Treating Transgender Youth

The American Psychiatric Association (APA), American Medical Association (AMA), and the American Academy of Pediatrics (AAP) all advocate “gender-affirming care” for the growing numbers of adolescents who experience distress—even depression and suicidal tendencies—because their biological sex does not match their gender identity. This care consists of gonadotropin releasing hormone agonists (“puberty blockers”) to suppress puberty. The idea is to give youths time to become comfortable with their birth gender or to decide to take hormones (estrogen or testosterone) that help them acquire characteristics of their desired gender. “Gender-affirming surgeries may follow in later adolescence or young adulthood,” according to APA’s 2020 Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth. APA’s statement says, “Trans-affirming treatment….is associated with the relief of emotional distress, and notable gains in psychosocial and emotional development, in trans and gender diverse youth.” Maybe this is true for some; but others, like Chloe Cole who has testified before state legislators and medical boards, deeply regret the treatment they received as young teens.

Unlike the US medical groups, health authorities in other countries are more cautious about advocating this type of medicalized treatment in these young people. In 2022, five AAP members asked the AAP (which ignored the request) to review the evidence and update their 2018 policy statement. In their proposed Resolution 27, these pediatricians cited the Finnish Health Authority, the Royal Australian and New Zealand College of Psychiatrists, France’s National Academy of Medicine, the Swedish National Board of Health and Welfare, and the UK’s National Health System—all of whom found low quality evidence to support the use of hormone treatments in children and youths. These groups also voiced concern about serious long-term effects from using puberty blockers and cross sex hormones. Carl Heneghan, professor of evidence-based medicine at University of Oxford (UK) and Editor in Chief BMJ EBM, and Tom Jefferson wrote in a 2019 BMJ blogpost:

There are a large number of unanswered questions that include the age at start, reversibility; adverse events, long term effects on mental health, quality of life, bone mineral density, osteoporosis in later life and cognition. We wonder whether off label use is appropriate and justified for drugs such as spironolactone which can cause substantial harms and even death. We are also ignorant of the long-term safety profiles of the different [gender-affirming hormone] regimes.

In 2022, the NHS announced the Spring 2023 closure of the Tavistock Centre in London, which provided England’s only gender identity development service. A review, led by past president of the Royal College of Paediatrics and Child Health, Dr. Hilary Cass, found safety issues related to the center’s “’unquestioning affirmative approach.’” The NHS will, instead, set up regional centers that focus on child health and development as well as mental health services to help the rising numbers of children with gender dysphoria. “In 2021/22 there were over 5,000 referrals to [Tavistock Centre], which compares to just under 250 referrals in 2011/12,” according to Owen Evans. An NHS statement reported a “’dramatic change in the case-mix of referrals from predominantly birth-registered males to predominantly birth-registered females presenting with gender incongruence in early teen years.’” Many of the children also exhibit neurodiversity, mental health issues, and risky behaviors that cannot be attributed solely to gender dysphoria.

Adolescence—even in the best of societies—is a time of identity exploration and intense emotion. I cannot imagine trying to navigate this challenging period with the added stresses of social media, online sexualized videos, and panic-promoting media.

AAP Resolution 27. In Support of a Rigorous Systematic review of Evidence and Policy Update for Management of Pediatric Gender Dysphoria. March 31. 2022. https://genspect.org/wp-content/uploads/AAP_Resolution_27_2022.pdf

Evans O. Tavistock Transgender Clinic for Children to Close. The Epoch Times. July 28, 2022.

