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IMPORTANT: 🚨🚨🚨 A detransitioner has just filed a lawsuit against Dr. Jason Rafferty, Dr. Michelle Forcier, Thundermist Health Clinic, and others. This is a major development, as Rafferty is the author of the @AmerAcadPeds policy statement on "gender-affirming care." 🧵

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The plaintiff, LU, had multiple psychiatric disorders, including dissociative identity disorder, ADHD, OCD, and bipolar disorder, when she sought help from Thundermist Health Clinic in Rhode Island.

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She had just "escaped from over 18 years of physical, sexual, and psychological torment at the hands of a cult and its leadership, which began for her around age 6." Among other things, the cult had subjected her to conversion therapy to try to "cure" her of being lesbian.

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In his clinical notes, Rafferty acknowledged: LU's "current goals are for... (testosterone) and 'top surgery' but describes internal turmoil between alters [multiple personalities] about meaning of gender identity that likely requires additional support and exploration."

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Rafferty nevertheless approved her for hormones, stating: "it is this provider’s perspective that Testosterone would be indicated based on history, and with essential psychological supports in place."

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After a brief hormone high period (T is thought to have antidepressant properties), LU "began experiencing dangerous mood swings, fits of anger, more frequent bouts of depression, and feeling even more disconnected from herself and her sexuality than she was prior to the [T]."

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"The facial hair and other bodily responses to the testosterone were more severe than advertised, and she quickly realized that the treatment was not going as promised."

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When LU inquired about discontining T, she was met with "cold, disinterested apathy" from Rafferty, according to the complaint. Thundermist allegedly provided her transportation to & from the clinic when she wanted to transition, but not when she wanted to detransition.

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After seeing Michelle Forcier, who also ignored the red flags and approved her for T, LU moved out of state and began receiving mental health therapy. This helped her "see that her desire for a male body was not gender dysphoria but body dysmorphia brought about by...

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a late puberty, childhood bullying, trauma from sexual assaults, and an unhealthy perspective that she could never achieve the beauty of all the women she encountered on social media and TV." By that point, however, the damage from T was done.

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LU now suffers from "body disfigurement, ongoing estrogen deficiencies, painful premenstrual dysphoric disorder, suspected osteoporosis, development of painful skin nodules from testosterone injection sites, an onset of severe histamine sensitivity resulting in...

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chronic severe allergies, suspected infertility, reduced sex drive, chronic hot flashes, genital pain and discomfort, chronic joint pain, and a host of emotional and/or psychological injuries including newly onset body dysmorphia,...

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as to the changes testosterone brought about her body, [and] significant emotional distress impacting many of her relationships."

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LU is represented by @detranslaw, a boutique law firm specializing in gender medicine, and is suing for medical malpractice, gross negligence, and lack of informed consent.

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This thread is based on the legal filing, but there is also a piece about the lawsuit in the Daily Mail: https://www.dailymail.co.uk/news/article-12654975/Detransitioner-multiple-personality-gender-reassignment.html

De-transitioner with multiple personalities slams doctors for therapy A North Carolina lesbian slammed doctors who led her down a path of transitioning as a 'fractured and unstable' adolescent, despite suffering from multiple personality disorder. dailymail.co.uk

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NEW: The Society for Evidence Based Gender Medicine (@segm) has just published a critical analysis of the new study on regret following "gender-affirming" mastectomy surgery. Here are the highlights 🧵

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The JAMA study (@JAMASurgery) was done on adults who got surgery at median age 27 at the U Michigan (@umichmedicine @UMich) hospital. The authors report "overwhelmingly low levels of regret" and express concern about state laws that restrict these surgeries to adults only.

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Using the ROBINS-I tool for assessing risk of bias in non-randomized studies, SEGM concludes that the study suffers from "critical risk of bias." That means that "the results reported by the study may substantially deviate from the truth."

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The critical risk of bias finding is due to the "high non-participation rate, important differences between participants and non-participants, and lack of control group."

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The median follow-up time for those who received surgery was 3.6 years, which the authors classify as "long-term." Only 1 out of 4 participants were followed up with at >5 years. Some research indicates average time to regret is 8-11 years, though longitudinal data are missing.

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As is typical in this area of research, the non-response rate is very high (41%). What, if anything, can be inferred from this non-response? SEGM calls attention to two potentially important differences between the response and non-response group that may bias the results.

