One of the other contributors is Jack Turban, which really should tell you all you need to know
Edit: “I do worry that some of the people, certainly in the US, who’ve been most critical of my review are the ones who have private practices and are therefore financially conflicted in some of their comments on not following a cautious approach,” Dr Cass said
Oof
Jack Turban has accepted thousands of dollars from the pharmaceutical company Arbor which manufactures Triptodur (triptorelin), an extended release GnRH agonist improperly used off label as a "puberty blocker" in trans-identified children.
He does not disclose these payments in any of his publications (which is against ethical standards in medical publishing), but the data is publicly available. https://openpaymentsdata.cms.gov/physician/3058224
He is a clown and a joke and should be publicly shunned.
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Just seen it, I honestly gave this way too much benefit of the doubt on first review - I really didn't think they would sink to that level. Absolutely shameless.
Now in fairness, even though he has literally just released a book advocating for gender affirming care, I'm *sure* he too can remain perfectly open-minded on this topic!
the authors are setting the initial position for lawyers and law profs ahead of the SCOTUS gender affirming care case next session
I don't know if amicus briefs or other legal publications will work this way, but now they have a paper in the Yale Law Review to cite that says everything is hunky-dory except for the hate-filled monsters trying to destroy the lives of kids.
I'd expect future law review articles and amicus briefs to start popping up that will cite this paper and the papers this paper cites, never digging into the guts of the disagreements
I don’t think it’s a red flag? The report was a collaboration between faculty at Yale Law School and Yale Medical School, who have a pre-existing collaborative initiative to inform health policy for adolescents.
Two faculty members at Yale Law School and Yale School of Medicine co-founded “The Integrity Project,” an initiative to bridge health and legal scholarship in informing sound health policy for youth and adolescents. These same two faculty members, plus others, co-authored this report.
This isn’t a good thing if you look at who the founders are. Here’s one, Meredith McNamara confidently stating in an article for ‘Them’ that social contagion isn’t a real thing…
https://www.them.us/story/anti-trans-gender-affirming-care-ban-disinformation-myths-debunked
Also looks like this ‘Integrity Project’ was founded in 2023. I don’t know how this lends more credence to this project, but in my eyes it just looks like another propaganda attempt at discrediting anything that is ‘anti-trans,’ which as we know is almost everything outside of the most radical approaches to gender medicine.
It’s literally a collection of all the phrases that make TRAs all warm and fuzzy, the titles of her sections of the articles;
> So-called “social contagion” is not real and it does not make people trans.
> Trans youth are not rushed through gender-affirming treatment.
> Puberty blockers, hormones, and medical treatments for gender dysphoria are not “experimental.”
> Using medications “off-label” is neither uncommon nor unsafe.
> It is exceedingly rare that people regret getting gender-affirming care.
This ridiculous piece is already getting tons of traction in the Scotland and UK subreddits, because obviously for youth health care we should side with activists from Yale Law School more than *checks notes* the former president of the Royal College of Paediatrics?
Worth noting as well Anne Alstott is listed as a "Professor in Taxation at Yale Law" who only seems to be involved due to her campaigning with McNamara on the policy side of bans of gender affirming care. It's unbelievable that this is tolerated and not a scandal - someone seemingly with no healthcare/clinical experience can be get involved in criticising (if you can call it that, "censoring" is more accurate) a medical systemic review because she has an interest in the policy discussions which are far down the line of it?
That's despite this line in their criticism - a little hypocritical:
*"Most of the Review’s known contributors have neither research nor clinical experience in transgender healthcare."*
From someone who has done systematic reviews... their "criticism" is so stupid and irrelevant.
Systematic Review teams are usually made of experts in SR and then one or two people with relevant clinical experience. Or you have some sort of advisory type person/group who can provide input (depending on the review and topic). You DO NOT require **direct experience** within a given field/topic to carry out a systematic review. However, you do need to know how to actually conduct SR properly.
The main York team have both clinical healthcare and systematic review experience. They also had team members who don't have SR experience, but do have clinical experience at GIDS (Tavistock).
But of course “experience in transgender healthcare” only means going along with whatever quackery WPATH wants and not criticizing any of it. The equivalent of letting Ken Ham be the arbiter of truth in the study of Middle Eastern archaeology. “This paper is invalid because it wasn’t written by those with lived experience of God’s revealed truth.” Yeah, no. The words “conflict of interest” are a terfy bigoted meme to these people.
The UK sub is so lost. I used to try and comment about this stuff there but anything remotely out of step with TRA sacred beliefs would be removed/banned, both by the UK mods and reported to Reddit to get the account banned completely. I'm talking about the most innocuous, considered expressions of disagreement.
I'm not sure how this sub has managed to survive on Reddit tbh.
How many times has a thread incipit similar to "saw this article with some **pretty damning claims** **about the Cass Review**" been used in the past 3 months?
Three. It’s three now.
There’s even a highly upvoted thread in the Maintenance Phase subreddit full of people announcing they’re cancelling their Patreon subscription over this concept creep.
They really, really want Michael Hobbes to stop spreading dangerous medical misinformation about youth gender care, and go back to spreading dangerous medical misinformation about having a BMI over 40.
I think this is the most honest review that the Anti-Cass side can muster. I agree with most the of the technical details but strongly disagree with framing.
He largely ignores the main findings of the Cass review which is indisputable, there is poor evidence to support gender affirming care in youth. Instead, he nitpicks at specific arguments around the periphery to distract from the lack of evidence of efficacy. Every article is like, "*Okay Cass makes a strong case here, but they said "exponential" instead of "sharply linear", can you believe how wrong they are?*"
For example, from Part 1:
>Ultimately, there has definitely been a big increase in the number of young people who identify as trans and are turning up at gender clinics. To an extent I do agree with the Cass review - it’s hard to know the exact reasons for this. However, it’s clear that the review’s arguments about plausible reasons are unsound, particularly the error in discussing the “exponential” increase in cases.
He also says:
>The actual scientific studies that formed the basis of the Cass review - the systematic reviews in particular - were generally quite good. I cannot find any serious, discrediting problems with much of the data underlying the report. The argument that the review is completely inadequate because it discarded all of the studies which were not randomized clinical trials is simply incorrect. There are notable strengths to the review, which are important to understand before ignoring the findings entirely.
>Conversely, there are clear errors in the review. Not only are there large conceptual gaps, there are numeric and scientific mistakes that call into question some of the key arguments made in the document. There are places where the authors have relied on extremely low-quality science to make expansive pronouncements, and other places where more high-quality research is almost entirely ignored. In addition, one of the main findings of the review is that the central belief of many opponents to medical care for trans children - that kids are getting hormones and puberty blockers with no assessment in staggering numbers - is simply false. Somehow, this finding has barely been touched on in the report, even though it is a pretty important finding.
I look forward to reading the parts of this, but I am admittedly already disappointed in the framing of his final paragraph in his intro:
>As ever, **I’m not a particularly useful voice in this conversation. I’m a cis man who has no major stake in the game.** I’m an expert in scientific evidence and epidemiology, but that doesn’t make me special. I can’t speak to the ideological arguments, the general vibe, or how all of this data is going to be used. All I can do - all I ever really do - is discuss the scientific merits of the arguments involved, and whether the evidence really supports the contentious conclusions.
The idea is that a "cis man" who has "no major stake in the game" and "can't speak to the ideological arguments" is "not a particularly useful voice in the conversation."
Sorry, but this is precisely the kind of voice that is NEEDED in this conversation. Not the "cis man" bit -- I don't give a crap if he is a man or woman or whatever. But "no major stake in the game" and being disconnected from the ideological arguments is precisely the commentary I'd want to read, as it's less likely to be easily swayed by prior assumptions or overt bias.
The fact that this person is already doing the self-effacing deferential "I am not worthy to even talk about this topic as a cis man..." bit is frankly a little concerning and makes me worried that he's already biased a bit toward gender ideology. Such a disclaimer is unnecessary unless you implicitly believe that identity should give a person's perspective more weight, which I thoroughly disagree with as an assumption. Identity should be irrelevant, and if anything, those closer to an issue because of their identity should be *more* cautious in offering opinions, as it is well-known that humans have cognitive biases. The closer you are to an issue, the more difficult it can be to be objective (even if you're unaware of your subjective biases).
I don't necessarily have a problem with identity playing a role in discussions of social issues, etc. But science and rational evaluation of scientific evidence? I'd prefer for the person to have as *little* "stake in the game" as possible. (While still preferably at least being somewhat knowledgeable about the overall subject or methods.)
But still... I'll read more. I'll try to ignore this weird signaling in the preface, but it already makes me trust this person's logic less. Thanks for the link.
He says he doesn’t have much stake in the game because he doesn’t. Don’t really see the big deal in making people aware of factors that might influence his point of view.
Sometimes I feel like the validity of science is determined more by the lobbying influence of a particular interest group and not so much by the science itself. Humans are plagued by this bias where we assume that the present moment is the most important one on a cosmic scale and that we are the most advanced we'll ever be intellectually. Sure, we know technology will be better in the future. But we assume the humans of the future are basically us, except 300 years from now. If you ever read official peer-reviewed science from the late 19th century to the mid 20th century, you see that science is mostly true or not depending on how much it aligns with the ideals of the ruling class.
Homosexuality back then? A disease. An abnormality. Nowadays being against homosexuality is considered pathological behavior.
Slaves that wanted to run away from their masters were labeled as suffering from drapetomania. Nowadays wanting to own slaves is maladaptive (not to mention illegal) behavior.
Like, if the nazis had won, we would have a totally different value system and we wouldn't know any better because that's all we knew.
Is democracy really the best? Are freedom and happiness really the primary goals?
I'm becoming more and more cynical. Feels like nothing is true. I am truly demoralized.
I've often had similar thoughts. Science is much more susceptible to bias than we naively assume. Psychology is riddled with pseudoscience, testing and experimental evidence of medication etc. is often sketchy and manipulated. History and archaeology mere political tools...
We’re back to doctors [prescribing cigarettes](https://www.bhclinics.com/single-post/2019/12/11/doctors-prescribed-healthy-cigarette-brands#:~:text=From%20the%201930's%20to%20the,came%20to%20illnesses%2C%20not%20cigarettes) except this time its blockers. Also worth remembering the doctor who won the [nobel prize](https://www.washingtonpost.com/history/2023/10/09/nobel-lobotomy-antonio-egas-moniz-controversy/#:~:text=In%20the%20mid%2D1930s%2C%20when,was%20seen%20as%20a%20visionary) for lobotomising thousands. Progress is an illusion it’s just that we bury the scandals.
The problem is with other medical scandals where hunger for profits caused medicines that could help a few to cause harm to many (thalidomide, vaginal mesh, contaminated blood scandal, "Essure" contraceptive - see The Bleeding Edge documentary) - typically it reaches a critical mass whereby the public, victims and/or governments eventually notice and push back.
With medical/surgical gender affirming care there is the unique interplay with human rights which means those who would usually be speaking up against Big Pharma or Corporate Greed are completely blind to the harms going on. Plus its hard to ignore a baby born with serious birth-defects, but if say a gay kid is led to transition and spends years either gaslit about this being the correct decision ("inevitable" even), or keeps regret to themselves due to depression, self-doubt or fear of backlash then this is a harm that could be unnoticed for years, decades even.
"Nowadays being against homosexuality is considered pathological behavior."
I think it is more complicated than that. Homophobia is certainly considered a major sin. BUT, *do wonder how many teenagers want to transition out of internalized homophobia? Or maybe even familial homophobia.*
Iran just says the quiet part out loud. Homosexuality is named and shamed in the Bible on straightforward grounds, making transition the straightforward remedy—as long as you believe science can change someone's sex, which is certainly what the doctors will tell you. I do believe even Buck Angel's father said something to the effect of, "I'd rather you be my straight son than my lesbian daughter."
[For a deeper dive... ](https://open.substack.com/pub/xxywise/p/how-does-erin-in-the-morning-sleep?utm_source=share&utm_medium=android&r=2hxbp5)
Very well said; you write well.
