a wider range of personalities”>>
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Because almost 90% of gender dysphoria resolves by age 20, affirmation therapy in children and adolescents hurts 9 in an effort to help 1, using drugs and surgeries that are unproven to even help the 1.
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This phenomenon has a provisional name of
#ROGD
coined by
@LisaLittman
. Jack purposefully avoids naming it, yet the clinicians who are in the room with these teens agree this is a real, and growing phenomenon. /4
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.
@TheEndoSociety
you are stating as fact things that are very contested; you have an obligation to acknowledge scientific debate regarding these issues; to do otherwise falls short of your mission as a medical society. >>
Puberty blockers are reversible and the recommended therapy for
#transgender
kids beginning early in puberty. Our Clinical Practice Guidelines () and Position Statement delve into the science ().
@bustle
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A thread on the Endocrine Society response to the Cass Review:
The 2017 Endocrine Society (ES)
@TheEndoSociety
gender dysphoria guidelines justified the use of puberty blockers for children just entering puberty by stating that appearance changes were more important than
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Important review formalizing what's been known for years. Puberty blockers and cross-sex hormones are unproven, experimental interventions for adolescents with gender dysphoria.
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The UK clinicians are also seeing rapidly increasing numbers of cases of adolescent females with recent-onset gender dysphoria and complex mental health histories. They are concerned by this poorly understood change and the treatment implications. /3
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Canadian pediatrician: “In any other branch of medicine, if you were causing sterility with body-altering surgery and cross-sex hormones, you had better have some pretty strong data...But we’re already going down that road with no strong data at all.”
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Yet another group of experienced UK gender clinicians agrees: “This rapid onset of gender dysphoria in assigned females post puberty is indeed a worrying phenomenon we are observing more and more” /5
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2 WPATH board members sound alarm on problems with puberty blockers and share perspectives on inappropriate medicalization of gender dysphoric youth.
Two remarkably accomplished experts in the field of gender medicine - a surgeon and a psychologist - display bravery, brilliance & independence in their interviews with me. I think a lot of light was shed, and I'm very proud to publish it on Common Sense.
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Sweden concluded the evidence for "affirmation" is lacking. The NHS review is underway. The UK High Court just ruled that patients under 16 can’t consent to the experimental "affirmative" protocol, suggesting that even 16-17 year-olds are vulnerable./10
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Gender Dysphoria thread:
56 studies on cross sex hormones and sex reassignment surgery have failed to provide convincing evidence that these interventions improve the psychological well being of individuals with gender dysphoria(GD). >>
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Moving on to the next fact. Jack claims the 70% desistance rate is false. However, 11 studies have demonstrated that anywhere between 61-98% of kids whose distress appeared for the first time in childhood will outgrow it before adulthood. /12
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Jack accuses
@AbigailShrier
of ignoring the evidence of improved mental health outcomes. Yet no quality long-term studies are able to show these improvements. A key study that claimed such improvements was recently corrected to conclude "no effect." /16
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“Sex has a biological basis, whereas gender is fundamentally a social expression. Thus, sex is not assigned — chromosomal sex is determined at conception and immutable. >>
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Even the lead investigator of the Dutch protocol recently wrote a commentary in Pediatrics where she warned that the hormonal and surgical treatment protocol is being widely misapplied, as it was never designed for kids with
#ROGD
-type presentation./11
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Having shown that contrary to
@jack_turban
assertion,
@AbigailShrier
book’s premise IS based on a well-documented and easily-demonstrable phenomenon (see a telling graph from
@TheEconomist
article), let's move on to the rest of his claims. /7
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Jack’s argument that the desisted kids were not “truly trans” has been effectively discredited by reanalyzing the data for those who met the strictest diagnostic criteria for “gender identity disorder.” 67% (roughly 70%) of them desisted./13
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New article in
@TheBJPsych
, link at end of thread.
Title: "Sex, gender and gender identity: a re-evaluation of the evidence."
Short excerpts below:
..."evidence suggests that the majority of children left alone reconcile their identity with their biological sex;" >>>
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.
@TheTorontoSun
: I understand Canadian law dictates you write the headline this way, but it's wrong and damaging on multiple levels, and you're cowards for complying.
