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TransYouthCan! is a study that fails

By Robin Singer

A recently completed Canadian youth study called TransYouthCAN! is the first of its kind in Canada -- but it has severe limitations which undermine its credibility. The study is important because its biased presentation continues to contribute to the explosion of children’s gender “transitions,” and seeks to provide justification for future growth in the number of such transitions through lower age-related barriers that benefit the synthetic sex industry. This investigation reports on the criticisms of the study, as well as on changing policies in other countries.

Dr. Greta Bauer is the Principal Investigator on the TransYouthCAN! Project, which received $1,298,801 in funding from the federal government’s health research agency, the Canadian Institute of Health Research (CIHR). (She has received a total of $2,455,422 from other CIHR grants since 2012, almost all for research on gender identity issues).

She is a Professor, Epidemiology & Biostatistics at Western University, and a Sex and Gender Science Chair of the CIHR. She described the survey as the first published research on trans patient access to primary and emergency care.

Significantly, Dr. Bauer previously researched suicidality among people unhappy with their sex. Reporting on the results of a 2012 Trans Pulse Survey, with a study cohort of ages 16 and up, she said “we found that 43 per cent of trans people had attempted suicide at some point in their life and 10 per cent in the last year." This statistic has now been undermined, but not before the mantra “Would you rather have a live daughter or a dead son?” was used by gender professionals to hasten wrong sex “affirmation” and access to drug therapy.

The Schulich School of Medicine and Dentistry at Western University, where Dr. Bauer is a professor, partners with a wide range of hospitals and hospital alliances in Southwestern Ontario. One of those is the London Health Science Centre. which was recently portrayed critically in the news because their Children’s Gender Pathways Service prescribes puberty blockers to children it has not yet seen. Dr. Bauer hosted the Gender Pathways Service London community webinar for TransYouthCAN!. Given the ties between The Schulich School of Medicine and the London Health Science Centre, it seems reasonable to ask if Dr. Bauer agrees with prescribing puberty blockers before the traditional in-person assessment of patients.

The study also serves as an example of how easily the gender ideology industry quietly migrates back and forth across the border between the United States and Canada by means of academia. Dr. Bauer announced recently that she is returning to her roots in the US as the incoming director of the Institute for Sexual and Gender Health (ISGH) at the University of Minnesota. Dr. Bauer has a personal connection to ISGH, having served as a research coordinator during her training when the Institute was the Program in Human Sexuality. The extent of her personal connection is demonstrated by her statement, “It is an honor to return to the University of Minnesota to helm ISGH, which continues to innovate and lead with a new master’s program and many stellar clinical faculty and dedicated staff."

Dr. Bauer is collecting $700,000 in a grant (April 1, 2020 - Mar 31, 2024) from the CIHR for the CIHR Sex and Gender Science Chairs Initiative. Will that Canadian funding continue at her new post at the University of Minnesota, beginning November 2022?

The outgoing director of ISGH, Dr. Eli Coleman (referred to as “he” on some websites and as “she” on others), is listed on Google Scholar as a regular co-author with Dr. Bauer. She is a former director of the World Professional Association of Transgender Health (WPATH) and Chairman of the SOC7 Committee (the body in charge of creating the 7th version of the WPATH Standards of Care). She says of her organization: “Our amazing faculty have produced important research; educated thousands of medical students, residents, and postdoctoral fellows; and cared for tens of thousands of patients . . .I am so pleased that through philanthropic efforts, we have secured a strong base of support for the future.”

We have some understanding of these “philanthropic efforts” from Jennifer Bilek’s June article in the publication TABLET, in which the ISGH is specifically mentioned. In her article, The Billionaire Family Pushing Synthetic Sex Identities (SSI) Bilek has this to say about the Pritzkers and their philanthropic efforts to promote SSI at the University of Minnesota:

The Pritzkers became the first American family to have a medical school bear its name in recognition of a private donation when it gave $12 million to the University of Chicago School of Medicine in 1968. In June 2002, the family announced an additional gift of $30 million to be invested in the University of Chicago’s Biological Sciences Division and School of Medicine. These investments provided the family with a bridgehead into the world of academic medicine, which it has since expanded in pursuit of a well-defined agenda centered around SSI (Synthetic Sex Identities). Also in 2002, Jennifer Pritzker founded the Tawani Foundation which has since provided funding to Howard Brown Health and Rush Memorial Medical Center in Chicago, the University of Arkansas for Medical Sciences Foundation Fund and the University of Minnesota’s Institute for Sexual and Gender Health, all of which provide some version of “gender care”. In the case of the latter, “clients” include “gender creative children as well as transgender and gender non-conforming adolescents.”

We can conclude that Dr. Bauer’s entire professional training as an undergraduate to the present moment can be described as biased toward universal child “affirmation,” which surely casts doubt on the findings of the TransYouthCAN! study. It is worth noting that in Canada “philanthropic efforts” are not needed due to the ongoing largesse of the federal government.