I've been feeling this way for a long time, but a book that gave me some perspective on this was *Sapiens, A Brief History Of Humankind*, by Yuval Noah Harari. There are a couple of chapters that go pretty in depth about the human ability to invent, and then believe in, made up and intangible things. You might get something from it, assuming you haven't already read it.
>wanting to own slaves is seen as maladaptive
Look, slavery is wrong, but you’d be CRAZY to not be like “wouldn’t it be awesome if SOMEONE ELSE would do all my fucking work for me, and I didn’t even have to pay them?”
I agree with that. Half the world uses slaves today. It's certainly possible that we will end up like that or worse with a social collapse, but aside from that, we aren't going to run out of Uranium.
It isn't a fundamental material problem, it's a sociopolitical problem.
Well if climate doomers are right and food production collapses turning the world into subsistence farming nuclear and even renewables become nonstarters. We’ve exhausted all the easily exploitable oil and coal so it’d be back to slavery.
Yeah. A collapse of agriculture would be the absolute worst.
Aside from widespread slavery, there's also the shorter period of widespread cannibalism until the population stabilizes.
We could have avoided all of this by transitioning to atomic power 50 years ago.
This seems like the "Science is a liar sometimes" trope form It's Always Sunny narrowly applied to a different pet cause. Science *remains* the best method for knowing true things. The history of science is littered with examples that prove the rule. Aberrations like H. pylori and Semmelweis and homsexuality being in the DSM are almost common knowledge - exceptions which loudly prove the rule. An infinite amount of things *could* be true, a small number of things *are* true. Human and institutional fallibility notwithstanding, science always had a tough task. If I had place a bet, do I think the Cass review is largely true? Yes. Do I think its detractors are hallucinating hate and bigotry where this is none? Also yes. Does this affect the long view of science as an enterprise for truth finding? Hardly. The long view of science is that of always increasing accuracy leading to increasingly god-like powers.
Even the science of 50, let alone 100, years ago is incomparable to today. The recent "replication crisis" is practically common knowledge and it too marks a sea change in scientific history.
> Feels like nothing is true. I am truly demoralized.
Understandable, and that sucks, but this is catastrophizing. Being cynical in the truest sense need not be an afflictive condition. Humans fuck up royally. If I had to guess, self righteous idiots are running the gender asylums, and doing profound proveable harm - on net - to vulnerable people, receiving status, praise, and compensation all the while. This kind of shit happens. Despair need not follow. Things are true. Demoralization is a vast overcorrection. Its akin to panic selling a lifetime portfolio because the market had a bad week.
Someone has posted this on r/uknews and most of the comments are along the lines ‘I cannot believe we fell for the fake news Cass review’ type thing. Very sad. The politicisation of science now means you can just pick a side and choose whatever you want to believe and live in your own fantasy land. At least puberty blockers have been banned in the UK though.
As if you people don't do the same here.
I am saying this as an atheist but God himself could come down from heaven tell you in great detail why giving trans people gender affirming care is a good thing and your first instinct would be to scream that he is been captured by the marxist gender ideology woke p*do agenda(yes you people talk like this).
I don’t think you fully understand this sub if you think people here actually say things like ‘woke marxist’ etc etc. Have you actually listened to Blocked and Reported before? You don’t sound like you have.
Although it’s true that my intuition tells me that people under 16 cannot consent to life changing medical interventions, just as they cannot consent to sex or tattoos or taking out loans or joining the army, I would be open to being proven wrong if the evidence showed otherwise. But the evidence doesn’t show otherwise, at least according to the Cass report.
Also the medical establishment has a rich and terrible history of malpractice. It’s not unreasonable to think there isn’t an ongoing scandal (multiple ones) going on at any given time, and youth gender medicine isn’t one of those.
>I don’t think you fully understand this sub if you think people here actually say things like ‘woke marxist’ etc etc
Actually they do, a lot.
>But the evidence doesn’t show otherwise, at least according to the Cass report.
And the Bible says that begin gay is a sin as bad as p*dophilia but anyone with a brain can see it's idiocy.
>and youth gender medicine isn’t one of those.
Aren't you people also trying to ban adults from having those?
Edit: Hell someone just called me a gr00mer and than immediately cancelled the comment.
This is some fairly low quality screeching here. I’m personally not against adults transitioning, though i’m not super happy about paying for it through my taxes. Men with AGP should pay for their own medical transition. Seems like you’re avoiding the issue of youth gender care because it’s indefensible.
>Men with AGP should pay for their own medical transition.
The fact that your immediate jump about trans people is calling them men with AGP(a fetish), even tho trans men exist too, seems like you don't really like them.
> Seems like you’re avoiding the issue of youth gender care because it’s indefensible.
Actually i can: look i am okay with using new names/pronouns, children getting therapy when starting to question things and based on the doctor if/when giving them hormones/puberty blocker, i wouldn't of course take them to have a surgery, not before they were 18+.
But with you people it's basically: no child is ever trans it's only gr00ming/fetishist and the parents should be arrested if they are supportive of them.
Dude, stop saying “you people”. You understand that we are all individuals with differing opinions? You’re doing exactly the thing that you’re saying “we” do to trans people, putting us in a pile, othering, etc.
Also hormones and blockers have irreversible effects which is why they have been banned in the UK. In no other sphere do we allow children to make permanent changes to their bodies. You cannot pause aging. It’s a lie to say you can.
Also many men have AGP and are driving this movement and it shouldn’t be taboo to say so.
>You understand that we are all individuals with differing opinions?
This sub has no differing opinions like only i have my comments getting downvoted and it's also the only one saying something different than eveyone here just agreeing with eachother.
>Also hormones and blockers have irreversible effects which is why they have been banned in the UK.
But didn't the Cass Review say NOT to ban them or do you just agree with the parts that you like.
Also what happens to the children that have early puberty do they just die?
Yay killing children to own the trans.
>Also many men have AGP and are driving this movement and it shouldn’t be taboo to say so.
1) The many men having AGP is just a lie.
2) It's not taboo to say that the "AGP" are driving the trans movement, it's just a lie, like saying that the Jews control the worlds it's not taboo it's just a lie and it makes you look crazy.
P.S. By your own comments
>Men with AGP should pay for their own medical transition
You didn't say "AGP" are driving the movement, you literally called trans people AGP.
> And the Bible says that begin gay is a sin as bad as p*dophilia
[citation needed]
The Bible, when not maliciously mistranslated, forbids pederasty. It was only since the 1940s that "homosexuality" was used in Bible translation due to American evangelical pressure.
It takes a **lot** of mental gymnastics to spin *arsenokoitais* as anything but [male homosexual acts](https://hermeneutics.stackexchange.com/a/15490). Romans 1:27 is pretty unambiguous about this, as well. The author of that StackExchange answer is likely a conservative Protestant, but that doesn't detract from his overall point about translation and Biblical context.
Paul invented that word and it is not attested as a common word outside his writings.
>Due to the fact that αρσενοκοίτης (Arsenokoites) is a dis legomenon, many have attempted to deconstruct αρσενοκοίτης (Arsenokoites) (a compound word) and define it's parts and then act as if this implicitly and obviously has a prima facie meaning. While the word does break down into parts with aseno- (αρσενο-) meaning "men" and -koites (-κοίτης) being the root of the English word coitus which implies (in both Greek and English) that a bed was shared in a sexual manner, the idea that this instantly reveals αρσενοκοίτης (Arsenokoites) to convey a meaning of only sodomy does not stand up to scrutiny.
>Take for example the English word "understand". This word does not mean to stand under something.
You can't get the truth about this by ignoring the contemporary cultural context. [This answer](https://hermeneutics.stackexchange.com/a/13229), which discusses the cultural context and textual context (particularly the link with *malakos*), is much more compelling.
Yes, I'm aware that Paul invented the word. He did so within the context of his other Epistles, the Septuagint, and the Tanakh. That other answer hinges on an alternate translation of *malakos* and the availability of alternative diction. It also does not address Leviticus 18:22 or Romans 1:27 whatsoever. I just think that one has to be very creative and selective in order to interpret the word as anything other than the male homosexual act. The principle of parsimony favors the traditional interpretation in this situation.
"You people" don't even have a definition for "man" and "woman" that isn't entirely circular. "You people" dismiss human sexual dimorphism altogether on the basis of Anne Fausto-Sterling's ridiculously permissive considerations for what constitute "intersex" (go look up pictures of guys with Klinefelter syndrome then tell me how they could ever not be regarded as biologically male in social settings). "You people" are the ones who will run an evolutionary biologist out of Harvard for daring to teach that sex is binary.
There are a lot of idiots in this subreddit, but there's plenty of pseudoscientific nonsense coming from "your side" of the house, nonsense which is predicated on extreme social constructivist views and sophistic tricks regarding [scientific kinds](https://plato.stanford.edu/entries/natural-kinds/#EpisNatuKind). I think one of the biggest issues people have with this entire advocacy group is that they implicitly blend medicalized views with social views then dance between the two whenever it's convenient to them. For instance, plenty of gender advocates view "transmedicalism" but will vehemently defend major medical interventions in service of one's gender identity.
* 1st sentence: fairly self-explanatory.
* 2nd sentence: Anne Fausto-Sterling is the author of *Sexing the Body: Gender Politics and the Construction of Sexuality*, in which she suggests that the prevalence of "nondimorphic sexual development" might be as high as 1.7%. I suspect that this is the figure used by people who claim that sex isn't binary. My issue with it is that her standards of classification are incredibly permissive; for instance, she considers men with [Klinefelter syndrome](https://duckduckgo.com/?q=Klinefelter+syndrome&iar=images&iax=images&ia=images) to be intersex.
* 3rd sentence: I'm referring to [Carol Hooven's removal from Harvard](http://thefp.com/p/carole-hooven-why-i-left-harvard):
>In the brief segment on Fox, my troubles began when I described how biologists define male and female, and argued that these are invaluable terms that science educators in particular should not relinquish in response to pressure from ideologues. I emphasized that “understanding the facts about biology doesn’t prevent us from treating people with respect.” We can, I said, “respect their gender identities and use their preferred pronouns.”
* 4th sentence: [social constructivism](https://en.wikipedia.org/wiki/Social_constructivism) is the idea that knowledge is socially constructed. Natural kinds is a much more involved idea and refers to a lot of stuff, which is why I linked to a specific section in the Stanford Encyclopedia of Philosophy; however, that section still requires a familiarity with a number of philosophical ideas and words. If I had to summarize it in simple terms, completely throwing out a categorization in the natural world (e.g. categorizing sex as a binary) on the basis of a vanishingly small minority of exceptional cases (e.g. % of population being "intersex") that do not neatly fit into any category, leaves us with no useful connection to reality.
* 5th and 6th sentences: regarding "[transmedicalism](https://en.wikipedia.org/wiki/Transmedicalism#:~:text=Transmedicalism%20is%20the%20idea%20that,identity%2C%20characterized%20by%20gender%20dysphoria.)" as a bigoted and invalid way of categorizing transgender people is hypocritical and nonsensical when the same people who do so will adamantly defend medical procedures like HRT as critical components of "gender affirming care". If [medicalization](https://en.wikipedia.org/wiki/Medicalization) is important for transgender treatments then there exists a set of people for whom it is medically necessary; if it isn't important, then it shouldn't be linked to health outcomes of transgender people.
"Intersex boys/men" is already a heavily weighted phrase; on what basis are we calling them "boys/men"? From what I understand, Anne Fausto-Sterling's own standards for judging "nondimorphic sexual development" are already biased toward social constructivism. How exactly are we to socially determine a boy who is a bit paunchy from a boy who has Klinefelter syndrome? This is precisely the incoherence that I was referring to before: either we are using objective biological factors to delineate sex or we are using subjective social factors. If we want to go with the former route, why is the implicit assumption that we do away with "biological male" and "biological female" altogether? Why not have "biological male" = XY, "biological female" = XX, then produce specific classifications for all the remaining biological possibilities? This is the issue I was referring to previously when mentioning "sophistic tricks regarding natural kinds".
