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January 9, 2025 - 10:00am
“I hope our paper cools heads on this issue”. These are the words of Landon Hughes, lead author of a study into the prescribing of puberty blockers and cross-sex hormones to gender-distressed children between ages 13-17.
According to Hughes and his fellow researchers, fewer than one in 1,000 US minors received “gender-affirming medical care” during the period 2018-2022. This, he declares, is a reason for critics to calm down. “We are not seeing inappropriate use of this sort of care,” he claims. “And it’s certainly not happening at the rate at which people often think it is.”
I am not sure what rate Hughes thinks “people” have been imagining. Just how many children have been set on a path to lifelong medicalisation, facing consequences such as sterility and brittle bones, on the spurious grounds that they might have been born in the wrong body? Personally, I have never had an exact figure in mind.
The extent proposed by the new study is lower than in research from 2022, though some of the new framing hints at a desire to downplay things (emphasising, for instance, that “no patients under age 12 were prescribed hormones”, even though the criticism has always been that puberty blockers at that age lead to hormones later on). Yet even if the figures — based on commercial insurance plans, but not Medicaid, and excluding surgeries — can be trusted as far as they go, should the heads of critics really be feeling “cooled”?
I’ll be honest: one in 1,000 still sounds a lot to me. That would be at least one child in every secondary school in my area. Moreover, while I know it could be worse, the problem with “gender-affirming care” was never simply one of numbers. One vulnerable child being medically supported to self-harm is still one child too many. By suggesting that critics of gender medicine have been fixated on inflated figures (as opposed to actual harm), its advocates have found a new way to dodge the more important debate. They had to do this, now that the old tactics no longer work.
For many years now, anyone who criticised the ethics of giving puberty blockers to gender-distressed children would be accused of spreading misinformation and engaging in hyperbole. The hypocrisy of this would be witnessed in breathless headlines claiming that “moral panic about puberty blockers endangers the lives of trans kids”. We were told “gender-affirming care” was “life-saving”, on the basis that without it “trans kids” would kill themselves. If anyone became used to getting by on exaggeration and fear-mongering, it was those suddenly claiming to be on the side of limited access, honest counting and cool heads.
Following the UK’s Cass Review and the light shed by cases such as US v. Skrmetti, those supporting gender medicine have had to change tack. As the American Civil Liberties Union’s (ACLU) Chase Strangio was obliged to admit before the US Supreme Court, suicides among gender-distressed young people are “thankfully and admittedly rare”. Lifelong damage can no longer be defended on the basis that the alternative would have been death. New gotchas are required. A recent paper defending gender-affirming treatment for adolescents rather inventively suggests that we reframe our understanding of what “‘effective outcomes” are, getting away from “the linear narrative of improvement”. Now Hughes et al. have arrived to reassure us that whatever is happening, it isn’t happening to that many children, and given the numbers are so small, the doctors must surely have selected them very carefully. One has to wonder what the next sideways step will be.
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SubscribeI was told by a progressive liberal that fear of trans men in women’s spaces was unwarranted because cases of abuse would be so rare. Now we have the notion that puberty blockers are rarely damaging. Perhaps we could find a rare piece of robust evidence.
Trans men of course requires a bit of definition – at what point of the transition might they be? But Trans using Women’s facilities not new. Trans isn’t new. What may be different is the number and the awareness. Quite poss, likely, the awareness has led to some malign self identification and that needs urgent tackling. But we need to try and differentiate as there is a group here who are vulnerable and trying more often to lead their difficult lives as best as poss, probably v embarrassed and worried by bandwagon jumpers on both sides.
Oops! I meant trans women!
Yes, some sympathy. And it really doesn’t help when people frame this as some sort of war on women.
Oh, well, then, it is only a very occasional child being sterilized and mutilated, you say? Such a fuss! Why should anybody be concerned about a tiny number of children being abused by experimental medicine?
Maybe I am a bit old school, but one child abused by doctors seems sufficiently high frequency to call a halt to me.
One of Unherd’s herd of Feminist writers, conspiculously silent over the Pakistani rape gangs operating in UK.
Why have the Feminist writers in Unherd failed to attack Labour and Starmer for avoiding a nationwide inquiry?
Why have they not asked for the resignation of Jess Phillips the Under Secretary of State for the Safeguarding of Women and Girls?
You are off topic here, and in your following comment. The article has nothing to do with Jess Phillips, or Starmer.
There are no electric fences here.
We’ve tried the cattle prod, but your hide is too thick; i doubt even an electrified fence would stop you.
But just to re-iterate, your constant off-topic rants do your cause (which in many cases, is our cause too) a disservice, rather than enhance it. Do you understand that?
There are no articles which criticise Feminism in Unherd. If I am going to, it seems appropriate to do so under the articles of the herd of Unherd (stupid name) Feminists.
Isn’t that entirely within the spirit of a truly Unherd magazine?
There are literally dozens of articles which are critical of feminism, you’re just too damn lazy to look for them using the Search facility.
I’m done providing links for you.
You’ve been here for two minutes, and bored the hell out of most of us, who understand the issues you’re trying to push much better than you do, since we’ve taken the trouble to look deeper into them.
