Linkage

After years of struggle, UK parents successfully lobbied the NHS to start prescribing gender-affirming medical treatments for minors under 16 in 2011. Their success, however, was short-lived.

In April, NHS England released the findings of a four-year inquiry into GIDS led by Dr. Hilary Cass, a pediatrician with no experience treating adolescents with gender dysphoria. On the recommendation of the Cass Review, which was highly critical of adolescent medical transition, the NHS services in England, Wales and Scotland have stopped prescribing puberty blockers for gender dysphoria. The British government also banned private clinics from prescribing them, at least temporarily.

Though there is much more evidence now to support gender-affirming care than in 2008, there is also a much stronger anti-trans movement seeking to discredit and ban such care.

British media coverage has given that movement a big boost in recent years, turning the spotlight away from the realities that trans kids and their families are facing, and pumping out stories nitpicking at the strength of the expanding evidence base for gender-affirming care. Its coverage of the Cass Review followed suit.

US media, unsurprisingly, gave less coverage to the British review, but most of the in-depth coverage followed British media’s model. Underlying this coverage are questionable claims by people with no experience treating minors with gender dysphoria, and double standards regarding the evidence for medical and alternative treatments.

I emphatically reject the author's opinion that "it’s not ridiculous to suggest, for example, that a randomized trial of puberty blockers would be a good idea." (Why not a randomised trial of ambulances? We'll send half of emergency callers an Uber instead.) But he's certainly thorough, and excepts like this are astounding.

The Cass review was an interesting juxtaposition. Some of the scientific arguments were very reasonable, and the York team generally did a decent job with the systematic reviews that informed the document. However, the review itself often positioned bizarre theories about gender dysphoria alongside data and evidence. I’ve recounted quite a few examples of this during my pieces, but I thought I’d share one more that I found recently:

“Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed. Some researchers (Nadrowski, 2023) suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content.” (Cass review, page 110)

This paragraph suggests that porn can potentially turn children trans. If you look up the reference, it is to this opinion piece from a psychiatrist. The paper itself contains no data connecting gender dysphoria to pornography, but basically argues that teen girls may view porn and become so disgusted with being women that they choose to instead become men. The paper also notes that “Girls affected by autism might be at higher risk because of their reduced mentalization capacities.”, although it does not provide any evidence that this is true.

The author of this opinion piece is a psychiatric trainee who lists their affiliation as Therapy First. Therapy First is an explicitly anti-medication group which campaigns to prevent children from being given hormones or puberty blockers for gender dysphoria - instead, they recommend psychotherapy as the first and in many cases only option. This is not evidence. It’s barely even an opinion. There is no reasonable excuse for the Cass review having included such a completely bizarre and unsubstantiated theory, especially without noting that it is entirely unsupported by even the most vague of evidence.

Seriously: would you test the effectiveness of chemotherapy by giving a control group of cancer sufferers saline water? I mean, assuming you're not a raving lunatic who insists that cancer is a fashionable lifestyle choice spread by social contagion on TikTok?

The absence of RCTs studying the impact of gender-affirming care on the mental health and well-being of transgender adolescents does not imply that these interventions are insufficiently supported by evidence. Although RCTs are considered high-quality evidence because of their ability to control for unmeasured confounders, the impossibility of masking which participants receive gender-affirming interventions and the differential impact of unmasking on adherence, withdrawal, response bias, and generalizability compromises the value of RCTs for adolescent gender-affirming care. RCTs are methodologically inappropriate for studying the relationship between gender-affirming interventions and mental health. These methodological considerations compound the serious ethical concerns raised by RCTs in adolescent transgender healthcare. Given the limitations of RCTs, complementary and well-designed observational studies offer more reliable scientific evidence than RCTs and should be considered of sufficient quality to guide clinical practice and policymaking. Adolescent trans healthcare is on solid footing.

a periodic reminder that these places exist:

• https://genderdysphoria.fyi/
• https://diyhrt.wiki/
• https://diyhrt.info/
• https://hrtcafe.net/
• https://transharmreduction.org/
• https://transfemscience.org/
• https://gtrr.artemislena.eu/
• https://diyhrt.market/transfem-hrt-guide
• https://www.reddit.com/r/estrogel/wiki/

and places like these:

