In the short term, it's vital to override the veto. Executive officeholders must feel the burn and our momentum must be seen overcoming all resistance. To settle for less would be political malpractice, a different problem than medical malpractice. Longer term, it's better to say that the "purple way" is the zone of acceptability where we can call the result a victory. One of the worst habits of Democrats is that they propose seemingly-reasonable half-measures and then lose ground to their opponents inch by policy inch. Instead, start by asking for a full ban or something near, settle for middle ground that resembles the purple way.
Three cheers for the purple way! Three cheers for attempts at evidence-based care! There is tons of room for discussion on what the purple way would look like, but neither the red or blue way is looking all that appealing to me. Thanks for reporting on some of these important details of the governor’s position.
The Purple Way has an opportunity to address a major flaw in the Red Way, which is: if you ban care for minors without addressing the off-the-rails protocol for adults, patients will turn to Planned Parenthood and similar clinics on their 18th birthday. They will receive cross-sex hormones without assessment or any therapy, at the end of their very first visit. There will be NO space for a therapy first approach. That is not a favorable outcome in my book. We don’t have a perfect solution yet, but if we continue thinking critically on this issue, we will get closer with every attempt.
[Note, for transparency's sake, I am a member of the Courage Coalition but not the author of this post, so any Substack author tag is misleading. Simply sharing my opinion as a concerned member of the public.]
You are right, Purple way is not enough but perhaps it's a step in the right direction. The good: Many kids simply outgrow their transgender identity stage. 2. The bad and the ugly: Those who don't outgrown, often don't even need a clinic like PP. Many obtain their hormones (definitely E, not sure about T) from some shady online shops . I have no idea what can be done legally about that.
I agree, this is a big problem for those obtaining E online / illegally. T is trickier, being a controlled substance - you could get it through friends who are prescribed (not that unlikely in this demographic) or maybe from men at the gym (unlikely in this demographic in my opinion). This will get worse if and when we see a push to deschedule testosterone. Right now PP and similar clinics are the easiest, quickest route for T.
In any case, I agree—the underground hormone trade is dangerous and I’m also not sure what can be done to effectively curb it.
Leibowitz wrote this extremely misleading article---https://www.psychiatrictimes.com/view/gender-affirming-care-for-adolescents-separating-political-polarization-from-medicine
A really really bad article. Because it sounds reasonable.
Things like:
"This is why clinical guidelines—written by experts, not legislators—exist. Guidelines integrate consensus expert opinion with a translation of the available evidence into clinical practice recommendations. In essence, guidelines provide a framework on how to ethically deliver the care, not ban it completely nor provide unfettered access for a wide array of youth with differing needs.
In September 2022, the World Professional Association of Transgender Health (WPATH), the first professional association to generate clinical transgender health guidelines, published its eighth version of the Standard of Care (SOC8); the first was published in 1979".
There is a really good description of what is wrong with these guidelines in a peer-reviewed investigative article by J. Block in The British Medical Journal: https://www.bmj.com/content/380/bmj.p382
He says nothing about how these guidelines couldn't seem to manage to do a systematic review of the evidence (said it wasn't possible, although others systematic reviews had already been done and *publicly announced*--had he not noticied the Cass Review--why not??...it's just that they didn't find positive outcomes...everyone who follows them puts psychotherapy first and the WPATH guidelines are just medical intervention instructions, not treatment of trans-identified people instructions). Nothing about how they used the Delphi process which is biased--the SOC7 guidelines were so bad that a review of guidelines group contacted them with advice on how to improve--they ignored it. ( see the rapid response in BMJ with details: "WPATH Standards of Care: A new edition using outdated methods weakens the trustworthiness of content" (https://bmjopen.bmj.com/content/11/4/e048943.responses#wpath-standards-of-care-a-new-edition-using-outdated-methods-weakens-the-trustworthiness-of-content).
Also, they do the assessments because the assessments have been shown to do....what?
Use our test because it has been shown to...to what?
Have they been shown to identify who will benefit?
NO.
Why not? **Because they have not tracked outcomes long enough. They do not know.**
I agree an assessment might identify someone who is not in a position to make a serious life decision but that is not the same as saying that they suffice and that is the end of it.
Here's another misleading statement from that APA article:
""The debate around medical treatments is often centered around the quality of evidence. In short, the evidence demonstrating benefit for gender-affirming care in minors is growing.11-19"
False. This was after the Chen et al 2023 debacle. A study which hid outcomes (6/8 they claimed they'd report) and the other two mental health outcomes looked weak relative to placebo for ftm and showed no benefit for mtf (even with placebo effects!), and 2 kids died.
He describes it thusly: "More recent longitudinal research demonstrating benefit was published in the New England Journal of Medicine.19 In a 2-year longitudinal follow-up study of 315 youth,"
The evidence demonstrating benefit is not growing. It is being seen to be weaker and weaker.
