Maintenance Phase - BONUS： Breaking Down The Latest Anti-Trans Victory Lap

00:00:00.000 do you have a tagline no i was that's part of the reason why earlier i was like do you have a tagline

00:00:16.220 wait you should do your sass report one do your sass report one why would i do it again

00:00:22.600 we gotta stop keeping our little outtakes because now we can't use our like b grade

00:00:29.920 our b list taglines hi everybody and welcome to maintenance phase the podcast that has its

00:00:35.020 notifications turned off on social media after this week's episode oh yeah we did hear from

00:00:41.820 the anti-trans brain trust as well as the smoothie truthers thank you for your feedback

00:00:48.060 so this this is like some somewhere halfway between like a bonus episode and like an episode

00:00:54.940 episode oh i i feel really bad that like we we sort of shortchanged the cast report in our rapid

00:01:00.480 onset gender dysphoria episode because we wanted to focus on the way that this specific narrative

00:01:06.080 has like taken over all these institutions of the u.s and the uk so that's what we focused on

00:01:10.400 in the cast report but of course the cast report is like 400 pages long listening back to that

00:01:14.560 episode i was like we went really easy on the cast report like i think we tried to get across

00:01:19.320 how like it's basically just like a a smorgasbord of anti-trans talking points but it's also just

00:01:25.300 like fairly bad on other things and it includes a lot of other just sort of bullshit and so we

00:01:30.020 wanted to break this out and do like its own little episode also i have covid and i feel like 0.81

00:01:34.380 shit bloody i don't know how detailed this is gonna be because i'm very tired and my throat

00:01:39.760 is sore but we're gonna do our best we're gonna read a bunch of uh excerpts i'm mostly gonna 0.98

00:01:44.500 make aubrey read them because her throat works not to brag but my throat works so again i mean

00:01:52.560 i guess we should preface this by just saying like if you're not on like fighting about transphobia

00:01:56.720 twitter you may not have seen the the release of this report this is yet another one of these like

00:02:02.080 smoking gun victory lap things that transphobism is doing this is this was the thing that inspired

00:02:07.860 jk rowling to be like i will accept an apology from daniel radcliffe and emil watson which like

00:02:15.320 they have in no way offered at any time i will accept a bottle of mccallan 12 yeah sure ma'am

00:02:24.060 we're all just putting shit out there the reason i wanted to go through this like kind of darkly

00:02:29.400 funny pattern in the episode was that this always happens there's like this thing comes out and 0.99

00:02:35.060 there's like this whole victory lap by all the anti-trans brain trust and it's like the smoking

00:02:39.200 gun we finally proved it and then there's more scrutiny of the thing that came out and it's like

00:02:43.340 this doesn't actually prove it and like that's essentially what's happened with the cast report

00:02:46.940 is like it comes out they do this massive victory lap the entire uk media just like goes ballistic

00:02:51.380 it's finally proven and then people are like wait a minute in appendix eight it says only 10 kids

00:02:56.180 detransitioned right and it they're not actually presenting any evidence and then since it came

00:03:01.080 out, there's been a lot of like more academic dissections of like its use of evidence and the

00:03:07.200 way that it's presenting the existing, like all that we know about like puberty blockers and

00:03:11.560 hormones and stuff. And so we're now at the place where like now that we have a clearer picture,

00:03:16.360 it's like, oh yeah, this is pretty clearly, I mean, people, people are very reluctant to conclude

00:03:21.720 this, but it feels very clear to me that this is like a moral panic document that is produced by

00:03:26.480 a government that is in the throes of a moral panic. And also just like, hello, an outsider

00:03:31.000 perspective from the US, I will say, listen, our house is not in order on trans stuff. I will start 0.75

00:03:38.480 there. And also looking in to the UK, it is absolutely bananas to me how mainstream it is

00:03:49.200 to be like, but trans people aren't who they say they are. I think there's a weird dynamic here 0.81

00:03:54.500 where it's like, it's impossible to say like, which country is worse? Because I think our

00:03:58.220 right wing is more extreme than like the tories like the republicans are much worse than the

00:04:03.180 i think but also we don't have a bipartisan consensus yeah that this form of care is like

00:04:10.220 fundamentally illegitimate and so that is what they have there but they have they don't have

00:04:15.020 laws that like if you provide gender affirming care you go to jail they don't have that yes we

00:04:20.720 do the issue here is like who claims centrism yeah yeah and in the uk i mean like keir starmer

00:04:26.860 who's the leader of the labor party just got on board with like bathroom bans basically exactly

00:04:32.920 so i mean we could spend another hour on this but in the interest of saving my throat i gotta watch 0.84

00:04:37.240 it on my fucking tangent i know that both of us for the first time ever we don't have time for 0.97

00:04:41.600 six hours of the same joke we have to actually fucking watch it the clock is ticking of how 0.95

00:04:46.680 much i can actually talk wait did i tell you i can't remember if i've told you what you just 0.89

00:04:51.800 said i gotta watch it on my tangents but it's funny all right give it to me give it to me

00:04:58.380 i'm enabling you i'm an enabler my dad wears hearing aids and every time i walk into his

00:05:05.520 house the first thing i see is him reaching up to turn down his hearing aids i wish it were a joke

00:05:13.460 it is so not a joke and i've talked to him about it and he's like i gotta do it he's like here's

00:05:18.920 here's my little biological sound machine my daughter at one point he was like i don't have

00:05:23.160 a lot of hearing left i gotta you gotta save it i'm going to rob you of your hearing yeah he's

00:05:30.120 like i'm saving this for youtube i'm not gonna waste this on my daughter hopefully that was

00:05:33.500 worth it tangent okay okay okay back i'm done now it's never happening again so in this episode

00:05:40.120 we are going to dive more into the report itself before we do very quickly we're just going to talk

00:05:46.920 about like the process by which the cast report came about hey we actually i just thought of a

00:05:53.660 tangent but i'm not gonna do it this is gonna be like the boulevard of broken dreams episode just

00:05:58.400 like so it's gonna be really hard i feel like we're gonna end up announcing every time i know

00:06:02.920 i hate to do this but yeah so the process itself is like kind of a little bit part of this moral

00:06:11.880 panic essentially there had been all these media reports of like all these kids are going to gender

00:06:16.260 clinics and like it's a big fake gender confusion thing essentially there's all these rumors and

00:06:21.140 eventually the nhs under all this pressure in 2020 was like okay we'll commission a review

00:06:27.000 if you read the original terms of reference for the cast report it's basically supposed to be

00:06:32.500 somebody investigating like it's a little fishy why there's so many referrals all of a sudden why

00:06:38.120 there's this like increase in referrals but that's not really an nhs question that's more like a

00:06:42.660 societal question, right? Like, why are so many more people identifying as trans, right? And it

00:06:47.340 does throw in, it's like, you also need to look at whether or not they're being rushed through

00:06:50.960 procedures. But that is the central question, right? Because as we've discussed, the fact that

00:06:56.320 more people are identifying as trans, unless you're a just straightforward bigot, there's

00:07:00.740 nothing wrong with more people identifying as trans. So to me, the sort of the poison pill 1.00

00:07:05.900 was like the entire mandate of this investigation, because it's basically being asked to speculate

00:07:10.840 why are so many more people coming into this clinic and that's what a lot of the cast report

00:07:14.900 spends its time on this is another one of those moments where i'm like again people are just

00:07:19.860 telling on themselves so hard it comes up in trans stuff all the time it also comes up in fat stuff

00:07:26.560 all the time which is just like there's gonna be so many of them yeah yeah like ergo there is a big 0.99

00:07:32.220 problem there's just like more of a kind of person it's like your dad's hearing aid thing it's like 1.00

00:07:37.440 we've already spent our minority points on like gay people we can't have this new minority 0.77

00:07:41.960 so to me one of the main red flags is this kind of terms of reference but then there's all kinds