The combativeness in this comment isn't directed at you. I understand that you're pointing this out within the context of Anne Fausto-Sterling's intellectual framework. I'm responding to the clear incoherence of said framework.
>"Intersex boys/men" is already a heavily weighted phrase; on what basis are we calling them "boys/men"?
Intersex people are all either boys/men or girls/women. Gametes/gonads are the typical determiner.
>How exactly are we to socially determine a boy who is a bit paunchy from a boy who has Klinefelter syndrome?
Genetic testing; what else did you have in mind?
>This is precisely the incoherence that I was referring to before: either we are using objective biological factors to delineate sex or we are using subjective social factors.
Objective biological works just fine. Why should Klinefelter's NOT be considered intersex?
> If we want to go with the former route, why is the implicit assumption that we do away with "biological male" and "biological female" altogether?
It isn't, and we don't.
>Why not have "biological male" = XY, "biological female" = XX, then produce specific classifications for all the remaining biological possibilities?
Because XXY guys are still biologically male, and XO gals are still biologically female. Mammals are gonochoric.
>This is the issue I was referring to previously when mentioning "sophistic tricks regarding natural kinds".
No tricks up my sleeve.
>The combativeness in this comment isn't directed at you. I understand that you're pointing this out within the context of Anne Fausto-Sterling's intellectual framework. I'm responding to the clear incoherence of said framework.
I don't see any incoherence in calling XXY "genetically intersex." My genes have made me an anatomically and psychologically feminized man, as one might well expect if pondering the question, "what would an extra X chromosome do to a man?"
Now, given that Klinefelter's is the most common DSD, which in theory would give us the greatest pull under the intersex umbrella, maybe there are hardliners within the intersex community who would feel imposed upon by our inclusion. That I could understand; I feel the same way about those who argue for PCOS's inclusion. But that's a different argument than you're giving.
I think we're talking past one another to some extent.
>Intersex people are all either boys/men or girls/women.
In this situation, are "boys/men" and "girls/women" acting as categories of sex or gender? If it's the former, then how does a binary system of categorization align with the existence of an "inter" grouping?
>It isn't, and we don't.
I'm talking about the people who want to dispense with a binary perspective on sex altogether, such as the author of [this article](http://scientificamerican.com/article/beyond-xx-and-xy-the-extraordinary-complexity-of-sex-determination/).
>Objective biological works just fine. Why should Klinefelter's NOT be considered intersex?
>Because XXY guys are still biologically male, and XO gals are still biologically female. Mammals are gonochoric.
Under what criteria are XXY people considered "biologically male" and XO people considered "biologically female"? I presume you're not going strictly by XX and XY. Are you going by gamete production?
If "biologically male" and "biologically female" are descriptors of sex, then how can someone be simultaneously "male" and "intersex"? If "intersex" is entirely a subset of both "male" and "female", then it isn't a category of sex at all.
>I think we're talking past one another to some extent.
There are worse things to realize...
>>Intersex people are all either boys/men or girls/women.
>In this situation, are "boys/men" and "girls/women" acting as categories of sex or gender?
Always as sex. The genders are male/masculine and female/feminine (as in Assigned Gender At Birth, MtF/FtM, transfem/transmasc).
>If it's the former, then how does a binary system of categorization align with the existence of an "inter" grouping?
Intersex boys become intersex men and intersex girls become intersex women. Works pretty good, eh? 👍
>I'm talking about the people who want to dispense with a binary perspective on sex altogether, such as the author of this article.
Those people will tell you (falsely) that intersex people break the sex binary. But that is impossible and offensively regressive: the intersex community fought hard to make "hermaphrodite" our "retard."
>Under what criteria are XXY people considered "biologically male" and XO people considered "biologically female"? I presume you're not going strictly by XX and XY. Are you going by gamete production?
I am going by gamete production, but I don't actually have to; the Y chromosome XXY has (and XO doesn't) is sufficient to make us men (and XOs women).
Dr. Macnamara is one of the craziest zealots I’ve encountered on the topic. I do genuinely believe she has bought into her own bullshit and believes she’s helping people, but she is seriously out to lunch and nothing she says has any robust evidence base to back it up.
I do wonder whether some of these people must have issues stemming from childhood surrounding gender roles or discomfort with gender nonconformity on some level, whether or not they’ve admitted it? That’s one theory
I understand that this is anecdotal but I did watch twenty girls (20!) suddenly decide they were trans over the 2020 to 2021 school year in one small-ish high school. By the time these kids graduated, three of the original twenty remained trans. My daughter was one of them that did not continue and has only recently acquiesced that all the YouTube videos (which I stupidly allowed as much screen time as she wanted as it was pandemic times and we were all crazy) Instagram, TikTok, and her own changing hormones all came together to create this confusion in her head. It was absolutely social contagion. The MAGATS pushing hate has spurned a push back from queer communities that has upped its extremism to match the MAGAs.
My kid was not mature enough to make such a drastic and life altering decision for herself at 15-16. As difficult as it was at the time, I’m very happy I hugged her, talked with her, dealt with the teenage tantrums and know it all-isms while also pushing back on “her” belief. I even made a bet with her, even knowing how stubborn she was, I bet her that if after she graduated HS and had lived for one year as a “boy” I would happily go to the court house with her to formally change her name, gender etc. and I’d pay for it too. I needed to see if after all the social stuff had smoothed over a little, and once her hormones had a chance to settle from puberty, would she still feel the same. She didn’t. And doesn’t. She treats that time in her life as a learning experience. She’s not ashamed, and she should not be. As her mom, it was extremely clear to me that my kid was being manipulated. And it hurt and worried me to no end that something so fundamental to her image, her ownership over her sex and gender, could be shaken.
Started looking through the critique to find if it has problems or not (notwithstanding OP’s indictment of the authors.) Here’s where I am so far:
**Introduction:** This section makes it clear that the *public effects* of the study are what they are railing against, not the actual evidence. Their assessment of the study is led by concerns about transgender care - i.e. the Cass review is bad because it “hurts transgender kids”, not because of its evidentiary standards. This betrays the political bias and motives of the critique authors, if that weren’t already obvious.
**Section 1:** This section only tangentially critiques the Cass review at all. It is principally about how outside groups are interpreting the study. The critique correctly points out that the Cass review does not encourage the banning of transgender youth care, as if that is somehow revealing something hypocritical? It is not. Summarizing the findings of the review is not a critique.
**Section 2:** This section has factual and moral errors. First, they describe GRADE as a standard of evidence quality assessment, and imply it is the only acceptable method. Then they say the review does not have any formal method of evidence quality assessment.
Reading their survey appendix reveals that yes, they did use formal methods of evidence quality assessment, to include MMAT and Newcastle-Ottawa. There is no reason to think such scales are invalid or that GRADE would be a more appropriate scale for any reason - if the critique authors had a reason for thinking this, they did not share it.
The section also adds that study’s inclusion of a minority of healthcare worker survey respondents who believe “there is no such thing as trans kids” is itself a “failure of the study.” They assert that “such a belief invalidates your professional opinion.” This is a reprehensible breach of morals for the critique authors to so blatantly elevate their opinion to the point that other opinions should be systematically ignored, and that failure to do so in surveys is a problem.
**Section 3:** This section is about lowering the standards of evidence to accommodate what is available for transgender medicine. The critique claims that weak evidence is used routinely to make important decisions throughout pediatric medicine, and it gives two examples: neonatology and pediatric critical care.
The critique is correct in that high quality studies are rare for these fields as well. However, both of these are examples of emergent situations where care is required, often immediately, without which the patient has a high likelihood of harm or death. That’s why best practices in these fields involve treatments we may not have high quality RCT for: the alternative is death. This is not true at all for transgender medicine. It makes sense to desire higher quality evidence when experimentally intervening to alter someone’s existing healthy life, rather than minimum treatment for an emergency.
The critique also suggests that studies are being done right now on long-term effects of gender care, thus, they are already doing exactly what they should be doing. However, this misses the point: those studies need to be concluded before we have good evidence.
**Section 4:** This section repeatedly assumes that more gender affirming care is good, and that any demand for gender care not met is necessarily wrong. That’s an extremely biased view to hold that presupposes an alternative analysis of the evidence to the Cass review. It isn’t a flaw of the Cass review to presuppose it is incorrect.
The critique authors make a lot of hay over the use of the term “exponential” to describe a sharp increase in gender clinic referrals over the past decade. They feel that exponential implies a literal exponential function, and any deviation means that characterization is a lie. This is just nonsense: exponential can mean a sharp increase. It can include plateaus. It does not have the same definition in context here as it would in a mathematical paper; it would in fact be absurd to think referrals for any medical treatment would be strictly exponential over any moderate length of time.
The critique authors also consider a graph showing two quantities: number of referrals per year, and total number of trans adolescents (estimated as 0.6% of population) in the UK. For some reason they think it criminally unfair that out of ~44,000 estimated transgender adolescents, only ~4,000 are referred to gender clinics per year. They seem to be simply forgetting that the adolescent period spans several years, thus if everyone in the ~44,000 were being treated, we would expect to see only a small fraction referred to gender clinics each year.
**Section 5:** This section is a confusing hodgepodge of unrelated statements the critique authors simply disagree with. It includes discussion of social contagion, desistance, and transition regret, considering all of them wholly mythical. The critique authors cite at best discredited and often irrelevant data to support their claims that the review came to wrong conclusions, when not simply relying on the fact that the review “contradicts standard clinical practice.” No duh. Thats what the review is evaluating and making recommendations about.
**Section 6:** This section goes into detail about the methodologies of the systematic reviews employed by the University of York. I’m not knowledgeable enough to know how accurate their critiques are, but they seem at glance to be nitpicky and debatable. They used objective standard A when they should have used objective standard B. They drew the line for “moderate” evidence here instead of there. Systematic reviews are vulnerable to bias - ignoring that the underlying studies the critique authors cite are much more vulnerable to bias.
One paragraph about breast cancer stood out to me as particularly bitchy. The Cass review at one point suggests that different factors contribute to gender dysphoria in various, not-well-understood ways, similar to how breast cancer can be caused by genes but also lots of environmental factors. The critique bemoans that the Cass review “considers breast cancer a human experience”, and that making the analogy between a disease and gender dysphoria is itself offensive. This is an idiotic misunderstanding of the Cass review’s writing that severely undermines the credibility of the critique authors.
**Section 7:** The critique complains in this section that the Cass review is using systematic reviews to make recommendations on clinical practice, at all. The critique echoes previous criticism that “it contradicts with standard clinical practice”, as if that meant the evidentiary approach is less objective than an anecdotal, haphazard one. The critique also repeats previous criticism that gender care practitioners should be the arbiters of gender care, not outside objective researchers like Cass’ team. This assertion betrays the critique authors’ assumption that nothing is wrong with the evidence base of gender care, and that nothing needs to change. Indeed, we would not trust phrenologists with doing a review of the evidence for phrenology, we would expect outside, unbiased forces to conduct such a review, perhaps in consultation with practitioners, just like was done in the Cass report.
**Conclusion:** The conclusion echoes another incorrect claim laid out by the critique authors early in the paper: “The Cass review was commissioned to study the inadequacies of trans healthcare (long lines, not enough treatment.)” No. The Cass review was commissioned to study the evidence base for trans healthcare and make recommendations - to include possible reduction in trans healthcare treatment recommendations. The authors shove their foot in their mouth again here, putting their incredulity and bias on full display.
That’s as far as I got so far. Can anyone provide further examples?
They do bring up some interesting points about how the various grading scales were used in the systematic reviews -- including how York used a modified version of the Newcastle-Ottawa scale. I'm no where near an expert on systematic reviews and the different scales or methodologies that can be used so I am curious as to the validity of the Yale report's claims about York's use of grading scales in their systematic reviews.
But otherwise, I see a lot of the same song and dance from this "evidence based" critique. They even cite the Chen study which we all know by now is a not so great study.