Heneghan C, Jefferson T. Gender-affirming hormone in children and adolescents. February 25, 2019. https://blogs.bmj.com

Making Public Health Decisions

On October 7, 2022, Florida’s State Surgeon General Joseph A. Ladapo, MD, PhD, recommended that males between the ages of 18-39 years not receive mRNA Covid-19 vaccines/boosters. “Those with preexisting cardiac conditions, such as myocarditis and pericarditis,” according to a press release, “should take particular caution when making this decision.” His recommendation was based on an analysis of data from Florida’s reportable disease repository (Merlin), Florida State Health Online Tracking System (FLSHOT$), and death records data from vital statistics. The analysis used the self-controlled case series method, an epidemiological design in which individuals act as their own controls. A 2016 BMJ article explains that this method was developed to evaluate vaccine safety. Florida residents, age 18 years or older, who died within 25 weeks of vaccination since the start of the vaccine roll-out (December 15, 2020) were included. The residents were excluded if they had a documented covid infection or covid-related death, received a booster, or got their primary series after December 8, 2021.

The analysis found a statistically significant increase in cardiac-related deaths for the entire population (RI=1.07, 95% CI=1.03-1.12). Those aged 25-39 had the highest increase (RI=2.16, 95% CI=1.35-3.47). (Data was sparse for the 18-24 age group.) “Risk was significantly higher during the risk period for males (RI=1.09, 95% CI=1.03-1.15) but not for females (RI=1.05, 95% CI=0.98-1.11).” In comparison, the all-cause death showed no increase overall during the same period. Moreover, participants over age 60 had a statistically significant decrease in all-cause mortality in the 28 days after vaccination (RI=0.97, 95% CI=0.94-0.99). The increased risk was associated with mRNA vaccines (Pfizer-BioNTech and Moderna), not non-mRNA products.

The analysis has several limitations, including its use of surveillance data and the sample size. It also does not take into account the use of multiple boosters. The authors also say that the data is from the first months of the vaccines’ availability, and the risk/benefit has likely changed since then: “In the fall of 2022, most people have either been vaccinated or have natural immunity to COVID-19. Many have had multiple vaccine doses, multiple infections, or both. Research to assess the current risks and benefits of the COVID-19 vaccine to help update vaccine recommendations should be studied in this context.”

Dr. Ladapo has a medical degree from Harvard University as well as a PhD in Health Policy from Harvard’s John F. Kennedy School of Government. As he explains in his book Transcend Fear – A Blueprint for Mindful Leadership in Public Health ((Skyhorse Publishing, 2022), his PhD studies focused on decision sciences, “a field that focused on optimizing decisions by characterizing the risks, benefits, and trade-offs associated with different choices.” After his residency in internal medicine, he obtained a faculty position as a clinician researcher at New York University and later University of California-Los Angeles and received multiple grants from the National Institutes of Health to conduct clinical trials focusing on behavioral interventions that help prevent cardiovascular disease.

Although Ladapo was successful professionally, long-standing anxiety, rooted in childhood trauma, threatened his relationship with his wife and three young sons. In late 2019, he began working with Christopher Maher, an ex-Navy SEAL, who used a combination of techniques based in Chinese meridian theory to heal his own emotional, physical, and spiritual pain. Maher wrote Free for Life; his website is truebodyintelligence.com. Ladapo credits the work with Maher for saving his marriage but also for allowing him to remain clear-headed when the covid pandemic hit.

Instead of being swayed by media-fed panic, Ladapo’s “internal housecleaning” and his background in decision sciences allowed him to use data in a consistent way—acknowledging what was unknown while making recommendations on what was reasonably sure. Throughout 2020, he wrote articles for Wall Street Journal, using his skills in decision making and research. “The messages in these articles would have been considered bread-and-butter public health in the past: education of children is important, avoid divisive policies with little or no proven benefit, avoid using fear as a communication strategy, and consider both benefits and cost associated with policies,” he wrote in his book. And it was this transparency in his articles and the consistency in his messaging that drew the attention of governor who asked him to become Florida’s state surgeon general.

Florida Health. Guidance for mRNA COVID-19 Vaccines. October 7, 2022. Floridahealth.gov.

Florida Department of Health. Exploring the relationship between all-cause and cardiac-related mortality following COVID-19 vaccination or infection in Florida residents: a self-controlled case series study. https://floridahealthcovid19.gov/wp-content/uploads/2022/10/20221007-guidance-mrna-covid19-vaccines-analysis.pdf

Petersen I, Douglas I, Whitaker H. Self controlled case series methods: an alternative to standard epidemiological study designs. BMJ. 2016;354:i4515.