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1. Respondents had surgery more recently than non-respondents (3.6 vs. 4.6 yrs). "Gender-affirming" procedures "are known to have a 'honeymoon' period, with quality of life and satisfaction... starting to fall after 3-5 years." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223813/

Quality of life of treatment-seeking transgender adults: A systematic review and meta-analysis The study aims to systematically extract and analyse data about Quality of Life (QoL) in the transgender population. A systematic literature search and meta-analysis were conducted using the MEDLINE, EMBASE, PubMed, and PsycINFO databases, up to July ... ncbi.nlm.nih.gov

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2. The response cohort appears to have had more anxiety and depression at baseline, resulting in a confound. This is a recurring problem in gender med research. See, for example, Michael Biggs' critique of Jack Turban et al.'s 2020 suicidality paper: https://link.springer.com/article/10.1007/s10508-020-01743-6

Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria - Archives of Sexual Behavior link.springer.com

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The authors' claim that lack of reversal procedures indicates satisfaction is a "fundamentally flawed" assumption. Some research indicates that regretters will not report back to their transition providers. People who regret a surgery may not seek out another invasive procedure.

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Perhaps most important: unlike mastectomies for cancer, "gender-affirming" mastectomies are usually not "reversible." This has to do with the nature of the procedure and the lack of insurance coverage for it (if there's no longer a GD Dx, insurance typically won't cover).

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Finally, "gender-affirming" mastectomies are cosmetic procedures. The primary function of breasts is milk production, and according to SEGM, no procedure can restore that function. Hence, the necessary motive may be missing from regretters.

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In short, the assumptiom that non-respondents were satified because they did not seek reversal surgery is unfounded. There is no way to know the satisfaction of those who didn't respond. Speculation about reasons should be framed as just that: speculation.

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SEGM further notes that the authors "did not attempt to investigate mental health or functional outcomes. Instead, the focus was on self-reported satisfaction." This is a key point.

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The main rationale for "gender-affirming" procedures is that they are "medically necessary" for mental health, not merely cosmetic. "Satisfaction" is important, but if "medical necessity" is the question, researcher should opt for more objective outcome measures.

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SEGM notes another "unexpected finding": a change in "gender identity" in 20% of the surgery/participant cohort.

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This raises an important question: if the purpose of surgery is not mental health/QoL improvement or achieving "gender congruence," what is it? How is it different from regular, cosmetic plastic surgery like rhinoplasty?

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If the goal is to help people achieve ever-shifting "embodiment goals" (or, as pro-GAC advocate Florence Ashley puts it, helping adults and teens turn their bodies into a "gendered art piece"), questions arise about physician ethical obligations and insurance coverage.

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Uncontrolled: As is common in gender med research, the study does not control for confounds like "the passage of time [regression to the mean], attention from medical professionals [Hawthorne Effect], counseling, better control of mental illness, or use of mood-enhancing drugs."

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Generalizability: Because participants seem to all be adults who got surgery as adults, the study's result, even if valid, cannot be applied to teenage girls. The decision-making capacity of a 27 year old is not equal to that of a 14 year old.

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Conflicts of interest: "There is a fundamental problem with research emerging from gender clinic settings. The same clinicians provide gender-transitioning treatments to individual patients in their practice; serve as primary investigators and custodians of data...

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used in research informing population health policies; and increasingly, provide paid expert witness testimony in courts defending the unrestricted availability of hormonal and surgical interventions for minors...

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Since any nuanced, balanced statements may be used against them in a court of law when they serve as expert witnesses, they must resort to the lowest common denominator of the 'winner-takes-all' adversarial approach. Such an approach does not tolerate nuance."

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SEGM concludes: "Prestigious scientific journals appear to have deviated from their previously high standards... & instead have become vehicles for promoting poor-quality research seemingly to influence judicial policy decisions rather than advance scientific understanding."

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SEGM's analysis: https://segm.org/long-term-regret-satisfaction-mastectomy-critical-appraisal The mastectomy study: https://jamanetwork.com/journals/jamasurgery/article-abstract/2808129#:~:text=Placed%20in%20context%20with%20other,decision%20following%20gender%2Daffirming%20mastectomy

Critical Appraisal of “Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy” Recent research published in JAMA Surgery evaluated satisfaction and regret among individuals who had undergone chest masculinizing mastectomy at the University of Michigan hospital. The average patient age at the time of mastectomy was 27 years; no patients who were under age 18 were allowed to participate in the study. segm.org

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It's @segm_ebm, not @segm. Apologies to SEGM!

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Reading through Hannah Barnes' Time to Think, it's interesting how Tavistock/GIDS people who wanted to defend their institution would do so by saying that they are at least more cautious than the Americans. 🧵

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At a House of Lords hearing in May, 2019, Laure Thomas, a Tavistock communications official, testified that the GIDS approach was "far more cautious" than practices in the U.S., according to Barnes.

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In 2018, Barnes writes, GIDS director Polly Carmichael "explained that in the United States, surgeons advocated 'early surgery and much earlier sex hormones'--something contrary to the Tavistock approach."