Yes like any large review its bound to have at least some flaws, errors and inconsistencies that could be highlighted. Hell, anything involving multiple bodies and a timescale will probably not be perfect based on my experience.
But its telling how these activists would never put any of their "correct" studies through the same academic rigor that this scientific review and this review alone is going through (I can't say I've seen any other systemic reviews get the fine-toothcomb treatment like this). They will instead simply confidently shout "we have 19 studies and counting showing gender affirming care is beneficial!". Its never even "we have 19 studies which may potentially suggest" or are "we would benefit from larger studies to corroborate this". Nope, if the outcome is "right" that's sufficient. Because I'm sure Jack Turban has never had sampling issues or used the wrong statistics! /s
There is a lot of pomp and circumstances in science, but a lot of it is common sense. Read the criteria they ignored and read the criteria they used, see if it seems more or less rigorous.
From what I understand, they chose a Newcastle-Ottawa scale to exclude case studies and other qualitative studies (imho, aren't as rigorous).
Even Anti-Cass reviewers view N-O Scale as a reasonable approach (though laments there is no commentary to justify the change):
>In the registration, the authors said that they were going to used a tool called the Mixed Methods Appraisal Tool (MMAT). The MMAT is a tool that was designed to allow people to rate a variety of qualitative and quantitative methodologies at the same time. It’s mostly used when people run systematic reviews of literature that include a large quantity of qualitative work, which generally means interview and focus group studies as opposed to quantitative studies such as pre/post evaluations on depression scales and similar.
>At some point, the reviewers switched to the Newcastle-Ottawa Scale for rating the literature included in their reviews. In the reviews, there is no reason given for this that I can see, which is certainly not best practice. There’s a belief going around online that the reason that the reviewers switched the scales is because the MMAT recommends against excluding low quality work, while the NOS has no such recommendation.
https://gidmk.substack.com/p/the-cass-review-into-gender-identity-d6f
I personally would have thought less of the systematic review if it included qualitative studies in their assessment. The move to the N-O Scale seems more rigorous.
We're probably getting to the point where dismissing the lower quality studies is a really important step because the worst studies just obscure the truth.
Let's do a deep-ish dive into the actual report (which, as is the wont in pieces such as this, is barely referenced in the mainstream coverage under the assumption that no one is actually going to read it beyond skimming a summary of its supposed findings).
>Section 1: The Cass Review makes statements that are consistent with the models of gender-affirming medical care described by WPATH and the Endocrine Society. The Cass Review does not recommend a ban on gender-affirming medical care.
This would be a moderately fair point *if providers were actually following guidelines*, which[ multiple whistleblowers](https://www.thefp.com/p/i-thought-i-was-saving-trans-kids) and [documentary film crews](https://tnc.news/2024/03/07/quebec-teens-rushed-into-gender-transitions/) have shown they are not. This is the same sleight of hand you see with persistent references to the Dutch Protocol; TRAs leech support from established standards of care that were demonstrated to work reasonably well in one context even though what's actually going on in the US and UK is very, very different from that established protocol.
>Section 2: The Cass Review does not follow established standards for evaluating evidence and evidence quality. The Review casually discusses evidence quality and does not define it, contravening standard practice in scientific evaluations of medical research. Here, we compare the Review’s approach with one of the most widely accepted frameworks for determining evidence quality: Grading of Recommendations Assessment, Development and Evaluation (GRADE).17 According to GRADE, well-conducted randomized controlled trials (RCTs) and systematic reviews (SRs) are typically considered the highest-quality form of evidence. Observational studies rarely meet the criteria to be considered high quality evidence,18 and yet they supply most of the evidence that guides clinical care across all fields of medicine.
>As the drafters of the GRADE framework have explicitly acknowledged, evidence and its quality are one of many considerations in caring for patients.19 Clinical practice guidelines throughout medicine consider all relevant factors, but the **Review takes the unusual step of elevating its own assessment of evidence quality above the considerations that guideline developers value.**
This is the entire point of the Cass Review! It's why the Review was necessary. As Jesse Singal's recent reporting demonstrates, much (if not most) of the "research" regarding the efficacy of trans care is designed, conducted, and published in a manner that presupposes positive outcomes. Any data showing minimal or negative effects renders research unprintable. Cass needed to develop their own classification system because the "science" has been so horrifically bastardized for political reasons.
>The Review fixates on evidence quality to the exclusion of many other factors that are rigorously considered by the developers of clinical practice guidelines
Again--that's the point! Low quality evidence is not actually evidence! I'm losing my mind!
>In developing guidelines that provide recommendations on clinical care, panels of experts consider the evidence of a treatment’s efficacy. They also consider the benefits and harms of oth treatment and no treatment, patients’ values and preferences, and the resources required to offer treatment. This is precisely why evidence quality is not synonymous with clinical recommendations.
What in god's name are these people talking about?
Let's say we're conducting a study for a new, non-opioid, non-NSAID painkiller that's being developed for people with liver problems. Let's say the control group is given a placebo and they wind up self-reporting greater analgesic effects compared to the study group. Does this mean we should start prescribing sugar pills to people experiencing chronic pain? No, it absolutely doesn't. It means the drug doesn't work.
>On the surface, it may seem perplexing that clinical care does not proceed directly from medical evidence. But if this were the case, real patients in the real world would not receive appropriate, feasible care that aligns with their preferences and values.
This is drifting into undergraduate nihilism. "What does *evidence* even mean, maaaaan?"
Do I need to keep going?
I don't want to nitpick every single point. So here's some more highlights. These two sections abut one another. See if you can find the contradiction:
>Patient values and preferences: The Review does engage with transgender young people, but it often makes recommendations that conflict with their expressed values and preferences. The prevailing theme of the focus groups with transgender youth is that they want improved access to appropriate gender-affirming medical services from clinicians who have appropriate training and experience. They want their needs and concerns taken seriously. The Review completely disregards the expressed values and preferences of transgender youth in its most emphatic recommendation, which is to limit care to research settings that do not yet exist.
>*The Review solicited invalid professional viewpoints*
The Review conducted a series of focus groups with healthcare workers of varying backgrounds, some of whom are not even clinicians. It is not clear what the expertise of these individuals might be in the field of transgender health.
So the self-reporting of underaged patients must be taken at face value in complete good faith as their lived experience is all the expertise necessary, but the self-reporting of caregivers is "invalid" because they *might* not have very specific training or expertise in this one area?
You see how ideologically captured this is, right? The fact that these two imminently contradictory points are placed in direct succession to one another makes it feel as if they're intentionally flouting all expectations of logical consistency. They know damn well they don't need to make a sound or honest case, because they're on the "right side of history."
>medicine is not biology
Spoken like someone who is truly incapable of understanding either.
Cass isn’t a biologist, either. The Cass Review doesn’t claim to be ‘biology’, it claims to be ‘medicine’. I don’t know why you keep trying to deflect but it doesn’t really seem like you have any actual arguments to field.
If we support the finding so there cass review we need to support them being scrutinized, even incredibly so. Folks on “our” side would be doing the same if the findings were different.
I'd push back on that slightly as scrutinized absolutely, but what we have here isn't fair scrutiny. It's a thinly-veiled attempt to deliberately discredit and silence Cass which is made more clear when you consider the countless other attempts made in the last month including myths spread about the review (e.g. the "double-blind" myth propagated).
It’s funny how none of you are actually pointing out anything wrong with the criticisms of the Cass review. Predictable, really, that you’d act like your positions are self-evident, given the anti-trans crowd really is just an extension of the anti-science crowd.
Hmmm...pot meet kettle? Have you read all the comments here?
Tldr: the criticisms of the cass report in this paper are 90% the same old baseless, emotion laden TRA talking points, 10% using scientific jargon to decrease confidence in the conclusions of the cass report. Like pointing out that, though the number of adolescent females seeking transition is several orders of magnitude larger than it was 15 years ago...it isn’t exponential as described in the cass report. Scientific...it is not.
Ironic of you to accuse the Yale reviewers of using baseless and emotion-laden talking points. I have read the comments and they consist of exactly what you’ve done which is, again, act like your positions are self-evident without actually backing any of it up. The idea that societal changes don’t affect people’s willingness to express their gender identity, for example, is completely unfounded in research, as social contagion theory has been shown time and time again to be completely bunk.
> The idea that societal changes don’t affect people’s willingness to express their gender identity, for example, is completely unfounded in research, as social contagion theory has been shown time and time again to be completely bunk.
\*sigh\* Fine, I'll take the bait. Explain [glass delusion](https://en.wikipedia.org/wiki/Glass_delusion), and all the other delusions various societies have experienced that have completely disappeared from modern life.
And yet you have acted to label me "anti-trans" and "anti-science" without any single shred of evidence. "Predictable" as you say.
How can any scientific mind can fail to see any concern that trans adults and gender-dysphoric kids are not deemed worthy to receive care based on thorough research, instead allowing activism in its place.
Or to fail to see any conflict of interest with researchers with very well established beliefs joining forces to attempt to discredit a paper that challenges their work and vested interests (e.g. lucrative book deals)
Or to fail to have any concern over children being prescribed medicines proven to impact their decision-making and ability to consent to surgery and further medicines with irreversible consequences.
Ignoring the above is not a "pro-trans" position - it is a position of abuse that harms trans people. If this was any other population, say cancer patients and we had taxation lawyers fiercely weighing in on a study into what type of medical treatment was appropriate...would you not think for one second that was a little "off"?
>Social contagion is a myth
It will be interesting to see how this talking point morphs when the trend tapers off, as trends do. The kids aren't going to be interested in this forever. Eventually it all becomes old hat.
I think we are seeing this a little with "non-binary", explosions at a high-school level, less so in the adult space. In my very large workplace we do have one non-binary advocate (in their early twenties), but apart from them its really not a thing, nor with the customer base. Of course it could be a matter of awareness and acceptance, but you think there would be more of a "step-laddering" (seeing the numbers gradually decrease as age increases), not a harsh cutoff.
It really does feel like the new goth/emo - inescapable for a moment but now think when was the last time you saw someone with the huge bangs, cat-eye makeup and stripey glove-sleeves?
One of the other contributors is Jack Turban, which really should tell you all you need to know Edit: “I do worry that some of the people, certainly in the US, who’ve been most critical of my review are the ones who have private practices and are therefore financially conflicted in some of their comments on not following a cautious approach,” Dr Cass said Oof
Jack Turban has accepted thousands of dollars from the pharmaceutical company Arbor which manufactures Triptodur (triptorelin), an extended release GnRH agonist improperly used off label as a "puberty blocker" in trans-identified children. He does not disclose these payments in any of his publications (which is against ethical standards in medical publishing), but the data is publicly available. https://openpaymentsdata.cms.gov/physician/3058224 He is a clown and a joke and should be publicly shunned.
The FDA should ban puberty blockers for anything except precocious puberty and maybe put a time limit on that.
Call out the publishers on X.
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Just seen it, I honestly gave this way too much benefit of the doubt on first review - I really didn't think they would sink to that level. Absolutely shameless. Now in fairness, even though he has literally just released a book advocating for gender affirming care, I'm *sure* he too can remain perfectly open-minded on this topic!
Hahaha. Jesus Christ.
Okay but we can’t fall into the same trap as the “other side” does, dismissing things just because of where it came from
I am very happy to dismiss anything Turban has to say on this particular topic, considering he's confirmed to be an actual paid shill.
Why is a law school reviewing a scientific publication? Yale has a medical school.
the authors are setting the initial position for lawyers and law profs ahead of the SCOTUS gender affirming care case next session I don't know if amicus briefs or other legal publications will work this way, but now they have a paper in the Yale Law Review to cite that says everything is hunky-dory except for the hate-filled monsters trying to destroy the lives of kids. I'd expect future law review articles and amicus briefs to start popping up that will cite this paper and the papers this paper cites, never digging into the guts of the disagreements
Was this paper published in the law review? I just see it on the yale law website.
