Undergoing gender transition treatment did not appear to be associated with a long-term resolution of eating disorders among a population of Finnish youth, according to a new study.

The study calls into question previous scholarship that has suggested that prescribing cross-sex hormones to youths experiencing gender dysphoria will help treat eating disorders, such as anorexia or bulimia, among them.

The paper, which was published recently by the European Journal of Developmental Psychology, is one of a slew out of Finnish research team that over the past decade have collectively called into question the presumption that gender-transition interventions are widely beneficial to youths attending gender clinics.

One of the coauthors of the eating disorder paper, Dr. Riittakerttu Kaltiala, a psychiatrist at Tampere University in Finland, was tasked with founding one of the nation’s two youth gender clinics in 2011. After she observed that the patient population’s outcomes were not in keeping with the promising results from the foundational pediatric-gender-medicine studies out of the Netherlands, she began systematically documenting these outcomes. She has consequently become a controversial figure and is a bête noire of many transgender activists.

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In April, Dr. Kaltiala and her colleagues published a study with a similar methodology to the eating disorder paper in which they found that a proxy measure for severe psychiatric problems—specialist psychiatric care—did not improve after youths underwent what in Finland is known as gender reassignment. The paper prompted an outcry from many academic supporters of pediatric gender medicine. The journal that published the paper recently published a slew of letters critiquing its methodology. These critiques prompted the paper’s authors to respond with their own rebuttals. (I hope to write in more detail about these exchanges in a forthcoming Substack.)

The new paper is sure to ruffle feathers by suggesting that gender dysphoria and eating disorders may have a common biopsychosocial root in young people, in particular for the adolescent natal girls among whom both conditions are particularly prevalent. The study authors depicted what they suggested is a glaring contraction between how two similar mental health conditions are treated. Both conditions concern an individual’s disproportionate focus on and unhappiness about their body. And yet the treatment for eating disorders is to help the patient minimize such discordance internally and come to accept their body; whereas the treatment for gender dysphoria is essentially the opposite, to lean into the concerns and to change the body to resolve the discordance.

Numerous studies, the paper’s authors noted, have found disproportionate rates of eating disorders among youth with gender dysphoria. But while research has suggested that gender-transition interventions may help resolve eating disorders, the authors noted that it almost entirely based on case reports and is of “very low quality,” and thus not reliable.

The new study was based on Finnish health-registry data regarding 2,080 youths who were 13 to 22 years old when they first presented at one of Finland’s two youth gender clinics between 1996 and 2019. The investigators analyzed data on the youth through June 2022. They assembled a control group by matching four natal males and four natal females with each youth attending the gender clinics, matched for birthplace and birth year, including 16,619 youth total.

The gender-dysphoric youth were an average age of 18.5 years at their first gender clinic visit. Fifty-nine percent of them were natal girls.

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Among all the gender dysphoric youth, 5.0 percent ever received specialist-level psychiatric treatment for an eating disorder—a 3.2-fold greater proportion than the 1.6 percent of the controls who did so.

Among the gender dysphoric youth, 2.5 percent were diagnosed with an eating disorder before first visiting the gender clinic and 2.4 percent were diagnosed after. A total of 2.8 percent received eating disorder treatment two or more years after that first gender-clinic visit. Those diagnosis rates were all about three to four times greater than those seen in the control group.

Gener reassignment was much more common among those without any history of an eating disorder. Of the gender dysphoric youth, 18 percent of those who were ever diagnosed with an eating disorder underwent gender reassignment, compared with 39 percent of those never diagnosed with an eating disorder. Of those gender dysphoric youth who were diagnosed with an eating disorder prior to attending a gender clinic, 15 percent went on to undergo gender reassignment, compared with 39 percent of those who were not previously diagnosed with an eating disorder.

At first glance, being diagnosed with an eating disorder after attending the gender clinic seemed to be associated with not receiving gender reassignment. Compared with the control group, the rate of those who were diagnosed with an eating disorder for the first time after attending the gender clinic was 4.9-fold higher among those who did not undergo gender reassignment and 2.1-fold higher among those who did receive gender reassignment. But when the study authors controlled for birth year, the year of the first visit to the gender clinic and legal sex, they found that regardless of whether they received gender reassignment, the gender dysphoric youth had a similarly higher rate—of about 3- to 4-fold higher than in the controls—of a subsequent eating disorder diagnosis.

The most crucial question was whether there was a difference in the elevated rate of needing eating disorder treatment two years or more after first attending the gender clinic. As with the recent paper these academics put out about mental-health treatment, the paper’s authors chose the two-year mark because they presumed that the youth who received gender reassignment were significantly into that process by then. Other academics criticized this research team’s paper on mental-health treatment for what they have deemed an imprecise measure that does not account for variations in treatment start times.

The eating disorder paper’s authors found that before they adjusted the data, those who did not undergo gender reassignment had the greater increased rate—5.5-fold higher than the controls, compared with 2.5-fold higher among those who did undergo gender reassignment—of needing eating disorder treatment two-plus years after first attending the gender clinic. This would suggest that there might have been a tempering effect on eating disorders of receiving gender reassignment.

However, then the study authors controlled for birth sex, birth year and the year of the first visit to the gender clinic. This reduced the difference in those two rates to 4.2-fold higher than the controls for those who didn’t receive gender reassignment and 3.3-fold higher for those who did. And then, after the investigators controlled for having received treatment for an eating disorder prior to attending the gender clinic, these rates became essentially identical: a respective 3.6-fold and 3.4-fold higher than the controls.

The greatest predictor, the study authors found, of receiving eating disorder treatment two-plus years after attending the gender clinic was having received such treatment beforehand.

The study authors concluded: “Literature has often suggested that [an eating disorder diagnosis, or ED] emerges as an attempt to control a body suffering distress due to [gender dysphoria, or GD]. In this case, resolution of ED after medical GR might be expected. In light of the present data, this is not the case.” They continued: “When ED prior to gender identity assessments was [accounted] for, the risk of requiring specialist-level treatment for ED two years or more after contacting the [gender clinic] was similar among the individuals with GD regardless of obtained medical GR interventions.”

The authors proceeded to make quite a number of bold claims in their efforts to theorize why gender reassignment might not have helped resolve eating disorders among the youth. Gender dysphoria, they wrote, may “provide an explanation for self-hatred and body dissatisfaction that predisposes” youth to eating disorders. They went on to state that online communities that foster “positive support and belonging” among youth with gender dysphoria “may strengthen symptom behaviors and halt identity exploration, resulting in rigid foreclosed identity commitment.” Then the authors compared such communities to “pro-anorexia or pro-bulimia online content,” saying: “Online communities may act similarly regarding development of feelings of gender dysphoria and pursuit of” gender reassignment.

In their brief section noting the study’s limitations, the authors did not broach ascertainment bias. It is possible that because youth undergoing gender reassignment were in more routine care, this would raise their likelihood of then receiving specialist-level eating disorder treatment, just by virtue of being so dialed into the care system. This could have effectively masked the benefit of gender reassignment.

It is also possible that the study simply wasn’t powered enough to detect actual differences in the rates of eating disorders treatment relative to the control group. Only 103 of the gender-dysphoric youth ever had an eating disorder. Just 19 of them underwent gender reassignment. And only 8 of those who underwent eating disorder treatment prior to attending the gender clinic did so.

This research group has also been criticized in the past for over-controlling their data, in particular in a 2024 study that found that there was no statistically significant, independent association between gender reassignment in Finnish youth attending gender clinics and the suicide death rate among them. Critics might argue, as they did with the suicide study, that controlling for a baseline factor that’s tangled up with the exposure washes out an important signal.

I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net

The announcement prompted immediate outcry on social media from critics of pediatric gender medicine, given Dr. Johnson’s position as a leading Canadian provider of gender-transition interventions to minors at the McMaster gender clinic she directs.

I’ll cover Dr. Johnson’s appointment in greater detail in an article I’m working on for next week. (If any experts out there want to comment for such an article, or if you have details that might help with my reporting, including suggesting people to contact, please get in touch.) But for now, I’ve published in this Substack a short conference presentation that Dr. Johnson gave at the 2022 World Professional Association for Transgender Health, or WPATH, conference.

Most notably, Dr. Johnson leveraged research about outcomes among youth attending gender clinics to assert that parents’ concerns about consenting to such treatment for their children should take a back seat to the youths’ preferences.

This conference video is one of over 100 that I viewed for my reporting about WPATH in Contact magazine. I am in the process of publishing these videos on my Substack. To see the full collection that I’ve published so far, visit:

The 2022 WPATH conference took place immediately after the organization published its long-awaited, much ballyhooed update to its transgender-care guidelines, known as the Standards of Care, Version 8, or SoC 8. So in her presentation, Dr. Johnson was taking issue with certain elements of the adolescent chapter of the SoC 8 in particular.

In short, she relayed that the Canadian youth attending gender clinics in her and her colleagues’ study did not undergo what she referred to a “a battery of psychological testing to verify their gender identity.” Nevertheless, she reported, two years after first presenting at the clinics, none of the youth who underwent gender-transition treatment significantly regretted it. She presented this to suggest that the SoC 8’s demands for how to assess these youth seeking gender-transition treatment were excessive and burdensome.

Dr. Johnson presented her data with Julie Temple, an adjunct professor of gender studies at Memorial University in St. John’s, Newfoundland. Neither of them suggested that their findings about treatment regret might be limited by the drop-off in youth providing survey responses at the two-year mark, or by the limited follow-up time. Research on detransitioning is notoriously sparse. But experts generally report that it can take several years or more for any treatment regret to sink in. Consequently, the two years of follow-up in this study would be unlikely to fully capture any ultimate regret that the cohort of youth might experience.

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The presentation considered an analysis of data from the Trans Youth Can survey study, of which Dr. Johnson and Dr. Newhook were each coauthors. Their presentation at the WPATH conference was meant to “inform SoC 8 revisions.”

Dr. Johson expressed concern that, as she saw it, “the statement in the Language and Statement 11” of the SoC 8’s adolescent chapter “prioritizes the perspectives and worries of parents over the lived experiences of youth, and introduces additional barriers to accessing gender affirming care.”

Dr. Johnson also expressed concern that “Statement 12b requires youth to demonstrate several years of gender incongruence, verified through comprehensive psychosocial assessments, to access gender affirming care.”

Regarding assessments of youth seeking gender-transition treatment, she suggested that specialists are not necessarily needed for this. This was part of a larger theme at WPATH conferences of pediatric gender medicine specialists pushing for greater access to these treatments by suggesting they could be provided through primary care clinics.

“We want to emphasize that this can be done,” Dr. Johnson said of gender-transition treatment for minors, “by a variety of health care professionals, as was the case for youth in the trans youth can study.”

“The recommendations in both statements 11 and 12b,” she said, “seem based on the unproven presumption that youth accessing gender-affirming care are experiencing harm and regret in significant numbers that would be sufficient to restrict access to care for trans youth. Our participant participants, in fact, did not demonstrate such regret over a two-year period.”

Dr. Temple was among the multiple presenters at the WPATH conference sessions I have reviewed who disparaged or otherwise sought to discount the hypothetical phenomenon of rapid-onset gender dysphoria, or ROGD. She referenced a paper her team had just published in The Journal of Pediatrics and said that “the negative mental health outcomes that were proposed by the theory of rapid-onset gender dysphoria do not vary based on the time that youth knew their gender.”

The Trans Youth Can study, Dr. Temple said, included 174 youth who had already started puberty and were under age 16 at 10 gender clinics across Canada. They were recruited at their first medical appointment at their respective clinics.