00:07:47.980 of other red flags in the process of creating the cast report so first of all the fact that

00:07:53.040 dr hillary cass has not like she's not a trans physician this is seen as an asset the fact that

00:07:58.640 she has no actual subject matter expertise oh she's a real washington outsider yeah i mean this

00:08:03.420 is this is from the cast review website it says given the increasingly evident polarization among

00:08:09.240 clinical professionals dr cass was asked to chair the group as a senior clinician with no prior

00:08:14.460 involvement or fixed views in this area so this is again the sort of resorting to conspiracy

00:08:20.940 where it's like well you know everyone who does this kind of care is like fundamentally

00:08:25.080 illegitimate right and they're biased so we have to go to somebody outside this is a thing that

00:08:31.000 comes up in politics quite a bit. I know I've yelled about it on the show before, so I'll keep

00:08:35.620 it short. The idea that it is an asset to have someone who has zero experience is not a thing

00:08:42.360 that you would stand for in a surgeon or a pilot. Yeah. And also, I mean, you know, as a totally

00:08:48.240 abstract principle, the idea of bringing in somebody independent to try to give some sort

00:08:53.660 of impartial adjudication in principle makes sense, I guess. I still think it's a little bit

00:08:59.160 iffy when we're talking about like technical health fields. But then what you would do in

00:09:02.660 that case is you would have a really transparent process, right? We're bringing in this person who

00:09:07.240 doesn't know anything. And so we're going to link them to every single expert. And we're going to

00:09:11.300 have them make sure that they hear the best arguments from everyone, right? So you sit down

00:09:15.440 with trans healthcare providers, you sit down with these parents, sure, fine, right? You hear

00:09:19.000 from everybody. And then you look at which side of this debate has evidence and which side doesn't,

00:09:23.120 right? That would be a fine process. But the problem with the cast report is that there's

00:09:27.200 no transparency about the process. The most egregious example of this is that it's not clear

00:09:32.120 how much CAS engaged with the actual clinicians at the clinic at the heart of this investigation.

00:09:38.160 Yeah. Like there's something really weird about the fact that, you know, we have this audit

00:09:41.900 as appendix eight, which lays out all the numbers, but we have no context for those numbers. So like

00:09:47.040 why did only 25% of kids get care? Right. And this is in keeping with the entire framing of

00:09:53.420 the report as people who do this care are fundamentally biased and illegitimate and

00:09:59.820 not worth engaging with. As we've said, this is a small field and they're not treating that many

00:10:05.440 patients. You could interview every single person who's providing this care in the UK. It would not

00:10:09.620 be that hard. So that's like the first, like beyond red, like bright red, like magenta flag.

00:10:16.000 and the second issue is the nature of the engagement with actual trans people so we do know

00:10:24.660 that hillary cast met with like pro-trans groups like mermaids and there's other ngos that work

00:10:30.800 with trans youth in the uk so they have not been completely cut out of the process although we have

00:10:35.320 heard from some of the people who were in these quote-unquote listening sessions who say that

00:10:38.880 they're like poll quotes and their messages were like taken out of context and included in the

00:10:43.320 report or basically that what they said was ignored was there a through line with those

00:10:47.820 comments was there like a theme of people being like they didn't include this and i said this

00:10:52.140 thing like was there was there alignment in the this thing yeah so basically it was a bunch of

00:10:56.780 people who said you know i told the cast review positive things about my own transition and

00:11:03.240 positive things about my care and they took my words and used them as ammunition for this care

00:11:09.620 being given out too easily so here i saved one of them these are these are what's known as pull

00:11:14.900 quotes it's like when you have one of these pdf documents it's kind of nicely laid out you have

00:11:19.760 these larger font quotes that are sort of highlighted as like one of the core messages

00:11:23.980 so just imagine you're seeing this like with no context at all that is what i am seeing oh yeah

00:11:30.900 good point i am imagine not knowing the name and circumstances of the person who's saying this

00:11:37.700 there's not only one route or one set way to transition or to be trans they might want just

00:11:45.640 hormones or just surgery people are different with different experiences presentations and bodies

00:11:50.320 it's fine for that to be the case it's okay to have different plans for your medical transition

00:11:55.760 yeah i mean sure i don't know different people are different yeah so okay then i'm going to send you

00:12:00.560 this is from a very interesting article that comes out afterwards called critically appraising

00:12:04.540 the Cass Report, Methodological Flaws and Unsupported Claims. While it seems that this

00:12:09.540 participant is advocating for increased availability of care options for trans people,

00:12:14.160 this quote directly informs the section, which suggests, quote, it is important to inform people

00:12:19.940 that medical transition is not the only option and that choosing not to go down that route

00:12:24.960 does not invalidate their identity. The report then reframes this response as evidence for the

00:12:31.340 need to reduce the number of medical transitions. Again, they're implying that people are being

00:12:35.940 pushed into medical transition, right? As if that's the only option when they've provided

00:12:40.760 no evidence of this being the case. Again, 75% of people who went to this UK gender clinic

00:12:45.460 did not get puberty blockers or hormones. So we already live in a world where people are not being 0.89

00:12:52.300 pushed into this kind of care and are not being told the only way that you'll ever be happy is

00:12:56.940 is if we medicalize you. That's not happening. This is so similar. The rhetoric here feels so

00:13:02.640 similar to the rhetoric around crisis pregnancy centers. Yeah, yeah, yeah. Oh, totally. You got

00:13:06.380 to go in and hear someone tell you and show you pictures and do all of this stuff to make you feel

00:13:12.800 even worse about an already complicated decision. Also timeshares. It's also how they get you to

00:13:19.040 buy timeshares. I just want to sit down with you for one hour. I just want you to know this is not

00:13:24.220 your only option it's really an investment you could have a timeshare there is like on one side

00:13:30.320 of this there's problems with the process of consulting trans people that the way that the

00:13:35.340 quotes are used is just kind of odd in the report but then there's also we don't know who else was

00:13:40.240 consulted for this so there's no information about who wrote the cast report there's no information

00:13:46.600 about which other groups they sat down with they do include on the website of like yes we sat down

00:13:52.000 with these like pro-trans groups. But I think they're doing that as like a box-ticking exercise

00:13:56.220 to prevent criticism because they know trans people are immediately going to look through

00:14:00.820 this and be like, wait a minute, did they talk to trans people or not? And they can point to this

00:14:04.180 and be like, look, we did. We did. Even if none of the things that trans people told them are

00:14:08.100 actually in the report substantively. And we know from Aaron Reid's reporting that they met with

00:14:13.380 this board in Ron DeSantis' Florida that put together this deranged quote-unquote evidence

00:14:19.780 briefing that informed the ban on gender affirming care in florida which they did not announce 0.99

00:14:24.000 right so we only get that from the fucking weirdos who are sitting on this board are like oh yeah i 0.94

00:14:30.320 also met with hillary cass that's not normal for for a report like this i really appreciate that 0.98

00:14:36.100 you call it ron de santis's florida i'm doing for our uk listeners i'm doing like do you think our 0.55

00:14:43.060 uk listeners know who ron fucking de santis is yes they absolutely do because of his little shoes 0.84

00:14:48.720 oh god because of his little shoes his little shoes i just was like you said it and i was like 0.94

00:14:53.160 oh it's like tyler perry's why did i get married tim burton's a nightmare before christmas yeah

00:14:58.160 yeah that's right stephen king's apt pupil

00:15:01.000 i'm trying to look i only got like 40 minutes of throat left i'm trying to get as much out as i can

00:15:08.300 i'm just i'm not tangenting i'm just inserting jokes so the first section of the cast report

00:15:16.140 is like the context, the context of the United Kingdom. So the main problem with this whole

00:15:21.360 section is that this is basically supposed to be telling the history of gender affirming care

00:15:26.120 for kids, right? Roughly what we went over in our first rapid onset gender dysphoria episode,

00:15:30.700 like the Dutch clinics, et cetera. But then over and over again, it keeps casting the gender 0.89

00:15:36.180 clinic in the UK, the Tavistock clinic. It keeps casting this clinic as like this rogue clinic. 0.70

00:15:41.700 and so here is a longer excerpt from this section it often takes many years before strongly positive

00:15:50.720 research findings are incorporated into practice there are many reasons for this one is that

00:15:56.020 doctors can be cautious in implementing new findings particularly when their own clinical

00:16:00.180 experience is telling them the current approach they have used over many years is the right one

00:16:06.180 for their patients. Quite the reverse happened in the field of gender care for children.

