I am trying to find the two comments regarding bicalutamide, sorry I am not able to respond directly underneath them. My response is yes but...yes bicalutamide is an androgen 'blocker' but it does not function in the same way that the word 'blocker' does in pediatric gender medicine and therefore we attempted to make great effort to ensure that parents and young people did not equate the two.
When working with the general public in medicine it has been part of my training and my professional role to work to ensure medical literacy and comprehension. Those that work with me know that I often will ask for edits and changes because we always seek to reach the general public at a "6th grade comprehension" level.
One of the ways that I can ensure patients and their families understand what I am conveying is to employ a method called a "teach back" that means that I explain a medical concept and then I ask the patient to teach it back to me.
When working with bicalutamide part of my job was to ensure that patients and their families and especially those providing informed consent understood clearly that bicalutamide was NOT functioning like a BLOCKER, because the general populations understanding of a BLOCKER is that it is completely REVERSIBLE. Bicalutamide is not reversible, once breast tissue changes the only way that can be changed is through surgery.
Bicalutamide is also a different kind of BLOCKER in that is does not work to stop the production of those hormones in the brain but rather gets in the way of the receptors being able to accept testosterone (its a lock/key concept) in all of the cells that are seeking testosterone.
Because I knew what our goal was in the clinic in terms of education I knew that we did not do a good job in educating and properly consenting this parent.
One further observation. The justification from puberty blockers has slid from helping the subjects pass when they become adults, to providing time to think, to providing some kind of short-term relief. It’s a treatment in search of a rationale. And every rationale fails miserably.
It’s that queering behaviour, isn’t it? Everything moves, nothing stays static in meanings or anything really. Totally useless ideology to base any rights from as having words mean certain things is essence of lawmaking.
OK, first, I think Azeen is a bit of a chameleon. She mirrors whomever she is talking to. I've talked to her for hours over the years and until 2023 she was willing to pick my brain forever, but never quote me, because I didn't fit into her storyline of Dems for, Republicans against.
In August of 2023 she was writing about the AAP re-upping their terrible horrible no good very bad Statement of 2018 but also, for some reason, saying they were going to do a systematic review of the evidence. They wouldn't say why, but Azeen knew why, and she talked to me before my clinic and again during my lunch hour, trying 17 different ways to get me to say I was in favor of state bans. I was not. In the end, I like my quote in her article, it was "we are making strong recommendations based on weak evidence." But it wasn't what she wanted.
There's a reason we call her the dread Azeen - you talk to her for hours, it really seems like she's picking up what you're putting down, and then you read what she publishes and it's a big disappointment. (I have some empathy for her, she is in a super hostile environment, but really it's mostly disappointment.) She interviewed me for this podcast, fancy microphone and everything, but I didn't make the cut AFAIK. I don't fit in her framing of the situation.
When I spoke with her a few years ago, she asked me, "Wow, why doesn't the press do a better job of covering all of this?" I was like, "Um, hello, you're a NYT reporter! Why are you asking ME that question?!"
This NYT podcast detailing theDutch protocol showed me there is as much similarity to Dutch Protocol and the American version as there is my old lady chair Yoga to Dallas Cowboy Cheerleaders routines.
Your best episode so far. Not just because of the importance of the topic but also because it was a focused conversation. You each brought your best. I hope you will emulate this approach in future episodes.
It is especially a privilege to share Jamie’s journey, from true believer to apostate. Your struggle with this difficult subject is an authentic one, and the others provide useful perspectives. More, please.
Thank you so much for this sober and nuanced conversation. I feel gratitude and also great sadness. What I'm now thinking of as the "fruit basket" model of medicine is deeply misguided and so wrong. Thank you again to Cori for his 2022 WaPo piece (https://www.washingtonpost.com/opinions/2022/04/11/i-was-too-young-to-decide-about-transgender-surgery-at-nineteen/). And, Jamie, thank you for filling in so thoughtfully some of the big gaps in The Protocol. Without trying to define "gender" or "gender identity" and without considering the "what if" you four explore at the end of this podcast "maybe we do the harder work to change society [to accept gender non-conformity]", the NYT has done more harm than good.
Thank you so much for this fascinating and enlightening conversation. Everyone’s questions of Jamie were so thoughtful and searching. I particularly appreciated Jamie’s recounting of how and why her thinking changed over time—and it makes such a lot of sense. The combined knowledge and experience the four of you have on these issues is truly powerful.
I am so grateful for you Jamie for choosing to come out as a whistleblower. Please forgive yourself for any harm you believe you have done by supporting this center. As a psychotherapist....sometimes I need to remind myself that clients will make poor decisions for themselves and I have no control over that. Even their youngness and naivete is not in my hands. We all have our journeys.