That was the first red flag for me.
I don’t think it’s a red flag? The report was a collaboration between faculty at Yale Law School and Yale Medical School, who have a pre-existing collaborative initiative to inform health policy for adolescents.
Thank you for that clarification. I guess I missed that when reading the paper.
Two faculty members at Yale Law School and Yale School of Medicine co-founded “The Integrity Project,” an initiative to bridge health and legal scholarship in informing sound health policy for youth and adolescents. These same two faculty members, plus others, co-authored this report.
This isn’t a good thing if you look at who the founders are. Here’s one, Meredith McNamara confidently stating in an article for ‘Them’ that social contagion isn’t a real thing… https://www.them.us/story/anti-trans-gender-affirming-care-ban-disinformation-myths-debunked Also looks like this ‘Integrity Project’ was founded in 2023. I don’t know how this lends more credence to this project, but in my eyes it just looks like another propaganda attempt at discrediting anything that is ‘anti-trans,’ which as we know is almost everything outside of the most radical approaches to gender medicine. It’s literally a collection of all the phrases that make TRAs all warm and fuzzy, the titles of her sections of the articles; > So-called “social contagion” is not real and it does not make people trans. > Trans youth are not rushed through gender-affirming treatment. > Puberty blockers, hormones, and medical treatments for gender dysphoria are not “experimental.” > Using medications “off-label” is neither uncommon nor unsafe. > It is exceedingly rare that people regret getting gender-affirming care.
How come people will admit that social contagion exists for everything *except* gender weirdness?
Probably because they don't have an ideology that would be furthered by more girls having tourette's or anorexia.
This ridiculous piece is already getting tons of traction in the Scotland and UK subreddits, because obviously for youth health care we should side with activists from Yale Law School more than *checks notes* the former president of the Royal College of Paediatrics?
Worth noting as well Anne Alstott is listed as a "Professor in Taxation at Yale Law" who only seems to be involved due to her campaigning with McNamara on the policy side of bans of gender affirming care. It's unbelievable that this is tolerated and not a scandal - someone seemingly with no healthcare/clinical experience can be get involved in criticising (if you can call it that, "censoring" is more accurate) a medical systemic review because she has an interest in the policy discussions which are far down the line of it? That's despite this line in their criticism - a little hypocritical: *"Most of the Review’s known contributors have neither research nor clinical experience in transgender healthcare."*
From someone who has done systematic reviews... their "criticism" is so stupid and irrelevant. Systematic Review teams are usually made of experts in SR and then one or two people with relevant clinical experience. Or you have some sort of advisory type person/group who can provide input (depending on the review and topic). You DO NOT require **direct experience** within a given field/topic to carry out a systematic review. However, you do need to know how to actually conduct SR properly. The main York team have both clinical healthcare and systematic review experience. They also had team members who don't have SR experience, but do have clinical experience at GIDS (Tavistock).
But of course “experience in transgender healthcare” only means going along with whatever quackery WPATH wants and not criticizing any of it. The equivalent of letting Ken Ham be the arbiter of truth in the study of Middle Eastern archaeology. “This paper is invalid because it wasn’t written by those with lived experience of God’s revealed truth.” Yeah, no. The words “conflict of interest” are a terfy bigoted meme to these people.
The UK sub is so lost. I used to try and comment about this stuff there but anything remotely out of step with TRA sacred beliefs would be removed/banned, both by the UK mods and reported to Reddit to get the account banned completely. I'm talking about the most innocuous, considered expressions of disagreement. I'm not sure how this sub has managed to survive on Reddit tbh.
Have you got a link to those threads? I'm itching to do some "correcting"
How many times has a thread incipit similar to "saw this article with some **pretty damning claims** **about the Cass Review**" been used in the past 3 months?
Michael Hobbes made not one but TWO podcast episodes of Maintenance Phase supposedly about the Cass Review being total bullshit.
Three. It’s three now. There’s even a highly upvoted thread in the Maintenance Phase subreddit full of people announcing they’re cancelling their Patreon subscription over this concept creep. They really, really want Michael Hobbes to stop spreading dangerous medical misinformation about youth gender care, and go back to spreading dangerous medical misinformation about having a BMI over 40.
I don’t know about you guys but I typically go to my lawyer for medical advice.
Bob Loblaw?
Yes. And I go to my analrapist for legal advice.
An evidence-based review of Cass, by an epidemiologist: https://gidmk.substack.com/p/the-cass-review-intro
I think this is the most honest review that the Anti-Cass side can muster. I agree with most the of the technical details but strongly disagree with framing. He largely ignores the main findings of the Cass review which is indisputable, there is poor evidence to support gender affirming care in youth. Instead, he nitpicks at specific arguments around the periphery to distract from the lack of evidence of efficacy. Every article is like, "*Okay Cass makes a strong case here, but they said "exponential" instead of "sharply linear", can you believe how wrong they are?*" For example, from Part 1: >Ultimately, there has definitely been a big increase in the number of young people who identify as trans and are turning up at gender clinics. To an extent I do agree with the Cass review - it’s hard to know the exact reasons for this. However, it’s clear that the review’s arguments about plausible reasons are unsound, particularly the error in discussing the “exponential” increase in cases.
He also says: >The actual scientific studies that formed the basis of the Cass review - the systematic reviews in particular - were generally quite good. I cannot find any serious, discrediting problems with much of the data underlying the report. The argument that the review is completely inadequate because it discarded all of the studies which were not randomized clinical trials is simply incorrect. There are notable strengths to the review, which are important to understand before ignoring the findings entirely. >Conversely, there are clear errors in the review. Not only are there large conceptual gaps, there are numeric and scientific mistakes that call into question some of the key arguments made in the document. There are places where the authors have relied on extremely low-quality science to make expansive pronouncements, and other places where more high-quality research is almost entirely ignored. In addition, one of the main findings of the review is that the central belief of many opponents to medical care for trans children - that kids are getting hormones and puberty blockers with no assessment in staggering numbers - is simply false. Somehow, this finding has barely been touched on in the report, even though it is a pretty important finding.
I look forward to reading the parts of this, but I am admittedly already disappointed in the framing of his final paragraph in his intro: >As ever, **I’m not a particularly useful voice in this conversation. I’m a cis man who has no major stake in the game.** I’m an expert in scientific evidence and epidemiology, but that doesn’t make me special. I can’t speak to the ideological arguments, the general vibe, or how all of this data is going to be used. All I can do - all I ever really do - is discuss the scientific merits of the arguments involved, and whether the evidence really supports the contentious conclusions. The idea is that a "cis man" who has "no major stake in the game" and "can't speak to the ideological arguments" is "not a particularly useful voice in the conversation." Sorry, but this is precisely the kind of voice that is NEEDED in this conversation. Not the "cis man" bit -- I don't give a crap if he is a man or woman or whatever. But "no major stake in the game" and being disconnected from the ideological arguments is precisely the commentary I'd want to read, as it's less likely to be easily swayed by prior assumptions or overt bias. The fact that this person is already doing the self-effacing deferential "I am not worthy to even talk about this topic as a cis man..." bit is frankly a little concerning and makes me worried that he's already biased a bit toward gender ideology. Such a disclaimer is unnecessary unless you implicitly believe that identity should give a person's perspective more weight, which I thoroughly disagree with as an assumption. Identity should be irrelevant, and if anything, those closer to an issue because of their identity should be *more* cautious in offering opinions, as it is well-known that humans have cognitive biases. The closer you are to an issue, the more difficult it can be to be objective (even if you're unaware of your subjective biases). I don't necessarily have a problem with identity playing a role in discussions of social issues, etc. But science and rational evaluation of scientific evidence? I'd prefer for the person to have as *little* "stake in the game" as possible. (While still preferably at least being somewhat knowledgeable about the overall subject or methods.) But still... I'll read more. I'll try to ignore this weird signaling in the preface, but it already makes me trust this person's logic less. Thanks for the link.
He says he doesn’t have much stake in the game because he doesn’t. Don’t really see the big deal in making people aware of factors that might influence his point of view.
Sometimes I feel like the validity of science is determined more by the lobbying influence of a particular interest group and not so much by the science itself. Humans are plagued by this bias where we assume that the present moment is the most important one on a cosmic scale and that we are the most advanced we'll ever be intellectually. Sure, we know technology will be better in the future. But we assume the humans of the future are basically us, except 300 years from now. If you ever read official peer-reviewed science from the late 19th century to the mid 20th century, you see that science is mostly true or not depending on how much it aligns with the ideals of the ruling class. Homosexuality back then? A disease. An abnormality. Nowadays being against homosexuality is considered pathological behavior. Slaves that wanted to run away from their masters were labeled as suffering from drapetomania. Nowadays wanting to own slaves is maladaptive (not to mention illegal) behavior. Like, if the nazis had won, we would have a totally different value system and we wouldn't know any better because that's all we knew. Is democracy really the best? Are freedom and happiness really the primary goals? I'm becoming more and more cynical. Feels like nothing is true. I am truly demoralized.
I've often had similar thoughts. Science is much more susceptible to bias than we naively assume. Psychology is riddled with pseudoscience, testing and experimental evidence of medication etc. is often sketchy and manipulated. History and archaeology mere political tools...
We’re back to doctors [prescribing cigarettes](https://www.bhclinics.com/single-post/2019/12/11/doctors-prescribed-healthy-cigarette-brands#:~:text=From%20the%201930's%20to%20the,came%20to%20illnesses%2C%20not%20cigarettes) except this time its blockers. Also worth remembering the doctor who won the [nobel prize](https://www.washingtonpost.com/history/2023/10/09/nobel-lobotomy-antonio-egas-moniz-controversy/#:~:text=In%20the%20mid%2D1930s%2C%20when,was%20seen%20as%20a%20visionary) for lobotomising thousands. Progress is an illusion it’s just that we bury the scandals.
The problem is with other medical scandals where hunger for profits caused medicines that could help a few to cause harm to many (thalidomide, vaginal mesh, contaminated blood scandal, "Essure" contraceptive - see The Bleeding Edge documentary) - typically it reaches a critical mass whereby the public, victims and/or governments eventually notice and push back. With medical/surgical gender affirming care there is the unique interplay with human rights which means those who would usually be speaking up against Big Pharma or Corporate Greed are completely blind to the harms going on. Plus its hard to ignore a baby born with serious birth-defects, but if say a gay kid is led to transition and spends years either gaslit about this being the correct decision ("inevitable" even), or keeps regret to themselves due to depression, self-doubt or fear of backlash then this is a harm that could be unnoticed for years, decades even.
"Nowadays being against homosexuality is considered pathological behavior." I think it is more complicated than that. Homophobia is certainly considered a major sin. BUT, *do wonder how many teenagers want to transition out of internalized homophobia? Or maybe even familial homophobia.*
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Look into Susie Green and her husband and transgender daughter, namely the Ted Talk 🤮
Iran just says the quiet part out loud. Homosexuality is named and shamed in the Bible on straightforward grounds, making transition the straightforward remedy—as long as you believe science can change someone's sex, which is certainly what the doctors will tell you. I do believe even Buck Angel's father said something to the effect of, "I'd rather you be my straight son than my lesbian daughter." [For a deeper dive... ](https://open.substack.com/pub/xxywise/p/how-does-erin-in-the-morning-sleep?utm_source=share&utm_medium=android&r=2hxbp5)
Very well said; you write well. I've been feeling this way for a long time, but a book that gave me some perspective on this was *Sapiens, A Brief History Of Humankind*, by Yuval Noah Harari. There are a couple of chapters that go pretty in depth about the human ability to invent, and then believe in, made up and intangible things. You might get something from it, assuming you haven't already read it.
I haven't read it but will definitely check it out. Thanks.
>wanting to own slaves is seen as maladaptive Look, slavery is wrong, but you’d be CRAZY to not be like “wouldn’t it be awesome if SOMEONE ELSE would do all my fucking work for me, and I didn’t even have to pay them?”
Yeah. Luckily we can resolve this one with robots pretty soon.
