Is the nearly vertical upward spike in reported cases of gender transition due, in part, to the placebo effect? Leor Sapir Reports at City Journal,  “The Placebo Is the Point: A new paper highlights the fundamental bias in the world of “gender-affirming” research.”

A paper published last month in the Archives of Sexual Behavior makes an important point about the environment in which “gender-affirming” drugs and surgeries are offered to minors. Positive outcomes from hormonal interventions, argues psychiatrist Alison Clayton, the article’s author, may be attributable to placebo effects generated by clinical encounters and the social context in which they take place, rather than to the underlying psychotropic effects of the drugs themselves.

Clayton’s basic intuition makes sense. If you take a teenager in emotional distress and tell her that drug X will solve her problems, while treatment Y will make them worse, and then bring her to a clinical setting where medical professionals repeat that message, it should come as no surprise that the teenager experiences emotional relief when you give her X, or distress when you give her Y—regardless of the psychotropic effects of X. The patient may regard the giving of X symbolically as adults listening to her and empathizing with her inner turmoil. “The ‘Hawthorne effect,’” writes Clayton, “describes the phenomenon where clinical trial patients’ improvements may occur because they are being observed and given special attention. A patient who is part of a study, receiving special attention, and with motivated clinicians, who are invested in the benefits of the treatment under study, is likely to have higher expectations of therapeutic benefits.”

It is indeed the case that promoters of “gender-affirming care” have created what Clayton calls “a perfect storm for the placebo effect.” In the left-of-center media, puberty-blockers, cross-sex hormones and (less frequently) surgeries are hailed as “medically necessary” and suicide-preventing measures for teens in distress, supposedly over having been wrongly “assigned” their sex at birth. Skeptics of these interventions are denounced as cruel deniers of life-saving medicine to youth at high risk of suicide. Meantime, alternatives to drugs and surgeries (e.g., psychotherapy) are denigrated as harmful “conversion therapy,” setting the stage for a nocebo (harmful) effect on those who receive psychotherapy but not drugs.

From the viewpoint of those who have become intensely interested in treating dysphoria medically (rather than the “watch and see” method), many have uttered the phrase “Munchausen syndrome by proxy,” which is “a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.”  Biologist Colin Wright has been observing various parent groups. His observations give credence to that concern.

Leor Sapir has written many other excellent articles on transgender ideology this year, including “The School-to-Clinic Pipeline: New rules from the Biden administration will worsen gender-related distress in children.”

Sapir’s article details that many schools are now gulping down transgender ideology and, further, that President Biden’s proposed admin Title IX rules will be gasoline on this fire.

All of this is going full speed ahead in U.S. schools, despite the fact that the UK recently declared that it is completely shutting down Taviscot, the world’s biggest transgender clinic, the UK health authorities declaring that the transgender policies that were prevalent at Taviscot (the same policies still honored in the U.S.) were harming children. It is also clear now that there is NO legitimate research demonstrating that it increases a child’s risk of suicide to the extent that a parent refuses consent to double-mastectomies and a lifetime course of testosterone for their daughter. That doesn’t stop transgender activists from making these baseless claims, however. I can refer you to credible sources for criticism of transgender activists’ preferred treatment. if you’d like. Unfortunately, I look like an especially cranky conspiracy theorist because many U.S. medical associations have bought into gender ideology hook, line and sinker (many of the members of these orgs abhor this, but are staying silent for fear of losing their jobs/teaching positions).

Sapir writes about the unintended affects of “affirmative care”:

In her review of the National Health Service’s Tavistock Centre prior to the closure of its Gender Identity Development Service, Hilary Cass, former president of the U.K.’s Royal College of Paediatrics and Child Health, raised concerns about social transition. Using a minor’s preferred name and pronouns to validate his or her “gender identity,” Cass observed, should not be considered “a neutral act” but instead an “active intervention” in a child’s psychosocial development. An “affirmed” child reaching the Tanner II stage of physical development—typically between ages nine and 13—in a state of gender dysphoria will likely go on to receive puberty blockers, especially given the widespread (but false) assumption that these expensive drugs are “fully reversible” and merely buy some time for self-reflection. Three studies completed over the past four years show that 96 percent to 98 percent of those who begin puberty blockers go on to cross-sex hormones, a more extreme form of intervention that typically entails permanent loss of fertility and sexual function in addition to heightened risk of cancer and heart disease.

Puberty blockers have never been subjected to randomized controlled trials (RCTs)—the highest standard for clinical drug trials—in the context of gender dysphoria. (Claims about their safety and reversibility rest on their use for precocious puberty, a different condition with a different etiology, diagnostic criteria, and prognosis.) A major reason for this situation is that activists have already asserted, independent of evidence, that these drugs are “medically necessary” and “lifesaving.” On this view, subjecting puberty blockers to RCTs, which typically require control groups that get either no treatment or placebos, would mean condemning many teenagers to suicide. The use of puberty-blocking agents like leuprorelin (brand name, Lupron) remains FDA-unapproved and off-label.

In practical terms, then, when a school strives to create a “safe, welcoming, and inclusive” environment for transgender-identified students, it greatly increases the chance that children who might otherwise go through a temporary stage of identity exploration or confusion will reject their bodies in favor of a risky experimental medical protocol. Even for those who believe that someone can consent to medical “gender transition” at 16 but not, say, at seven, this should be sobering news. It means that a teacher’s expression of kindness and desire to be inclusive could have serious unintended effects. Given mounting evidence of the socially contagious nature of transgender identification among teenage girls with preexisting mental health conditions, parents are right to worry about the consequences of the new Title IX rules.

In the meantime, most left-leaning legacy media (NYT, WaPo, NPR, MSNBC) have throttled back coverage of the facts or suppressed them entirely. In these “news” organizations, transitioning is still seen as glorious and celebratory; many articles proclaim that a child should always be “affirmed” and that only bigots would have any reservations. J.K. Rowling declared her concerns a few years ago and she has been receiving death threats ever since. “Billboard Chris” walks the streets of many cities trying to engage people in calm conversation about these issues (I largely agree with his positions).  About two weeks ago, he was attacked by a mob of young men who broke his arm.  This is at least the second time he has been sent to the hospital in the past year for trying to discuss this issue out of concern for children. I agree with Billboard Chris that no 15-year old could ever be sufficiently informed to “consent” to surgery that will cause sterility or even taking “puberty blockers,” which almost inevitably also lead to a lifetime course of cross-sex hormones.