Dr. Temple said of the study design: “We included clinical medical records and short online symptom checklists for parents. Our measures included checklists of worries and positive feelings about their youth; gender for adolescence; for parental support for their gender-affirming medical care for both parents and adolescents. They completed a two-year follow up, a decision regret scale, including five items scored from 0 to 100, with scores above 50 indicating regret.”

The study, Dr. Johnson said, found that parents’ positive feelings about their children’s gender identity generally remained stable over time, while the worries decreased. In particular, their worries about making irreversible decisions about gender-transition treatment decreased.

The youth, meanwhile, reported that support from their parents about their gender-transition treatment increased over time. At the first visit, 55 percent of the youth reported that their parents were very supportive of gender-transition treatment, a figure that increased to 69 percent two years later. (Note that the study as presented at the conference did not measure when these youth actually started treatment.)

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Dr. Temple pointed to a diagram of the youths’ expressions of regret about their decisions about treatment. None of the youth expressed regret that crossed the threshold indicating significant regret. Note that only six of the 174 youth stopped treatment. That means that the two-year mark only included survey responses from 122 of 168 youth who went through with treatment—a response rate of just 73 percent, which went unmentioned. Did the 27 percent of youth who did not respond to the year-two survey regret their treatment? There is no information on that.

These were the five questions the youth were asked:

• It was the right decision.

• I regret the choice that was made.

• I would make the same choice again.

• The choice harmed me.

• The decision was a wise one.

As you can see, of the 122 youth who responded to the survey at the two-year mark, they overwhelmingly endorsed answers suggesting that they did not regret their decision to undergo gender-transition treatment.

At the two-year mark, only three parents passed the threshold for regret on the scale.

Dr. Temple said: “The two parents you see here who had scored 90 and 95,” indicating very strong regret, “these were not parents whose regret was based on their youth’s experience. Instead, these were parents who had expressed regret right from baseline that they were against gender affirming care, and those feelings did not change. This is in spite of the fact that their youth did not express regret about gender-affirming care, and had continued to receive care.”

“So in conclusion,” Dr. Johson said, “youth in the Trans Youth Can study did not undergo a battery of psychological testing to verify their gender identity. Overall, there was minimal regret for parents and no regret for youth. Parents’ worries decreased over time and their support for their youth increased.”

Most notably, Dr. Johson concluded: “This suggests that parents’ feelings should not be prioritized over the youth’s experiences” when deciding whether to start minors on gender-transition medications. “There is no evidence to delay care based on the initial feelings of parents, given how their worries decreased over time and support increases.”

It is worth noting that this was a small study and there were only tiny numbers of parents who objected to gender-transition treatment. So it would have been impossible to detect a statistically significant signal of any association between parental objection and youth regret.

Otherwise, Dr. Johnson’s argument that parental objection should be deprioritized is framed solely from the youth’s point of view, based on a single variable: whether the youth regretted treatment two years after presenting at the clinic. The study did not consider other, more objective variables, such as whether the youths’ fertility or sexual function were apparently compromised, and whether those outcomes were associated with parental objections.

Nor did Dr. Johnson note that there may have been a selection bias at play, with more supportive parents tending to take their children to these particular clinics. Thus, the study would not have been able to capture the full breadth of parental feelings about youth seeking gender-transition treatments, or the other medical or psychological experts that families might have sought out to inform them about such treatment and possibly provide it.

This is also only a single data point, but it is worth noting that Claire Deacon, the mother of Fox Varian, the detransitioner who recently won a $2 million jury award after suing her psychologist and the plastic surgeon who performed her mastectomy when she was 16, was always opposed to the surgery. Ms. Varian did not openly admit that she regretted the surgery until three years later.

The Free Press

A Legal First That Could Change Gender Medicine

Fox Varian had a turbulent childhood. Her parents split when she was 7, triggering a three-year custody battle that ultimately saw her estranged from her father. She suffered from a constellation of mental health problems, including depression, anxiety, and social phobia. She was diagnosed with autism and bounced around various schools. Her first period sent her into a meltdown, and she battled disordered eating and body-image issues. By mid-adolescence, she was completely lost…

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4 months ago · 379 likes · 737 comments · Benjamin Ryan

I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net

As an antidote, they frequently offered misinformation of their own, or at the very least made non-evidence-based claims.

This video of the conference session in question is the latest in an ongoing series I’m publishing of conference videos from WPATH and its US offshoot, USPATH, spanning 2021 to 2023. I covered the full scope of these videos as they applied to pediatric gender medicine in a recent article for Compact magazine. You can find the full roster of the videos I’ve published thus far here:

The title of the panel I’m focusing on in this Substack was: “When Science is Misused in law: How to Address the Biased Science that Underlies Legal Bans on Gender-Affirming Care for Youth.”

The panel was moderated by Anne L. Alstott, a professor at Yale Law School and included:

• Jennifer Levi, the director of the transgender rights program at GLAD, the LGBTQ legal advocacy group

• Dr. Christy Olezeski, an associate professor of psychiatry and the director of the Yale Pediatric Gender Program (she was on the program but wasn’t in attendance)

• Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale (who presented Dr. Olezeski’s slides and her own presentation)

• Dr. Nathalie Szilagyi, an instructor at the Yale Child Study Center

Dr. McNamara in particular has established herself as one of the leading voices straddling medicine and policy in the effort to protect minors’ access to gender-transition treatments. In recent years, she has often served as a paid expert witness in legal settings defending the medical field—a practice that is highly lucrative for witnesses on either side of this dispute.

Ms. Alstott and Dr. McNamara are the cofounders of The Integrity Project, which acts as a kind of rapid-response hub in the face of legal and scientific threats to pediatric gender medicine. The project is most known for putting out a white paper criticizing Britain’s Cass Review of this field.

has subjected that particular white paper to a withering three-part critique in which he said that it was guilty of spreading reams of misinformation.

The Manhattan Institute’s Leor Sapir published a scathing account of what he characterized as Dr. McNamara’s misrepresentation of her clinical experience. In an August 2024 article in City Journal, Dr. Sapir analyzed a deposition that Dr. McNamara gave in the federal lawsuit over Alabama’s ban of gender-transition interventions for minors. Most notably, Dr. Sapir focused on Dr. McNamara’s admission that she did not provide gender-affirming care herself; and since 2021, she had only ever referred two minors to a pediatric gender clinic.

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This admission is remarkable, given that Dr. McNamara has often suggested she is a hands-on expert in pediatric gender medicine. And indeed, in the 2022 WPATH panel, she suggested she was one.

What amazed me about this conference panel was how seldom the speakers rebutted misinformation with substantive information of their own. Oftentimes they simply sweepingly declared something untrue and expected the audience to take it on faith that this was an accurate assertion. This was not an unreasonable presumption, given how WPATH conference-goers almost never challenged the ideas of presenters—at least in the well over 100 videos that I watched during my reporting for Compact.

The 2022 legal panel was based on a certain bedrock of confidence among the speakers that their methods of combatting what they asserted was misinformation would help their movement prevail in the face of major, mounting political attacks on pediatric gender medicine. And while hindsight is 20/20, it is now clear that they were being wholly naive about just how aggressive—and ultimately successful—their opponents would be in this fight.

Little did they know that they were waging a fast-losing battle.

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Jennifer Levi

Ms. Levi expressed her dismay over what she characterized as “a coordinated, nationwide strategy to roll back protections” for the transgender community. This included attacks on pediatric gender medicine; school-related legislation that governed, for example, what could be addressed regarding LGBTQ issues in the classroom; and restrictions on cross-sex sports participation.

Regarding sports-related laws, Ms. Levi said, “The only tiny sliver of light here is that where these laws are challenged, courts have seen the bans for the bias that they reflect.”

In the coming weeks, the nation will see the culmination of that fight when the Supreme Court issues its ruling about the constitutionality of sex-based restrictions on sports participation and whether such restrictions square with Title IX. Legal experts expect the transgender plaintiffs will likely lose.

Speaking to laws banning pediatric gender-transition interventions, Ms. Levi said, “Proponents of these discriminatory laws and defenders of these discriminatory laws are actually abusing and misusing research to distort the truth and the underlying facts about transgender young people and the well-established medical care that many young people need.”

It is safe to say that Ms. Levi’s next assertion is contradicted by multiple systematic literature reviews of this medical field, which have found the evidence backing gender-transition interventions for minors wanting and uncertain. Journalist reported in BMJ in 2023, for one, that gender-transition treatment cannot be considered evidence based.

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This video is the latest in the series I’m publishing of 2021 to 2023 USPATH and WPATH conference videos. To see the full set, go to this master list:

Dr. Rosenthal is a professor of pediatrics at the University of California, San Francisco and the co-founder and medical director of the multidisciplinary UCSF Child and Adolescent Gender Center. Dr. Olson-Kennedy is a pediatrician and until the clinic was shuttered last year under pressure from the Trump administration, directed the pediatric gender clinic at Children’s Hospital Los Angeles. She now does similar work for a private clinic in Pasadena.

Dr. Olson-Kennedy is the lead investigator on the long-running study of medical interventions to treat gender dysphoria among youth, the Trans Youth Care Study, that has received some $10 million in National Institutes of Health funds to date. Dr. Rosenthal is one of the co-principal investigators on the study. The study is particularly controversial because of reporting by The New York Times in 2024 that Dr. Olson-Kennedy had refrained from publishing results of their research about puberty blockers for political reasons. (Dr. Olson-Kennedy has said her interview with the Times was mischaracterized.)

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This 2021 USPATH video is particularly notable because it includes Dr. Olson-Kennedy going into the weeds about the first year of follow-up of 316 youth after they started cross-sex hormones. At the time, she was more optimistic about how publishing her data would sway the political debate about pediatric gender medicine. But as a 2023 conference video demonstrates, by then her perspective had darkened, and she came to the conclusion that it was more politically expedient to be very cautious about publishing. As I reported in Compact magazine:

In 2021, Olson-Kennedy reported that her team had amassed a trove of data from the federally backed study. Facing rising political scrutiny, she suggested sunlight was the best disinfectant. “We want to prioritize publishing this information because it needs to get out into the general public while there is this ongoing attack on transgender youth and transgender youth care,” she said. By the 2023 conference, she reported her team had up to seven years of follow-up data and were working on “several more manuscripts.” But now they were wary about publishing.

“I asked our person at the NIH if there was a prize for the grant that got the most FOIA requests, and she said, ‘No, but even if there was, you would still be behind Covid and fluoride,’” Olson-Kennedy said, to laughter. Describing her team’s painstaking efforts to avoid providing fodder for a backlash, Olson-Kennedy said, “Every single manuscript is absolutely impeccable with what it is, what it is stating, the results that are being reported. We’re thinking about how things can be taken out of context and misused and potentially come back and damage us.”

Following Dr. Rosenthal and Dr. Olson-Kennedy’s USPATH 2021 presentations, she engaged in a detailed dialogue with Dr. Joshua Safer. Dr. Safer is a professor of endocrinology at Mount Sinai in New York, where he is the executive director of the transgender program. He was a leader in the revision of WPATH’s transgender-care guidelines, the Standards of Care, Version 8, or SoC 8, which were published to much fanfare (and controversy) in September 2022.

Introducing the plenary, Dr. Safer said it would address how “we navigate our evidence-based approaches in an environment where sometimes the conversations we have are distorted for political gain.”

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Dr. Rosenthal

The first to present, Dr. Rosenthal reported that the prevalence of trans identification in adolescents and young adults was about 0.7 percent. (This figure would only soar in the subsequent couple of years—to about 3 percent. Although data recently analyzed by psychologist has suggested this figure has since retreated again.)