Thank you so much for doing this. While I realize “I am not the audience,” I was trying to listen as someone more new to all this, and I commend you all.
Thanks for linking to “The Myth of Reliable Research.” (For anyone who’s curious, I also recommend the conference talk given by one of its authors, Zhenya Abbruzzese in 2023: https://youtu.be/XrqLcAff9iI?si=R2Jh-StQ3_D3_WR1 Don’t be deterred by the sensational, “shouty” title frame. It’s a thoroughly scholarly talk.)
I was a tomboy, came out as soft butch dyke at 18yo in 1978- If I were a teenager today, and asked about my dislike of having to behave like a girl, dress like a girl, etc.- I would be transitioned! Thank you for the in-depth discussion.
Thanks for a great episode--such thoughtful discussion, as usual.
I went "grrrrr" when I learned what the Protocol left out in that recording of that parent yelling at Jamie. When there's an actual fact--about a dangerous drug given a child--it's edited out. When it turns out the parent did not know what the drug was, the horror was complete.
The NY Times follows the Trans Journalists' Association Style and Coverage Guide, which demands news outlets not to report any negative results (family alienation, detransitions, increased not decreased suicides, serious health outcomes and lack of psychological healing) of "affirmative care." I suggest to Informed Dissent panel to go over "The Protocol" episode by episode, keeping in mind that you will have new viewers who need every detail explained, as they will have found you from looking up Jamie Reed. Eliza (Sarah) and you have information about the long term results of the Dutch Study subjects which have not been published, from your attendance at one of their seminars. While you 5 can almost speak to each other in code and use abbreviations for so many details, the general public has been in the dark on this. Cori is very good about asking questions to clarify for the non-initiated, but even then many details, chronologies and personalities must be explained. Especially when discussing the "FG" and "Manon" cases, where FG is a natal female and Manon is a natal male. Unfortunately, the facts about The Dutch Study (DeVries, Cohen-Kettenis, Steensma et al, 2014) must be driven home, with the ever diminishing subject numbers, the skewed measures of "satisfaction" and researcher bias told in excruciating detail. The general public believes researchers are vetted, that they don't hide bad results, that they consider influence in being funded by pharma companies and they strongly believe in their mission to create opposite sex mannequins. This is partly Dutch arrogance, a historical fact since the building of the sea walls and water-pumping windmills to create arable land 900 years ago. It is all of a piece.
Jamie Reed’s vision towards the end of this episode is of utmost importance: “We didn’t teach true tolerance…instead we just reinforced…those were the moments…imagine where we’d be now if…”
Jamie explains the Dutch had a choice and they took the path to change FG’s body instead of helping and working on the environment that would meet her needs: “…or we do the actual hard thing and work with FG’s parents…”
Such an important episode. Jamie Reed’s thoughts on what the Dutch could have and should have done needs to be turned into a true progressive protocol, mental health standards of care, and a curriculum for teachers.
Thank you for this fantastic episode; it really got the heart of the issue, which the NYTimes podcast failed to do. I will recommend it to as many people as possible.
One thing I was thinking about while listening to the NYTimes podcast, specifically the episode featuring Leibowitz, is how the availability of the treatment itself appears to be creating distress in these children (and their parents). He talks about this in the context of the impending effectiveness of the ban in his state (framing it as a harm the ban created), but I think it applies more broadly and is another form of iatrogenic harm of this protocol.
I don't have data to prove this, but it seems to me that many of these children want these interventions and suffer from intense gender dysphoria precisely because they know these treatments are available. They have been told that puberty is an optional process, and so they feel an anxious urge to prevent it from happening that would not occur to them if they accepted it as inevitable.
It reminds me of the Buddhist saying "pain is inevitable, suffering is optional", which means that the suffering comes from struggling against the inevitable pain of life, rather than accepting it. That is what these kids are doing, because of what adults have done to them by offering these treatments as a solution their pain.
This is something that I had been thinking about with the rise of school anxiety and avoidance among the kids who were hit with the Covid closures. Adults taught them that school is not essential or inevitable, and they don't accept it as an inevitable fact of life anymore, which in turn creates struggle instead of acceptance, and therefore suffering.
With the kids who get caught up in "gender-affirming care", the consequences of this attitude that adults fostered are even more destructive.
I hadn't read your Substack, but I did watch the last episode (under a bit of duress during a chaotic weekend), so I must have heard it from you and assimilated it as my own idea, given it matched my thinking about this in the context of school closures so well. My apologies for the unintended plagiarism!
