I agree the difference comes down to our health care system being for profit. It's so tragic. "In the end, perhaps what makes the Swedish and Finnish approaches so different from the American approach is that they have socialized medicine, not the consumer model here, where gender surgeons have a great financial incentive to ignore risk, and some doctors advertise surgeries directly to children on TikTok." The reality of a healthcare system that is fueled by profit rather than actual concern for children's health makes the media influence the ONLY way to change the trajectory in the US. Please get a paid subscription to this important Substack if you can. Lisa, I hope you will still get this published in the other publication too!

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Fantastic and important piece, thank you for writing!

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Jul 22, 2022Liked by Lisa Selin Davis

This is an excellent summary of the different places and their approaches, I will share!!!

Thank you!

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While I’m sure money and decentralized medical care play a massive part in why the US is ignoring the lack of evidence, you cannot ignore that powerful, wealthy TIMs are very much involved. The desire to destigmatize and legitimize their life choices would be a significant bonus on top of the profits they will rake in. These are not people who are concerned about the welfare of our children.

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Articles like this are why I decided to subscribe about a month ago. You're making it well worthwhile, and have been for quite some time. Thanks, Lisa.

I'm sorry to say it's unlikely anyone will regard the Florida study as nonpartisan. Mostly that's because nothing gets to be nonpartisan in this country anymore. It's all tribalism, all the way down.

But also, Quentin Van Meter - their key pediatric expert - is the head of the American College of Pediatricians (ACP). And his political commitments are troubling to anyone who cares about the LGB. It's worth visiting the ACP About page. The organization continues to insist that being gay is hazardous in and of itself, and that children raised by gay parents are at a disadvantage compared to kids of straight parents. These points have both been thoroughly debunked. Leaning on him as an expert made the Florida review instantly appear partisan even if the content of it is completely dispassionate. (I haven't read it carefully, only skimmed it, so I can't offer my informed opinion on whether the review itself is solid or shoddy. Just reading backward from the bibliography, it seems unlikely the review steelmanned the evidence for transition. I'd need to look into the Appendices, because that's where the expert opinions are located, and they're not in the copy of the main report that I downloaded.)

It's also important to note that the Florida review was conducted specifically to address the question of whether Medicaid should cover transition-related medical expenses - a policy that we can assume DeSantis opposes, which again casts some doubt on whether the review was conducted in an open-ended fashion. It's not limited to youth transition care, either, although it does address it separately. Given that the U.S. public is broadly more supportive of adult transition, the review is more likely to be seen as politicized by moderates and liberals insofar as it recommends against public funding for adults too.

To date, the most compelling North American critique of pediatric gender affirmation is the dissection of the AAP position on youth transition by James Cantor, which I *have* read carefully and consider extremely well-founded. I'd expect his contribution to this review to be equally rigorous and fair - but also undermined for a liberal reader who's familiar with the stances taken by ACP and Van Meter regarding gays and lesbians.

There's no easy solution here as the AAP has totally abandoned ship. Plus, any doctor, academic, or journalist who raises even the most reasonable questions about youth transition immediately gets tarred as a bigot and 'phobe - as you know all too well.

(Anyone who hasn't read Cantor's takedown of the AAP position should - it's super-accessible and concise, albeit detail-oriented. It is not peer-reviewed but since what he's doing is mainly showing how the AAP position statement is founded on misrepresentations, it meets my standards for solid scholarship. I'm not a doctor but much of my research is in the social history of medicine. Here's Cantor: http://www.sexologytoday.org/2018/10/american-academy-of-pediatrics-policy.html)

(Edit: While the above-linked version of Cantor's critique of the AAP position is not peer-reviewed, it did go through peer review and was published here - behind a paywall, unfortunately: https://www.tandfonline.com/doi/full/10.1080/0092623X.2019.1698481 I can't vouch for whether any substantive changes were made.)

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thank you _again_ lisa, this is an excellent article. this is a good one for sharing with ppl who are open to listening but don’t have a big picture yet.

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“ In the end, perhaps what makes the Swedish and Finnish approaches so different from the American approach is that they have socialized medicine, not the consumer model here, where gender surgeons have a great financial incentive to ignore risk, and some doctors advertise surgeries directly to children on TikTok.”


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For folks interested in how the who "trans" issue is affecting politics in America, I suggest looking up a Paola Ramos' report on MSNBC about voting Latinos in Florida. Paola, in the hour-long program, detailed how Latino voters, even formerly liberal ones, are now Republicans specifically due to the whole "trans rights for minors" push.