Dr. Rosenthal posed the question of what drove the “marked increase” in referrals to youth gender clinics in recent years. He pointed to Dutch research concluding it was driven by reduced stigma towards trans identities. He did not explicitly suggest that there was a cultural component to this increase. He further noted the recent inversion of the sex ratio—youth presenting at clinics used to be largely natal boys and now they are largely natal females—but did not offer a reason for this dramatic shift.

Instead, he spoke more generally about the notion that “gender identity is not simply a psychosocial construct, but very likely reflects a complex interplay of biological factors as well as environmental and cultural factors.” He did not broach this subject, he said, to “develop a litmus test of being transgender, and certainly not to identify something to be fixed to prevent gender diversity.” Rather, he said, he hoped “this can lead to destigmatization, which can then lead to increased acceptance and decrease health disparities for people of diverse gender identities.”

The SoC 8, which greatly loosened guardrails around pediatric gender-transition treatment, was not out yet. So Dr. Rosenthal referred instead to the most recent Endocrine Society guidelines, which he noted, said that cross-sex hormones could be prescribed to youth who have “sufficient mental capacity to give informed consent, which most adolescents have by age 16 years.” But the guidelines, he said, did allow for commencing hormones at younger ages in select cases.

The authors of the SoC 8, acting under pressure from a Biden administration health official, the American Academy of Pediatrics, and the Trevor Project, would remove the age limits on pediatric gender-transition interventions in the guidelines. They kept secret that they did not make this change based on scientific research, but under duress. Child psychiatrist Dr. Scott Leibowitz, the lead author of the adolescent chapter in the SoC 8, then got up in WPATH’s 2022 conference and made a number of false claims about the reason for the removal of the age limits, as I reported in a previous Substack.

Dr. Rosenthal then went into specifics about the Trans Youth Study.

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For an eloquent and eyebrow-raising account of this and several other nonbinary-focused conference videos included in the videos I obtained, I also direct you to Leor Sapir’s December article in The Free Press. He wrote:

One of the biggest revelations from the recordings is how these clinicians acknowledge performing unproven, seemingly experimental treatments—only it appears there is often no protocol being followed, no formal research being conducted, and no ethics-board approval being sought. These practitioners say their goal is to fulfill the “embodiment” desires of their patients, whatever these may be, and doing this may require “deviat[ing] from guidelines.”

The conference video I’m documenting in this Substack includes a particularly astonishing admission by one care provider that made it into Dr. Sapir’s headline. The provider said, “We’re all just winging it” where medical interventions for nonbinary patients are concerned.

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To see all the previous WPATH conference videos I’ve published, see:

Despite a paucity of research to guide gender interventions for nonbinary patients, the WPATH presenters in the 2022 nonbinary session insisted that this fast-growing population had a genuine medical need for all manner of experimental hormonal treatments and body-modification surgeries, sometimes effecting bodies that do not appear in nature. And the audience members who came up to the mic made it clear that they generally wanted guardrails stripped down to facilitate access to meet the swelling patient demand.

(Psychologist , note, has recently presented data in her Substack suggesting that nonbinary identification has sharply declined in adolescents and young adults in the years since this conference. This has added fodder to the argument that such an identity is largely shaped by shifts in culture and not by fixed biological forces.)

As Dr. Sapir wrote, there was a heavy emphasis on treatment “goals” in this and other conference presentations about nonbinary-related treatment. Such a service-minded orientation took over this field because, as the presenters acknowledged, there is sometimes no established precedent for the medical interventions this population seeks. This is all a part of a larger postmodern, deconstructionist project to “move away from the binary” in the gender-care field. Such an academic project has merged with a departure from traditional medical paternalism, in which the doctor was seen as an infallible demigod, and toward more patient-led care with minimal guardrails around what any individual person might seek from a white-coated professional bearing a medical license and a prescription pad or a scalpel.

The 2022 presentation opened with words from Dr. Joz Motmans, who is the director of the Centre for Sexology and Gender at Ghent University Hospital in Belgium. Dr. Motmans was one of a slew of coauthors of the new nonbinary chapter in WPATH’s Standards of Care, Version 8. The SoC 8, as it’s known, is the trans-care guideline update that was published to much fanfare in September 2022, days before this particular conference.

As was often the case in the WPATH conference videos I reviewed, Dr. Motmans apologized for a lack of racial diversity in the leadership. (I made particular note of this brand of self-flagellation in a recent essay I published in UnHerd.) He alluded to the fact that the coauthors of the SoC 8 nonbinary chapter were all white. “We do miss some diversity in the authorships,” he said. “But I think that’s the case in most of the chapters.”

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Dr. Motmans said that doctors should observe a particularly open mind when caring for nonbinary patients, saying: “It’s very important that health care professionals recognize a need of an individual to access gender-affirming medical procedures and that you cannot predict that need based on someone’s gender role, expression, or identity,” He continued: “So it’s important that health professionals provide information about existing medical procedures and options that might help alleviate gender dysphoria or incongruence and increase body satisfaction without making assumptions about which treatment options may best fit.”

Next, Dr. Walter Bouman, a transgender care specialist at the Nottingham Centre for Transgender Health in the United Kingdom, took to the lectern. Along with Dr. Motmans, he led the WPATH working group on nonbinary genders.

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I have an article out in The New York Sun today in which I break the news that transgender activist and Substacker succeeded in her campaign to undo the accreditation of a series of continuing medical education, or CME, courses that cast doubt on pediatric gender medicine. In the fall, the reporting in Ms. Reed’s Substack about these courses, which were created by the Society for Evidence Based Gender Medicine, or SEGM, and accredited by Washington State University, or WSU, fueled an activist outcry.

Behind the scenes, the Accreditation Council for Continuing Medical Education, or ACCME, which regulates the nation’s CME courses, launched an investigation. As I report for The Sun, the investigation was based on the only inquiry the ACCME received to have come in before the organization compelled WSU to take down the SEGM CME course series; WSU took the courses down an hour after Ms. Reed ran her first story on the matter. And I further report that the wording of that inquiry was nearly identical to portions of an email that Ms. Reed’s staff reporter, , sent to a WSU spokesperson inquiring about the university’s accreditation of the SEGM course series. Baum made a particular point of the Southern Poverty Law Center, or SPLC, having designated SEGM a hate group, a dubious designation that I’ve covered before.

In the end, the ACCME voided WSU’s accreditation of the SEGM course series and the university decided not to object.

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This Substack of mine serves as an appendix to my article in The Sun, which I encourage you to read. Below, I will include screenshots of the numerous internal documents I obtained and that informed my reporting, including:

• S. Baum’s communications with WSU

• Internal WSU deliberations on how to respond publicly to the imbroglio

• Emails from a WSU LGBTQ group expressing dismay over the university’s work with SEGM

• An email to that LGBTQ group from a City University of New York graduate student and trans activist

• The assessments of the SEGM course series written by anonymous reviewers who the ACCME recruited for its investigation

• Letters between WSU and the ACCME.

Below is the October 23 email from Ms. Reed’s staffer, S. Baum, to WSU spokesperson Pam Scott that began the imbroglio. Take note of the following wording, which will come up again later on when I detail the complaint that gave rise to the investigation by the ACCME:

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Camille Kiefel, the prominent detransitioner who sued a pair of Portland, Oregon, area mental health providers who each referred her for a gender-transition mastectomy following a single appointment, has reached a settlement with the defendants.

The malpractice lawsuit, in which Ms. Kiefel, 36, sought $3.5 million, had been set to enter what would have been a historic jury trial in the Circuit Court in Multnomah County, Oregon, in January. But the parties entered a confidential settlement just days before the trial was slated to begin.

The existence of the settlement has not previously been reported.

The lawsuit’s defendants included the two authors of the referral letters for surgery that Ms. Kiefel obtained in 2020: Amy Ruff, a licensed clinical social worker and her employer, Brave Space; and Mara Burmeister, a licensed professional counselor and her employer, Quest Center for Integrative Health. The suit alleged malpractice, intentional infliction of emotional distress and fraudulent misrepresentation.

A July 2025 amended complaint filed with the court alleged that Ms. Ruff and Ms. Burmeister effectively rubber stamped Ms. Kiefel’s request for a referral letter, in each case following a single telehealth appointment lasting under an hour. The lawsuit alleged that each of these mental-health professionals failed to adhere to their employers’ training for providing such a letter, which the suit suggested already set quite a low bar and was in conflict with the care guidelines set by a major transgender-medicine organization.

Ms. Kiefel underwent a mastectomy in August 2020, at age 30. At the time, she identified as nonbinary, but has since reverted to identifying as a woman. The legal complaint detailed a lengthy history of serious mental-health problems on Ms. Kiefel’s part dating back to childhood, which ultimately rendered her unable to maintain employment and put her on long-term disability. Her litany of diagnoses included generalized anxiety disorder, major depressive disorder, post-traumatic stress disorder, ADHD and other-specified personality disorder with mixed borderline and dependent features.

Amid the raging national political fight over the care of minors with gender dysphoria, Ms. Kiefel’s case raises complicated questions about who is ultimately responsible if an adult undergoes gender-transition treatment or surgery and ultimately comes to conclude that the intervention was harmful, in particular if they have serious mental health problems.

According to her website, Ms. Kiefel “once believed a non-binary double mastectomy would finally provide relief where 20 years of talk therapy with conventional modalities hadn’t; she lives with physical health issues from the surgery.”

“Gender affirming treatments are experimental, risky and distributed inconsistently,” Ms. Kiefel stated on her web site. “Before we consider invasive surgeries, we must first look at all low-risk alternative treatments that address the physical health of the individual.”

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Ms. Kiefel also sued the plastic surgeon who performed her mastectomy, Dr. Tina Jenq, and her employer, Oregon Cosmetic and Reconstructive Clinic. That case was dismissed due to the statute of limitation running out. Ms. Kiefel and her attorneys did not pursue it further.

In recent years, adult transgender care in particular has increasingly moved toward what is known as an informed-consent model, in which there are minimal barriers for patients to cross when seeking gender-transition treatment or surgeries. Ms. Kiefel’s legal complaint asserted that both Brave Space and Quest had established systems that facilitated patients’ desires for such medical interventions with a relatively minimal amount of so-called gatekeeping.

In the emerging field of detransition litigation, Ms. Kiefel’s settlement marks the first of its kind, given she and the defendants entered into the agreement at the 11^th hour before a jury trial. At least two other such lawsuits have been dismissed pursuant to a settlement, but without having scheduled a trial.

The lawsuit called into question whether such a minimal-gatekeeping care model might leave care providers exposed to legal liability, especially given the recent surge of transgender identification among adolescent and young-adult biological girls and women in particular. This population has a high rate of psychiatric comorbidities and autism, which may complicate any process of assessing them for gender-transition interventions. There is considerable conflict within the transgender-care community over whether even severe mental-health conditions serve as a contraindication for such interventions.

The Oregon trial had been slated to begin only days following the launch of the three-week trial in White Plains, New York, in which Fox Varian, 22, became the first detransitioner to bring a malpractice lawsuit before a jury. Ms. Varian sued her Westchester County-area psychologist and plastic surgeon over the gender-transition mastectomy she underwent at age 16. She was awarded $2 million by the jury on January 31. (I was the sole reporter to attend the entire trial.)

My appearance on CBS News to discuss the Varian case:

Had Ms. Kiefel’s case gone before a jury, it would have been the first trial in which a detransitioner had sued their care providers over a gender-transition intervention they received as an adult.