Being prescribed a treatment can also serve a main benefit of validating the person’s pain or experience as “legitimate” or enacting a ritual to initiate into an identity group. You see this amongst in the eating disorder patients where being admitted to the hospital or given a feeding tube is desired not because it is improving health because it’s a sign that they are “truly ill.” There are many adolescents seeking psychiatric medications or therapy not with a primary care that it leads to material improvement in their lives but because it validates that they are struggling in a way that should be seen as unique and special from their peers. I wonder if Jamie’s vision would work in today’s society where a large number of these adolescents seek these interventions precisely to signal that they are so unique/special in their suffering compared to their peers that they resist efforts of other’s to accept their uniqueness as non-pathological.
Yes! Having resilience is based on tolerating things that are painful.
When I was going through an unwanted divorce, I kept telling myself "I must go through it, I can't go around it," and I kept my faith that a better future would reveal itself. It did.
When the lack of data about people's actual medical condition, not to mention life functioning, came up, I wanted to yell, "There's no objective measurement, anywhere!"
The only thing measured seems to be self-reports of mental states.
That is a poor metric for obvious reasons. People may want to insist they are okay, even if they aren't. Without assessing objective markers, both physical and functional, there's no way to know. Which, I suppose, is what the ideologues want.
I am trying to find the two comments regarding bicalutamide, sorry I am not able to respond directly underneath them. My response is yes but...yes bicalutamide is an androgen 'blocker' but it does not function in the same way that the word 'blocker' does in pediatric gender medicine and therefore we attempted to make great effort to ensure that parents and young people did not equate the two.
When working with the general public in medicine it has been part of my training and my professional role to work to ensure medical literacy and comprehension. Those that work with me know that I often will ask for edits and changes because we always seek to reach the general public at a "6th grade comprehension" level.
One of the ways that I can ensure patients and their families understand what I am conveying is to employ a method called a "teach back" that means that I explain a medical concept and then I ask the patient to teach it back to me.
When working with bicalutamide part of my job was to ensure that patients and their families and especially those providing informed consent understood clearly that bicalutamide was NOT functioning like a BLOCKER, because the general populations understanding of a BLOCKER is that it is completely REVERSIBLE. Bicalutamide is not reversible, once breast tissue changes the only way that can be changed is through surgery.
Bicalutamide is also a different kind of BLOCKER in that is does not work to stop the production of those hormones in the brain but rather gets in the way of the receptors being able to accept testosterone (its a lock/key concept) in all of the cells that are seeking testosterone.
Because I knew what our goal was in the clinic in terms of education I knew that we did not do a good job in educating and properly consenting this parent.
Very good explanation. Shows why you’re so successful in convincing on these issues.
One further observation. The justification from puberty blockers has slid from helping the subjects pass when they become adults, to providing time to think, to providing some kind of short-term relief. It’s a treatment in search of a rationale. And every rationale fails miserably.
Treatment in search of a rationale is a great way to put it.
Goal-post moving is a constant in gender world.
It’s that queering behaviour, isn’t it? Everything moves, nothing stays static in meanings or anything really. Totally useless ideology to base any rights from as having words mean certain things is essence of lawmaking.
I have so much I want to say . . .
OK, first, I think Azeen is a bit of a chameleon. She mirrors whomever she is talking to. I've talked to her for hours over the years and until 2023 she was willing to pick my brain forever, but never quote me, because I didn't fit into her storyline of Dems for, Republicans against.
In August of 2023 she was writing about the AAP re-upping their terrible horrible no good very bad Statement of 2018 but also, for some reason, saying they were going to do a systematic review of the evidence. They wouldn't say why, but Azeen knew why, and she talked to me before my clinic and again during my lunch hour, trying 17 different ways to get me to say I was in favor of state bans. I was not. In the end, I like my quote in her article, it was "we are making strong recommendations based on weak evidence." But it wasn't what she wanted.
There's a reason we call her the dread Azeen - you talk to her for hours, it really seems like she's picking up what you're putting down, and then you read what she publishes and it's a big disappointment. (I have some empathy for her, she is in a super hostile environment, but really it's mostly disappointment.) She interviewed me for this podcast, fancy microphone and everything, but I didn't make the cut AFAIK. I don't fit in her framing of the situation.
Brings to mind what Janet Malcolm said about journalists doing what is morally indefensible, soliciting intimacies in order to crush.
When I spoke with her a few years ago, she asked me, "Wow, why doesn't the press do a better job of covering all of this?" I was like, "Um, hello, you're a NYT reporter! Why are you asking ME that question?!"