Nationwide Enquiry – why over 14 years did the Right not just make a decision to do what you want RL? Starmer and Phillips had no say in the matter for all that time.
Didn’t Bojo say something about not spaffing a load more money on yet another Inquiry and let the Jay investigation complete? Can you find anything in Hansard where other vocal Tories now contested that then or when Jay report finalised? Can you reference the UnHerd article complaining at those times too?
You keep pushing your racial hustle but it does look silly that you’d probably not been that interested until recently.
I am now convinced JW is a fictional, joint account of the Labour Party. It is not one person.
You are a kind of single issue guy aren’t you
You may be correct, but this is not an appropriate thread for this message. All you are achieving by doing this is putting off people from ever reading your contributions, which in the right context may be of serious interest.
That doesn’t make sense. So only write about what the author says. What if they are hiding important issues? They are out of bounds?
“the new framing hints at a desire to downplay things (emphasising, for instance, that ‘no patients under age 12 were prescribed hormones’, even though the criticism has always been that puberty blockers at that age lead to hormones later on).”
Progressives specialize in the cynically curated half-truth to advance their unpopular agendas.
Thank you for the clarifying analysis of this child destroying practice. If air travel killed 1 in a thousand airlines would be shut down. If any other set of medical procedures besides gender “affirmation” led to even a fraction of the multople harms well documented for “affirmation”, the procedure would be at the leasr severely curtailed.
I followed the link to the JAMA article by Landon Hughes and here are the first two sentences:
The idea that 1.4% of adolescents in the 13-17 age group are transgender/gender diverse (whatever “gender diverse” means) is pretty wild. Because the actual incidence of indeterminate sex at birth (ambiguous genitalia) is somewhere around 1 in 5,000 live births (https://pmc.ncbi.nlm.nih.gov/articles/PMC7845444/), or 0.02%. It’s almost a 100-fold step from there to 1.4%.
However, if we take seriously the 1.4% idea (for the sake of argument) there would indeed be about 300,000 transgender kids between 13 and 17 in the US
).
And if 1% of that group are getting hormone treatment, that’s about 30,000 kids. And I do not consider that a small number, even if it is a small percentage.
Using medical technology to warp the development of 30,000 young lives, with an additional 6,000 recruited each year (as the older ones age out of the cohort) is willful medical malpractice on a large scale.
It is organized crime.
“We are not seeing inappropriate use of this sort of care,” he claims. “And it’s certainly not happening at the rate at which people often think it is.”
What a fine and predictable job of ignoring the point, which is that life-altering drugs and therapies to kids should be a non-starter. That this requires explanation suggests a deficit of intelligent life in TheScience(TM).
“Calm down, you bigots. Can’t you see that we have lives to permanently screw up over this latest social contagion?”
I’m a bit with the Author – on what basis is the 1 in 1000 deemed a reasonable number? I note this rate excludes Medicaid and low income families and they can’t access this form of treatment so population rate is probably even lower, but nonetheless the point still holds.
I note from the actual JAMA paper it seems US paediatricians also v reluctant to start anyone 12 or younger. Well good to hear that but again it’s not the same as good assurance clinicians are making the correct calls when they do.
Overall what we know is the issue of some people feeling they are in the wrong gender goes back Centuries. It’s not a new issue. What is new is the ability to intervene early with medications to help someone struggling with what nature has given them coupled with the acceleration in awareness from multi-media, and importantly the possible impact of social media on mental health. Anyone being definitive on what the data may be indicating seems somewhat over confident to me.
It’s also cross cultural. There is something very real here. The only thing I would add is that in the past it was very strongly linked with homosexuality. That isn’t our current interpretation – we try to keep gender and sexual orientation separate.
Also, it is not clear that medical intervention is the best outcome. We seem to simply assume it is because we can (in an approximate way) do it.
Transgenderism is what happens when a mental illness is “transitioned” into a civil rights movement. When the history of this woke age is written, gender affirming care and the medical criminals who were responsible for this abomination will be considered to have been depraved monsters.
This one is just going to run and run.
One thing we can ask for is honesty. And part of this is admitting that the best we can do is turn a person of one sex into a rough approximation of the other sex. We have no magic wand that can turn girls into boys and vice versa. And this is the case even if we agree as a society to call trans women women and trans men men.
Now it may still be that for some this is actually the best that they can hope for. But it’s still a pretty poor outcome, and we need to be completely clear about that.
The second thing that can be asked for is sympathy. Any way you look at it these people have been thrown a curved ball. They will never truly be what they want to be. Their lives will never be easy. So we should show some moral generosity in accommodating them where we can, and certainly stop hating and denigrating them.
“Look! Jess Phillips is the victim here! Don’t you get it? Musk said some horrible things about her. He crossed the line. Typical misogynist.
Men! Look at them! Coming on here criticising the Feminist Unherd herd. More misogyny. It never stops.
And that nice Starmer, he defended Jess. Yes he did.
Pakistani rape gangs? What are they? Hate crime! Hate crime! Police! Police!”
Sit down have a cup of tea, and call 111. Describe the breakdown you are having and see what they advise.
I am not going to reply to a joint account of the Labour Party. So this will be my last reply to all of you.
Take your Labour spin elsewhere.
There are many threats to young people today. Pakistani rape gangs are one and gender affirming care is another.