In stark contrast to Ms. Varian, who has tightly guarded her privacy regarding her lawsuit, Ms. Kiefel has maintained a public profile as a detransitioner. She is among a small group of such individuals who have testified in state legislatures arguing for greater institutional support for detransitioners or on behalf of restrictions on pediatric gender medicine. The most common such advocate is Chloe Cole, who has sued Kaiser Permanente in California over the gender-transition treatment and surgery she received during her adolescence. Ms. Cole’s trial is slated for next year, and, given her high profile, should provoke a media bonanza.

In a joint statement, two of Ms. Kiefel’s attorneys, Josh Payne, of Campbell Miller Payne, and Zac Hostetter, of the Oregon-based Hostetter Law Group, told me: “We are proud to have represented Camille Kiefel in her pursuit of justice. It was our privilege to fight for her, and we are pleased the parties were able to resolve the matter shortly before the trial was set to begin. We are not at liberty to disclose the terms of the settlement as they are confidential.”

Attorneys for the defendants did not return my request for comment.

There are 27 known detransitioner lawsuits that have been filed in the United States since 2022, a figure that includes both those who underwent gender-transition interventions as minors and those who did so as adults (the oldest I have documented was 32 at the time of the intervention). A number of these cases have run into obstacles related to statutes of limitation, including the lawsuit against prominent pediatric gender medicine physician Dr. Johanna Olson-Kennedy. The plaintiff’s attorneys in that case have filed an appeal.

Isabelle Ayala in 2023 sued Dr. Jason Rafferty, a Brown University pediatrician who wrote the American Academy of Pediatrics’ influential—and highly contested—2018 policy statement on the gender-affirming care method, over the testosterone treatment she received as a minor. Ms. Ayala also sued the AAP itself. Her case has been dismissed pursuant to a settlement.

Ms. Ayala is represented by Campbell Miller Payne, a Dallas firm established for the sole purpose of representing detransitioners. The firm’s leadership has recently undergone major changes. Founding partner Jordan Campbell left in 2025 to lead a unit Department of Justice devoted to targeting the field of pediatric gender medicine. And another founding partner, Ron Miller, died of cancer earlier this year at age 38. Mr. Payne is the sole remaining founding partner.

A representative for the firm declined to comment on Ms. Ayala’s case.

The other known lawsuit to be dismissed pursuant to a settlement was waged by Christopher Miller, who in 2024 sued Identity Hormones in Arizona over estrogen treatment he received as an adult. Mr. Miller’s attorney did not return a request for comment.

Erin Friday, a California attorney and outspoken activist campaigning against all forms of medicalized gender transitions, told me in a statement that she hoped that Ms. Kiefel’s settlement, however confidential the terms, might send a chilling effect across the field of transgender medicine.

“For some medical providers, moral arguments and lack of efficacy of the treatments is sufficiently compelling, but for others it is only the fear of malpractice suits that will stop them,” Ms. Friday said.

Adam Deutsch, a partner at Fiedler Deutsch in White Plains and Ms. Varian’s attorney, told me that since his victory in her case, he thought that care providers and insurance carriers “are taking a harder look at the exposure these detransitioner cases present.” The Varian case, he said, “showed these claims can carry real litigation and reputational risk, which makes pretrial settlement a more attractive option. In my view, as more of these cases are filed and better understood, we’re likely to see more of them resolve before trial.”

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Ms. Kiefel’s case

Ms. Kiefel’s 2025 legal complaint characterized her as severely burdened by a constellation of mental-health conditions that left her in a poor position to decide upon whether to undergo surgery to remove her breasts, even well into adulthood. The complaint further suggests that gender dysphoria—the mental health diagnosis that doctors typically require to provide gender-transition interventions—did not play a major role in her mental health struggles during the years leading up to the surgery.

According to the complaint, the borderline features of her personality disorder included an “unstable sense of self, impulsivity, recurrent suicidal gestures, affective instability due to reactivity in mood, and chronic feelings of emptiness.” The complaint further asserted: “Kiefel’s dependent features include difficulty making decisions, the need for others to assume responsibility for major areas of life, and difficulty initiating projects.”

Brave Space and Quest, the complaint suggested, had engineered the transgender-care assessment process such that patients with complex psychological profiles were at risk of falling through the cracks, given how much these organizations favored lowering guardrails over protecting patients from medical interventions that might not be in their best interest.

Both Brave Space and Quest, the complaint alleged, sought to “eliminate barriers” for patients seeking gender-transition surgeries.

The complaint alleged that Ms. Ruff’s employer, Brave Space, “eliminated safety barriers for transgender individuals seeking ‘gender-affirming’ surgeries, such as the requirements of a valid mental health diagnosis and a valid mental health assessment before such surgeries.”

Ms. Burmeister, the complaint alleged, “wholly failed to provide Kiefel an adequate mental health assessment before filling in blanks on a form letter to a plastic surgeon so that Kiefel could receive ‘gender affirming’ surgery.”

Ms. Kiefel adopted a nonbinary identity in 2015, when she was in her mid-twenties. She was ultimately diagnosed with gender dysphoria by a therapist.

Three years later, she underwent a major depressive episode and, according to her legal complaint, “became unable to work or drive, went on short-term disability, and applied” for medical leave from her job. She ultimately went on long-term disability due to her mental-health struggles.

She underwent mental-health treatment from various providers from the fall of 2018 to the spring of 2020. During that period, she was not diagnosed with gender dysphoria, per her legal complaint.

In April 2020, she told her primary care provider, Dr. Ewen Harrison, of the Providence Medical Group in Clackamas, Oregon, that she thought she needed a breast reduction. Dr. Harrison, who did not diagnose Ms. Kiefel with gender dysphoria at the time, wrote in his notes that she identified as nonbinary and that she did “not require masculinizing surgery, but would be comfortable with reduction only, no surgery to nipples or areolae.”

Dr. Harrison then referred Ms. Kiefel to Dr. Jenq. One of Ms. Kiefel’s mental health providers, meanwhile, referred her to Brave Space to obtain a referral letter for gender-transition surgery.

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The referrals

In an August 2025 deposition, Ms. Kiefel stated that she thought the purpose of the assessment with the mental-health providers was to determine “whether or not I was truly nonbinary.”

Ms. Ruff and Ms. Burmeister seem to have been trained, on the contrary, as facilitators of gender-transition interventions, not as gender-identity auditors.

Ms. Kiefel’s legal complaint suggested that the providers did not properly obtain her informed consent for the operation. The complaint alleged that neither Ms. Ruff nor Ms. Burmeister “assessed Kiefel’s knowledge regarding the impacts of surgery would have on parenting, the potential for revision [surgery and] the possibility of regrets or later detransitioning.” Nor did they discuss with her “other, non-surgical ways to manage gender dysphoria.” Nor did they address how the surgery might impact sexual intimacy.

Ms. Ruff’s Zoom session with Ms. Kiefel, held May 13, 2020, lasted less than an hour. Ms. Ruff wrote the referral letter for the mastectomy to Dr. Jenq that same day. The letter, referring to Ms. Kiefel with gender-neutral pronouns, stated that “they do not identify with either gender and thus are not interested in transition.”

At that point, Ms. Kiefel was still on disability. Nevertheless, Ms. Ruff’s mental-health examination put her “within normal limits” for all related categories. Ms. Ruff’s referral letter, according to the legal complaint, did not include any diagnostic assessments for Ms. Kiefel and how those mental health conditions might have adversely impacted her capacity to provide informed consent for the surgery. The complaint alleged that Ms. Ruff falsely asserted in the letter that Ms. Kiefel’s mental-health conditions were “successfully managed.”

The World Professional Association for Transgender Care, or WPATH, publishes widely observed transgender care guidelines known as the Standards of Care. Even after these guidelines have been considerably liberalized in recent years, some in the trans-care community who favor greater bodily autonomy for transgender people still find them overly restrictive.

This appeared to include Brave Space and Ruff.

Ms. Kiefel’s legal complaint alleged that “Brave Space and Ruff purport to follow” WPATH’s Standards of Care. “In reality,” the complaint countered, “Brave Space and Ruff rejected the WPATH standards of care, and maintained that the WPATH standards of care create barriers for individuals seeking gender-affirming care.”

The complaint continued: “Brave Space and Ruff believe the transgender community should actively participate in developing clinical practice guidelines and standards of care for transgender individuals, that transgender individuals are the experts and that they should self-determine what medical therapies and surgeries are right for them.”

The lawsuit suggested that such a liberal philosophy was ill-suited for a patient with needs as complex as Ms. Kiefel.

Soon after obtaining the letter from Ms. Ruff, which cleared her as essentially mentally stable, Ms. Kiefel told another mental-health provider that she had “chronic thoughts of death” and that she “might be taking on to [sic] much right now,” per the legal complaint.

After Dr. Jenq’s office told Ms. Kiefel that she needed a second referral letter for the mastectomy, she attended a Zoom session with Ms. Burmeister on July 1, 2020. During that approximately 40-minute session, the legal complaint asserted, Ms. Kiefel described her struggles with her mental health conditions “and disclosed that her treatments of those conditions had not been successful.”

Nevertheless, Ms. Burmeister wrote the referral letter for surgery the following day. According to the legal complaint, the letter violated Quest’s own policies in myriad ways. These included Ms. Burmeister’s omission of “any documentation to support a DSM 5 diagnosis that was the medically appropriate reason for services in question.” Nor did Ms. Burmeister “adequately address Kiefel’s mental health conditions.” She also falsely referred to Ms. Kiefel as male (she identified as nonbinary at the time), characterized her mental-health symptoms as mild, and wrote that her “only instance of suicidal ideation was a couple of months ago.”

The complaint faulted Ms. Burmeister for not obtaining or reviewing Ms. Kiefel’s medical or mental health treatment records or consulting with her other care providers. (This was a key sticking point in the Varian case. Ms. Varian’s psychologist never sought the notes from another mental-health-care provider with whom the girl was more candid about her ambivalence over her gender identity.) Nor did Ms. Burmeister alert Dr. Jenq that she had not engaged in such due diligence, which the legal complaint asserted was in violation of Quest’s policies.

On July 21, 2020, Dr. Harrison noted that Ms. Kiefel was experiencing increasing symptoms of depression, anxiety and insomnia, and, per the legal complaint, that she “had poor self-care at home, and inability to drive as she felt too unstable to keep appointments.”

Ms. Kiefel underwent the mastectomy, including the removal and repositioning of her nipples, on August 27, 2020.

According to the complaint, Ms. Kiefel has since suffered from feelings of “betrayal by and mistrust in health professionals,” as well as “humiliation, distress and anxiety” over losing her breasts. This includes “deep feelings of regret over unnecessarily and permanently losing her choice ever to breastfeed a child, and fears and anxiety over finding a life partner sexually and romantically attracted to a woman without breasts.”

I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net

Note: After the April 26, 2026, panel, I obtained some video of protests and disruptions as well as audio of the moderator introducing the panel. I dropped those at the end of this article. I also updated the article to show a response from the Pediatric Endocrine Society on April 27.

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In 2024, a federal judge unsealed a raft of internal emails from the World Professional Association for Transgender Health, or WPATH, that shone light on this tightly held secret. The following year, that judge further unsealed hundreds of WPATH conference videos, which I ultimately obtained and covered in a recent feature article for Compact magazine.

One of those videos, which I have published in full above, provides remarkable documentation of what transpired when a coauthor of the new adolescent chapter of WPATH’s guidelines, child psychiatrist Dr. Scott Leibowitz, presented the chapter to his colleagues at the organization’s September 2022 conference. During his presentation, Dr. Leibowitz made a series of claims about the removal of the age limits that the internal emails would later reveal to be false.

In this Substack, which is the sixth in an ongoing series I am publishing about the WPATH conference videos I obtained, I zero in on Dr. Leibowitz’s statements and measure them against the email documentation. You’ll see individual clips paired with screen shots of internal WPATH emails.