This NYT podcast detailing theDutch protocol showed me there is as much similarity to Dutch Protocol and the American version as there is my old lady chair Yoga to Dallas Cowboy Cheerleaders routines.
Thank you for sharing. This is so enlightening and tracks with what Jamie said about Azeen acting differently when Austen was with her.
Let's have you come on and talk about this!!
I would love to!
I really liked Cori's question "what are you treating", eye-opening
Your best episode so far. Not just because of the importance of the topic but also because it was a focused conversation. You each brought your best. I hope you will emulate this approach in future episodes.
It is especially a privilege to share Jamie’s journey, from true believer to apostate. Your struggle with this difficult subject is an authentic one, and the others provide useful perspectives. More, please.
Thank you so much for this sober and nuanced conversation. I feel gratitude and also great sadness. What I'm now thinking of as the "fruit basket" model of medicine is deeply misguided and so wrong. Thank you again to Cori for his 2022 WaPo piece (https://www.washingtonpost.com/opinions/2022/04/11/i-was-too-young-to-decide-about-transgender-surgery-at-nineteen/). And, Jamie, thank you for filling in so thoughtfully some of the big gaps in The Protocol. Without trying to define "gender" or "gender identity" and without considering the "what if" you four explore at the end of this podcast "maybe we do the harder work to change society [to accept gender non-conformity]", the NYT has done more harm than good.
Thank you so much for this fascinating and enlightening conversation. Everyone’s questions of Jamie were so thoughtful and searching. I particularly appreciated Jamie’s recounting of how and why her thinking changed over time—and it makes such a lot of sense. The combined knowledge and experience the four of you have on these issues is truly powerful.
I am so grateful for you Jamie for choosing to come out as a whistleblower. Please forgive yourself for any harm you believe you have done by supporting this center. As a psychotherapist....sometimes I need to remind myself that clients will make poor decisions for themselves and I have no control over that. Even their youngness and naivete is not in my hands. We all have our journeys.
Thank you so much for doing this. While I realize “I am not the audience,” I was trying to listen as someone more new to all this, and I commend you all.
Thanks for linking to “The Myth of Reliable Research.” (For anyone who’s curious, I also recommend the conference talk given by one of its authors, Zhenya Abbruzzese in 2023: https://youtu.be/XrqLcAff9iI?si=R2Jh-StQ3_D3_WR1 Don’t be deterred by the sensational, “shouty” title frame. It’s a thoroughly scholarly talk.)
Key parts of your conversation also reminded me of Episode 1 of “Gender: A Wider Lens,” titled “Trans: Identity vs. Dysphoria,” where Stella and Sasha discuss these competing perspectives. (For anyone who’s curious, it’s here: https://podcasts.apple.com/us/podcast/gender-a-wider-lens/id1542655295?i=1000502801877)
Many thanks again, Jamie and your Informed Dissent crew members—and much respect.
P.S. to anyone new to all this: I recommend this 2023 memo as an excellent explainer— https://transpolicy.substack.com/p/trans-memo
Its author (pen name “Orlando”) has personal experience regarding cross-sex ideation.
P.P.S. Let me also put on your radar this group, if you don’t already know of it: Democrats for an Informed Approach to Gender (DIAG). Good group.
http://www.di-ag.org/
www.di-ag.org
Thanks! & sorry about the bad link! (I think I’ve fixed it in my comment now.)
I was a tomboy, came out as soft butch dyke at 18yo in 1978- If I were a teenager today, and asked about my dislike of having to behave like a girl, dress like a girl, etc.- I would be transitioned! Thank you for the in-depth discussion.
Thanks for a great episode--such thoughtful discussion, as usual.
I went "grrrrr" when I learned what the Protocol left out in that recording of that parent yelling at Jamie. When there's an actual fact--about a dangerous drug given a child--it's edited out. When it turns out the parent did not know what the drug was, the horror was complete.
The NY Times follows the Trans Journalists' Association Style and Coverage Guide, which demands news outlets not to report any negative results (family alienation, detransitions, increased not decreased suicides, serious health outcomes and lack of psychological healing) of "affirmative care." I suggest to Informed Dissent panel to go over "The Protocol" episode by episode, keeping in mind that you will have new viewers who need every detail explained, as they will have found you from looking up Jamie Reed. Eliza (Sarah) and you have information about the long term results of the Dutch Study subjects which have not been published, from your attendance at one of their seminars. While you 5 can almost speak to each other in code and use abbreviations for so many details, the general public has been in the dark on this. Cori is very good about asking questions to clarify for the non-initiated, but even then many details, chronologies and personalities must be explained. Especially when discussing the "FG" and "Manon" cases, where FG is a natal female and Manon is a natal male. Unfortunately, the facts about The Dutch Study (DeVries, Cohen-Kettenis, Steensma et al, 2014) must be driven home, with the ever diminishing subject numbers, the skewed measures of "satisfaction" and researcher bias told in excruciating detail. The general public believes researchers are vetted, that they don't hide bad results, that they consider influence in being funded by pharma companies and they strongly believe in their mission to create opposite sex mannequins. This is partly Dutch arrogance, a historical fact since the building of the sea walls and water-pumping windmills to create arable land 900 years ago. It is all of a piece.