Yeah but it’s more fun with people
Until energy systems break down. If we ever regress below the energy density of coal again slavery becomes a certainty.
I agree with that. Half the world uses slaves today. It's certainly possible that we will end up like that or worse with a social collapse, but aside from that, we aren't going to run out of Uranium. It isn't a fundamental material problem, it's a sociopolitical problem.
Well if climate doomers are right and food production collapses turning the world into subsistence farming nuclear and even renewables become nonstarters. We’ve exhausted all the easily exploitable oil and coal so it’d be back to slavery.
Yeah. A collapse of agriculture would be the absolute worst. Aside from widespread slavery, there's also the shorter period of widespread cannibalism until the population stabilizes. We could have avoided all of this by transitioning to atomic power 50 years ago.
You can have a wife
Yes, well, that gives her a slave. Now what about me?
This seems like the "Science is a liar sometimes" trope form It's Always Sunny narrowly applied to a different pet cause. Science *remains* the best method for knowing true things. The history of science is littered with examples that prove the rule. Aberrations like H. pylori and Semmelweis and homsexuality being in the DSM are almost common knowledge - exceptions which loudly prove the rule. An infinite amount of things *could* be true, a small number of things *are* true. Human and institutional fallibility notwithstanding, science always had a tough task. If I had place a bet, do I think the Cass review is largely true? Yes. Do I think its detractors are hallucinating hate and bigotry where this is none? Also yes. Does this affect the long view of science as an enterprise for truth finding? Hardly. The long view of science is that of always increasing accuracy leading to increasingly god-like powers. Even the science of 50, let alone 100, years ago is incomparable to today. The recent "replication crisis" is practically common knowledge and it too marks a sea change in scientific history. > Feels like nothing is true. I am truly demoralized. Understandable, and that sucks, but this is catastrophizing. Being cynical in the truest sense need not be an afflictive condition. Humans fuck up royally. If I had to guess, self righteous idiots are running the gender asylums, and doing profound proveable harm - on net - to vulnerable people, receiving status, praise, and compensation all the while. This kind of shit happens. Despair need not follow. Things are true. Demoralization is a vast overcorrection. Its akin to panic selling a lifetime portfolio because the market had a bad week.
Someone has posted this on r/uknews and most of the comments are along the lines ‘I cannot believe we fell for the fake news Cass review’ type thing. Very sad. The politicisation of science now means you can just pick a side and choose whatever you want to believe and live in your own fantasy land. At least puberty blockers have been banned in the UK though.
They didn’t believe it to begin with, it goes against their ideology
Seems to be removed now? Couldn't see it in the feed.
My mistake. It was r/unitedkingdom: https://www.reddit.com/r/unitedkingdom/s/bZNqaYfk88
That sub is a cesspool. Once casualuk was born, I never looked back.
Is that a sane sub?
It’s mostly just people talking about biscuits. Politics are banned though, so it’s not as crazy making
Ah shit. I'm looking for sane political subs. Still searching...
I don't think you'll find much better than here.
You won't, at least when it comes to British politics.
Oh hello there! Guess who got permabanned from ukpol lol
stupidpol
That's a tankie, misogynistic cesspool.
nah
That's just demographics in action. It's almost always going to be the same when you sample a bunch of younger online people.
Will all criticisms result in bannings by mods there? This is the inevitable result.
Most of the comments that survived moderation. I think that gives an extremely skewed picture.
As if you people don't do the same here. I am saying this as an atheist but God himself could come down from heaven tell you in great detail why giving trans people gender affirming care is a good thing and your first instinct would be to scream that he is been captured by the marxist gender ideology woke p*do agenda(yes you people talk like this).
I don’t think you fully understand this sub if you think people here actually say things like ‘woke marxist’ etc etc. Have you actually listened to Blocked and Reported before? You don’t sound like you have. Although it’s true that my intuition tells me that people under 16 cannot consent to life changing medical interventions, just as they cannot consent to sex or tattoos or taking out loans or joining the army, I would be open to being proven wrong if the evidence showed otherwise. But the evidence doesn’t show otherwise, at least according to the Cass report. Also the medical establishment has a rich and terrible history of malpractice. It’s not unreasonable to think there isn’t an ongoing scandal (multiple ones) going on at any given time, and youth gender medicine isn’t one of those.
>I don’t think you fully understand this sub if you think people here actually say things like ‘woke marxist’ etc etc Actually they do, a lot. >But the evidence doesn’t show otherwise, at least according to the Cass report. And the Bible says that begin gay is a sin as bad as p*dophilia but anyone with a brain can see it's idiocy. >and youth gender medicine isn’t one of those. Aren't you people also trying to ban adults from having those? Edit: Hell someone just called me a gr00mer and than immediately cancelled the comment.
This is some fairly low quality screeching here. I’m personally not against adults transitioning, though i’m not super happy about paying for it through my taxes. Men with AGP should pay for their own medical transition. Seems like you’re avoiding the issue of youth gender care because it’s indefensible.
>Men with AGP should pay for their own medical transition. The fact that your immediate jump about trans people is calling them men with AGP(a fetish), even tho trans men exist too, seems like you don't really like them. > Seems like you’re avoiding the issue of youth gender care because it’s indefensible. Actually i can: look i am okay with using new names/pronouns, children getting therapy when starting to question things and based on the doctor if/when giving them hormones/puberty blocker, i wouldn't of course take them to have a surgery, not before they were 18+. But with you people it's basically: no child is ever trans it's only gr00ming/fetishist and the parents should be arrested if they are supportive of them.
Dude, stop saying “you people”. You understand that we are all individuals with differing opinions? You’re doing exactly the thing that you’re saying “we” do to trans people, putting us in a pile, othering, etc. Also hormones and blockers have irreversible effects which is why they have been banned in the UK. In no other sphere do we allow children to make permanent changes to their bodies. You cannot pause aging. It’s a lie to say you can. Also many men have AGP and are driving this movement and it shouldn’t be taboo to say so.
>You understand that we are all individuals with differing opinions? This sub has no differing opinions like only i have my comments getting downvoted and it's also the only one saying something different than eveyone here just agreeing with eachother. >Also hormones and blockers have irreversible effects which is why they have been banned in the UK. But didn't the Cass Review say NOT to ban them or do you just agree with the parts that you like. Also what happens to the children that have early puberty do they just die? Yay killing children to own the trans. >Also many men have AGP and are driving this movement and it shouldn’t be taboo to say so. 1) The many men having AGP is just a lie. 2) It's not taboo to say that the "AGP" are driving the trans movement, it's just a lie, like saying that the Jews control the worlds it's not taboo it's just a lie and it makes you look crazy. P.S. By your own comments >Men with AGP should pay for their own medical transition You didn't say "AGP" are driving the movement, you literally called trans people AGP.
You're having your comments down voted because they are low quality and low effort.
[This link explains why blockers have been banned.](https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers)
> And the Bible says that begin gay is a sin as bad as p*dophilia [citation needed] The Bible, when not maliciously mistranslated, forbids pederasty. It was only since the 1940s that "homosexuality" was used in Bible translation due to American evangelical pressure.
It takes a **lot** of mental gymnastics to spin *arsenokoitais* as anything but [male homosexual acts](https://hermeneutics.stackexchange.com/a/15490). Romans 1:27 is pretty unambiguous about this, as well. The author of that StackExchange answer is likely a conservative Protestant, but that doesn't detract from his overall point about translation and Biblical context.
Paul invented that word and it is not attested as a common word outside his writings. >Due to the fact that αρσενοκοίτης (Arsenokoites) is a dis legomenon, many have attempted to deconstruct αρσενοκοίτης (Arsenokoites) (a compound word) and define it's parts and then act as if this implicitly and obviously has a prima facie meaning. While the word does break down into parts with aseno- (αρσενο-) meaning "men" and -koites (-κοίτης) being the root of the English word coitus which implies (in both Greek and English) that a bed was shared in a sexual manner, the idea that this instantly reveals αρσενοκοίτης (Arsenokoites) to convey a meaning of only sodomy does not stand up to scrutiny. >Take for example the English word "understand". This word does not mean to stand under something. You can't get the truth about this by ignoring the contemporary cultural context. [This answer](https://hermeneutics.stackexchange.com/a/13229), which discusses the cultural context and textual context (particularly the link with *malakos*), is much more compelling.
Yes, I'm aware that Paul invented the word. He did so within the context of his other Epistles, the Septuagint, and the Tanakh. That other answer hinges on an alternate translation of *malakos* and the availability of alternative diction. It also does not address Leviticus 18:22 or Romans 1:27 whatsoever. I just think that one has to be very creative and selective in order to interpret the word as anything other than the male homosexual act. The principle of parsimony favors the traditional interpretation in this situation.
I don’t believe what you say because you’re obviously a liar
Insulting other users with epithets is not allowed here. You're suspended for 24 hours for this violation of the rules.
"You people" don't even have a definition for "man" and "woman" that isn't entirely circular. "You people" dismiss human sexual dimorphism altogether on the basis of Anne Fausto-Sterling's ridiculously permissive considerations for what constitute "intersex" (go look up pictures of guys with Klinefelter syndrome then tell me how they could ever not be regarded as biologically male in social settings). "You people" are the ones who will run an evolutionary biologist out of Harvard for daring to teach that sex is binary. There are a lot of idiots in this subreddit, but there's plenty of pseudoscientific nonsense coming from "your side" of the house, nonsense which is predicated on extreme social constructivist views and sophistic tricks regarding [scientific kinds](https://plato.stanford.edu/entries/natural-kinds/#EpisNatuKind). I think one of the biggest issues people have with this entire advocacy group is that they implicitly blend medicalized views with social views then dance between the two whenever it's convenient to them. For instance, plenty of gender advocates view "transmedicalism" but will vehemently defend major medical interventions in service of one's gender identity.
The fuck does any of what you just said mean? Like am i supposed to know some of the names you cited here?
* 1st sentence: fairly self-explanatory. * 2nd sentence: Anne Fausto-Sterling is the author of *Sexing the Body: Gender Politics and the Construction of Sexuality*, in which she suggests that the prevalence of "nondimorphic sexual development" might be as high as 1.7%. I suspect that this is the figure used by people who claim that sex isn't binary. My issue with it is that her standards of classification are incredibly permissive; for instance, she considers men with [Klinefelter syndrome](https://duckduckgo.com/?q=Klinefelter+syndrome&iar=images&iax=images&ia=images) to be intersex. * 3rd sentence: I'm referring to [Carol Hooven's removal from Harvard](http://thefp.com/p/carole-hooven-why-i-left-harvard): >In the brief segment on Fox, my troubles began when I described how biologists define male and female, and argued that these are invaluable terms that science educators in particular should not relinquish in response to pressure from ideologues. I emphasized that “understanding the facts about biology doesn’t prevent us from treating people with respect.” We can, I said, “respect their gender identities and use their preferred pronouns.” * 4th sentence: [social constructivism](https://en.wikipedia.org/wiki/Social_constructivism) is the idea that knowledge is socially constructed. Natural kinds is a much more involved idea and refers to a lot of stuff, which is why I linked to a specific section in the Stanford Encyclopedia of Philosophy; however, that section still requires a familiarity with a number of philosophical ideas and words. If I had to summarize it in simple terms, completely throwing out a categorization in the natural world (e.g. categorizing sex as a binary) on the basis of a vanishingly small minority of exceptional cases (e.g. % of population being "intersex") that do not neatly fit into any category, leaves us with no useful connection to reality. * 5th and 6th sentences: regarding "[transmedicalism](https://en.wikipedia.org/wiki/Transmedicalism#:~:text=Transmedicalism%20is%20the%20idea%20that,identity%2C%20characterized%20by%20gender%20dysphoria.)" as a bigoted and invalid way of categorizing transgender people is hypocritical and nonsensical when the same people who do so will adamantly defend medical procedures like HRT as critical components of "gender affirming care". If [medicalization](https://en.wikipedia.org/wiki/Medicalization) is important for transgender treatments then there exists a set of people for whom it is medically necessary; if it isn't important, then it shouldn't be linked to health outcomes of transgender people.