As you will see, these documents make clear that Dr. Leibowitz was uttering falsehoods in his presentation. The documents also raise important questions about what Dr. Leibowitz knew at that moment about what the truth actually was.

To see the other conference videos I have published thus far, visit and bookmark this page, where I will keep publishing links to each new installment:

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WPATH’s big secret: Why they really removed the age limits

All these revelations about WPATH stem from a federal lawsuit over Alabama’s ban of gender-transition treatments for minors. The state’s attorney general wound up subpoenaing WPATH’s records. In June 2024, the judge overseeing the case unsealed the internal emails.

The emails demonstrated that a Biden health official, Admiral Rachel Levine, had pressured WPATH to remove the age limits from the draft of the 2022 revision to its trans-care guidelines, called The Standards of Care, Version 8, or SoC 8. Dr. Levine was explicitly motivated in this pressure campaign by political considerations, the emails showed. WPATH leaders resisted, but they ultimately caved to pressure after the American Academy of Pediatrics threatened to come out against the SoC 8 if they didn’t remove the age limits. WPATH leaders subsequently developed a cover story to tell inquiring journalists: that they had removed the age limits because they favored “individualized” care for young people.

As I reported for Compact:

When the guidelines were published online on September 15, 2022, the age limits remained. But WPATH took the document down that same day. When it was republished hours later, the age limits had vanished.

Four days later, Leibowitz, who then ran the gender clinic at Nationwide Children’s Hospital in Columbus, Ohio, presented the new adolescent chapter to the WPATH conference. Acknowledging the “risks associated” with “including or not including age minimums,” he enumerated various criteria he said should take precedence, such as a child’s maturity and ability to provide informed consent. He added that “currently the final document landed on protecting the criteria,” because “ages were serving as a distracter from those important criteria, and that would not have allowed for adolescents to access the care that they need.”

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Here is where Dr. Leibowitz enumerated the criteria that should take precedence:

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Earlier this month, Finnish researchers published an analysis of national health records that found that the use of specialty psychiatric care, which they considered a proxy for serious mental health problems, surged among youth who underwent gender-transition interventions.

The study provoked a round of protestations and recriminations from advocates of pediatric gender medicine.

Prominent transgender activist and Substacker slapped one of her trademark “Fact check: false” red banners on the study, falsely asserting that its authors had claimed that gender care for youths doesn’t improve mental health outcomes. In a subtle but important distinction, the study authors did not use such causal language; they actually wrote that their analysis “does not support the suggested improvement in mental health af…

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I published an article in The Free Press yesterday that peels the lid off the American Medical Association and reveals what that led the organization’s board president to claim, without evidence, that the The New York Times had misquoted its statement endorsing limits on youth gender surgeries. I revealed that the AMA’s CEO contradicted the board president in an employee town hall, asserting that the board had signed off on the statement (while deferring any responsibility for it). This new Substack serves as a complement and appendix to my Free Press article, which I encourage you to read. It includes a lot of extra details about the surrounding politics that appear to have given rise to the imbroglio at the AMA.

This Substack is free to read. At the end of it, behind the paywall, I will provide for you the two key pieces of internal documentation on which I based my reporting for The Free Press:

1. The official transcript from a February 10 AMA town hall at which the CEO, Dr. John Whyte, and the director of communications, Josh Zembik, each addressed the media’s reporting of the AMA’s position on youth gender surgeries.

2. Comprehensive records from the message board of the AMA’s LGBTQ+ affinity group, on which numerous members expressed their upset that the AMA had gone against policy by at least generally advising against gender surgeries for minors.

I previously wrote about this story in a Substack that diagrammed how all the media outlets that quoted the AMA on the matter published some portion of the five-sentence statement from Mr. Zembik that the Times asserted in a March 27 statement that it received from the communications director in February.

The AMA Faces Political Peril

All of the drama started after the American Society of Plastic Surgeons on February 3 announced in a policy statement that it was recommending its members not provide gender-transition surgeries to patients under age 19. This prompted the AMA to tell The National Review and The New York Times, among other outlets, that it agreed with the ASPS and that such surgeries should “generally” be deferred to adulthood.

The resulting internal chaos at the AMA comes at a politically perilous time for the medical behemoth. Lawmakers in Washington have threatened to unravel the AMA’s monopoly over medical billing codes that generate well over $100 million in annual royalties for the organization. Multiple individuals who have held top positions at AMA expressed concern to me that Dr. Whyte, who became CEO last year, seems keen on appeasing President Trump by aligning with the administration’s conservative overhaul of major institutions. Trump has been vocal about his disdain for pediatric gender medicine, and gender clinics at multiple major children’s hospitals have closed after the administration has threatened to cut off access to federal funding.

The AMA did not respond to multiple requests for comment.

In January, the Centers for Medicare and Medicaid Services director Dr. Mehmet Oz held what the Times reported was a “tense meeting” with the leaders of top medical associations to discuss the field of pediatric gender medicine. In attendance were Dr. Aizuss and Dr. Whyte. Two of the AMA leaders I spoke with told me that Dr. Oz has previously spoken of his and Dr. Whyte’s long-standing relationship. I contacted the U.S. Department of Health and Human Services, which confirmed the relationship. At the January meeting, ASPS leadership made evident that they were preparing to publicly oppose gender surgeries for minors.

The AMA board then set to work drafting a response should media outlets ask them about the ASPS’s position, according to the March 26 board newsletter penned by Aizuss in which he accused the Times of misquoting the organization.

On February 3, the ASPS published its policy statement opposing youth gender surgeries. In its coverage of the development, the Times ran a statement from the AMA: “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.” The National Review, and multiple other publications, published parts of the broader AMA statement.

According to two of the AMA leaders I spoke with, board members were immediately upset that the statement given to the Times did not reflect the statement the board had crafted. In particular, the board did not intend to say that it sided with the ASPS. It’s not clear what the exact wording of the intended statement actually was.

This set off a period of confusion and debate among AMA membership over whether the news outlets had misquoted Mr. Zembik.

The day the Times story ran, Dr. Andrew Norton, a pediatrician at the University of Wisconsin, wrote on the LGBTQ+ group’s message board that “it appears whoever spoke” to the press about the AMA’s position on youth gender surgeries “did not follow policy.” He referenced a 2024 AMA policy document that stated that “medical and surgical treatments for gender dysphoria” are “medically necessary” and that made no suggestion of age limitations.

Some of the group’s members expressed concern that politics had been broadly guiding AMA decision-making, and conveyed a wider loss of trust in the organization’s leadership.

Dr. Frank Dowling, a psychiatrist at Stony Brook School of Medicine expressed suspicion that at “least some in the AMA are working” on “an agenda and against our clear policies.”

“The fact that section leaders do not have answers, have no paper trail on this announcement, and we have no policy or report to back it,” Dr. Scott Chaiet, an otolaryngologist at the University of Wisconsin-Madison, wrote, “is very telling of our organization today.”

Dr. Kavita Arora, an OB/GYN at the UNC School of Medicine, voiced concerns about the AMA’s apparent political leanings. “Over the past several months, I have become increasingly uneasy about a number of significant decisions that appear to have been made at the management level rather than originating from, or bering directly directed by” the board, she said. She lamented “the reduction of state-level advocacy on women’s health, the scaling back of DEI initiatives, the discontinuation of the AMA Journal of Ethics, and most recently, decisions related to pediatric gender-affirming care.”

According to comments on the message board and my conversations with AMA leaders, the board initially decided not to seek a correction to the February 4 Times article, believing doing so would only feed the news cycle and worsen the public-relations fiasco. Better to do nothing, they thought, and hope the story would die down. It did not. The Times referred to the statement in an editorial by , “Medical Associations Trusted Belief Over Science on Youth Gender Care,” on February 24 and again in the March 16 article on the Oz meeting.

The board’s inaction infuriated Dr. Frances Grimstad, a gynecologist at Boston Children’s Hospital, who gained notoriety in 2022 for a widely circulated video, since deleted, of her enthusiastically promoting gender-transition hysterectomies. (Amid uproar over the video, Boston Children’s asserted that it did not provide such surgeries to minors. The hospital also treats young adults.) On February 11, she wrote on the message board: “Choosing to be silent is the board being complicit in allowing the statement to stand as AMA’s voice, suggesting they support it, which is a smack in the face.”

Dr. Grimstad went on to say that “the policies and procedures that typically safeguard an org from being at the ideological whim of one person are being ignored, similar to our federal admin.” She asked if the organization was “just becoming the trumpian AMA,” guided by “rogue leadership?”

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I wrote for The Free Press:

To complicate matters further, a video The Free Press reviewed from a February 10 AMA town hall showed the organization’s CEO, Dr. John Whyte, insisting that the board had, in fact, signed off on the published statement about youth gender surgeries.

At the gathering, which was limited to AMA employees, Whyte said that the AMA had publicly sided with the ASPS on youth gender surgery because this “was a position that the board of trustees voted on.” He continued: “Consistent with what the board felt was existing policy is that it generally should be delayed until adulthood.” He deferred responsibility, saying, “I’m not a member of the board.” The AMA did not reply to multiple requests for comment.

Mr. Zembik did not challenge Whyte’s characterization during the town hall. But he did say at the gathering that the statement “wasn’t a position change. This was a clarification in case we were asked.”

And yet there is no evident documentation of the AMA having ever issued a public statement regarding age limits for gender surgeries.

I wrote for The Free Press:

On March 26, nearly two months after the original Times article ran, the AMA’s board chair, Dr. David Aizuss, published a newsletter in which he declared that the newspaper had published an incorrect statement whose “phrasing did not come from the AMA.”

“During our Board discussion, we were clear that we were not changing AMA policy,” he wrote. Aizuss said the AMA had written to The New York Times and “requested a correction on their part to reflect the actual language the AMA used.”

But the following day, the Times communications department defended its reporting in a press release, which included the full five-sentence remark that AMA’s communication’s director, Josh Zembik, provided the paper. The Times also wrote that it “received no requests to correct, clarify or update our articles from the A.M.A.”

After reading the Times’ statement, Dr. Paula Amato, an OB/GYN at Oregon Health & Science University, who is part of the LGBTQ+ group, told me: “The AMA statement is inconsistent with current AMA policy.”

I wrote for The Free Press:

Once it appeared clear that The New York Times had, indeed, not misquoted the AMA spokesperson, members of the LGBTQ+ group trained their ire on the AMA’s leadership.

Dr. Sophia Spadafore, an emergency medicine attending physician at Mount Sinai in New York, wrote on the LGBTQ+ message board, “That fact that our board may have been lied to about such a huge issue (whether the misstatement was intentional or not I don’t know) needs to have real consequences.”

I wrote for The Free Press:

On March 29, Aizuss wrote on the group’s message board that he had addressed the matter “with senior management” and would be discussing it further at the April board meeting. He said that “there continues to be a discrepancy between what the New York Times states they were told and what our communications people say they said.” He added: “If our spokesperson said that the AMA agrees with the ASPS, that was a clear error and was not authorized by the board. He unfortunately does not recall if he used those words.”

Dr. Aizuss said that the “board gave very specific guidance” to the communications team. He made it evident that he believed that the AMA spokesperson had conveyed the statement to the Times verbally and had no recording of the conversation.

And yet a representative for the Times told me that the statement from Mr. Zembik came in over email. The author of the National Review piece, Haley Strack, also told me that she received the statement from the AMA in writing. A journalist at another publication, who asked for anonymity because they were not cleared to speak on the matter, said they received the full statement from Mr. Zembik digitally; I reviewed a copy of the message from Mr. Zembik.