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The average 85% desistance rate of childhood gender dysphoria is a hard truth for the gender clinicians to accept. I’ve linked to a paper and have screen shots of the relevant text showing this fact. >>
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Further, Jack disputes the well-established claim that most of the kids who desist grow up to be lesbian and gay. Yet the studies clearly demonstrate it, as in one by
@JamesCantorPhD
. Gender dysphoria is a common developmental path for LGB people. /14
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Jack disputes the fact that adolescents on puberty blockers are on a virtually irreversible path to complete medical transition. Yet all 3 studies that have been published on this showed nearly 100% of teens on PB's process to cross-sex hormones. The UK court agreed. /15
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PB halts the rapid increase in bone density that should be occurring during this critical time.
Here is a graphic representation of the negative effect of PB on bone density, courtesy of Prof Biggs: >>
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New documentary coming soon regarding gender dysphoria:
Watch “[Trailer] Not My Cup Of T” on
#Vimeo
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Former WPATH/USPATH board member believes social contagion driving massive increase in gender distressed youth: “How is it possible that gender identity formation constitutes the only area of development in adolescence that is immune from peer influence?”
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More information regarding psychotherapy for gender dysphoria can be found in the link below: ///
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Article here:
/6
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All 12 of 12 studies that have examined the trajectory of gender-variant youth show that the most common outcome is natural desistance from a trans-identification, sometime before reaching adulthood. Thank you for your voice
@stellaomalley3
.
@genspect
.
Psychotherapist Stella O’Malley says 80 per cent of children who have “gender issues” grow out of them by the time they reach adulthood.
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Should doctors be able to remove breast tissue and reproductive systems from adolescents who have been wrongly convinced by others that they were born in the wrong body?>>>
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Vulnerable young people with gender dysphoria are being sterilized under a banner of civil rights.
BREAKING:
@WPATH
Gender Doctor Expresses Concern For Mental Health of Minors Following Transition Surgeries
“Reproductive regret…it’s there, and I don’t think any of that surprises us.”
#ReproductiveRegret
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Must read. Open access.
"We believe that exploratory psychotherapy that is neither “affirmation” nor “conversion” should be the first-line treatment for all young people with GD, potentially reducing the need for invasive and irreversible medical procedures."
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“Why are we giving teenagers the choice to have cross sex hormones almost ten years before the part of the brain responsible for decision making and understanding consequences has even developed?”
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We must not conflate medical care for gender-dysphoric youth with experimental and risky interventions that are based on low-quality evidence. It's Time to Hit Pause on 'Pausing' Puberty in Gender-Dysphoric Youth via
@medscape
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In 2004, the FDA issued a black box warning about bone loss from a particular form of injectable birth control (Depot- Provera), raising particular concern about its use in adolescence (see figure).
The same warning should apply to PB drugs.
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An article like this would have been unheard of 2 years ago. As “The Dutch Protocol/Gender Affirming Care” results in the sterilization of gender dysphoric kids, it is only right that it be medically, ethically and legally scrutinized. by
@LisaSelinDavis
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Editor in Chief of the British Medical Journal reports:
“Puberty blockers are being used in the context of profound scientific ignorance”
and
“The current evidence base does not support informed decision making and safe practice in children.
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“...my position is pretty straightforward, in my opinion. I don't believe that it's possible to change biological sex. So I think that you're born either male or female, and you remain male or female for life.”
—Meghan Murphy
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"There is no agreed scientific basis for someone having the mind of someone from the opposite sex or being born in the wrong body."
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Broken link above fixed here:
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@jk_rowling
Medical societies have failed to educate clinicians about the lack of evidence surrounding adolescent transition, resulting in over-treatment and insufficient counseling. This is a multi-level scandal. Myself and other clinicians are starting to push back:
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“The trans lobby teaches children the regressive lesson that if they do not conform to narrow gender stereotypes, they are probably “trapped in the wrong body.”
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"Sex is not a spectrum and is not assigned at birth." (Names are assigned. Sex is observed.)
Sex and gender
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2. How is it ethical to apply controversial treatments (affirmation and PB) to a group of patients that's only intended for 10% of them?
3. There are no validated protocols to separate out the 10% of patients whose GD persists. Why is PB being used at all?
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Clinical and Ethical Considerations in the Treatment of Gender Dysphoric Children and Adolescents: When Doing Less Is Helping More.
November 2021
David Schwartz, Ph.D.