• https://diyhrt.market/
• https://www.unitedpharmacies-uk.md

and some country specific things (please recommend more):

• https://genderkit.org.uk/

feel free to boost, and reply with other useful links for #trans people

Theoretically, we make use of a framework that combines Andrew Baker’s work on social purpose with a novel conception of professional legitimacy, which we divide into internal legitimacy and external legitimacy. Especially when they articulate a strong sense of social purpose and are open to co-constitution, such forms of knowledge can have widespread popular appeal while being vehemently rejected by the economics profession. This means that policymakers must examine not just the potential of alternative expertise per se but also weigh the appeal of the two forms of legitimacy against one another. As a result, this framing can help us understand the complex and sometimes non-linear trade-offs associated with upstart forms of expertise.

Yet, this framing also leaves open crucial questions, that should be addressed by future research on the rise of indie economics. Indeed, as a broader field of ‘lay experts’ emerges, potentially challenging and undermining the more centralised form of knowledge production that has been dominant over the course of the long twentieth century, we will need to grapple with new questions of quality control. Science has always had to contend with tensions between scientific rigour and creativity and has developed mechanisms such as peer review to deal with it. But the changes we now face are altering the nature of this trade-off: co-constitution and the enrolment of lay actors can open new intellectual frontiers and democratise science, but they can also open the floodgates for manipulation, pseudoscience, and misinformation of various forms. Future research should explore the mechanisms of quality control (or lack thereof) that are evolving to navigate this new reality.

To return to Daniela Gabor’s question from the introduction, the rise of MMT shows in no uncertain terms we are in a political climate in which trust in mainstream economic knowledge is desperately frayed and – given this lack of trust – anti-establishment credentials become a crucial source of appeal. The rise of alternative forms of economic expertise is menacing to mainstream macro not just to the extent that it competes with it for finite attention, but also in that it is a symptom of the deeper malaise of the discipline and its failure to prove itself fit for social purpose in the face of interlinking crises.

NCAA President Charlie Baker told a Senate panel there are fewer than 10 transgender athletes he is aware of who currently compete in college sports, pouring cold water on an issue Republicans have said is a nationwide problem and one that is increasingly fraught territory for Democrats.

“How many athletes are there in the U.S. in NCAA schools?” Sen. Dick Durbin (D-Ill.) asked Baker during a Senate Judiciary Committee hearing Tuesday on federal regulations around sports gambling.

“Five hundred and ten thousand,” said Baker, a former Republican governor of Massachusetts who has served since 2023 as president of the NCAA, which governs intercollegiate athletics at more than 1,000 colleges and universities across the country.

“How many transgender athletes are you aware of?” Durbin asked.

“Less than 10,” Baker said. He did not say whether that number includes transgender men. 

[…]

A recent cross-sectional study published in the British Journal of Sports Medicine found that transgender women who completed more than one year of hormone replacement therapy performed worse than cisgender women in tests measuring lower-body strength and lung functioning.

Trans women’s bone density, which is linked to muscle strength, was found to be equivalent to that of cisgender women, and there were no meaningful differences in levels of hemoglobin, which facilitates oxygen delivery to muscles and is related to greater aerobic performance.

An earlier study, also published in the British Journal of Sports Medicine, found that transgender women who went through male puberty retained an athletic edge after one year of hormone therapy. The study’s lead author has cautioned against using the results to categorically ban transgender athletes from competitive sports. 

There can be no doubt that while Biden rhetorically discussed a more humane approach to the border, his actual tenure has been devastating for migrants. Biden deported 271,484 people in 2024 alone — the highest number of any year since 2014. He maintained Trump-era border restrictions, such as the misuse of the Title 42 public health statute to deny migrants access to the U.S. and violate due process of asylum seekers. In its opening days, the Biden administration detained 14,000 Haitian migrants seeking asylum, and summarily deported them en masse. The devastating episode involved U.S. border agents on horseback whipping Haitians, producing photos reminiscent of slavery.