Dr. Grimstad pointed the finger squarely at the AMA, on March 29 writing on the message board: “In this moment where the credibility of American medicine is being questioned at every turn, for the AMA to add to the national distrust by suggesting NYT has no editorial standards and, when facts come to light, it was the AMA that was the source of misinformation…a massive deal.”

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Fact checking a misleading article in The Advocate

(Feel free to scroll past this if you just want to look at the source materials, including the AMA town hall transcript and the detailed records from the LGBTQ+ group’s message board.)

One member of the AMA’s LGBTQ+ group is Alex Sheldon, executive director of GLMA: Health Professionals Advancing LGBTQ+ Equality. Sheldon, who uses gender-neutral pronouns, gave an interview to The Advocate for an article that ran April 1: “Doctors’ group says American Medical Association didn’t retreat on gender-affirming care for minors.”

The article sought to do two things that it never acknowledged are in direct conflict with one another:

1. Deny that the AMA released a statement about youth gender surgery that ran contrary to what the board prepared for the press

2. And yet credulously insist that the organization had not, in fact, publicly changed its policy on the matter in the statement Mr. Zembik provided.

Both of these things cannot be true at the same time. For starters, as I have made clear, there is no evidence that the AMA had ever taken a stance on age limits for gender surgeries. And the statement Mr. Zembik provided did agree with the ASPS on generally deferring surgeries until adulthood. Furthermore, multiple AMA members have made evident that the statement published by the Times did represent a change in policy.

The Advocate stated the following regarding what the Times had reported about the AMA’s stance on youth gender surgeries:

In an interview with The Advocate, Alex Sheldon…said the controversy reflects misinterpretation rather than any substantive shift in medical guidance.

“We knew right away that any shift in policy that was being reported was a grave exaggeration,” Sheldon said, pointing to GLMA’s role within the AMA’s House of Delegates, where it has a voting seat and direct visibility into policymaking.

…

Sheldon argued that the nuance was lost in translation and then amplified.

“In this case, the New York Times relied on a quote that was itself sourced from another outlet,” they said, describing an “echo effect” that distorted the AMA’s underlying policy framework.

Being a member of the AMA’s LGBTQ+ group, Sheldon had access to its message board, where he was an active participant (as you can see in the screenshots below). There, the group had emotionally-charged, in-depth discussions about how the gender-surgery-related statement that the press reported was not what the board had prepared and represented a change in poicy. And yet, despite recent developments that were discussed on the message board, Sheldon still tried to pin the blame on the Times.

It is always possible that Sheldon did not check the message board to see Dr. Aizuss post on March 29 the very strong suggestion that the Times was not at fault, that the problem was internal. And then there was Dr. Grimstad making abundantly clear that the AMA was the culprit.

Dr. Aizuss’ complete quote on the message board was:

“I’ve had a number of calls yesterday with senior management regarding the statements to the New York Times. I will be discussing this further with the Board at our April meeting. At this point, there continues to be a discrepancy between what the New York Times states they were told and what our communications people say they said. Unfortunately, there is no tape recording to my knowledge, and it is difficult to verify exactly what was stated by our spokespeople compared to what the New York Times says they were told. Regardless, there will be further discussion of this entire matter. As you can imagine, I am deeply disappointed by the information that was provided to me. the board gave very specific guidance to enterprise communications, and specifically what was to be utilized in responding to press inquiries, as I have said to all the groups that I met with it now appears that there may have been some deviation.

“If he use [sic] those words, it was just in regards to the fact that we stated gender, affirming surgery in minors should be generally deferred to adulthood, which is similar to what was stated by the ASPS. However we do not agree under any circumstances with the ASPS 9 page statement. If our spokesperson said that the AMA agrees with the ASPS, that was a clear error and was not authorized by the board. He unfortunately does not recall if he use those words.

“As I noted, I will continue to follow up with senior management, both our CEO and Josh are out for the next week. I will be in Chicago the following week for meetings some of which will be addressing this issue as well as the following week for the board meeting.”

Sheldon claimed to be providing The Advocate with a “clarification” on the matter. (Incidentally, this is the same word that Mr. Zembik used to characterize what he told the press when addressing the issue at the town hall. That word also showed up in reporting by NPR on February 8 and STAT News on February 10. Coincidence?) And yet Sheldon was, knowingly or not, clouding over the internal confusion and upset at the AMA over how Mr. Zembik gave the Times a statement that did indeed represent a major change in policy.

All this raises the question of why Sheldon felt the need to make these claims to The Advocate at this particular moment in time. And did the AMA put Sheldon up to it, or did Sheldon go rogue?

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The internal AMA documents I obtained:

Just below are screenshots from the official transcript of the February 10 AMA town hall, which was limited to AMA employees and took place one week after the ASPS released its policy document on youth gender surgeries and the AMA provided its response to that document to media outlets.

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At the 2023 conference of the World Professional Association for Transgender Health’s U.S. branch, USPATH, a top communication firm schooled attendees on how to combat misinformation in the media about pediatric gender medicine. Except, as is often the case in the intellectual battle over this controversial medical field, the PR mavens offered a cocktail of misinformation as an antidote.

The video is one of hundreds I obtained of WPATH and USPATH conferences spanning 2021 to 2023. I covered the videos applying to pediatric gender medicine for a feature article in Compact magazine earlier this month. Over the coming weeks and months, I will be publishing the most notable videos in my Substack. To see the full set of them (this is the fifth), visit this landing page, which I will update regularly:

As I wrote for Compact:

[USPATH president Dr.] Maddie Deutsch by 2023 flipped about speaking to the media. But by then WPATH was no longer merely defending the science. It had advanced to an active training mode, politically and rhetorically, and was coaching members to observe its rigidly prescribed terms. “The work that we do is important. It’s life-saving,” Deutsch said at the 2023 conference. “And because this charge does bring great responsibility, we have to be evidence-based. We have to be measured—measured in our approach, measured in dealing with the press, measured in dealing with conflict.”

Deutsch announced that WPATH had brought in experts from the prominent communications firm BerlinRosen to advise attendees on messaging.

The PR training was hosted by two representatives from BerlinRosen: Laura Brandon, who at the time was a senior vice president, and Kara Watkins-Chow, then an account supervisor at the agency.

Most notably, Ms. Watkins-Chow asserted that “the body of evidence” backing pediatric gender medicine “is strong.” This is categorically false, according to a slew of systematic literature reviews that started emerging in the late 2010s. Even Dr. Deutsch acknowledged at the 2022 WPATH conference that the supporting evidence was of low quality according to such reviews; although she was keen to emphasize that this did not mean “there was sloppy science.”

As was fairly typical across the WPATH conference videos I reviewed, the BerlinRosen reps barely made any explicit reference to minors, children or adolescents during their presentation. Instead, they just spoke more generally of “care” and did not often make age-based distinctions.

Ms. Watkins-Chow dismissed the idea that pediatric gender medicine was an “anomaly that’s completely different from all other health care.” This assertion ignores the fact that in no other branch of pediatrics do doctors change the appearance of the body to treat a psychiatric disorder. This field represents a three-way bridge between endocrinology, plastic surgery and psychiatry that is without parallel.

The BerlinRosen rep went into detail about how to vet—and potentially shun—a reporter, including by scanning the journalist’s previous reporting and social-media presence. “If you see that they’ve covered other nuanced health care or social issues in a way that kind of sends up red flags for you, that’s always a sign you can disengage,” she said. Ghosting was always an option, she said: “It’s fine to sort of pretend you didn’t get the message or just follow up with a polite ‘Thank you for reaching out. I’m not able to speak with you.’”

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I obtained a video of this presentation, the slides of which are all labeled with the admonition “DO NOT COPY OR RECORD,” along with hundreds of other conference videos thanks to a subpoena that the Alabama attorney general waged in a lawsuit over that state’s ban on pediatric gender transition treatments. The videos come from 2021 to 2023 conferences held by the World Professional Association for Transgender Health (WPATH) and its U.S. offshoot, USPATH.

I reviewed all the videos pertaining to pediatrics and covered them in an article for Compact magazine, which I encourage you to read. I am otherwise publishing the most notable of the conference videos on my Substack. I will put links to all of them on this landing page if you want to bookmark that for future reference. This is the fourth video in the series.

In this video, a team of six self-described “providers, clients, advocates and activists” presented an assessment model at the 2023 USPATH conference that a collective of them had spent two years developing. Dr. Colt St. Amand, a psychologist and family medicine doctor in New York state, introduced the session, cautioning attendees to keep a lid on it: “By viewing this presentation, you also agree not to record or photograph or transmit any portion of the presentation or the slide deck or conversations among the participants,” he said. Here are the collective members:

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Here Dr. St. Amand is speaking about addressing youths’ “embodiment goals:

WPATH’s 2022 trans-care guidelines recommend a comprehensive biopsychosocial assessment for all minors seeking access to gender-transition interventions. However, as I wrote in Compact, many presenters at the WPATH and USPATH conferences seemed eager to chip away at these assessments:

But the conference videos suggest a gulf between WPATH’s guidance and actual practice by at least some in its membership. Dr. Scott Leibowitz, a child psychiatrist, current WPATH board member, and coauthor of the 2022 guidelines’ adolescent chapter, said at the 2023 training conference that the guidelines are “very flexible” and essentially aspirational.

“What we’re putting forward is more of a gold standard—not necessarily: ‘You must do this,’” Leibowitz said.

Even presenters who favored a more cautious and circumspect approach often characterized assessments primarily as a conduit for individualizing care. They rarely made clear that the assessments were at least partly meant to prevent poor outcomes by selecting out those who didn’t meet diagnostic criteria.

Indeed, the presenters in this session eyed assessments warily. Like many presenters at these conferences, they were eager to disparage any effort to assess whether a child is truly transgender. Similarly, they were dismissive of any suggestion that a trans identity in a young person might be an outgrowth of a deeper psychopathology.

Laura Kuper, a psychologist at UT Southwestern Medical Center and a coauthor of the WPATH trans-care guidelines’ nonbinary chapter said in the 2023 video: “Assessment of someone’s gender identity from the perspective that providers have an ability to discern some true identity that exists beyond what is articulated by the person—and related to that attempts to identify root causes of gender identity, expression, or embodiment that would somehow disqualify one from treatment when they are otherwise able to articulate their treatment goals and provide informed consent.” Dr. Kuper said that “these conceptualizations reflect a pathologizing lens. And we find them inconsistent with that perspective of cultural humility.”

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Today’s Substack is my first effort to publish all the Olson-Kennedy videos. This particular video, featured in full above, contains her astonishing admission that she is not “interested in” the “conversation” about whether young patients who present to pediatric gender clinics are “really trans.”

I covered 130 of the pediatrics-related conference videos in a feature article for Compact magazine last week. I encourage you to read that. And please subscribe and support my work, as I begin the long process of publishing and providing analysis about all these videos.

This particular video features a symposium of leading figures in pediatric gender medicine, held at the USPATH conference in November 2023. The panel was moderated by Dr. Maddie Deutsch, director of University of California, San Francisco’s gender clinic, who was USPATH’s president at the time. (She would pass the torch to Dr. Olson-Kennedy.)