00:16:11.180 Based on a single Dutch study, which suggested that puberty blockers may improve psychological

00:16:16.520 well-being for a narrowly defined group of children with gender incongruence, the practice

00:16:22.120 spread at pace to other countries. This was closely followed by a greater readiness to start

00:16:27.860 masculinizing slash feminizing hormones in mid-teens, and the extension of this approach

00:16:33.520 to a wider group of adolescents who would not have met the inclusion criteria for the original

00:16:38.320 Dutch study. Some practitioners abandoned normal clinical approaches to holistic assessment,

00:16:44.940 which has meant that this group of young people have been exceptionalized

00:16:48.620 compared to other young people with similarly complex presentations.

00:16:53.080 Some practitioners abandoned normal clinical approaches to holistic assessment.

00:16:57.780 Well, wait, did they? The whole point of this report should be to figure out whether or not

00:17:01.500 that was the case. And based on the fact that they were seeing people 14 times before giving

00:17:07.520 them puberty blockers or hormones, I think that sounds pretty holistic to me. I don't think

00:17:12.840 they're like playing Parcheesi during those 14 appointments. I think they're probably asking kids

00:17:16.900 what is going on in their lives and inquiring about like other mental health conditions that

00:17:21.000 they have. The idea that these assessments are not rigorous or holistic is completely absurd.

00:17:26.960 But again, they just say this shit. 0.99

00:17:29.560 Do we think Parcheesi has a different name in the UK? 1.00

00:17:34.120 It's probably something racist.

00:17:36.840 I learned recently that tic-tac-toe is knots and crosses.

00:17:40.600 So that is the first problem with the context section.

00:17:43.020 The second problem with the context section is what we mentioned very briefly in the Rapids

00:17:48.040 of Gender Dysphoria episode, that it doesn't mention the rise of transphobia in the UK.

00:17:52.640 Okay, so this is another excerpt from the Critically Appraising the Cass Report report.

00:17:59.040 The report fails to adequately consider the evidence of significant increases in societal

00:18:04.100 transphobia in recent years. For instance, the number of recorded hate crimes against

00:18:09.240 transgender people reached a record high in 2023, while the British Social Attitudes Survey

00:18:15.060 shows a marked decline in attitudes toward transgender people. 36% of people now describe

00:18:21.340 themselves as prejudiced against transgender people, twice as many as in 2019. Describe

00:18:27.360 themselves as prejudiced. If we're self-reporting bias, it is safe to assume that this is a dramatic

00:18:35.500 underreport because most of us don't like to see ourselves as biased or prejudiced people.

00:18:42.320 So that's the context section. Then we have a huge section of the report dedicated to

00:18:49.720 understanding the patient cohort. So this is the whole thing of like, why are the numbers rising?

00:18:55.020 So this is a very telling excerpt from this. And this is like what it's like to read this entire

00:19:00.580 section of the report. Through adolescence, peers have an increasing influence and parents

00:19:05.200 a lessening influence. Adolescence evaluation of their social and personal worth is strongly

00:19:11.000 influenced by what their peers think about them. Studies have shown adolescence to be

00:19:15.920 hypersensitive to social isolation, so much so that going along with peers in order to avoid

00:19:21.580 social risk, even if it means taking health and legal risks, might be seen as the rational choice

00:19:27.220 because it reduces the possibility of social exclusion. So this is one of those things where

00:19:31.480 it's like, sometimes teenagers will say wacky stuff just to fit in. And you're like, why is

00:19:37.860 this in a report about trans kids? First of all, they do not provide any evidence that kids think

00:19:44.840 other kids are cooler when they're trans. This is like the linchpin of their entire argument

00:19:49.700 and they don't even bother trying to prove it. Like, are there schools, are there social groups

00:19:56.140 where like, yeah, having a minority identity makes you like slightly cooler, I guess.

00:20:01.400 Is that the majority of schools in the United Kingdom in 2024? It's really far-fetched and 0.99

00:20:07.840 they're not even bothering to prove it. Secondly, we are not talking about whether kids say that

00:20:14.960 they are trans due to peer pressure. We are talking about whether kids persist in their

00:20:19.560 trans identity for years and then pursue irreversible medical treatments to confirm

00:20:25.660 that identity. That is so different than just do kids identify as trans.

00:20:32.060 More tangents. It's happening. 1.00

00:20:33.620 Tangent. Tangent.

00:20:34.540 it i had a friend in high school we were at like peak peer pressure nonsense this was like dare

00:20:39.360 era a friend of mine made like a comic strip called peer pressure girl and every comic strip

00:20:47.200 started with peer pressure girl being pressured to do something that she didn't want to do

00:20:52.280 and every comic strip ended with peer pressure girl dying from eating rat poison nice that's

00:20:59.200 good and this this really feels like a peer pressure girl kind of but where i'm like

00:21:03.460 yep we're in panic times this is something that i feel like reactionary movements do a lot is

00:21:09.380 they'll say something kind of in the abstract that's true that they're like well do you think

00:21:15.120 teens say things just to fit in and you're like well yeah yeah no you'd be a weirdo if you

00:21:20.840 disagreed with that but then once they get you to agree with that they're like well we proved it 0.65

00:21:25.040 they're saying they're trans to fit in sorry wait no no no no nothing further your honor

00:21:30.280 we rest our case you're really getting some mileage out of you re-watching perry mason 0.86

00:21:38.780 it's not perry mason it's law and order and it's hilarious and then they have an entire

00:21:45.660 fucking bizarre chapter called growing up in the 2000s where it's talking about like these these

00:21:51.620 attitude shifts among young people, where obviously young people are much more likely 0.98

00:21:55.940 to believe like there's more than two genders than older people, right? And that's something

00:21:59.400 that arose relatively recently. This is also the first section where we start to get a glimpse of

00:22:05.060 the just sort of like overall kind of weird sloppiness in this document. It makes a lot of

00:22:09.400 claims that don't even have footnotes. So this is an excerpt from another very good article called

00:22:14.000 Biological and Psychosocial Evidence in the Cass Review, a critical commentary.

00:22:17.840 In exploring the factors causing changes in patient profiles, the review asserts that, quote,

00:22:24.060 for many centuries, transgender people have been predominantly trans females.

00:22:28.160 It is unclear what evidence supports this statement.

00:22:31.580 Yeah. 0.99

00:22:32.700 Fucking yeah. 0.99

00:22:34.120 That's such a weird thing to say in your report with no citation. 0.99

00:22:37.640 For centuries now, most trans people have been trans women.

00:22:41.160 Wait, okay. 1.00

00:22:42.220 I just fucking hate it. 1.00

00:22:43.440 I just hate it. 1.00

00:22:44.580 Yeah.

00:22:44.820 In 0.8.14, the review cites Karamanis et al. as a large register-based population study

00:22:52.760 to show that trans identity is mainly determined by environmental factors

00:22:56.540 rather than having a genetic basis.

00:22:59.420 However, this study included only 67 twins,

00:23:03.320 and as such is much smaller than the numerous other studies

00:23:06.400 which did find support for heritability of trans identity. 1.00

00:23:10.180 This is just sort of janky and weird.