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According to Barnes, the director of the Big Lottery Fund, which had given money to the radical gender medicine group Mermaids, said that Carmichael "feels it could be argued that the Mermaids approach is more aligned to the American model" (quote from the BLF director).

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The Cass Interim Report found that "care staff... feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters."

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Cass noted that the "affirmative model" had "originated in the USA" (citing articles by, among others, Diane Ehrensaft, Johanna Olson-Kennedy, and Robert Garofalo).

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Last year, Reuters interviewed staff at 18 pediatric gender clinics and found that "[n]one described [using] anything like the months-long assessments [the Dutch] adopted in their research." https://www.reuters.com/investigates/special-report/usa-transyouth-care/

As children line up at gender clinics, families confront many unknowns Thousands of transgender U.S. youths are medically transitioning. The treatments they receive have little scientific evidence of long-term safety and efficacy. reuters.com

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Yet American affirmers like @LGBTDoc have said, on the record, that the Dutch study is "the best data that we have" and that the Dutch approach is "the prevailing model that most American clinics have based their care upon.” https://www.city-journal.org/article/reason-and-compassion-on-gender-medicine

Reason and Compassion on Gender Medicine The state adopts the more cautious European model of pediatric care—and exposes American “gender-affirming” advocates as incompetent and dishonest. city-journal.org

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Affirming clinics in the U.S. say they provide multidisciplinary care and comprehensive mental health support.

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Having spoken to people who work with these clinics, what they mean is that they have medical professionals from several disciplines who all practice the affirm-first/affirm-only approach. Psycho-"therapy" means helping the presumed "trans kid" cope with "minority stress."

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That's how American gender clinics and their defenders get away with persuading the public that there's no discrepancy between what they do and what other countries are now doing. They've redefined the words.

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As Barnes notes in her book, since 2014 GIDS has had a blend of affirming and exploratory staff. Whether you get one or the other is largely up to chance. In the U.S., it appears, very little is left to chance. You're almost guaranteed an affirmative approach.

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The myth that trans-identified kids will kill themselves if not given drugs and surgeries is pernicious disinformation. Here are 10 things you need to know to combat it: 🧵

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1. "Suicide" is not the same thing as "suicidality." The one refers to death and serious efforts to die, the other to ideation about suicide and non-lethal self-harm (typically cries for help). Helping kids deal with "suicidality" does not necessarily mean "life-saving" care.

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2. Kids who identify as trans DO seem to be at higher risk for both suicide & suicidality. Thankfully, however, suicide is extremely rare even among trans-ID youth. There is NO evidence of an epidemic of youth suicide before "gender-affirming care" became available 15 years ago.

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3. There is NO evidence that the risk of suicide/suicidality is because of "gender" issues. Consequently, there is no evidence that it can be best managed through social or medical transition.

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4. There IS evidence that teenagers who ID as trans and seek medical transition have very high rates of preexisting mental health problems that are themselves linked to suicidal ideation and behavior.

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5. It is very likely, therefore, that kids with suicidal tendencies are gravitating towards a trans ID rather than the other way around. The use of "minority stress" to explain (away) suicidality is unscientific. Classic correlation/causation confusion.

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6. Systematic reviews of evidence abroad have found that studies linking hormonal interventions to reduced suicidality suffer from problems of bias and confounding, and are too unreliable to support "gender-affirming care" as an evidence-based practice.

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7. Finland's top expert in pediatric gender medicine, the psychiatrist Dr. Riitta Kaltiala, recently told the country's liberal newspaper of record that the suicide narrative is "purposeful disinformation" and that using it is "irresponsible."

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8. Putting the therapeutic focus on "gender" can come at the expense of proper exploratory therapy, which is the best tool we have for discerning and addressing the true causes of distress ("diagnostic overshadowing").

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9. The CDC, suicide prevention groups, and LGBT advocacy groups have themselves warned NOT to say that some law or policy (like restricting access to sex change drugs and surgeries to age 18+) will cause suicide. Doing so can become a self-fulfilling prophecy.

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10. Despite telling the public that decisions to medicalize are "highly individualized" and deferential to parental wishes, many parents report being bullied into agreeing to medicalization with suicide threats made by the clinicians, at times in front of their kids.

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For citations and to read more about the affirm-or-suicide myth: https://www.tabletmag.com/sections/science/articles/finland-youth-gender-medicine https://www.city-journal.org/article/reckless-and-irresponsible

Finland Takes Another Look at Youth Gender Medicine A recent interview with the country's top gender expert shows how out of step the American medical establishment is with its European counterparts tabletmag.com

Reckless and Irresponsible The “affirm or suicide” narrative is politically potent, but also reckless and misleading. city-journal.org