HOW GENDER MEDICINE SET ITSELF UP FOR DISASTER For @CompactMag, I report on what the 100s of WPATH conference videos I obtained tell us about this troubled field: compactmag.com/article/how-g… 👉I 'll be publishing the conference videos on my Substack: benryan.substack.com/p/i-obt… As I write for Compact magazine: This catalogue, which the World Professional Association for Transgender Health, or WPATH, fought to keep shielded, provides a rich account of how leading figures in pediatric gender medicine approached scientific research, drove the evolution of medical practices, and strategized politically during a critical turning point in this field’s brief and tortured history. The two years following Chase Strangio’s 2021 address were a period in which statehouse Republicans escalated their attacks on this field. The WPATH conference presenters largely responded to the political siege by doubling down. Rather than engage in soul searching over whether their methods in pediatrics were ethically sound and whether any criticisms had merit, they overwhelmingly stuck to their guns. Presenters frequently downplayed fundamental hazards about irrevocably altering adolescents’ bodies. Meanwhile, a parade of systematic reviews—the gold standard of scientific evidence—was concluding that the evidencebacking pediatric gender medicine is weak and inconclusive. These findings have led health authorities in a number of European nations, concerned about risks such as infertility, to reverse course. They reclassified pediatric gender-transition interventions as experimental and sharply restricted minors’ access. Not WPATH. The organization remained on an inexorable trajectory in the opposite direction, toward its eventual head-on collision with the second Trump administration. For highlight clips, see the 🧵👇

Over on Bluesky, Popehat, who is an attorney who often schools others in the finer points of the law, insinuates that there would be a moral upside to someone killing Elon Musk.

Parade. Thursday. Manhattan.

Testosterone therapy in men may be overprescribed, inconsistent with clinical guidelines Only a small number of men who were prescribed testosterone therapy received appropriate, guideline-concordant diagnostic testing, according to a study being presented Saturday at ENDO 2026, the Endocrine Society’s annual meeting in Chicago, Ill, by Sophia Sinha, M.D., clinical assistant professor at the University of Michigan in Ann Arbor, Mich. “Our study findings highlight opportunities to improve patient care and reduce inappropriate testosterone prescribing. Long-term, these findings can lead to quality-improvement efforts and clinical decision support tools that promote consistent, guideline-concordant testosterone prescribing,” said senior author Maria Papaleontiou, M.D., associate professor at the University of Michigan in Ann Arbor, Mich. The retrospective chart review included a random sample of 200 males assigned at birth (mean age, 52.5 years) with at least one outpatient primary care visit at Michigan Medicine in the past year, who had a diagnosis of hypogonadism, and received an initial testosterone prescription during the study period (2020 to 2025). The most common coexisting medical conditions in the study population included obesity (63%), hypertension (52%), depression (40%), diabetes (28%) and arthritis (28%). That data show only 12% of men who received an initial testosterone prescription had two low morning testosterone levels (total testosterone < 300ng/dL), free testosterone < 70pg/mL, or low bioavailable testosterone, between 5 a.m. and 10 a.m.), had their LH and/or FSH measured, and had no contraindications to testosterone therapy. More than half of the patients (62%) had a prostate-specific antigen (PSA), and 77% had a complete blood count measured in the year before the initial testosterone prescription. Overall, 55% of the men had obstructive sleep apnea, 4% prostate cancer and 1.5% PSA >4 ng/mL before being prescribed testosterone. Prescriptions were written by primary care physicians (45%), urologists (35.5%), endocrinologists (18%) and other specialists (1.5%). The most common testosterone prescription was a topical formulation (68.5%). Sinha and Papaleontiou said improving guideline-concordant testosterone prescribing can help prevent avoidable risks in people who may not have a true clinical need for it. “Future studies should evaluate whether targeted interventions are needed,” Papaleontiou said.

There is a real resistence to standardized testing that has broken the brains of some folks. They interpret evidence completely backwards (like this NYMagazine article). What is clear evidence of predictive validty gets spun as clear evidence of a failure. I've seen this for too many years, with SAT and GRE tests too, to believe it's an isolated error. Instead, it's a systemic ideological failure. People are unwilling to look at the evidence in an open-minded way and draw accurate conclusions. And they don't have the institutional checks and balances to root out biases. This is a serious problem that extends beyond magazines to our leading universities that repealed standardized tests and are now dealing all the problems this has created. It also reduces public trust in these institutions. I have a subscription to NYMagazine and this issue makes me trust the magazine less. The only solution is that these institutions and organizations need to issue a correction, re-examine their editorial policies, hire staff who have the analytic skills to evaluate this type of data, and then listen to those staff. This is what it will take to earn and sustain the trust of the public. Making the same mistake over and over again only reveals that they don't care about accuracy.

Gifted and Talented, or G&T, programs have long been a perennial subject of debate, particularly in New York City, where it has bedeviled mayors for years. Some parents have already washed their hands of the whole G&T business, refusing to participate in what they view as a corrupt system of segregation. But countless others still place significant stock in the G&T designation and what it offers and are comfortable relying on cognitive testing, should it be required, to determine whether a child qualifies. “When your intelligence is the foundation of your self-perception, failing to achieve feels like soul death,” writes Katie Arnold-Ratliff. But if the limited amount of information we have about gifted kids long-term is any indication, most lead, at best, ordinary lives of modest accomplishment. A 35-year study of 677 gifted children found that by age 50, only 12.3 percent had reached a level of “eminence,” defined as “full professors … Fortune 500 executives … judges and lawyers, leaders in biomedicine, award-winning journalists and writers.” This means 88 percent never did. Arnold-Ratliff digs into the myth of the gifted child, and how our notions of intelligence may be inherently flawed: nymag.visitlink.me/9mc2Wh

Every time I see one of those prompts like, “You become a billionaire, but you have to eat a Costco-sized jar of pickles every morning for the rest of your life—are you taking the deal?” I know my answer before I even finish the sentence. Becoming a billionaire is the dealbreaker. The pickles would be manageable. The billionaire thing would ruin my life.

Following youth who medically transition for an average of 2.4 years is not likely to detect the true detransition rate among them, given that researchers believe it can typically take several years for detransitioning in this population to occur. And then there is the fact that this clinic did not reach out to these patients after they left the clinic, which happened automatically once they became adults. So there is no way of knowing if they detransitioned past their adolescence. I am in the process of writing an article about a pediatric gender clinic doctor who once presented data at a conference with two years of follow-up of youths attending gender clinics and found that among those who underwent gender-transition treatment, there was no treatment regret at that point. This physician presented the study as evidence of great success. I have interviewed a patient of hers who detransitioned six years after being put on testosterone. This patient is deeply unhappy about the care they received and believes that the doctor harmed them egregiously. If they had been in the aforementioned study, their detransition would not have been detected due to insufficient follow-up time.