>>
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This piece of journalism is refreshing-- my thanks to the authors for highlighting concerns with the affirmation model. Free registration to read.
Short excerpt below:
Transgender Teens: Is the Tide Starting to Turn? via
@medscape
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5. Why is there so much resistance to efforts to understand the causes of ROGD?
6. How can adolescents consent to therapy that can lead to lifelong infertility?
7. Why aren’t our medical societies generating robust debate surrounding these issues?
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“What we are doing now is a massive uncontrolled medical experiment on children without adequate informed consent and without the backing of any kind of institutional review board,” said pediatrician
@JuliaMasonMD1
of the Society for Evidence-Based Gender Medicine.
The medical establishment is betraying science in dealing with gender-dysphoric children. via
@AbigailShrier
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Translation of newest article by
@Sven_Roman
, child and adolescent psychiatrist, published 10/8/19 in Dagens Medicin:
"Immediately stop all treatment of gender dysphoria for children and young adults"
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This is must watch.
@TuckerCarlson
hits all the main points regarding medical and surgical interventions in youth with gender dysphoria. The most comprehensive reporting from cable news to date?
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The UK Court reached the correct conclusion: puberty blockers are experimental. While other sources are silent regarding this decision or propagate false
#genderfolklore
,
@TheEconomist
provided nuanced and accurate coverage for which many are grateful. /15
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“”Castrating children” is the phrase used by pediatrics professor John Whitehall to describe unscientific experimentation on youth in the name of transgenderism. “
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What doctors did to this ROGD teenage girl is nothing short of criminal.
Video of her mother speaking at a Supreme Court rally and full text are below.
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“Given our deficiencies in knowledge about the etiology and trajectory, and the possibility of future surgical regret of adolescent-onset GD patients, [...]many of our patients may be better served by mental health support, not irreversible surgeries.”
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10. Why are some of the world’s experts in gender dysphoria (Blanchard, Zucker, Bailey, McHue) being cut out of the conversation?
11. What sort of support is being provided to detransitioners at gender clinics?
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“My double mastectomy was severely traumatizing. I paid a guy, who does this every day for cash, ... to cut away healthy tissue. I did this because I believed it would heal all of the emotional issues I was blaming on my female body. It didn't work.”
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"If there is some kind of “gender identity” that is universal in humans, and which causes dysphoria when mismatched with sex, it remains elusive. No one has yet found a way of detecting its presence, and verifying that it is causally responsible for dysphoria.⁹" >>
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Similar impairments of bone density are seen in childhood disease states, and cause significant concern: >>
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4. When large numbers of pubertal girls with no prior history of gender dysphoria began presenting to gender clinics, why was the already controversial affirmation and PB protocol applied to them?
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New study by
@LisaLittman1
published open access today in Archives of Sexual Behavior:
"The data in this study strengthen, with first-hand accounts, the rapid-onset gender dysphoria (ROGD) hypotheses which, briefly stated, are that psychosocial factors, >>>
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Some detransitioners are *wrongly* blaming themselves for what’s happened to them,& some are being blamed by trans activists, and some subtly blamed by their doctors(“I was only doing what you asked me to”). Remember, none of this would have happened without a willing doctor.
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Gender dysphoria and hormone side effect thread:
Many mental health professionals believe endocrinologists should not question a diagnoses of trans ID, and should simply prescribe hormones when the MHP makes that recommendation. >>
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**New** Legal Case to Protect Children From Experimental Medical Treatment (UK)
"We cannot stand by and watch young people be part of an experimental medical treatment that exposes them to very significant risks."
--GIDS whistleblower
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As an American endocrinologist and a member of the Endocrine Society, I continue to hold out hope that the leadership of the
@TheEndoSociety
will acknowledge the need to reconsider its current politicized stance and will return to the time-honored principles of evidence-based
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8. Were advocacy groups involved in the writing of our medical society guidelines? If so, how is that ethical?
9. Why is the age for irreversible interventions dropping lower and lower?
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12. Why aren’t case reports and other data about detransitioners being shared so that more aren’t harmed, and why aren’t medical societies showing public support for doctors who are publishing on ROGD?
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@ACLU
A child’s parents can become confused when noticing how different their child’s behavior is from other kids. In reality, sex-atypical behavior is part of the natural variation exhibited both within and between the sexes and shouldn’t be pathologized.
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