More on the possible small or medium size hole in the dam:

These statements were released days after a woman named Fox Varian became the first person to win a malpractice case after undergoing gender transition care and later regretting it. Ms. Varian and her lawyer argued that her psychologist and plastic surgeon in suburban New York, despite her serious mental health problems and apparent ambivalence over her transgender identity, failed to safeguard her by going forward with a double mastectomy when she was 16.

That last clause should be “went ahead with a double mastectomy when she was 16, thus failing to safeguard her despite her serious mental health problems and apparent ambivalence over her transgender identity.”

In short it’s “when in doubt, do the drastic life-altering surgery.”

The most striking finding of the Cass review, a 2024 British inquiry that found “remarkably weak” evidence to back up the practice of youth gender medicine, was the shoddy quality of the professional guidelines for this treatment.

Researchers at the University of York, who provided underlying work for the Cass review, found that rather than being linked to careful, independent evaluations of the evidence, these guidelines relied heavily on other organizations’ guidelines. 

Ahhh yes, isn’t that illuminating. Of course they did. It’s like the people of Pharyngula, relying heavily on each other’s rage and venom instead of pausing for a minute to wonder how they got here. Somebody under this huge pile of words must be right, right? They can’t all be wrong, not when they shout so loudly.

A 2018 policy statement by the American Academy of Pediatrics provides a useful example of how these documents can go wrong. At one point, it argues that children who say they are trans “know their gender as clearly and as consistently as their developmentally equivalent peers,” an extreme exaggeration of what we know about this population.

Not to mention what we know about that word. “Gender” is as sacred and taboo as any other core religious word, so of course it tricks medical academies into talking childish drivel about children “knowing their gender.” You might as well say children know their nervous systems or how to get from Tulsa to Winnipeg without looking at a map.

The document also criticizes the “outdated approach in which a child’s gender-diverse assertions are held as ‘possibly true’ until an arbitrary age” — the A.A.P. was instructing clinicians to take 4- and 5-year-olds’ claims about their gender identities as certainly true.

Bam. This kind of thing is what I’ve been scribbling about for far too many years – people who should know better, people who used to know better, people who probably do know better but can’t face the fallout. All so that they won’t get yelled at. News flash: getting yelled at is a lot better than throwing your own brains into the septic tank.

Policy statements like this one can reflect the complex and opaque internal politics of an organization, rather than dispassionate scientific analysis. The journalist Aaron Sibarium’s reporting strongly suggests that a small group of A.A.P. members, many of whom were themselves youth gender medicine providers, played a disproportionate role in developing these guidelines.

No conflict of interest there!

The shakiness of the guidelines didn’t matter, though — they were cited numerous times in news accounts and court documents as evidence that the most important pediatric association in the country supported youth medical transition.

So round and round and round we go, getting stupider with every circle.