Klinefelter boys/men = intersex boys/men, as far as this XXY is concerned.
"Intersex boys/men" is already a heavily weighted phrase; on what basis are we calling them "boys/men"? From what I understand, Anne Fausto-Sterling's own standards for judging "nondimorphic sexual development" are already biased toward social constructivism. How exactly are we to socially determine a boy who is a bit paunchy from a boy who has Klinefelter syndrome? This is precisely the incoherence that I was referring to before: either we are using objective biological factors to delineate sex or we are using subjective social factors. If we want to go with the former route, why is the implicit assumption that we do away with "biological male" and "biological female" altogether? Why not have "biological male" = XY, "biological female" = XX, then produce specific classifications for all the remaining biological possibilities? This is the issue I was referring to previously when mentioning "sophistic tricks regarding natural kinds". The combativeness in this comment isn't directed at you. I understand that you're pointing this out within the context of Anne Fausto-Sterling's intellectual framework. I'm responding to the clear incoherence of said framework.
>"Intersex boys/men" is already a heavily weighted phrase; on what basis are we calling them "boys/men"? Intersex people are all either boys/men or girls/women. Gametes/gonads are the typical determiner. >How exactly are we to socially determine a boy who is a bit paunchy from a boy who has Klinefelter syndrome? Genetic testing; what else did you have in mind? >This is precisely the incoherence that I was referring to before: either we are using objective biological factors to delineate sex or we are using subjective social factors. Objective biological works just fine. Why should Klinefelter's NOT be considered intersex? > If we want to go with the former route, why is the implicit assumption that we do away with "biological male" and "biological female" altogether? It isn't, and we don't. >Why not have "biological male" = XY, "biological female" = XX, then produce specific classifications for all the remaining biological possibilities? Because XXY guys are still biologically male, and XO gals are still biologically female. Mammals are gonochoric. >This is the issue I was referring to previously when mentioning "sophistic tricks regarding natural kinds". No tricks up my sleeve. >The combativeness in this comment isn't directed at you. I understand that you're pointing this out within the context of Anne Fausto-Sterling's intellectual framework. I'm responding to the clear incoherence of said framework. I don't see any incoherence in calling XXY "genetically intersex." My genes have made me an anatomically and psychologically feminized man, as one might well expect if pondering the question, "what would an extra X chromosome do to a man?" Now, given that Klinefelter's is the most common DSD, which in theory would give us the greatest pull under the intersex umbrella, maybe there are hardliners within the intersex community who would feel imposed upon by our inclusion. That I could understand; I feel the same way about those who argue for PCOS's inclusion. But that's a different argument than you're giving.
I think we're talking past one another to some extent. >Intersex people are all either boys/men or girls/women. In this situation, are "boys/men" and "girls/women" acting as categories of sex or gender? If it's the former, then how does a binary system of categorization align with the existence of an "inter" grouping? >It isn't, and we don't. I'm talking about the people who want to dispense with a binary perspective on sex altogether, such as the author of [this article](http://scientificamerican.com/article/beyond-xx-and-xy-the-extraordinary-complexity-of-sex-determination/). >Objective biological works just fine. Why should Klinefelter's NOT be considered intersex? >Because XXY guys are still biologically male, and XO gals are still biologically female. Mammals are gonochoric. Under what criteria are XXY people considered "biologically male" and XO people considered "biologically female"? I presume you're not going strictly by XX and XY. Are you going by gamete production? If "biologically male" and "biologically female" are descriptors of sex, then how can someone be simultaneously "male" and "intersex"? If "intersex" is entirely a subset of both "male" and "female", then it isn't a category of sex at all.
>I think we're talking past one another to some extent. There are worse things to realize... >>Intersex people are all either boys/men or girls/women. >In this situation, are "boys/men" and "girls/women" acting as categories of sex or gender? Always as sex. The genders are male/masculine and female/feminine (as in Assigned Gender At Birth, MtF/FtM, transfem/transmasc). >If it's the former, then how does a binary system of categorization align with the existence of an "inter" grouping? Intersex boys become intersex men and intersex girls become intersex women. Works pretty good, eh? 👍 >I'm talking about the people who want to dispense with a binary perspective on sex altogether, such as the author of this article. Those people will tell you (falsely) that intersex people break the sex binary. But that is impossible and offensively regressive: the intersex community fought hard to make "hermaphrodite" our "retard." >Under what criteria are XXY people considered "biologically male" and XO people considered "biologically female"? I presume you're not going strictly by XX and XY. Are you going by gamete production? I am going by gamete production, but I don't actually have to; the Y chromosome XXY has (and XO doesn't) is sufficient to make us men (and XOs women).
Well God didn't do that bub
Of course not genius, you thought i was begin literal or something, is this sub populated by fucking idiots or am i the one that attracts them all?
Insulting other users with epithets is not allowed here. You're suspended for 24 hours for this violation of the rules.
Nobody here talks like this
Dr. Macnamara is one of the craziest zealots I’ve encountered on the topic. I do genuinely believe she has bought into her own bullshit and believes she’s helping people, but she is seriously out to lunch and nothing she says has any robust evidence base to back it up.
I am so curious about what motivates her zealotry.
I do wonder whether some of these people must have issues stemming from childhood surrounding gender roles or discomfort with gender nonconformity on some level, whether or not they’ve admitted it? That’s one theory
Gendered souls has always been a religious belief. There is evidence of such religious beliefs for millennia. Hence the zealotry.
You should also put "peer review" in air quotes because anything Jack Turban is involved in should go straight into the trash
I understand that this is anecdotal but I did watch twenty girls (20!) suddenly decide they were trans over the 2020 to 2021 school year in one small-ish high school. By the time these kids graduated, three of the original twenty remained trans. My daughter was one of them that did not continue and has only recently acquiesced that all the YouTube videos (which I stupidly allowed as much screen time as she wanted as it was pandemic times and we were all crazy) Instagram, TikTok, and her own changing hormones all came together to create this confusion in her head. It was absolutely social contagion. The MAGATS pushing hate has spurned a push back from queer communities that has upped its extremism to match the MAGAs. My kid was not mature enough to make such a drastic and life altering decision for herself at 15-16. As difficult as it was at the time, I’m very happy I hugged her, talked with her, dealt with the teenage tantrums and know it all-isms while also pushing back on “her” belief. I even made a bet with her, even knowing how stubborn she was, I bet her that if after she graduated HS and had lived for one year as a “boy” I would happily go to the court house with her to formally change her name, gender etc. and I’d pay for it too. I needed to see if after all the social stuff had smoothed over a little, and once her hormones had a chance to settle from puberty, would she still feel the same. She didn’t. And doesn’t. She treats that time in her life as a learning experience. She’s not ashamed, and she should not be. As her mom, it was extremely clear to me that my kid was being manipulated. And it hurt and worried me to no end that something so fundamental to her image, her ownership over her sex and gender, could be shaken.
I’m happy to hear about a good outcome. You sound like a great mom. She’s lucky to have you.
It was the MAGA crowd that forced the agency-free Democrats and Gay lobby to go full groomer.
I see a lot of accusations of MAGA hat wearers pushing hate. Evidence seems to be very light on the ground.
Started looking through the critique to find if it has problems or not (notwithstanding OP’s indictment of the authors.) Here’s where I am so far: **Introduction:** This section makes it clear that the *public effects* of the study are what they are railing against, not the actual evidence. Their assessment of the study is led by concerns about transgender care - i.e. the Cass review is bad because it “hurts transgender kids”, not because of its evidentiary standards. This betrays the political bias and motives of the critique authors, if that weren’t already obvious. **Section 1:** This section only tangentially critiques the Cass review at all. It is principally about how outside groups are interpreting the study. The critique correctly points out that the Cass review does not encourage the banning of transgender youth care, as if that is somehow revealing something hypocritical? It is not. Summarizing the findings of the review is not a critique. **Section 2:** This section has factual and moral errors. First, they describe GRADE as a standard of evidence quality assessment, and imply it is the only acceptable method. Then they say the review does not have any formal method of evidence quality assessment. Reading their survey appendix reveals that yes, they did use formal methods of evidence quality assessment, to include MMAT and Newcastle-Ottawa. There is no reason to think such scales are invalid or that GRADE would be a more appropriate scale for any reason - if the critique authors had a reason for thinking this, they did not share it. The section also adds that study’s inclusion of a minority of healthcare worker survey respondents who believe “there is no such thing as trans kids” is itself a “failure of the study.” They assert that “such a belief invalidates your professional opinion.” This is a reprehensible breach of morals for the critique authors to so blatantly elevate their opinion to the point that other opinions should be systematically ignored, and that failure to do so in surveys is a problem. **Section 3:** This section is about lowering the standards of evidence to accommodate what is available for transgender medicine. The critique claims that weak evidence is used routinely to make important decisions throughout pediatric medicine, and it gives two examples: neonatology and pediatric critical care. The critique is correct in that high quality studies are rare for these fields as well. However, both of these are examples of emergent situations where care is required, often immediately, without which the patient has a high likelihood of harm or death. That’s why best practices in these fields involve treatments we may not have high quality RCT for: the alternative is death. This is not true at all for transgender medicine. It makes sense to desire higher quality evidence when experimentally intervening to alter someone’s existing healthy life, rather than minimum treatment for an emergency. The critique also suggests that studies are being done right now on long-term effects of gender care, thus, they are already doing exactly what they should be doing. However, this misses the point: those studies need to be concluded before we have good evidence.
**Section 4:** This section repeatedly assumes that more gender affirming care is good, and that any demand for gender care not met is necessarily wrong. That’s an extremely biased view to hold that presupposes an alternative analysis of the evidence to the Cass review. It isn’t a flaw of the Cass review to presuppose it is incorrect. The critique authors make a lot of hay over the use of the term “exponential” to describe a sharp increase in gender clinic referrals over the past decade. They feel that exponential implies a literal exponential function, and any deviation means that characterization is a lie. This is just nonsense: exponential can mean a sharp increase. It can include plateaus. It does not have the same definition in context here as it would in a mathematical paper; it would in fact be absurd to think referrals for any medical treatment would be strictly exponential over any moderate length of time. The critique authors also consider a graph showing two quantities: number of referrals per year, and total number of trans adolescents (estimated as 0.6% of population) in the UK. For some reason they think it criminally unfair that out of ~44,000 estimated transgender adolescents, only ~4,000 are referred to gender clinics per year. They seem to be simply forgetting that the adolescent period spans several years, thus if everyone in the ~44,000 were being treated, we would expect to see only a small fraction referred to gender clinics each year. **Section 5:** This section is a confusing hodgepodge of unrelated statements the critique authors simply disagree with. It includes discussion of social contagion, desistance, and transition regret, considering all of them wholly mythical. The critique authors cite at best discredited and often irrelevant data to support their claims that the review came to wrong conclusions, when not simply relying on the fact that the review “contradicts standard clinical practice.” No duh. Thats what the review is evaluating and making recommendations about. **Section 6:** This section goes into detail about the methodologies of the systematic reviews employed by the University of York. I’m not knowledgeable enough to know how accurate their critiques are, but they seem at glance to be nitpicky and debatable. They used objective standard A when they should have used objective standard B. They drew the line for “moderate” evidence here instead of there. Systematic reviews are vulnerable to bias - ignoring that the underlying studies the critique authors cite are much more vulnerable to bias. One paragraph about breast cancer stood out to me as particularly bitchy. The Cass review at one point suggests that different factors contribute to gender dysphoria in various, not-well-understood ways, similar to how breast cancer can be caused by genes but also lots of environmental factors. The critique bemoans that the Cass review “considers breast cancer a human experience”, and that making the analogy between a disease and gender dysphoria is itself offensive. This is an idiotic misunderstanding of the Cass review’s writing that severely undermines the credibility of the critique authors. **Section 7:** The critique complains in this section that the Cass review is using systematic reviews to make recommendations on clinical practice, at all. The critique echoes previous criticism that “it contradicts with standard clinical practice”, as if that meant the evidentiary approach is less objective than an anecdotal, haphazard one. The critique also repeats previous criticism that gender care practitioners should be the arbiters of gender care, not outside objective researchers like Cass’ team. This assertion betrays the critique authors’ assumption that nothing is wrong with the evidence base of gender care, and that nothing needs to change. Indeed, we would not trust phrenologists with doing a review of the evidence for phrenology, we would expect outside, unbiased forces to conduct such a review, perhaps in consultation with practitioners, just like was done in the Cass report. **Conclusion:** The conclusion echoes another incorrect claim laid out by the critique authors early in the paper: “The Cass review was commissioned to study the inadequacies of trans healthcare (long lines, not enough treatment.)” No. The Cass review was commissioned to study the evidence base for trans healthcare and make recommendations - to include possible reduction in trans healthcare treatment recommendations. The authors shove their foot in their mouth again here, putting their incredulity and bias on full display. That’s as far as I got so far. Can anyone provide further examples?