00:23:11.860 like twin studies are kind of infamously bad and we'll i want to do a whole episode on it 0.99

00:23:16.320 it's actively bad i mean i think the like majority of trans people have been trans women 0.96

00:23:21.460 thing ah when we were working on trans health care we had a wild ass fucking moment with the press 0.97

00:23:32.140 with um fox news actually let me hang on i feel like you're more tangenty this episode than usual 0.95

00:23:37.920 i feel like you're doing this on purpose whatever leave me alone this is worth it

00:23:42.760 let me cook do you smell what the googling is cooking what that was terrible it was really bad

00:23:52.660 that was terrible so in 2013 california and oregon instituted new regulations requiring

00:24:02.160 private insurance uh carriers to cover health care for trans people and it got a bunch of 0.95

00:24:09.540 media coverage because we were like a couple of the first states to do that and fucking fox news 0.92

00:24:15.520 picked it up oh no and i am sending you oh this is the image that they used to go with the story 0.77

00:24:21.740 oh god oh it's it's mrs doubtfire yes and it's like a scene from that movie where she's like

00:24:27.820 putting out fires on her boobs yep yes yes yes so we worked with like media matters and got a

00:24:36.400 petition up and out and blah blah blah blah like all of this sort of stuff but it was like this 0.99

00:24:40.080 is like the level of shit and that is also it feels very linked to me to like the majority of 0.92

00:24:46.780 trans people have been trans women and i'm like you're just thinking about depictions designed 0.98

00:24:52.900 by and for cis people. It'd be funny if the citation was like Mrs. Doubtfire, Tootsie,

00:24:58.320 some like it hot, start listing out. Yeah, God. Okay. So getting back to understanding the patient

00:25:05.340 cohort and like, why, why are more kids showing up at gender clinics? I really couldn't believe

00:25:10.520 what I was reading when I got to the section. So the children's commissioner's report in 2023

00:25:17.660 found that pornography is so widespread and normalized that children cannot quote-unquote

00:25:23.720 opt out pornography the average age when children first see pornography is 13 but 10 percent have

00:25:30.980 seen it by age nine the pornography that they are exposed to is frequently violent depicting

00:25:36.780 coercive degrading or pain-inducing acts younger exposure had a negative impact on self-esteem

00:25:44.920 We are going full, Andrea Dworkin. 0.97

00:25:47.780 This whole section is really fucking weird. 0.82

00:25:50.020 And I thought this was just going to be another thing where they're like, 0.99

00:25:53.160 the kids are seeing porn now.

00:25:54.640 And I'm also quite concerned with younger kids stumbling upon porn on the internet

00:25:58.920 with no context to understand it.

00:26:00.520 I think this is a thing that people are anxious about that is fair enough to be anxious about. 0.71

00:26:04.720 But then it explicitly links this to more trans kids. 0.97

00:26:09.620 So here's the next couple paragraphs.

00:26:10.940 Several longitudinal studies have found that adolescent pornography consumption is associated with subsequent increased sexual, relational, and body dissatisfaction.

00:26:21.300 Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed.

00:26:28.740 Some researchers suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content.

00:26:37.520 What?

00:26:37.780 First of all, I was going to ask what a research commentator is, but I think that might just be us.

00:26:43.680 I think that's us, given color commentary.

00:26:47.260 Some research Monday morning quarterbackers. 0.99

00:26:50.660 Some fucking dickweeds with microphones. 1.00

00:26:55.880 So this is basically just like kids are watching porn and kids are trans. 1.00

00:27:01.020 And so like we should look into it. 0.99

00:27:02.720 but there's there's at the most basic level there isn't even a fucking correlation between 0.95

00:27:09.060 like kids who were exposed to pornography earlier are more likely to identify as trans they don't 0.99

00:27:13.740 even have a fucking correlation and a correlation wouldn't prove shit they don't even have that 0.99

00:27:17.400 it's just like questions have been raised and then it has a citation of like some researchers 0.99

00:27:22.420 suggest that we should look into this and just some random fucking article of like yeah this 0.68

00:27:26.420 could be this could be a thing that's not evidence of anything yeah this is like a far right like a 0.99

00:27:31.200 christian right talking point that it's like the porn is turning them trans because the christian

00:27:36.200 right wants to ban pornography there's no basis for this whatsoever they're thinking about like 0.99

00:27:43.120 reactivating the fucking comstock act yeah they want nothing to do with pornography so if they 1.00

00:27:50.980 can link together transphobia and anti-porn bullshit and they're like weird shit about sex 1.00

00:27:56.700 workers. Great. Maybe this is too many examples. But like, I just can't get over how just openly 1.00

00:28:02.200 right wing of a document this is like, it's very openly just aping all of these conservative

00:28:07.980 messages. So here is maybe the worst thing in the entire document, which like, boy, oh, boy,

00:28:14.880 that's saying something. Yeah, maybe not. I don't know. It's hard. It's hard to have a favorite.

00:28:18.100 It's hard to pick faves. It's hard to have a favorite. I love all my transphobic excerpt

00:28:22.260 children equally. The role of psychological therapies in supporting children and young

00:28:26.320 people with gender incongruence or distress has been overshadowed by an unhelpfully polarized

00:28:32.140 debate around conversion practices. Terms such as affirmative and exploratory approaches have

00:28:39.800 been weaponized to the extent that it is difficult to find any neutral terminology.

00:28:44.840 This has given the impression that a young person can have either therapeutic interventions or a

00:28:49.780 medical pathway. The intent of psychological intervention is not to change the person's

00:28:54.820 perception of who they are, but to work with them to explore their concerns and experiences

00:28:59.520 and help alleviate their distress, regardless of whether they pursue a medical pathway or not.

00:29:05.800 It is harmful to equate this approach to conversion therapy, as it may prevent young

00:29:10.460 people from getting the emotional support they deserve. It is harmful to equate this approach

00:29:15.040 to conversion therapy why would you stick up for people who are trying to talk kids out of being

00:29:21.840 trans don't compare this to what it's trying to do it just so it just feels so transparent to me

00:29:28.620 the problem is parents being called transphobic the problem is therapy being called conversion

00:29:33.260 therapy sorry are is transphobia a problem is conversion therapy a problem it also just feels

00:29:38.760 like we are sort of in a moment with trans health care that feels like grids yeah yeah no kidding

00:29:46.100 yeah yeah yeah inverts for folks who are unfamiliar hiv and aids used to be referred to as grids

00:29:53.520 which stood for gay related immune deficiency syndrome yep and the discourse followed because 0.99

00:30:01.140 this is where the discourse was at fucking anyway to be like well then the answer is don't be gay 1.00

00:30:06.860 Yeah. It feels like we're in a similar place around trans healthcare where it's just like 0.99

00:30:10.360 people, there's a incredibly high level of like just sort of ambient discomfort.

00:30:16.140 Right. So anytime there's anything that is an excuse for people to like hit the ejector seat

00:30:20.880 and get out of there and not have to think about it, people will take that. Right. Exactly. And

00:30:25.500 this is like the cast review is just like one ejector seat button after the next.