The panel included (from left to right in the video):

• Dr. Natalie Nokoff, a pediatric endocrinologist at Children’s Hospital Colorado

• Laura Kuper, a child and adolescent psychologist in Dallas

• Dr. Olson-Kennedy, a pediatrician who was then the head of the gender clinic at Children’s Hospital Los Angeles (which was closed in July 2025 under pressure by the Trump administration)

• Dr. Robert Garofalo, who runs the pediatric gender clinic at Lurie Children’s in Chicago (which is teetering under pressure from Trump)

• Dr. Stephen Rosenthal, a pediatric endocrinologist and the medical director at UCSF’s gender clinic

• Lisa Griffin, a clinical psychologist working with children and adolescents in Baltimore

Dr. Deutsch emphasized that there was to be no photography or recording of the panel—part of the veil of silence that WPATH and USPATH imposed over these confabs during an increasingly secretive time for the joint organizations. WPATH fought tooth and nail to keep a federal judge from unsealing the nearly 500 conference videos that the Alabama attorney general subpoenaed, and ultimately lost that fight last year. That led me to obtain the lot of them.

The panel was comprised by members of a “quality task force” that had been established within WPATH to assess the quality of care provided by mental-health and medical professionals in the gender-medicine field. In particular, they sought to assess such providers’ adherence to WPATH’s trans-care guidelines when caring for minors. Those guidelines are known as The Standards of Care, Version 8, or SoC 8. The group, which had met every couple of months since the spring of 2023, wanted to know what the process of assessing pediatric patients seeking gender-transition interventions looks like in practice.

Here are the members of the task force:

“There may be barriers to the recommendations that we come up with and then make recommendations for training, qualifications and access to care,” Dr. Deutsch said of the task force’s efforts. “So we see this as sort of a companion document to the SoC 8.”

The panel was held a year after WPATH secretly capitulated to pressure from the American Academy of Pediatrics, the Trevor Project, and a Biden health official to remove the age limits in the SoC 8, which was published in September 2022. At the 2023 conference, Dr. Deutsch, whether she knew the truth or not, effectively glossed over why the age limits were removed when addressing the subject.

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A large study of health data on Finnish youths who sought care from gender clinics has found evidence that its authors suggest challenges the prevailing claim that gender-transition interventions are tied to improvements in mental health. The study found that the use of specialist psychiatric care—a general, if imperfect, indication of serious mental health problems—increased dramatically among those adolescents and young adults who underwent gender-transition interventions.

Among such youths, the proportion who had appointments with specialist psychiatrists prior to attending the gender clinic, compared with the proportion who had such appointments during later years, surged: among natal males, from 10 percent to 61 percent; and among natal females, from 22 percent to 55 percent.

The study, published Saturday in Acta Paediatrica, included data on nearly 2,100 Finnish people who first sought care from a gender clinic before age 23 between 1996 and 2019. Thirty-eight percent …

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I obtained near-exclusive access to these videos after Alabama’s attorney general, Steve Marshall, subpoenaed them and a federal judge unsealed the lot last year. The videos include USPATH’s 2021 and 2023 conferences, WPATH’s 2022 conference, and a 2023 WPATH conference devoted to training care providers.

I’ll be posting links all of the videos I publish here:

After spending months reviewing over 130 of the videos that concern the care of minors who identify as transgender, I reported my findings in a feature article for Compact magazine on Wednesday. I encourage you to read that piece, which charts how WPATH responded to a mounting political backlash against gender-transition interventions for minors by doubling down and trying to manage the message. (Kindly comment on and share my thread about the Compact article on X.)

I hope you’ll consider supporting my efforts to make public—and put into context—these fascinating and edifying historical documents by becoming a paid subscriber to my Substack. This project demands an extraordinary amount of time and energy. Thanks very much.

My Compact article opens with an account of a rousing speech Mr. Strangio gave at USPATH’s virtual conference in November 2021, the full video of which is posted above. The speech was entitled “Criminalizing Trans Bodies and Medicine: a Look at the Pivotal Next Year in Trans Advocacy.”

At that moment in history, the transgender movement stood at a critical precipice. During 2021, Arkansas had passed the first state ban of gender-transition interventions for minors—a harbinger for what came next as Republican legislatures in other states geared up to do the same.

In his address, Mr. Strangio, who is a transgender man and the co-director of the ACLU’s LGBT & HIV Project, called upon USPATH members to rise up and fuse trans activism with their work as care providers.

The speech serves as a remarkable time capsule, revealing Mr. Strangio’s various absolutist stances: demanding transgender inclusion in sports and opposing engaging with critics—positions that he would wind up walking back (and in the case of calling skeptics transphobes, would claim he never held) by the time of his December 2025 sit-down with The New York Times’ Ross Douthat.

“This is an all-hands-on-deck moment,” Mr. Strangio said at USPATH 2021. Referring to pediatric gender-transition interventions, he continued: “We need people testifying in every state legislative hearing in 2022, to make clear that this is care that is effective, that it is safe, that it is important and that it is provided pursuant to protocols—that banning it, which is fundamentally unlike how medical care is treated in every single other context, is inappropriate and deeply harmful, not only to our trans community, not only to your patients, not only to my clients, but to the practice of medicine.”

(Mr. Strangio failed at this point to note that abortion was treated with similarly draconian legislative restrictions. And yet, a few minutes later, he compared the backlash to pediatric gender medicine to “entrenched backlash that we see to abortion.”)

Looking to the uncertain future, Mr. Strangio asked the USPATH crowd, “Are we on the verge of moving towards increased gains in law and policy and public discourse? Or are we about to be set on a trajectory of defensiveness and loss?”

“I would say 2022 is probably going to be the year that determines the trajectory of the next 10 to 15 years,” he said, in a prediction that now seems wholly accurate. “Because if we end up in a situation where five to 10 bills criminalizing care for trans minors pass, it may be that we spend the next 40 years trying to undo that rather than moving the ball forward.”

Perhaps the most remarkable moment in this speech was when Mr. Strangio appeared to dismiss sex-based differences in athletic competitiveness—contradicting what he told Mr. Douthat four years later. (More specifics on that contradiction below.)

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A spurious specter of suicide?

In his speech, Mr. Strangio repeatedly characterized the burgeoning legal attacks on the transgender movement as posing an existential threat to transgender youth in particular.

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Past the conference’s tightly sealed doors, conservative lawmakers had escalated their attack on pediatric gender medicine during the previous two years. This swift and decisive backlash was driven by the accusation that this care field’s practitioners egregiously deferred to the whims of children when prescribing irreversible, body-altering and potentially sterilizing medical interventions.

Amongst friends who were effectively sworn to secrecy about his speech, Dr. Baker advised that WPATH members keep from the public the fact that, in his words, “we all support trans kids in the driver’s seat” when it came to minors receiving gender-transition interventions. This wasn’t a fact that the Average Joe was prepared to hear, he said, given “they are very scared by the idea that young people are making irreversible decisions and that no one else has any oversight over those decision.”

Dr. Baker’s admission is but one of myriad remarkable revelations about WPATH and the wider field of pediatric gender medicine now coming to light due to a subpoena that Alabama’s attorney general, Steve Marshall, filed in a federal lawsuit over that state’s ban on gender-transition interventions for minors. Mr. Marshall’s legal maneuvering ultimately led a federal judge to unseal a trove of nearly 500 USPATH and WPATH conference videos, spanning 2021 to 2023.

I subsequently obtained the lot of those recordings and covered them in detail for Compact magazine. I am now beginning the long process of publishing the 130 videos pertaining to pediatrics, along with my analysis. (Subscribe to receive each video as I publish it over the coming weeks and months.)

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The uncovered video of Dr. Baker’s speech provides an invaluable window into how WPATH, which has become increasingly secretive in the face of burgeoning political opposition and attacks, has sought to reframe the truth about pediatric gender medicine. Warning of the “creeping trend of fascism,” Dr. Baker instructed conference attendees to avoid making certain empirical claims, to simplify or omit inconvenient truths, and to tailor their language to avoid pitfalls that would invite further backlash.

Dr. Baker is currently the senior advisor for health policy at the LGBTQ-focused nonprofit the Movement Advancement Project. At the time of his 2023 USPATH speech, he held a similar position at another LGBTQ nonprofit, the Whitman-Walker Institute.

He was the lead author of one of just two systematic literature reviews to have been published from the much larger collection that WPATH commissioned from evidence-based-medicine experts at Johns Hopkins University, where he received his PhD in 2021. The paper, published in 2021, examined the impact of cross-sex hormone treatment on psychological outcomes and included in its analysis three studies about adolescents.

Among the more astonishing moments in his speech was the point when Baker theatrically mocked concerns about the potential long-term impacts of puberty blockers, as addressed by a 2022 New York Times article. He dismissed this as “concern trolling, both-sidesing.” He quipped, “You can just feel the pearls being clutched.”

This Substack features greater details from Dr. Baker’s speech, which is published in full at the top of this page.

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The speech

Following an admonishment that recording and photography were forbidden, Dr. Baker opened his speech by referencing the sour state of political affairs that the transgender movement faced. “I’m hopefully not going to be too much of a downer because, you know, as you know, there’s some stuff going on out there in the world,” he said. “We are in the middle of an unprecedented explosion of hatred directed at our communities.”

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I have a major feature article out in Compact magazine today: “How Gender Medicine Set Itself Up for Disaster.” It is based on the nearly 500 videos I obtained of 2021 to 2023 conference videos from the World Professional Association for Transgender Health (WPATH) and its U.S. offshoot, USPATH.

I write in my article: “This catalogue, which WPATH fought to keep shielded, provides a rich account of how leading figures in pediatric gender medicine approached scientific research, drove the evolution of medical practices, and strategized politically during a critical turning point in this field’s brief and tortured history.”

I hope you’ll read it and will share it widely and share my X thread about it.

This particular Substack acts as a companion piece to my Compact article. In it, I have placed clips from all the conference videos I quote or specifically reference in the article. Those clips are compiled in full in the video above. And each individual clip is published in order below.

My plan is to publish the most notable WPATH conference videos in full during the coming weeks and months. These videos provide invaluable insights into this influential and secretive organization.

So I hope you’ll consider subscribing me and supporting me in this effort. Reviewing and cataloguing these conference videos has been an extraordinary, months-long effort.

Bookmark this page, because as I publish the conference videos in full, I will paste links to all them here.

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Chase Strangio

“Kids are going to die.”

Chase Strangio

These bans are just “an entry point” to “banning care for all trans people.”

Chase Strangio

“Impossible for us to survive.”

Maddie Deutsch

Don’t reference too many potential harms of treatment in public-facing materials.

Jamison Green

“WPATH doesn’t function as an advocacy organization.”

Natasha Johnson

“This suggests that parents’ feelings should not be prioritized over the youth’s experience.”

Ren Massey

Introducing the specter of a CPS call.

Scott Leibowitz

SoC 8 is “more of a gold standard.”

Florence Ashley

Doctors required referral letters ““to essentially cover their ass.”

Amelia Brewer

“One session may be sufficient.”

“Embodiment goals”

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Dianne Berg

“This really concerns me.”

Johanna Olson-Kennedy

“If you want breasts at a later point in your life, you can go and get them.” (2018 undercover video)

Olson-Kennedy

“If you were to google my name…”

Olson-Kennedy

“That’s actually not the discussion that I’m interested in participating in.”

Olson-Kennedy

12-month data

Olson-Kennedy

“We want to prioritize publishing.”

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Olson-Kennedy

FOIAs

Briahna Yuodsnukis

Sexual satisfaction study.

Joshua Safer

“There are no plans with any of the guideline groups to do more than recognize that tension, to say out loud that the age-based criteria are just very, very rough guidance.”

Leibowitz

Acknowledging the “risks associated” with “including or not including age minimums.” Making claims about using Delphi.

Geolani Dy

OHSU performed vaginoplasties on minors.

Leibowitz

“I’ll just adopt.”

Sean Moundas

“Adultism bias.”

Simona Giordano

“Ageism is unethical.”

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Leibowitz

“Can every adolescent appreciate the lifelong implications of their decisions?”