Here is what he says in that article (parenthetical is me):
"What do not exist are:
1 Studies demonstrating long-term psychological benefits in the absence of care (which would be unethical), and [but there are no studies demonstrating long-term psychological benefits in the presence of these interventions, why is the burden of proof being presented this way?...and why is care the same as medical intervention? why not compare different kinds of care, e.g., the care which is prioritized in countries that have used the outcomes of the systematic reviews, psychological care??]
2 Research results to demonstrate that regret and detransition are the most likely outcomes for minors who transition medically. [so if it is not most likely that you will detransition then it is ok? no one has checked, they don't know the detransition rate. if a medicine was only badly harming, say, 4% of the patients, it would be ok, it's only bad if it terribly harms 51%? they don't know the number!]
What do exist are:
1 Evolving research results on direct benefits of care, [which are not finding benefit!]
2 Research demonstrating that adolescents who start hormones as minors with parental oversight have higher continuation rates than adults,25 [this **can** just mean kids get locked in] and
3 Research demonstrating the negative psychosocial consequences of early or delayed puberty in cisgender youth, suggesting the importance of timing for developing correct pubertal changes during adolescence.26,27 [precocious puberty is a disorder, going through puberty at the right time....is not. it might bother you but whether it is best to put you on hormones is not shown to help...why haven't they looked, why don't theyknow?]]
In my opinion, overly focusing on the quality of evidence distracts from the bigger picture. [don't look at the evidence! distracting!] Claims of insufficient evidence negate the fact that transgender adolescents exist, [huh? you can say there are trans-identified kids and that the evidence for these interventions helping is woefully inadequate and that harm is being observed, how on earth does this sentence make sense??] and experiencing the correct physical changes of puberty during adolescence is important for their psychological well-being." [the correct physical changes of puberty are programmed into their bodies...he is stopping their maturation into fertile adults with drugs whose effects are not understood long term-they are known to harm the reproductive system, the brain, immune system, bones, cardiovascular system...and they are taken for life].
These arguments are ridiculous.
And don't get me started on suicide. The governor was woefully misinformed. Another reason WPATH is not out to help these kids or anyone who won't benefit from medical intervention. It's pro-medicalization not pro-trans identified people, of any age.
It's like going to purdue pharma and to ask what we need to help with our pain....
The Purple Way = The Overton Window has shifted so far over the past 10 years that medical experimentation on mentally ill kids and adults in a futile attempt to change their sex has become an acceptable position.
the purple way isnt much different than the debunked affirmation approach, perhaps no different and perhaps worse. No, its not true most would support this. 75% of both blue and red people oppose giving gender meds to kids . 75% oppose allowing biological males into womens spaces. banning some from surgery is a red herring intended to distract from the issue and change the subject. As Ms. Reed can attest, "multidisciplinary comprehensive care" means nothing if its just a rubber stamp for gender affirmation. And certainly thats what the purple approach would be or could be. We now know, via every gov systematic review ever done on earth, that there is zero evidence gender meds help pediatric gender dysphoria, mental health or social function. and there is a lot of evidence gac makes all these things worse. We know gender meds severely harm kids. and we know most kids grow out of their wish to take these meds if prevented from taking them until after puberty.
We know that 98% of kids who start puberty blockers go on to cross sex hormones. we know that blockers followed by hormones cause permanent loss of sexual function, permanent sterility, boat loads of lide long and severe catastrophic health problems including increased suicide and general misery. amsterdam says ppl on these meds long term die early 2x more than ave. they have 50 years of data that shows this. the purple approach allows scammers to continue to harm kids. it allows scammers to continue to sterilize kids. what good is it? oh yes, it would seem to address what some view as the problem: people have found out what a harmful fraud gender care is. but thats not the problem. the problem is that gender care is a harmful fraud and ppl are contineing to promoting it even though it doesnt work. gac is anti gay. it harms gays. its anti gnc ppl. it harms gnc ppl. its the opposite of allowing gender non conformity. it locks people into rigid sterootypes. yes, im aware some claim gac helps. the problem is there is zero evidence it does. for every person that claims it helps there maybe 200 it harms. and many of the peope who claims it helps we later found out it didnt
I get it that purple is between red and blue but isn't it a bit ironic since lavender color symbolizes trans empowerment and resistance or something? (I don't have any alternative color suggestions :))
In the short term, it's vital to override the veto. Executive officeholders must feel the burn and our momentum must be seen overcoming all resistance. To settle for less would be political malpractice, a different problem than medical malpractice. Longer term, it's better to say that the "purple way" is the zone of acceptability where we can call the result a victory. One of the worst habits of Democrats is that they propose seemingly-reasonable half-measures and then lose ground to their opponents inch by policy inch. Instead, start by asking for a full ban or something near, settle for middle ground that resembles the purple way.