00:30:31.380 All right. So now we are getting to the meat of the document. The ostensible purpose of the rest

00:30:39.600 of the report is assessing the evidence behind gender-affirming care. How much do we know about

00:30:45.500 whether or not this helps kids, right? So essentially, the CAS review process commissioned

00:30:51.040 the University of York to carry out seven systematic reviews of existing evidence of

00:30:55.600 various things. The ones that we are going to talk about are social transition, puberty blockers,

00:31:00.000 and hormones. I personally find this a little bit weird because there's already been a ton of

00:31:08.680 systematic reviews done. Like the American Academy of Pediatrics did its own review. WPATH did its

00:31:14.360 own review. And like, there's not that much research on trans kids. Like one of the things

00:31:20.440 that the sort of the trans skeptical side is correct about is that there isn't a huge body

00:31:25.960 of research, right? I was reading stuff about social media use and like depression and anxiety

00:31:32.340 among teenagers the other day. And there's so many studies that it's like you have to do meta

00:31:37.160 analyses of the meta analyses. It's like there's like dozens of studies. And so it helps to sort

00:31:43.780 of gather everything together and try to come to some sort of consensus. But for youth transgender

00:31:50.260 care, it is a relatively new field. And because the field was so careful for so long, I mean,

00:31:56.600 some of these clinics we're seeing fewer than 10 kids a year. So we don't have, you know, 40 year

00:32:02.540 longitudinal studies of 10,000 kids because they weren't doing this 40 years ago and they weren't

00:32:07.300 doing it on 10,000 kids 40 years ago. So we're just not going to have that kind of data right

00:32:11.060 now. But this is totally normal in medicine, right? That if we're trying to figure out if

00:32:16.620 a treatment works, we don't start by giving it to 10,000 kids and then we wait 20 years and we see

00:32:23.000 what happened, right? We start basically with anecdotes, then we give it to 100 people and we

00:32:27.440 wait like a year. You kind of zigzag your way toward a conclusion based on like larger and

00:32:33.800 larger pieces of data. And so everything that's been going on in youth transition care is really

00:32:39.620 just like that process happening. It started out with a very small number of kids. The early results

00:32:43.740 were really promising in the Netherlands. And then clinics throughout the rest of the world

00:32:47.820 were like, okay, let's try this. Let's go really slowly. Let's be really careful. This is what the

00:32:51.380 Tavistock Clinic did too. And started gathering data, started seeing kids. This is just like

00:32:56.720 medicine. Like this is developing a body of medicine, right? There's nothing inherently

00:33:00.100 like suspicious about this. I think the anti-trans movement is trying very hard to make this a debate

00:33:05.400 about like, is gender affirming care for kids perfect? Does it quote unquote work in every

00:33:11.020 single case they're trying to make that like the question that we answer but the real question is

00:33:15.760 is this care promising enough that we should continue giving it to kids and continue scaling

00:33:20.600 up appropriately i think another core question is all right you'd like more data that will take

00:33:27.460 decades what are all of the sort of trans kids and trans people and their families supposed to

00:33:33.780 do in the meantime right right like we've got to be able to walk and chew gum on this stuff a little 0.64

00:33:38.240 bit it's very funny when when like transphobes are like we want large-scale randomized controlled

00:33:42.180 trials it's like oh so we should just give it to 10 000 kids right now yeah because that's what

00:33:45.840 you need to have a large-scale study but like you guys don't want that the whole approach to me and

00:33:51.960 the sort of tenor of discourse around this stuff just feels like hit the brakes on absolutely

00:33:56.740 everything yeah exactly and like there's no real sort of grappling with yeah this is like a big

00:34:02.760 community of people who need resources and need support now yeah so like what's your actual theory

00:34:10.260 of change here what do you think needs to happen right and when you ask that question the answer

00:34:14.700 you get is uh don't call it conversion therapy but a description of conversion therapy right

00:34:20.400 again sort of on its face this seems like a completely legitimate process where for these

00:34:25.260 evidence reviews what they do is they're trying to stratify the studies according to quality

00:34:30.980 So this is something that you often see in meta-analyses.

00:34:34.560 It's like you got like, you know, 1,500 studies. 0.98

00:34:37.500 You got to like put them into tranches and be like, well, these kind of suck.

00:34:40.560 And so we can just like spend less time looking at them.

00:34:43.480 These are medium.

00:34:44.300 These are high.

00:34:45.280 Let's sort of weight the high quality ones a little bit better.

00:34:47.600 This is like a totally normal process.

00:34:49.180 And there's all kinds of objective criteria that are supposed to be content neutral that

00:34:54.560 you can use when you're determining, okay, is this high quality evidence?

00:34:58.520 Is this medium quality evidence or low quality, right?

00:35:00.460 The thing that is weird about the approach that is taken for the Cass report is, first of all, they constantly conflate the term quality with like the academic definition and the layperson definition.

00:35:15.000 So when me and you hear like this is a low quality study, we're like, oh, that means it sucks, right?

00:35:20.380 But in academia, in the context of these meta-analyses, low quality means it's low certainty.

00:35:26.480 How much can we conclude from this study?

00:35:29.540 This is the aspartame classification stuff.

00:35:32.520 Yes, exactly.

00:35:33.120 Yes.

00:35:33.320 Everybody's like, it definitely gives you cancer.

00:35:35.240 And you're like, no, they reclassified the strength of the evidence.

00:35:39.720 Exactly.

00:35:40.520 And the way that the report and Cass herself talk about the evidence is constantly using

00:35:47.700 the colloquial form.

00:35:49.440 So in the report and in interviews, Cass herself has said that this field is based on remarkably

00:35:55.460 weak evidence.

00:35:56.880 but that's not what the reviews found yeah the reviews found that most of the studies on this

00:36:02.900 are low certainty they're promising but again because they're relatively small and relatively

00:36:08.000 short we can't state for certain that they will alleviate gender dysphoria in every single kid

00:36:13.960 the the crucial pieces of context to that classification of like low quality evidence is

00:36:19.340 that first of all we know from the report that only 97 kids a year are getting hormones right

00:36:25.180 only around 150 are getting puberty blockers. So this is not being like given out like candy on

00:36:32.680 the basis of poor evidence, right? This is a field that's being extremely careful and is

00:36:38.420 continuing to gather data. And the second piece of context is that vast swaths of medical care

00:36:44.600 are given out on the basis of quote, low quality evidence all the time. Again, if you're in the

00:36:51.060 process of figuring out the the dimensions by which a treatment works and you know the treatment

00:36:56.320 is safe right it's not going to kill you you do sort of start giving it to more and more people

00:37:00.560 on the basis of the evidence that you have most if not all medical treatments are some level of

00:37:05.800 calculated risk right even when you take an advil if you're taking ibuprofen that's like hard on

00:37:12.000 your kidneys yes and you're deciding i would rather not be in pain than worry about this being

00:37:17.900 like a little bit hard on my kidneys and different people will have to make different decisions

00:37:21.580 around that thing. We don't think about those as having any amount of risk attached because we're

00:37:27.520 so accustomed to them. But like, this is sort of the name of the game. Can I tell, can I,

00:37:34.680 can I go on an ibuprofen tangent? Can I do an ibuprofen tangent? So I have been told to take

00:37:39.660 ibuprofen by whack little skeleton because everything hurts all the time. And I did not

00:37:43.800 know this, but apparently using ibuprofen over time, one of the kind of well-known side effects

00:37:49.820 is nosebleeds. You just like get nosebleeds. So I was on a date at a pho place and I was like

00:37:57.340 chatting with this dude and I look down and it's like raining like little drops of like chili oil

00:38:05.660 into my pho and i had no idea and he was like ah i was like bleeding and i just like had to like 0.89

00:38:15.220 die for a bunch of napkins at this pho place god damn it i never saw him again and i never

00:38:20.180 ate there again even though it was nobody's fault but my own so the the first kind of category of 0.97

00:38:25.860 this we're going to talk about is they summarize the data on social transition so can you describe

00:38:33.600 what social transition is aubrey yeah social transition is any of the like sort of like

00:38:37.360 non-medical parts of transition so it'd be for some folks it'll mean changing your pronouns

00:38:42.500 uh for some folks it'll mean asking folks to call you by a different name all of that kind of stuff

00:38:47.960 yes so here is how the cast report summarizes it oh i hate it wait it gets so much worse than

00:38:56.840 this aubrey social transition may not be thought of as an intervention or treatment because it is

00:39:01.980 not something that happens within health services however it is important to view it as an active

00:39:07.460 intervention because it may have significant effects on the child or young person in terms

00:39:11.800 of their psychological functioning which like again i would agree but i would imagine