“How emotionally mature is the young person for their age in terms of their decision-making capacity?”

“Respecting human rights is just as important as the evidence base.”

Deutsch

“The work we do is important.”

BerlinRosen

“Blanket restrictions or limitations on care based on age are really arbitrary.”

Kellan Baker

“I love a good trans agenda.”

“I’m going to go ahead and call bullshit on this whole thing.”

“I think we all support trans kids in the driver’s seat.”

I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News and The New York Sun. I have also written for theWashington Post, The Atlantic and The Nation. Follow me on Twitter: @benryanwriter and Bluesky: @benryanwriter.bsky.social. Visit my website: benryan.net

The American Medical Association has sought to walk back the assertion it made last month that the organization was generally opposed to minors receiving gender-transition surgeries. In service of this about-face, the AMA’s board chair on Thursday claimed that The New York Times in particular had misstated the organization’s position on the matter in its reporting.

However, The New York Times on Friday published the full statement that the AMA provided to the paper’s reporters in February. The statement supported the veracity of its reporting on the AMA’s position on youth gender surgeries.

The AMA has offered no evidence to back up its claims that it was misquoted on the matter and that it has consistently supported youth gender surgeries.

The slow-simmering imbroglio began on February 3, when the American Society of Plastic Surgeons released a policy statement, long in the coming, in which the medical society advised its members against performing gender-transition surgeries on patients younger than age 19. The evidence base was too weak and the potential consequences too great, the ASPS concluded.

The statement came just days after a young woman in New York state received a $2 million jury award after suing her plastic surgeon and psychologist for malpractice over the gender-transition surgery she received at age 16. I covered the trial for The Free Press:

The Free Press

A Legal First That Could Change Gender Medicine

Fox Varian had a turbulent childhood. Her parents split when she was 7, triggering a three-year custody battle that ultimately saw her estranged from her father. She suffered from a constellation of mental health problems, including depression, anxiety, and social phobia. She was diagnosed with autism and bounced around various schools. Her first period sent her into a meltdown, and she battled disordered eating and body-image issues. By mid-adolescence, she was completely lost…

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4 months ago · 376 likes · 741 comments · Benjamin Ryan

Later on February 3, The National Review ran a story in which it quoted the AMA’s response to the ASPS’s position:

The AMA said in a statement to National Review that because “the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement . . . the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

The AMA supports “evidence-based treatment,” including other types of gender-affirming care for minors, the organization added.

The next day, The New York Times ran its own story, “Doctors’ Group Endorses Restrictions on Gender-Related Surgery for Minors,” in which it stated:

The American Medical Association said in its own announcement that it continued to support treatment for minors seeking gender-related care. But given the sparse research on the risks and benefits of surgical procedures, it concurred with the plastic surgeons.

“In the absence of clear evidence, the A.M.A. agrees with A.S.P.S. that surgical interventions in minors should be generally deferred to adulthood,” the statement said.

On February 10, STAT News ran a story on the subject, “Did the AMA change its position on surgery for transgender minors?” It cited the AMA’s position as such:

[T]he American Medical Association told some media organizations last week that “surgical interventions in minors should be generally deferred to adulthood.”

…

“The AMA supports evidence-based treatment, including gender-affirming care,” reads the comment, which was not published on its site or attributed to any of the group’s leaders. But it goes on to call the evidence for surgery on minors “insufficient” and says that, “in the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

On February 24, published an editorial in the Times entitled “Medical Associations Trusted Belief Over Science on Youth Gender Care.” He wrote:

[T]he American Medical Association — which has long approved of such procedures — announced that “in the absence of clear evidence, the A.M.A. agrees with A.S.P.S. that surgical interventions in minors should be generally deferred to adulthood.”

Mr. Singal stated in his editorial that the A.M.A. would not grant him an interview.

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Finally, on March 16, the Times ran an article, “In Tense Meeting, Mehmet Oz Pressed Medical Societies on Trans Care for Teens,” that referred back to its reporting from the previous month:

The American Medical Association has since announced a shift in its position, hedging its guidance on surgery for minors: “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood,” the group said last month.

The A.M.A. did not mention nonsurgical interventions, saying only that the organization “supports evidence-based treatment, including gender-affirming care.”

An about-face, and an accusation absent evidence

In a startling turn of events, the AMA on Thursday published a “Board Newsletter” stating that, contrary to multiple news reports, “AMA policy on gender-affirming care is unchanged.”

The statement continued: “Our recent response to questions about ASPS’s position statement was intended to preserve—not diminish—access to gender-affirming care, and to clarify and reinforce what our policy has long reflected and standards of care. The AMA supports gender-affirming care as medically necessary per our policy.”

Nowhere in the AMA’s new statement did it put into plain language that, in fact, the organization did support minors’ access to gender-transition surgeries in particular. It just relied on the more general language of supporting “gender-affirming care”—a term that can encompass puberty blockers, cross-sex hormones and surgeries, as well as other non-medical interventions, such as honoring a new name or pronouns.

The AMA stated that its leadership had been aware since January that the ASPS was apparently preparing to declare publicly its opposition to gender-transition surgery. So its board chair convened the organization’s executive committee to discuss and prepare a potential response. Their plan was to only provide that response if they were contacted by media outlets asking for a reaction to the ASPS’s public position.

News outlets, the AMA asserted, had in turn misquoted the organization when they reported that the organization sided with the ASPS in opposition to minors receiving gender surgeries. “While some media coverage characterized this as agreement with the ASPS statement,” the board newsletter stated, “that phrasing did not come from the AMA. Unfortunately, how reporters frame their stories is beyond our control.”

The AMA faulted the Times in particular, asserting: “In recent days, AMA communications to the New York Times have requested a correction on their part to reflect the actual language the AMA used in response to their inquiry. Additionally, a letter to the editor has been submitted requesting a public correction—this was neither a policy change nor was it an endorsement of a position taken by another medical society.”

All this raises the question: If The New York Times so glaringly misstated the AMA’s position on youth gender surgeries on February 4, 10 and 24 and March 16, why would the organization wait until March 26—over seven weeks after the original article—to object?

I contacted Mr. Singal for comment. He referred me the statement he made on X on Thursday. He said: “I spoke with a press person at the AMA to try to set up an interview as I was working on my column, which references the NYT piece at issue. He said he’d try to find someone. Then total silence and no response to a followup email. AMA had every opportunity to dispel confusion.”

I contacted the Times communications team for comment. They ultimately referred me to a statement they published Friday afternoon. In includes the full, original statement that Joshua Zembik, the AMA’s chief communications officer, provided in February. It read:

Our colleagues at ASPS concluded that the evidence supporting gender-related surgery in minors is insufficient and of low certainty. The American Medical Association respects the expertise and dedication of surgeons who care for patients every day. The AMA supports evidence-based treatment, including gender-affirming care. Currently, the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement. In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.

This text precisely matches what The National Review, STAT and The New York Times all reported. This refutes the AMA’s claims that it was misquoted and makes evident that it did indeed publicly state its opposition to minors receiving gender surgeries.

The Times defended its reporting, stating that the paper “has received no requests to correct, clarify or update our articles from the A.M.A. After the board chair’s comments, Times reporters also confirmed with the A.M.A. spokesperson that the statements reflected in our previous reporting remain accurate in reflecting the association’s stated positions. The board chair’s claims are not based in fact, and are in contradiction to both the association’s own statements provided to The Times.”

I contacted Mr. Zembik multiple times, including to ask for his response to the Times’ statement. He did not reply to my emails.

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On March 27, ran a credulous article in her Substack that failed to ask why the AMA waited so long to correct supposedly erroneous quotes regarding its position on youth gender surgeries.

Erin In The Morning

The Largest Physician Organization In The US Reaffirms Gender-Affirming Care Is Medically Necessary

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2 months ago · 578 likes · 19 comments · s. baum

On Bluesky, transgender advocates, who routinely demonize the Times on the left-wing social-media site, reveled in what they assumed was the paper’s folly. This included Harvard Law School clinical instructor and transgender activist Alejandra Caraballo, who asserted: “The NYT purposefully mischaracterized the position of the AMA to make it seem like they changed policy.”

Ms. Caraballo, who wields a powerful influence on social media, was centrally responsible for a storm of misinformation about Britain’s Cass Review, which was published in 2024.

Dr. Jack Turban, a child psychiatrist at the University of California, San Francisco and prominent advocate of gender-transition interventions for minors, stated: “The New York Times really needs to get it together. This is disgraceful reporting.”

After the Times published its defense of its reporting on Friday afternoon, Ms. Caraballo doubled down, claiming absent evidence that it was the Times that was doubling down.

This is the last of my series of articles going into depth about the historic detransitioner lawsuit that reached a $2 million verdict in White Plains, New York, at the end of January and that I covered for The Free Press. Given I was the only reporter to attend the entire trial, and given the records, including the transcripts, are sealed, my notes are the only way for the public to learn about the finer details of this important case.

In this piece, I’ll be examining the expert-witness testimony by Dr. Joseph Serletti, a plastic surgeon who testified on behalf of the defense and who is the chief of plastic surgery at Penn Medicine in Philadelphia.

To recap, the trial concerned Fox Varian, 22, who sued her long-time psychologist, Kenneth Einhorn, and plastic surgeon, Dr. Simon Chin, for malpractice for their respective roles in the gender-transition mastectomy she underwent at age 16. Ms. Varian had only first mentioned she might have a transgender identity a bit over a year before the December 2019 surgery. And she had only begun a social transition 11 months prior.

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The bulk of the trial concerned Ms. Varian’s complex relationship with Dr. Einhorn, given he treated her for over two and a half years prior to the surgery. But the most interesting expert-witness testimony came from the contrasts between the two outside plastic surgeons who took the stand.

I previously covered the testimony of Dr. Loren Schechter, the head of the gender-affirming surgery program at Rush University Medical School in Chicago. Dr. Schechter stunned the gender world by testifying on behalf of the plaintiff, given he is the president-elect of World Professional Association for Transgender Health. And he further threw people for a loop by asserting on the stand that WPATH’s widely referenced trans-care guidelines, which the organization boldly entitles The Standards of Care (much to the irritation of the judge in this case), were not, in fact, the legal standard of care—at least where this case about pediatric gender-transition surgery was concerned. (For more on this apparent incoherence, I recommend a new essay in The Dispatch, by Joseph Figliolia, a very wise policy analyst at the Manhattan Institute.)

Dr. Serletti struck a striking contrast to Dr. Schechter in his C.V., manner and delivery alike. Both men were highly educated and accomplished in their shared field and had published widely. But unlike Dr. Schechter, who had published widely about transgender medicine in particular, Dr. Serletti has not published any papers about the field. Nor is he a member of WPATH. Despite this—or, I was inclined to wonder, perhaps because of it—Dr. Serletti was dramatically more eager to perform mastectomies on minors than Dr. Schechter. Whereas Dr. Schecter said that no more of 2 percent of his gender-transition-surgery patients were minors, Dr. Serletti reported that the overwhelming majority of the approximately 100 so-called top-surgeries he’d performed in a recent four-year period were on patients under age 18.

Dr. Schechter also came across as more grounded, confident and stalwart than Dr. Serletti, who had a more uncertain demeanor, appeared befuddled at times, and wavered under intense cross-examination by Ms. Varian’s attorney, Adam Deutsch, a partner at the White Plains firm Fiedler Deutsch. Dr. Serletti, however, got paid considerably more: $1,000 per hour to Dr. Schechter’s $650, plus $5,000 for his day in court. Usually, the jurors observed the trial impassively, but in response to this particular disclosure, one of the jurors looked quite agape.

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