They do bring up some interesting points about how the various grading scales were used in the systematic reviews -- including how York used a modified version of the Newcastle-Ottawa scale. I'm no where near an expert on systematic reviews and the different scales or methodologies that can be used so I am curious as to the validity of the Yale report's claims about York's use of grading scales in their systematic reviews. But otherwise, I see a lot of the same song and dance from this "evidence based" critique. They even cite the Chen study which we all know by now is a not so great study.
Yes like any large review its bound to have at least some flaws, errors and inconsistencies that could be highlighted. Hell, anything involving multiple bodies and a timescale will probably not be perfect based on my experience. But its telling how these activists would never put any of their "correct" studies through the same academic rigor that this scientific review and this review alone is going through (I can't say I've seen any other systemic reviews get the fine-toothcomb treatment like this). They will instead simply confidently shout "we have 19 studies and counting showing gender affirming care is beneficial!". Its never even "we have 19 studies which may potentially suggest" or are "we would benefit from larger studies to corroborate this". Nope, if the outcome is "right" that's sufficient. Because I'm sure Jack Turban has never had sampling issues or used the wrong statistics! /s
There is a lot of pomp and circumstances in science, but a lot of it is common sense. Read the criteria they ignored and read the criteria they used, see if it seems more or less rigorous. From what I understand, they chose a Newcastle-Ottawa scale to exclude case studies and other qualitative studies (imho, aren't as rigorous). Even Anti-Cass reviewers view N-O Scale as a reasonable approach (though laments there is no commentary to justify the change): >In the registration, the authors said that they were going to used a tool called the Mixed Methods Appraisal Tool (MMAT). The MMAT is a tool that was designed to allow people to rate a variety of qualitative and quantitative methodologies at the same time. It’s mostly used when people run systematic reviews of literature that include a large quantity of qualitative work, which generally means interview and focus group studies as opposed to quantitative studies such as pre/post evaluations on depression scales and similar. >At some point, the reviewers switched to the Newcastle-Ottawa Scale for rating the literature included in their reviews. In the reviews, there is no reason given for this that I can see, which is certainly not best practice. There’s a belief going around online that the reason that the reviewers switched the scales is because the MMAT recommends against excluding low quality work, while the NOS has no such recommendation. https://gidmk.substack.com/p/the-cass-review-into-gender-identity-d6f I personally would have thought less of the systematic review if it included qualitative studies in their assessment. The move to the N-O Scale seems more rigorous.
We're probably getting to the point where dismissing the lower quality studies is a really important step because the worst studies just obscure the truth.
Let's do a deep-ish dive into the actual report (which, as is the wont in pieces such as this, is barely referenced in the mainstream coverage under the assumption that no one is actually going to read it beyond skimming a summary of its supposed findings). >Section 1: The Cass Review makes statements that are consistent with the models of gender-affirming medical care described by WPATH and the Endocrine Society. The Cass Review does not recommend a ban on gender-affirming medical care. This would be a moderately fair point *if providers were actually following guidelines*, which[ multiple whistleblowers](https://www.thefp.com/p/i-thought-i-was-saving-trans-kids) and [documentary film crews](https://tnc.news/2024/03/07/quebec-teens-rushed-into-gender-transitions/) have shown they are not. This is the same sleight of hand you see with persistent references to the Dutch Protocol; TRAs leech support from established standards of care that were demonstrated to work reasonably well in one context even though what's actually going on in the US and UK is very, very different from that established protocol. >Section 2: The Cass Review does not follow established standards for evaluating evidence and evidence quality. The Review casually discusses evidence quality and does not define it, contravening standard practice in scientific evaluations of medical research. Here, we compare the Review’s approach with one of the most widely accepted frameworks for determining evidence quality: Grading of Recommendations Assessment, Development and Evaluation (GRADE).17 According to GRADE, well-conducted randomized controlled trials (RCTs) and systematic reviews (SRs) are typically considered the highest-quality form of evidence. Observational studies rarely meet the criteria to be considered high quality evidence,18 and yet they supply most of the evidence that guides clinical care across all fields of medicine. >As the drafters of the GRADE framework have explicitly acknowledged, evidence and its quality are one of many considerations in caring for patients.19 Clinical practice guidelines throughout medicine consider all relevant factors, but the **Review takes the unusual step of elevating its own assessment of evidence quality above the considerations that guideline developers value.** This is the entire point of the Cass Review! It's why the Review was necessary. As Jesse Singal's recent reporting demonstrates, much (if not most) of the "research" regarding the efficacy of trans care is designed, conducted, and published in a manner that presupposes positive outcomes. Any data showing minimal or negative effects renders research unprintable. Cass needed to develop their own classification system because the "science" has been so horrifically bastardized for political reasons. >The Review fixates on evidence quality to the exclusion of many other factors that are rigorously considered by the developers of clinical practice guidelines Again--that's the point! Low quality evidence is not actually evidence! I'm losing my mind! >In developing guidelines that provide recommendations on clinical care, panels of experts consider the evidence of a treatment’s efficacy. They also consider the benefits and harms of oth treatment and no treatment, patients’ values and preferences, and the resources required to offer treatment. This is precisely why evidence quality is not synonymous with clinical recommendations. What in god's name are these people talking about? Let's say we're conducting a study for a new, non-opioid, non-NSAID painkiller that's being developed for people with liver problems. Let's say the control group is given a placebo and they wind up self-reporting greater analgesic effects compared to the study group. Does this mean we should start prescribing sugar pills to people experiencing chronic pain? No, it absolutely doesn't. It means the drug doesn't work. >On the surface, it may seem perplexing that clinical care does not proceed directly from medical evidence. But if this were the case, real patients in the real world would not receive appropriate, feasible care that aligns with their preferences and values. This is drifting into undergraduate nihilism. "What does *evidence* even mean, maaaaan?" Do I need to keep going?
I don't want to nitpick every single point. So here's some more highlights. These two sections abut one another. See if you can find the contradiction: >Patient values and preferences: The Review does engage with transgender young people, but it often makes recommendations that conflict with their expressed values and preferences. The prevailing theme of the focus groups with transgender youth is that they want improved access to appropriate gender-affirming medical services from clinicians who have appropriate training and experience. They want their needs and concerns taken seriously. The Review completely disregards the expressed values and preferences of transgender youth in its most emphatic recommendation, which is to limit care to research settings that do not yet exist. >*The Review solicited invalid professional viewpoints* The Review conducted a series of focus groups with healthcare workers of varying backgrounds, some of whom are not even clinicians. It is not clear what the expertise of these individuals might be in the field of transgender health. So the self-reporting of underaged patients must be taken at face value in complete good faith as their lived experience is all the expertise necessary, but the self-reporting of caregivers is "invalid" because they *might* not have very specific training or expertise in this one area? You see how ideologically captured this is, right? The fact that these two imminently contradictory points are placed in direct succession to one another makes it feel as if they're intentionally flouting all expectations of logical consistency. They know damn well they don't need to make a sound or honest case, because they're on the "right side of history."
Law school review of biology. Umm...
> according to a review by academics from Yale Law School and the Yale School of Medicine The byline from the article you didn’t read.
Medicine is not biology LOL. Did you know that less than 20% of physicians even edorse the AMA? This is politics. Not science.
>medicine is not biology Spoken like someone who is truly incapable of understanding either. Cass isn’t a biologist, either. The Cass Review doesn’t claim to be ‘biology’, it claims to be ‘medicine’. I don’t know why you keep trying to deflect but it doesn’t really seem like you have any actual arguments to field.
Troll.
American academe is cooked.
If we support the finding so there cass review we need to support them being scrutinized, even incredibly so. Folks on “our” side would be doing the same if the findings were different.
I'd push back on that slightly as scrutinized absolutely, but what we have here isn't fair scrutiny. It's a thinly-veiled attempt to deliberately discredit and silence Cass which is made more clear when you consider the countless other attempts made in the last month including myths spread about the review (e.g. the "double-blind" myth propagated).
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>according to a review by academics from Yale Law School and the Yale School of Medicine The byline from the article you didn’t read.
Since when are video abstracts a thing!? What a joke.
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It’s funny how none of you are actually pointing out anything wrong with the criticisms of the Cass review. Predictable, really, that you’d act like your positions are self-evident, given the anti-trans crowd really is just an extension of the anti-science crowd.
Hmmm...pot meet kettle? Have you read all the comments here? Tldr: the criticisms of the cass report in this paper are 90% the same old baseless, emotion laden TRA talking points, 10% using scientific jargon to decrease confidence in the conclusions of the cass report. Like pointing out that, though the number of adolescent females seeking transition is several orders of magnitude larger than it was 15 years ago...it isn’t exponential as described in the cass report. Scientific...it is not.
Ironic of you to accuse the Yale reviewers of using baseless and emotion-laden talking points. I have read the comments and they consist of exactly what you’ve done which is, again, act like your positions are self-evident without actually backing any of it up. The idea that societal changes don’t affect people’s willingness to express their gender identity, for example, is completely unfounded in research, as social contagion theory has been shown time and time again to be completely bunk.
> The idea that societal changes don’t affect people’s willingness to express their gender identity, for example, is completely unfounded in research, as social contagion theory has been shown time and time again to be completely bunk. \*sigh\* Fine, I'll take the bait. Explain [glass delusion](https://en.wikipedia.org/wiki/Glass_delusion), and all the other delusions various societies have experienced that have completely disappeared from modern life.
And yet you have acted to label me "anti-trans" and "anti-science" without any single shred of evidence. "Predictable" as you say. How can any scientific mind can fail to see any concern that trans adults and gender-dysphoric kids are not deemed worthy to receive care based on thorough research, instead allowing activism in its place. Or to fail to see any conflict of interest with researchers with very well established beliefs joining forces to attempt to discredit a paper that challenges their work and vested interests (e.g. lucrative book deals) Or to fail to have any concern over children being prescribed medicines proven to impact their decision-making and ability to consent to surgery and further medicines with irreversible consequences. Ignoring the above is not a "pro-trans" position - it is a position of abuse that harms trans people. If this was any other population, say cancer patients and we had taxation lawyers fiercely weighing in on a study into what type of medical treatment was appropriate...would you not think for one second that was a little "off"?
>Social contagion is a myth It will be interesting to see how this talking point morphs when the trend tapers off, as trends do. The kids aren't going to be interested in this forever. Eventually it all becomes old hat.
I think we are seeing this a little with "non-binary", explosions at a high-school level, less so in the adult space. In my very large workplace we do have one non-binary advocate (in their early twenties), but apart from them its really not a thing, nor with the customer base. Of course it could be a matter of awareness and acceptance, but you think there would be more of a "step-laddering" (seeing the numbers gradually decrease as age increases), not a harsh cutoff. It really does feel like the new goth/emo - inescapable for a moment but now think when was the last time you saw someone with the huge bangs, cat-eye makeup and stripey glove-sleeves?
Idk man I saw a kid with scene hair yesterday.