[…]

Will Trump be worse than Biden? This has been a complicated question to answer for many on the left in light of Biden’s unwavering participation in Israel’s genocide in Gaza. For sections of the population, there will be a dramatic, catastrophic change from Biden to Trump. The new attacks on reproductive rights, LGBTQ folks and women, immigrants and Muslims should not be underestimated. We should also prepare for a new round of attacks on organizing, beginning with especially vulnerable activists, such as international students, Muslim and immigrant organizers. But such attacks are already happening under Biden, who has presided over mass arrests of student protesters and the criminalization of organizing for Palestine.

[…]

This continuity between Biden and Trump — and convergence between the Democratic Party and MAGA — complicates an assessment of Trump and made it difficult for many progressives to support Kamala Harris’s campaign.

I'm shocked, I tell you. Shocked!

The researchers found that respondents who viewed female athletes as less deserving of attention, support, and media coverage were more likely to oppose transgender inclusion in sports. For example, individuals who disagreed with statements like “Women’s sports deserve the same amount of media coverage as men’s sports” were significantly less likely to support transgender athletes’ rights.

The researchers also found that adherence to traditional standards of femininity—such as prioritizing thinness and attractiveness—was a strong predictor of opposition to transgender athlete inclusion. For instance, respondents who endorsed the idea that women should be thin or that women’s muscles were less attractive were less supportive of transgender athletes competing in alignment with their gender identity.

Similarly, those who agreed with statements like “Female athletes will never be as good as male athletes” were more likely to oppose allowing transgender athletes to compete according to their gender identity and to support sex testing.

Negative attitudes toward homosexuality were another powerful predictor of opposition to transgender athletes’ rights. Participants who expressed homophobic views, such as agreeing with statements like “I would be disappointed if I found out my child was homosexual,” were significantly more likely to support sex testing and oppose transgender inclusion.

According to the researchers, the findings suggest that opposition to transgender inclusion often reflects efforts to uphold traditional gender norms and maintain the existing gender order rather than a genuine commitment to advancing women’s sports.

The massive programme of cuts and deregulation that Musk and Ramaswamy seek extends the sadomasochistic politics now ascendant on both sides of the Atlantic. Demagogues have found that it doesn’t matter how much their followers suffer, as long as their designated enemies are suffering more. If you can keep ramping up the pain for scapegoats (primarily immigrants), voters will thank you for it, regardless of their own pain. This is the great discovery of the conflict entrepreneurs, led by Musk himself: what counts in politics is not how well people are doing, but how well they are doing in relation to designated out-groups.

[…]

Why has the class war been unleashed now, not just in the US, but in much of the rest of the world? Because the democratising, distributive effects of two world wars have worn off. We fondly imagine that the semi-democratic era (exemplified in rich nations by the years 1945–1975) is the normal state of politics. But it was highly atypical, and made possible only by the wars’ erosion of the power of the ruling classes. The default state of centralised societies, to which nations are now reverting, is oligarchy.

[…]

In nations that have not yet fully succumbed to oligarchy we need to recognise, and recognise fast, that democratic politics do not emerge spontaneously. Our systems achieve a quasi-democratic character only with an active citizenry, whose engagement is largely defined by protest, and an independent media. But, at the direct behest of capital, governments are criminalising peaceful protest, while many independent media, such as the BBC, shut out dissenting voices.

Bannon said after Zuckerberg’s visit, “the floodgates opened up and they were all there trying to be supplicants. I look at this, and I think most people in our movement look at this, as President Trump broke the oligarchs. He broke them and they surrendered.” Bannon added, with a laugh: “They came and said: ‘Oh, we’ll take off any constraints, no more checkings, everything.’”

“I view this as September of 1945, the Missouri, and you have the [Japanese] imperial high command, and he’s like Douglas MacArthur. That is an official surrender, OK, and I think it’s powerful”, Bannon added.

The comments come as Joe Biden warned that “an oligarchy is taking shape in America of extreme wealth, power and influence that literally threatens our entire democracy” and of “the dangerous concentration of power in the hands of a few ultra-wealthy people”.

But according to the White House archives, Biden had not uttered the word “oligarchy” in the context of American politics until last week. Progressive Democrats called out Biden for being an imperfect messenger having courted and relied on big-ticket donors during his 50-year career.

“It’s cowardly that after representing the oligarchs for 50 years in office, he calls out this threat to our nation with just days left in his presidency,” said Nina Turner, a national co-chair for the senator Bernie Sanders’ last presidential campaign.