00:39:18.940 that i would have a different inflection yeah i mean this is this weird anti-trans talking point

00:39:26.000 that social transition like is a medical intervention because it leads to medical

00:39:32.300 interventions but social transition is like i you know i tell my parents that i'm a trans girl

00:39:37.780 and like i i go to the target and we get different clothes and i ask people to call me by she her

00:39:43.180 pronouns yep that's not a permanent thing that's something you can reverse in literally minutes

00:39:48.240 the only you know the only barrier would be potentially getting a haircut would be the

00:39:52.560 hardest thing, but they're essentially casting it as like a medical intervention, which it just

00:39:56.960 straightforwardly is not. It's also something that like parents and schools do. And as they

00:40:00.460 acknowledge here, the NHS would not be involved in any way. You don't get your haircut at the

00:40:04.120 doctor's? I get approval first. I have seven appointments before I get my haircut. That's

00:40:09.560 why you have the fucking beard. Okay, so here's the next, wait, let me give you the next two 1.00

00:40:16.460 paragraphs. There are different views on the benefits versus the harms of early social

00:40:20.640 transition. Some consider that it may improve mental health and social and educational

00:40:24.980 participation for children experiencing gender related distress. Others consider that a child

00:40:30.600 who might have desisted at puberty is more likely to have an altered trajectory, culminating in

00:40:36.800 medical intervention, which will have lifelong implications. The lifelong implications from

00:40:42.320 what we know about adult trans people are positive, by the way, sort of like a little weird. It's 1.00

00:40:47.400 lifelong implications. Well, all trans people say they're really happy with their care. So I don't 0.50

00:40:51.000 know why we're talking about these grave lifelong implications. So these University of York

00:40:56.480 systematic reviews go over the evidence for social transition as if it's a medical intervention,

00:41:03.240 right? Again, they're trying to stratify all of the research into low quality, moderate quality,

00:41:10.360 or high quality. But after all of this quality analysis, somehow the highest quality study

00:41:16.160 of social transition is a study that interviewed parents, but not trans kids.

00:41:22.040 They also recruited parents from a clinic in Hamburg that does not take an affirming approach.

00:41:28.240 It's like a watchful waiting clinic.

00:41:30.100 It's weird. It feels like the research equivalent of like voter suppression or something.

00:41:34.300 Yeah.

00:41:34.580 I'm like, oh, you created a system in which the most important voices

00:41:37.820 are the ones that are most panicked.

00:41:40.120 If your criteria leads you to this outcome, you have chosen the wrong criteria.

00:41:44.160 Right. This is, I mean, listen, this is everything about like a gay judge talking about marriage. 0.94

00:41:51.360 We do this shit all the time where we act like people who have the most privilege, 0.99

00:41:55.320 like people who have the most privilege have their identities sort of centered to the point 0.99

00:41:59.800 of erasure that their identities don't strike them as identities. Right. Right. So they're

00:42:03.920 so used to being at the center that we confuse that with like neutrality or objectivity.

00:42:09.720 There's only 11 studies of social transition of trans kids. So very small number of studies. They throw out nine of the studies and they're only left with two. And so this is the conclusion that they reach on the basis of those two.

00:42:25.460 The systematic review showed no clear evidence that social transition in childhood has any positive or negative mental health outcomes and relatively weak evidence for any effect in adolescence.

00:42:36.780 However, those who had socially transitioned at an earlier age and or prior to being seen in a clinic were more likely to proceed to a medical pathway.

00:42:46.020 So we can't say if it helps or not, but people who socially transition are more likely to medically transition.

00:42:51.820 It's just, yeah.

00:42:53.340 again that's probably a sign that they're trans right we have we have no evidence that for example

00:42:59.300 they're more likely to proceed to a medical pathway and 98 of them detransitioned because

00:43:04.140 they regret it and they were rushed through no it's just they proceeded to a medical pathway

00:43:09.780 yeah there's no evidence that this was a bad outcome or these kids are unhappy

00:43:13.180 at all it's just that they transitioned the other thing about this social transition as a step in

00:43:20.400 medical transition feels like a slip slide into this like ongoing medicalization of trans identities

00:43:30.240 and experiences right yeah this feels like further pathologization of transness right to be like

00:43:38.080 social transition is actually also medical at a time when so many trans people are like can you 0.95

00:43:43.420 fucking not yeah can the door we walk through to get here not be a mental health diagnosis how about 0.99

00:43:50.320 that. Right. And this feels like it's like leaning hard in the other direction. They are trying to 1.00

00:43:56.100 cast an easily reversible step as irreversible. Yeah, yeah, yeah, yeah, yeah. The risks of

00:44:02.140 checking it out of like, oh, I'm going to be a girl for a week. Yeah. Okay. Is there any physical

00:44:07.440 harm of that? No. Is there any emotional or mental harm of that? Potentially bigotry from other

00:44:12.160 people, but the actual experience of that, there's no risk at all. And yet this document is casting

00:44:18.200 this as a medical intervention and saying that there's no evidence that it helps on the basis of

00:44:24.760 we threw out nine of the 11 studies that have ever been done on this.

00:44:28.380 I also think there's something to say for not hiding from the fact that within that framework,

00:44:32.940 this is low quality research, right? Yeah. We have not devoted the resources to this that we

00:44:38.460 have devoted to other research that people are more accustomed to hearing, like cancer research

00:44:43.500 or alzheimer's research or whatever right yeah again this feels like another weird own goal

00:44:48.660 that's happening here where they're like the research is low quality and i'm like

00:44:52.240 yeah fuckos that's because it's not been being institutionally funded and supported in the ways 0.94

00:44:57.580 that it needs to be to like get to the bottom of shit another very conspiratorial element of this 0.99

00:45:02.680 is that you often hear these this kind of anti-trans brain trust say things like well i just 0.98

00:45:07.260 think we should study it as if trans people themselves do not want to study what is the

00:45:12.800 most effective care for trans people right as if like the dreaded trans activists are like stop all

00:45:19.080 the studies and give it to everybody like trans people very much want to know what is the best

00:45:24.140 pathway for people what are the best dosages what are the side effects this really affects people's

00:45:28.240 lives and they have a way higher stake in this yeah than cis people do so like if puberty blockers 0.91

00:45:33.800 for example affect bone density that's something trans people are extremely fucking interested in

00:45:38.220 so there's no reason any there's no anyone anywhere in this field saying we should stop 0.87

00:45:44.460 studying it yeah i would go so far as to say not even that trans people have more of a stake in it

00:45:49.520 than cis people but trans people have a stake in it yeah yeah and people who do not have a stake

00:45:58.060 in it are the people who are sort of making themselves a weird human shield exactly so that

00:46:03.700 was social transition. This has been this has been previously on. So we're not going to talk

00:46:12.420 about puberty blockers. So the evidence for puberty blockers. Again, they do the same thing

00:46:16.340 where they look at all of the research that has been conducted. They do this high, moderate and

00:46:20.520 low quality analysis. There are 50 studies on the effects of puberty blockers. They keep 26 of them.