Yeah, at this point this has to go back to a beginning, foundational proposition of no child is born in the wrong body. Full stop, override veto.
Excellent point. I actually first thought the opposite, let's start small and expand but I think you are right. Shoot for the moon!
And we must get a similar bill onto the ballot (and then passed) in California:
https://protectkidsca.com
Three cheers for the purple way! Three cheers for attempts at evidence-based care! There is tons of room for discussion on what the purple way would look like, but neither the red or blue way is looking all that appealing to me. Thanks for reporting on some of these important details of the governor’s position.
The Purple Way has an opportunity to address a major flaw in the Red Way, which is: if you ban care for minors without addressing the off-the-rails protocol for adults, patients will turn to Planned Parenthood and similar clinics on their 18th birthday. They will receive cross-sex hormones without assessment or any therapy, at the end of their very first visit. There will be NO space for a therapy first approach. That is not a favorable outcome in my book. We don’t have a perfect solution yet, but if we continue thinking critically on this issue, we will get closer with every attempt.
[Note, for transparency's sake, I am a member of the Courage Coalition but not the author of this post, so any Substack author tag is misleading. Simply sharing my opinion as a concerned member of the public.]
You are right, Purple way is not enough but perhaps it's a step in the right direction. The good: Many kids simply outgrow their transgender identity stage. 2. The bad and the ugly: Those who don't outgrown, often don't even need a clinic like PP. Many obtain their hormones (definitely E, not sure about T) from some shady online shops . I have no idea what can be done legally about that.
I agree, this is a big problem for those obtaining E online / illegally. T is trickier, being a controlled substance - you could get it through friends who are prescribed (not that unlikely in this demographic) or maybe from men at the gym (unlikely in this demographic in my opinion). This will get worse if and when we see a push to deschedule testosterone. Right now PP and similar clinics are the easiest, quickest route for T.
In any case, I agree—the underground hormone trade is dangerous and I’m also not sure what can be done to effectively curb it.
Leibowitz wrote this extremely misleading article---https://www.psychiatrictimes.com/view/gender-affirming-care-for-adolescents-separating-political-polarization-from-medicine
A really really bad article. Because it sounds reasonable.
Things like:
"This is why clinical guidelines—written by experts, not legislators—exist. Guidelines integrate consensus expert opinion with a translation of the available evidence into clinical practice recommendations. In essence, guidelines provide a framework on how to ethically deliver the care, not ban it completely nor provide unfettered access for a wide array of youth with differing needs.
In September 2022, the World Professional Association of Transgender Health (WPATH), the first professional association to generate clinical transgender health guidelines, published its eighth version of the Standard of Care (SOC8); the first was published in 1979".
There is a really good description of what is wrong with these guidelines in a peer-reviewed investigative article by J. Block in The British Medical Journal: https://www.bmj.com/content/380/bmj.p382
He says nothing about how these guidelines couldn't seem to manage to do a systematic review of the evidence (said it wasn't possible, although others systematic reviews had already been done and *publicly announced*--had he not noticied the Cass Review--why not??...it's just that they didn't find positive outcomes...everyone who follows them puts psychotherapy first and the WPATH guidelines are just medical intervention instructions, not treatment of trans-identified people instructions). Nothing about how they used the Delphi process which is biased--the SOC7 guidelines were so bad that a review of guidelines group contacted them with advice on how to improve--they ignored it. ( see the rapid response in BMJ with details: "WPATH Standards of Care: A new edition using outdated methods weakens the trustworthiness of content" (https://bmjopen.bmj.com/content/11/4/e048943.responses#wpath-standards-of-care-a-new-edition-using-outdated-methods-weakens-the-trustworthiness-of-content).
Also, they do the assessments because the assessments have been shown to do....what?
Use our test because it has been shown to...to what?
Have they been shown to identify who will benefit?
NO.
Why not? **Because they have not tracked outcomes long enough. They do not know.**
I agree an assessment might identify someone who is not in a position to make a serious life decision but that is not the same as saying that they suffice and that is the end of it.
Here's another misleading statement from that APA article:
""The debate around medical treatments is often centered around the quality of evidence. In short, the evidence demonstrating benefit for gender-affirming care in minors is growing.11-19"
False. This was after the Chen et al 2023 debacle. A study which hid outcomes (6/8 they claimed they'd report) and the other two mental health outcomes looked weak relative to placebo for ftm and showed no benefit for mtf (even with placebo effects!), and 2 kids died.