Ah yes! Man battles against natural forces. Interesting thought that it may be a cultural attitude.
I wish I could give you a hug, Jamie, thank you for what you are doing x
Jamie Reed’s vision towards the end of this episode is of utmost importance: “We didn’t teach true tolerance…instead we just reinforced…those were the moments…imagine where we’d be now if…”
Jamie explains the Dutch had a choice and they took the path to change FG’s body instead of helping and working on the environment that would meet her needs: “…or we do the actual hard thing and work with FG’s parents…”
Such an important episode. Jamie Reed’s thoughts on what the Dutch could have and should have done needs to be turned into a true progressive protocol, mental health standards of care, and a curriculum for teachers.
Thank you for this fantastic episode; it really got the heart of the issue, which the NYTimes podcast failed to do. I will recommend it to as many people as possible.
One thing I was thinking about while listening to the NYTimes podcast, specifically the episode featuring Leibowitz, is how the availability of the treatment itself appears to be creating distress in these children (and their parents). He talks about this in the context of the impending effectiveness of the ban in his state (framing it as a harm the ban created), but I think it applies more broadly and is another form of iatrogenic harm of this protocol.
I don't have data to prove this, but it seems to me that many of these children want these interventions and suffer from intense gender dysphoria precisely because they know these treatments are available. They have been told that puberty is an optional process, and so they feel an anxious urge to prevent it from happening that would not occur to them if they accepted it as inevitable.
It reminds me of the Buddhist saying "pain is inevitable, suffering is optional", which means that the suffering comes from struggling against the inevitable pain of life, rather than accepting it. That is what these kids are doing, because of what adults have done to them by offering these treatments as a solution their pain.
This is something that I had been thinking about with the rise of school anxiety and avoidance among the kids who were hit with the Covid closures. Adults taught them that school is not essential or inevitable, and they don't accept it as an inevitable fact of life anymore, which in turn creates struggle instead of acceptance, and therefore suffering.
With the kids who get caught up in "gender-affirming care", the consequences of this attitude that adults fostered are even more destructive.
Yup, I talk about this on the last episode and here: https://elizamondegreen.substack.com/p/the-protocol
Availability of puberty suppression makes prospect of going through puberty optional and thus intolerable.
I hadn't read your Substack, but I did watch the last episode (under a bit of duress during a chaotic weekend), so I must have heard it from you and assimilated it as my own idea, given it matched my thinking about this in the context of school closures so well. My apologies for the unintended plagiarism!
Not at all! Not an original idea for me either! Just definitely was on my mind listening to this podcast, over and over again. Leibowitz, Manon, FG.
Inspiration! (Not plagiarism.) Spreading good ideas is good.
Being prescribed a treatment can also serve a main benefit of validating the person’s pain or experience as “legitimate” or enacting a ritual to initiate into an identity group. You see this amongst in the eating disorder patients where being admitted to the hospital or given a feeding tube is desired not because it is improving health because it’s a sign that they are “truly ill.” There are many adolescents seeking psychiatric medications or therapy not with a primary care that it leads to material improvement in their lives but because it validates that they are struggling in a way that should be seen as unique and special from their peers. I wonder if Jamie’s vision would work in today’s society where a large number of these adolescents seek these interventions precisely to signal that they are so unique/special in their suffering compared to their peers that they resist efforts of other’s to accept their uniqueness as non-pathological.
Yes! Having resilience is based on tolerating things that are painful.
When I was going through an unwanted divorce, I kept telling myself "I must go through it, I can't go around it," and I kept my faith that a better future would reveal itself. It did.
Our youth are being taught the opposite.
When the lack of data about people's actual medical condition, not to mention life functioning, came up, I wanted to yell, "There's no objective measurement, anywhere!"
The only thing measured seems to be self-reports of mental states.
That is a poor metric for obvious reasons. People may want to insist they are okay, even if they aren't. Without assessing objective markers, both physical and functional, there's no way to know. Which, I suppose, is what the ideologues want.