00:46:27.620 So they end up throwing out around half as low quality. There are not that many studies on the

00:46:33.340 mental health aspects of this. So because puberty blockers have been around for cisgender kids for

00:46:37.380 so long, there's lots of studies on like physiological things. On cisgender kids,

00:46:42.040 there's not as many on the mental health effects of cisgender kids because that's not really like

00:46:45.620 the thing that people are trying to do with cisgender kids. They're just like, oh, we just 0.81

00:46:48.900 need to delay puberty. So for transgender kids, there's only four studies that look at puberty 1.00

00:46:55.180 blockers and their effect on mental health and like how happy kids are with their bodies,

00:46:59.000 like the kinds of things that we are looking at for transgender kids. There's only four studies

00:47:02.800 of this this is from the university of york review and this covers what's called internalizing and

00:47:08.920 externalizing symptoms which isn't really something that people use colloquially but

00:47:12.940 internalizing symptoms is like depression anxiety and then externalizing symptoms are like aggression

00:47:17.360 and like acting out gotcha it says three studies assessed internalizing and externalizing symptoms

00:47:23.180 with one reporting improvements in both one improvement in internalizing but not externalizing

00:47:28.900 symptoms and one observed no change in either a truly mixed bag it then says for other psychosocial

00:47:35.000 outcomes there was either a single study or two studies showing inconsistent results with studies

00:47:40.340 reporting either a small to moderate significant improvement or no change i don't know if i'd call

00:47:45.180 that inconsistent because it's either like they're improving or nothing i mean on some level that's

00:47:50.280 inconsistent but it's not like half of them said they got better and half of them said they got

00:47:53.620 worse it's a really weird way to hide the ball yeah this to be like oh things are either neutral

00:47:59.460 or much better there's not a lot of studies i think that's by far the greatest weakness in

00:48:03.880 this field there just aren't that many studies on like our kids doing better after they take

00:48:07.240 puberty blockers but from what we do know it appears that like they either do the same or

00:48:13.600 they do better any like good faith summary of that would be like yeah it's promising enough

00:48:19.360 that we should probably keep giving this to kids right we don't have an increase in any of these

00:48:23.540 negative symptoms. I don't know, Mike. I don't trust anything that improves children's mental

00:48:29.260 health. It's also funny with puberty blockers too, because the evidence on puberty blockers

00:48:35.160 is not as strong as it is on hormones. But some of that is mostly just because like puberty

00:48:39.840 blockers don't actually do anything. Like there's some studies that are like kids are just as

00:48:44.420 gender dysphoric after taking puberty blockers as before. And it's like, well, yeah, their bodies

00:48:48.900 didn't change. The whole point is that you don't feel comfortable with your body and puberty

00:48:52.660 blockers pause your development but they don't change it yeah so the the review also uses that

00:48:58.500 as kind of an excuse to be like oh well they don't even have that much of an effect it's like

00:49:02.400 the the point was never that they would have an effect on gender dysphoria the point was that

00:49:07.180 they would buy you time so that you can really think about whether you want to stay in this

00:49:10.620 identity and then go through with something more irreversible so it's it's again like holding them

00:49:15.840 to this kind of weird standard and even by this standard they are actually showing improvements

00:49:20.380 in mental health markers. Yeah. The point of puberty blockers is to avoid a wrong gender

00:49:25.180 puberty. The point is not to alleviate dysphoria. The point is to avoid making dysphoria worse.

00:49:32.980 So this gets worse when we get to hormones. So hormones are like a bigger deal. It's like a more

00:49:38.460 irreversible intervention. But again, we only have five studies that look at the mental health

00:49:44.580 effects of trans kids taking hormones. Gotcha. The University of York makes a table where they 0.96

00:49:50.360 break out every single result so they they stratify by like depression what did the study

00:49:54.040 say anxiety what did the study say and so i am going to send you the list of bullet points since

00:49:59.600 there's only five studies it's quite easy to just read all of the mental health effects that the

00:50:04.320 drugs had so i'm going to send you a list of this there's there's gonna be more than five bullets

00:50:08.880 in this list because a lot of the studies measure many different things but we're only talking about

00:50:13.760 the results of five studies here suicidality scores decreased increase in well-being lower

00:50:20.100 levels of dissatisfaction with body image. Depressive symptoms were lower. Decreased

00:50:26.100 levels of anxiety. No evidence for difference between groups in suicidality. Prevalence of

00:50:32.760 recent depression lower. Treated participants less likely to have seriously considered suicide

00:50:38.820 or attempted suicide. Need for treatment for depression decreased at follow-up. Need for

00:50:44.980 treatment for anxiety decreased. Need for treatment for self-harm and suicidality decreased.

00:50:50.100 No change in need for treatment for all outcomes.

00:50:53.760 Improvement in gender dysphoria score.

00:50:56.300 Decrease in depression.

00:50:58.440 Anxiety decreased over time.

00:51:00.580 So, listeners at home, are you pulling out any themes?

00:51:07.080 Sounds pretty dangerous.

00:51:09.060 We have tons of decreases in anxiety.

00:51:12.040 Tons of decreases in suicidality.

00:51:14.200 Tons of decreases in depression.

00:51:15.440 And a couple of findings that are like, eh, we didn't really see a big effect.

00:51:19.160 there's like shit we do all the time that does not have effects this uniformly like neutral to

00:51:24.800 positive so here is how dr hillary cass uh or whoever wrote this report summarizes these 0.95

00:51:30.780 findings as expected hormone treatment induced puberty in the desired gender inconsistent results

00:51:37.400 were found for height slash growth bone health and cardiometabolic health evidence relating to

00:51:43.320 gender dysphoria body dissatisfaction psychosocial and cognitive outcomes was insufficient to draw 0.99

00:51:50.040 clear conclusions insufficient that's all they say again fucking ask a trans person that's what 0.98

00:51:59.560 the studies did and they're fucking ignoring it wait but then then this is this is the one that 0.99

00:52:04.800 fucking killed me aubrey here's the next paragraph now i'm the one who's flagging this 0.97

00:52:09.420 sucks there were inconsistencies regarding suicidality and or self-harm with three of 0.98

00:52:16.140 four studies reporting an improvement and one no change three studies found kids are less suicidal

00:52:21.880 one study found nothing who could possibly say what effect this has on suicidality 0.97

00:52:27.860 jesus come the fuck on so it's like if you had a pill that it was like oh yeah three studies said 0.96

00:52:33.600 it made you taller one study said it did nothing oh we can't say anything about whether it makes 0.99

00:52:38.360 you taller or shorter yeah totally i know someone recently who started antidepressants for the first

00:52:43.720 time and they were like i don't know if i'm gonna keep taking these i don't feel any different and

00:52:48.360 i was like well do you get feedback from people in your life and this person was like uh my partner

00:52:53.800 says they've never been more in love with me and my friends are all super happy about it and i was

00:52:58.960 like so there's a pill that you can take where you feel no different but people in your life love and

00:53:04.360 appreciate you more that's like my that's like my beard my face itches but all of my grinder 0.57

00:53:09.700 messages end with sir now oh you hate it but it's fucking hot so we could easily spend like three 0.93

00:53:15.200 fucking hours talking about like the specific studies and the follow-ups and and more of this 0.92

00:53:19.140 criteria stuff but it's like any sort of zoomed out good faith look at the evidence around this 0.96

00:53:25.420 issue finds like yes methodological issues none of these studies are perfect you can nitpick about

00:53:30.360 any single study you want to. But overall, we find nearly unanimous benefits to gender-affirming

00:53:38.100 care for kids. To the extent that we don't find that, we typically find no change. We don't find

00:53:43.840 harms in any of these studies, right? And I think it would be one thing if we, you know, these

00:53:49.180 studies might find kind of short-term benefits, but then we do find, you know, five years down

00:53:53.320 the line, we find regret rates of, you know, 50, 70 percent. Like, people are falling off of these

00:53:58.380 drugs as they become adults in droves. But we don't see that either. We see study after study

00:54:03.320 after study with regret rates, even with like three-year follow-ups of less than 5%, which is

00:54:08.880 not typical of like the medical system. Usually regret rates are much higher than that for various

00:54:14.180 routine procedures. So sorry, on what basis are we saying that there's weak evidence for this care

00:54:21.280 and fucking banning it by law and sending doctors to jail for providing it? 0.78

00:54:27.260 I love it that you say we could talk about this for three hours after we have recorded for, I'm going to say, 12 hours on this topic. 0.99

00:54:36.000 I'm going to limit myself.

00:54:37.620 You're like, look, man, we can go on.