Casualties of Unpopular Science

The November 2022 “Shorts” column included a piece about the review article by Seneff S, et al: “Innate immune suppression by SARS-CoV-2 mRNA vaccinations: The role of G-quadruplexes, exosomes, and MicroRNAs,” published in Elsevier’s Food and Chemical Toxicology (FCT) in April 2022. The article’s authors included MIT research scientist Stephanie Seneff, PhD; Greg Nigh, ND, LAc; microbiologist Anthony Kyriakopoulos, PhD; and Peter McCullough, MD, an internationally known cardiologist. The article presents evidence that the synthetic vaccine mRNA may interfere with the body’s immune response against infections and cancers. The paper was submitted in response to a request by FCT’s editor-in-chief, Dr. José Luis Domingo, who sought papers on vaccine safety: “’…the goal in calling for research on potential toxicological effects of the vaccines, was to reduce skepticism to vaccination,’” according to The Epoch Times. Dr. Domingo is a respected toxicologist who has served on the editorial boards of over 11 scientific journals and became FCT’s Editor-in-Chief in 2015.

Recognizing that the paper was controversial and involved a “‘very sensitive social and scientific topic,’” Dr. Domingo asked five outside scientists—instead of the usual two or three—to “scrutinize” the article: “They provided detailed written feedback and required the authors to do three rounds of revisions. After the third iteration, all five were unanimous in recommending the paper be accepted.”

About a month after publication, Domingo began receiving “angry emails and messages. These included insults, calls to resign, demands to retract the paper, and even threats.” Domingo received only one scientific response to the review article. He agreed to publish it as a Letter-to-Editor if it passed peer review, but three of four reviewers deemed it “’scientifically poor’” even after it was revised and re-submitted following a first peer review. Despite the pressure, Dr. Domingo refused to retract the Seneff et al paper.

On October 28, Dr. Domingo sent out an email to colleagues with the subject heading: “My resignation as Editor-in-Chief of FCT induced by the PUBLISHER….” Although his contract actually ends on December 31, 2023, Dr. Domingo explained that he sent publisher Jagna Mirska a letter of resignation on October 16, 2022. In this email, Dr. Domingo states that Bryan Delaney, PhD, was appointed the new Editor-in-Chief even before his resignation had been accepted. According to The Epoch Times, Delaney, a toxicologist, works for Haleon, GlaxoSmithKlein’s consumer health unit. Dr. Domingo stated in his email that his public request for studies looking at “potential toxicological effects of the vaccines for the COVID-19” and his refusal to retract the Seneff paper “was the final nail in my coffin.”

Also in October, coincidently (or not?), Peter McCullough, co-author on the FCT paper, was “terminated as the Editor-in-Chief of Cardiorenal Medicine and Reviews in Cardiovascular Medicine after years of service and rising impact factors.” “There was no phone call, no board meeting, no due process. Just e-mails or certified letters,” he wrote in an email to Steve Kirsch. Dr. McCullough is one of many doctors who advocated early covid treatment (see “Shorts” July 2021) and co-authored the book The Courage to Face COVID-19: Preventing Hospitalization and Death While Battling the Biopharmaceutical Complex with John Leake. As a cardiologist with over 500 peer-reviewed articles to his name, McCullough has been outspoken about the adverse cardiovascular effects of mRNA vaccines, particularly in young people. In addition to this termination, McCullough was stripped of his board certifications in internal medicine and cardiology “after decades of perfect clinical performance, board scores, and hundreds of peer-reviewed publications” on October 28, 2022.

Kirsch S. Dr. Peter McCullough is being progressively stripped of his medical credentials. October 29, 2022. https://stevekirsch.substack.com/

Margulis J, Wang J. Editor-in-Chief of Renowned Science Journal Ousted for Publishing Science Questioning COVID-19 Vaccine Safety. The Epoch Times. October 30, 2022.