The most heated and divisive issue of our time — in 18 minutes

Why a broad coalition is calling out gender treatments in youth

Hi and welcome,

You’ve likely arrived here to watch the doc short on the issue of puberty blockers, hormones, and surgeries in youth. More about that below. But first, you might want to know more about me and why I’m joining the legions of journos on Substack.

I have been writing at the intersection of politics and medicine for about two decades, starting as a junior editor at Ms. magazine. The relationship is obvious when it comes to abortion and contraception, but the truth is no area of health care is immune to outside influence and conflicts of interest, especially in our fragmented, for-profit system.

I drew attention to the rising C-section rate and national maternal mortality crisis before either was acceptable public conversation—the title of my first book sums up the problem that continues to plague us: Pushed. From there I looked into the many ways women and our health are undermined.

I did not shy away from contested areas that have put me in the outgroup among the lefty, feminist journalist circles I once traveled in: topics like obstetric violence, home birth, breastfeeding, surrogacy, hormonal contraception, DIY abortion, and "wellness" practices, to name a few. So of course I continued asking hard questions and reporting uncomfortable evidence—unpopular science—on covid policy and youth gender medicine—two of the most politically divisive, controversial topics of our time.

No doubt my work on both, even for the eminent BMJ—a peer-reviewed medical journal!—has only propelled me further into the journalistic hinterlands. That’s OK. I didn't go into this work to stay safely pigeonholed.

When the BMJ hired me as an investigative reporter for its journalism unit and assigned me a piece looking into the evidence behind what’s known as “gender affirming” treatments in adolescents, I did what I’ve always done: searched out a diversity of viewpoints and expertise, looked at primary sources, and methodically separated rhetoric from fact. And what I found is what every other serious journalist and systematic evidence review to date has found: the mantra that puberty blockers, hormones, and surgery are “lifesaving” “evidence-based” and “medically necessary” is based on professional consensus without strong evidence.

And yet that mantra is still being used to shut down conversations that are crucial for parents and patients to make informed decisions.

I have met parents who were told by medical professionals that if they didn't get behind medical transition they would have a dead child. They were not told about long term consequences, about the literature on identity development, or about the strong correlation between gender nonconformity in youth and same sex attraction (i.e. many kids who are today identifying as trans would in other eras grow up to be gay adults without medical treatment that affects their sexual and cognitive development). They were not given an honest account of what's known and unknown about this protocol. And some were even shamed for expressing concerns or doubt.

These are medical and ethical questions that must be separated from right-left politics. And that’s been my goal in my reporting, and what my co-producer on this film, Eric Vaughan (The Con), and I aimed to do with this short film.

Once upon a time, those of us on the Left denounced the way the Right was politicizing climate science, or spreading bogus stats about condom effectiveness, or lying about abortion causing breast cancer. And to be fair, conservative politicians may be using the issue of pediatric gender medicine for their own gains, and trans people generally as a scapegoat. But here the Left is also guilty of politicizing what could have been a sober, informed, respectful public dialogue, demanding that skeptical parents, clinicians, and even researchers and journalists stand down. The reporters on the recent NYT podcast The Protocol throw up their hands and call the medicine and politics “inextricably linked.” I disagree. We can and must put space between the two. As journalists, that’s actually our job.

Our short film walks through a story that we think should have been major, earth shattering news: the medical guidelines that physicians trust and follow, which are presented to patients and families as vetted and sound, and which the media and wider public interpret as settled science, were not developed with scientific rigor or honesty. In fact there is hard evidence of direct political meddling—by the same physician leaders who have reassured the public over and over again that this life altering protocol is evidence based.

The genesis for this film was the investigative feature I wrote for The BMJ, which came out in February 2023. My editors committed serious resources toward producing a high-quality video component. But my print piece drew the ire of the British Medical Association, which owns the journal, and ultimately the video and follow-up reporting were killed.

Still, after shooting for The BMJ, Eric and I both felt this subject deserved a careful, head-on, independent full feature documentary treatment. We still do. And maybe someday one will exist.

In the meantime, we release this short and hope it is received with as much grace as we’ve intended. We are both denizens of the Left, and parents, and we know that families want their kids to thrive. We also believe they deserve full, accurate, honest information upon which to make consequential medical decisions.

As for this Substack, I'll use this space to report and comment on scientific and medical issues that are caught up in the culture wars or muddled by conflicts of interest or outright misinformation campaigns. My goal is two posts a month, and I will keep them free to all subscribers for now. That said, if you'd like to support more independent work like this, I thank you for choosing a paid subscription!

And please let us know what you think of the film, and what questions you’d want answered in a future production.

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