00:54:40.040 I'm not going to spend two entire months of my podcast producing words about this report.

00:54:47.920 So another thing that's missing from this report is any good faith overview of the alternatives to gender affirming care.

00:54:57.260 One of the things the CAS report refuses to engage with is the fact that kids going through

00:55:01.240 puberty, if they already have gender dysphoria, is extremely upsetting. And that's also irreversible.

00:55:05.780 And so either way, a kid is going to go through something irreversible.

00:55:10.260 That the option of them not going through anything irreversible is not on the table.

00:55:14.300 So you basically need to decide you have a binary choice of like, do they go through

00:55:18.760 one puberty or the other? And all of the data on conversion practices, we're not even going

00:55:26.060 to get into it because it's so fucking dire. The approach that this document proposes and that the

00:55:31.720 NHS, it appears, is now going to be built around is basically giving them therapy. Not necessarily

00:55:37.020 like gender therapy, but like kind of classic my kid is struggling type of therapy, like things

00:55:43.520 like CBT, right? Or like maybe you put them on antidepressants or maybe you deal with their

00:55:48.000 anxieties. Basically, you're acting as if the trans identity is an output of these other mental 0.98

00:55:53.980 illnesses. And so you're treating those mental illnesses directly. So the Cass review also 0.93

00:55:59.860 commissioned a University of York systematic review of psychotherapeutic interventions for

00:56:07.340 trans kids. And our friend, the health nerd, Gideon Meyerowitz-Katz, he has been doing this

00:56:14.040 like accidental deep dive into the Cass report. He's an epidemiologist. It was supposed to be

00:56:19.220 one article and then it became a series of three articles and now it's up to seven because like so 0.75

00:56:25.180 many other people who look into this you're like wait a minute i can't fucking believe what they're

00:56:29.860 doing here yeah yeah yeah the first thing that he noticed was that they're using a totally different

00:56:35.340 standard of quality than they use in all of the other reviews there's like the one that they're

00:56:40.520 using the other reviews is called the newcastle ottawa scale and then without saying why they

00:56:46.060 switched to something called the mixed methods appraisal tool when it comes to therapy interventions.

00:56:52.180 I don't think there's a clear view of like which standard is better, but it's really fucking weird

00:56:57.540 to say that, oh, we have these like very high standards of quality. We have this objective

00:57:01.900 marker of like whether these are high or low quality studies. And then as soon as we get to

00:57:06.160 therapy, as soon as we get to something that doesn't include puberty blockers and hormones,

00:57:09.760 they're like, oh yeah, we're using a different standard. And they don't say why. And so under

00:57:12.900 the quality rubric that they are using, these are the studies that they have considered high

00:57:19.340 enough quality to be included in the analysis. So Gideon lists them out. I'm not going to read

00:57:25.500 all of them, but I'm going to read the first one. One of them is a case study of attachment-based

00:57:30.300 therapy on a single transgender teen. Astonishingly, this was the study considered to be the highest

00:57:36.240 quality of the research are you fucking kidding me a fucking case study a literal n of one 0.93

00:57:42.980 i'm gonna flip a fucking table mike but then they also they also include a study of eight 0.99

00:57:49.120 trans teens that looks at whether having a therapist affirm their identity helps them 0.97

00:57:53.100 there's a study of 41 trans teens who take an online mindfulness training there's a study of

00:57:59.040 two children who downloaded Headspace on their parents' phone.

00:58:04.140 And also the one larger study that they include is a study of 201 adolescents that followed

00:58:10.700 them over one year.

00:58:12.180 And it compares trans kids who got therapy to trans kids who got therapy and puberty

00:58:18.220 blockers.

00:58:18.960 And it says, well, the kids who got therapy were doing better a year later.

00:58:23.600 So therapy works.

00:58:25.120 But Gideon points out, the kids who got therapy and puberty blockers were doing even better than

00:58:29.940 that. Sorry, is this a high quality study or not? If we're trusting this study, then we should be

00:58:34.100 giving them therapy and puberty blockers, not just therapy. You're going full internet. Make it make

00:58:38.800 sense. Not you using the mixed method analysis tool. The math isn't mathing.

00:58:46.820 and so here is an excerpt from gideon's latest post on this these findings are in a word mixed

00:58:56.640 most of these papers are undeniably low quality and as with the low quality literature for other

00:59:02.620 aspects of health care for trans teens don't really add much to the literature in addition

00:59:08.200 the results were pretty contradictory while some of these psychological interventions found that

00:59:13.140 trans teens reported better mental health, some of the studies showed the opposite effect.

00:59:18.820 One trial of traditional psychological care for trans youth found that it might make depression

00:59:23.840 worse. In addition, this review found no data whatsoever looking at interventions aimed at

00:59:29.780 improving gender dysphoria, the entire point of the document. The majority of the studies looked

00:59:35.880 at traditional psychological therapy in a subgroup of transgender children. We already know that CBT 0.77

00:59:41.680 is useful for depression. All this review shows is that traditional psychological therapies may

00:59:47.160 not be effective for transgender teens, which also casts doubt on one of the speculative arguments of

00:59:52.400 the cast review that bad mental health turns children trans. At best, we could say that 1.00

00:59:57.960 psychological interventions could theoretically have benefits for trans teens, but that they

01:00:03.000 seem less effective than medical assistance. In addition, the data is so weak that there's very

01:00:09.220 little you can reasonably say about them at all. The reason I wanted to zoom in on this is that if

01:00:13.920 you're someone who engages with the things that these kind of allegedly I'm not transphobic but

01:00:19.640 transphobic people say is the thuddingly obvious double standards, right? When it comes to any

01:00:26.160 study that affirms that puberty blockers and hormones work for kids, they're like, well,

01:00:31.480 you know, the dropout rate was like 7%. And you know, the questionnaire studies, they didn't use

01:00:36.460 the right scale to measure gender dysphoria and like they pretend to have these extremely exacting

01:00:43.440 scientific standards about the methodology right and they will nitpick you to death but when it

01:00:47.440 comes to anything that goes against the consensus that gender affirming care works they're like oh 0.99

01:00:52.440 yeah bring in a study with like a 50 dropout rate bring in a study that interviews fucking parents 0.99

01:00:57.560 about the subjective experience of their kids bring in a study where the fucking conclusions 0.99

01:01:02.500 of the study are in the consent form they don't give a shit yeah and to have someone look at this 0.99

01:01:07.540 and be like what the fuck are they doing over there yeah totally is like so cathartic this 0.98

01:01:12.740 section is called mike feels validated yeah it's like yeah because i feel like i'm screaming into 0.95

01:01:17.860 the void because it's so hard to get people to engage with this stuff on the merits yeah this

01:01:22.640 is bad work this is shoddy work and it's really obvious how motivated it is and it's really

01:01:27.680 obvious what it is motivated by right what they're trying to do is throw out any evidence that shows

01:01:33.740 that this care helps children and they're trying to validate these other approaches that are just

01:01:39.900 not related to the issue at hand we're at the point now where like it's it's just time to close

01:01:46.760 this debate what oh no i downloaded an air horn app it doesn't sound like an air it's like a

01:01:57.460 fog horn yeah it's like not good wait hang on let me do a different one i'm getting a different one

01:02:04.560 wait say say your closing line again until we get some real evidence it's time to close the debate

01:02:10.300 what was that that's a cheering

01:02:14.660 i can barely even hear that he's right that's what the people are i mean i could have done this

01:02:23.760 oh no that's worse that's worse eventually i won't even need you aubrey eventually

01:02:28.400 look you have the app on your phone that's true i can just it does most of what i do

01:02:35.380 i have some bad news aubrey i will no longer be needing you

01:02:38.460 replaced by ai

01:02:39.680 I'll see you next time.

01:03:09.680 You

Maintenance Phase - July 01, 2024

BONUS： Breaking Down The Latest Anti-Trans Victory Lap

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