He describes it thusly: "More recent longitudinal research demonstrating benefit was published in the New England Journal of Medicine.19 In a 2-year longitudinal follow-up study of 315 youth,"
https://www.reddit.com/r/medicine/comments/15hhliu/the_chen_2023_paper_raises_serious_concerns_about/
The evidence demonstrating benefit is not growing. It is being seen to be weaker and weaker.
Here is what he says in that article (parenthetical is me):
"What do not exist are:
1 Studies demonstrating long-term psychological benefits in the absence of care (which would be unethical), and [but there are no studies demonstrating long-term psychological benefits in the presence of these interventions, why is the burden of proof being presented this way?...and why is care the same as medical intervention? why not compare different kinds of care, e.g., the care which is prioritized in countries that have used the outcomes of the systematic reviews, psychological care??]
2 Research results to demonstrate that regret and detransition are the most likely outcomes for minors who transition medically. [so if it is not most likely that you will detransition then it is ok? no one has checked, they don't know the detransition rate. if a medicine was only badly harming, say, 4% of the patients, it would be ok, it's only bad if it terribly harms 51%? they don't know the number!]
What do exist are:
1 Evolving research results on direct benefits of care, [which are not finding benefit!]
2 Research demonstrating that adolescents who start hormones as minors with parental oversight have higher continuation rates than adults,25 [this **can** just mean kids get locked in] and
3 Research demonstrating the negative psychosocial consequences of early or delayed puberty in cisgender youth, suggesting the importance of timing for developing correct pubertal changes during adolescence.26,27 [precocious puberty is a disorder, going through puberty at the right time....is not. it might bother you but whether it is best to put you on hormones is not shown to help...why haven't they looked, why don't theyknow?]]
In my opinion, overly focusing on the quality of evidence distracts from the bigger picture. [don't look at the evidence! distracting!] Claims of insufficient evidence negate the fact that transgender adolescents exist, [huh? you can say there are trans-identified kids and that the evidence for these interventions helping is woefully inadequate and that harm is being observed, how on earth does this sentence make sense??] and experiencing the correct physical changes of puberty during adolescence is important for their psychological well-being." [the correct physical changes of puberty are programmed into their bodies...he is stopping their maturation into fertile adults with drugs whose effects are not understood long term-they are known to harm the reproductive system, the brain, immune system, bones, cardiovascular system...and they are taken for life].
These arguments are ridiculous.
And don't get me started on suicide. The governor was woefully misinformed. Another reason WPATH is not out to help these kids or anyone who won't benefit from medical intervention. It's pro-medicalization not pro-trans identified people, of any age.
It's like going to purdue pharma and to ask what we need to help with our pain....
Because they lie, the purple way is not enforceable.
The Purple Way = The Overton Window has shifted so far over the past 10 years that medical experimentation on mentally ill kids and adults in a futile attempt to change their sex has become an acceptable position.
the purple way isnt much different than the debunked affirmation approach, perhaps no different and perhaps worse. No, its not true most would support this. 75% of both blue and red people oppose giving gender meds to kids . 75% oppose allowing biological males into womens spaces. banning some from surgery is a red herring intended to distract from the issue and change the subject. As Ms. Reed can attest, "multidisciplinary comprehensive care" means nothing if its just a rubber stamp for gender affirmation. And certainly thats what the purple approach would be or could be. We now know, via every gov systematic review ever done on earth, that there is zero evidence gender meds help pediatric gender dysphoria, mental health or social function. and there is a lot of evidence gac makes all these things worse. We know gender meds severely harm kids. and we know most kids grow out of their wish to take these meds if prevented from taking them until after puberty.
We know that 98% of kids who start puberty blockers go on to cross sex hormones. we know that blockers followed by hormones cause permanent loss of sexual function, permanent sterility, boat loads of lide long and severe catastrophic health problems including increased suicide and general misery. amsterdam says ppl on these meds long term die early 2x more than ave. they have 50 years of data that shows this. the purple approach allows scammers to continue to harm kids. it allows scammers to continue to sterilize kids. what good is it? oh yes, it would seem to address what some view as the problem: people have found out what a harmful fraud gender care is. but thats not the problem. the problem is that gender care is a harmful fraud and ppl are contineing to promoting it even though it doesnt work. gac is anti gay. it harms gays. its anti gnc ppl. it harms gnc ppl. its the opposite of allowing gender non conformity. it locks people into rigid sterootypes. yes, im aware some claim gac helps. the problem is there is zero evidence it does. for every person that claims it helps there maybe 200 it harms. and many of the peope who claims it helps we later found out it didnt
Overide the veto.
Lets start at the beginning and let gender activists PROVE their points.
I get it that purple is between red and blue but isn't it a bit ironic since lavender color symbolizes trans empowerment and resistance or something? (I don't have any alternative color suggestions :))
I was taken aback when I saw "Purple Way," since my alma mater's color is purple. What, I thought, does Northwestern have to do with this?