They are supporting DeSantis for higher office, in the hopes that if he is elected President he will pass a national ban on all sorts of "trans" things.

Latinos make up nearly 18% of the U.S. population, without a large chunk of Latino votes, Democrats cannot win.

For whatever reason, the "trans" issue is freaking Latinos out -- even though they are generally ok with gay rights.

It will affect elections, despite trans people making up a tiny percentage of the population. There will be a huge back-lash. Unfortunately for us Dems, this issue is very much helping Republicans.

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Jul 25, 2022·edited Jul 25, 2022

My Mom was a dissident in Cuba, had colleagues imprisoned and one was even executed without trial. She also had her best friend, a gay man, thrown into jail for being gay. And, she's been quite liberal for decades while happily living in NYC., & strongly in favor of gay rights (she hosted a large group of lesbians at our house when they emigrated out of Cuba).

Sooo, one would think she'd be in favor of "trans" issues, but this is her take:

State actors in China/Russia/etc. are always looking for ways to undermine America. They have found a great one in TikTok and social media, where they are pushing/promoting/brain-washing kids into "trans care" in order to make a percentage of the American population infertile and hooked on life-long drugs, and suffering from physical ailments such as decreased bone-density, etc.

She's convinced family members to ban TikTok and social media in general for the minors in the family. Kids were given pretty dumb cell phones, no ipads and computer time is limited to home work research. They're following the Michelle Obama method for raising kids (lots of sports, limited screen time, etc.).

Make of this what you will -- but, Mom knows a thing or two from her gun-running from Varadero to Santa Clara days.

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Great article. How do we give a tip?

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I haven’t even finished this grand essay. Thx you. But a doctor friend sent me this and wanted to share. More evidence from the Swedes this is experimental https://medicalxpress.com/news/2023-04-systematic-outcomes-hormonal-treatment-youths.html

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Dear Lisa! Great article. Could you please tell me where you got your quotes from on social transition refering to Finland? "Social transition for young people is not recommended". I can't find it in Finish guidelines.

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Lisa: "... it took a long time to research and write, so please consider a paid subscription or tip if you can ...."

I can sympathize - and can periodically contribute. But you might consider the plight of your commenters - and commenters in general - who often spend as much time in the trenches "to research and write" what are hopefully cogent and insightful comments ... 😉

But a fairly comprehensive and informative article hitting pretty much all of the high points - nice to see that some other countries walking back from what has been "conventional wisdom" for too long about "gender-affirming care".

However, not sure that the article addresses the roots of that "vicious culture war", though I think you've alluded to it in other articles. However, as I've argued in my recent Welcome post (link below), it seems that the biggest problem is that every man, woman, otherkin - and their cats, dogs, and gerbils - has different definitions for sex, gender, and gender identity. If everyone has different definitions for those terms - that many often take as gospel truth, as articles of faith - then it's rather risible to even suggest that there's any actual communication going on.

But for one example of dozens, Wikipedia has a decent definition for "female" as a sex but then snatches defeat from the jaws of victory by asserting it refers to a gender - without saying exactly what it is that a "female gender" consists of:

"Female (symbol: ♀) is the sex of an organism that produces the large non-motile ova (egg cells), the type of gamete (sex cell) that fuses with the male gamete during sexual reproduction. ....

In humans, the word female can also be used to refer to gender."


Mucking idiots - and "female can also be used to refer to plumbing and electrical connectors". 🙄

And then, as both Matt Walsh and Graham Linehan have noted, Merriam-Webster - in a classic case of circular definitions - defines the terms "male" and "female" as "gender identities". A portion of my comment at the latter's Substack:

"Merriam-Webster: 'female: having a gender identity that is the opposite of male.'

And if you look at their definition for 'male' it says this:

'male: having a gender identity that is the opposite of female.'

What a bunch of idiots; 'Circular definitions R Us'. ..."


There's generally some rhyme and reason to how and why we create definitions, and why some are better than others - about which honest people may disagree. But refusing to grapple with those issues just contributes to that transgender clusterfuck, and to the transloonie nutcases and thugs riding roughshod over reason and logic and foundational principles - not to mention over women's rights - that are absolutely essential to whatever we call our "scientific" and rational "civilization".


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Curious, in the United States are "top surgery" and "bottom surgery" and puberty blockers for under 18 people covered by medical insurance of parents, etc?

I had heard that much of transitioning is cash basis....

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Fantastic summary. Thank you.

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