Criticism of the TransYouthCAN! Study

The TransYouthCAN! study was an observational study which is of limited usefulness to healthcare workers and parents compared with a treatment study, and involved a very small number of patients over a very short period of time. Nonetheless, a torrent of 56 articles, posters, YouTubes, infographics etc., based on the study were published in journals and circulated at conferences, including the Canadian Pediatric Society, Society For Adolescent Health, Pediatrics, Canadian Psychological Association, Canadian Conference on Medical Education and Journal of the Endocrine Society.

Predictably, the widespread Rapid Onset Gender Dysphoria (ROGD) Littman hypothesis was not supported even though 126 children left the study of the original 300 who signed up. The study concluded, “Although emergence of gender dysphoria at puberty is long established, a distinct pathway of “rapid onset gender dysphoria” (ROGD) was recently hypothesized based on parental data. Using adolescent clinical data, we tested a series of associations that would be consistent with this pathway, however our result did not support the ROGD Hypothesis.”

Might those who left the study have desisted?

Observational studies are a type of nonexperimental research in which exposure is not controlled by the investigator. Observational studies are by far the most common form of clinical research because of their relatively low complexity, cost, and ethical constraints compared to randomized trials or other forms of clinical experimentation. Bias, confounding, and issues with validity are more common in observational studies.

Unfortunately, observational studies are the only studies available so far in “transgender care” for children, but the limitations associated with them have not prevented their use to justify treatments causing irreversible bodily changes and harm to youth. Conversion Therapy Watchdog, Bernard Lane, wrote in his Substack, Overreach:

In the U.S. Senate this month, acting director of the National Institutes of Health Dr. Lawrence Tabak was asked about the safety of puberty blockers as an off-label treatment for minors. Dr. Tabak said the research in this area was limited to “observational studies”. This methodology is regarded as producing weaker evidence than an experimental study involving, say, random allocation of patients to a puberty blocker treatment group or a group receiving psychological treatment as an alternative.

The Society for Evidence Based Gender Medicine (SEGM), tweeted a comment which expanded on this theme in an article written by Dr. Susan Bradley, an adolescent psychiatrist and autism expert who has been involved in the medical transitioning of children since such treatments began in the late 70’s in Canada at the Clarke Institute of Psychiatry in Toronto. The tweet said:

Dr. Bradley, a child psychiatrist & founder of Canada's first youth gender clinic, has published a commentary raising grave concerns regarding the practice of “gender-affirmation” for young females with high functioning autism-spectrum disorders (ASD). In her commentary, Dr. Bradley talks about the rapid rise in ASD females presenting with recent-onset gender dysphoria, the social difficulties they face as a result of their ASD, and the frequent (mis)attribution of their distress to being "transgender.”

Dr. Bradley’s full paper may be read here: Understanding Vulnerability in Girls and Young Women with High-Functioning Autism Spectrum Disorder.

Readers may also listen to her interview at Gender: A Wider Lens: The Big Picture in which Dr. Bradley tells of being promised by the endocrinologists 30 years ago that puberty blockers were safe and harmless. She regrets the results of this faulty advice during the early 2000s (minute 43:00) saying,

Is this really reversible? What’s really going to happen? And we, not being well educated, accepted that. Obviously, the literature since then suggests it’s not very simple. What does discourage me is now when I see the literature that when kids go on puberty blockers, it’s pretty sure they are going to go on to cross-sex hormones. That stream has solidified. We thought we were helping to buy time but we were probably making it worse.

She also noted that “suicidality is part of the autism spectrum disorder and you don’t take that away by [gender] transition.”

Stella O’Malley and Sasha Ayad interviewed Dr. Thomas Steensma and Dr. Annelou de Vries in the same Pioneer Series of Gender: A Wider Lens, Where It All Started - The Dutch Researchers. Steensma and DeVries are the creators of an early study which became known as “The Dutch Protocol” which became the primary justification for all subsequent transgender studies. During the interview the authors admitted to fundamental research weaknesses but said they did their best at the time. Dr. Michael Biggs who has written extensively on The Dutch Protocol and puberty blockers wrote recently, “While the use of GnRHa to suppress puberty helped to created the juvenile transexual, it could now be creating another “new way of being a person” (Wren, 2020) a sexless adult.

The weakness of the study included using different forms to assess the patients before transition than those used after treatment to gauge results. They also considered that a patient who had never managed a successful relationship in the 22 years since transition and was also disgusted by his genitals, to be a successful transformation! They claimed that the replacement of gender dysphoria by body dysphoria in a patient also equalled success.

The American National Library of Medicine Appendix D article on Common Weaknesses in Study Designs considers the lack of a control group and demonstrable bias to be negatives. The TransYouthCAN! study does not use control groups.

The short two-year duration of the TransYouthCAN! study is also not enough to determine the efficacy of transition according to SEGM’s First Large Study of Detransitioners which noted that “detransition occurred roughly 5 years after transition was initiated, with males taking somewhat longer to detransition.” SEGM did the first large-sample, peer-reviewed study of the experiences of individuals who identify as detransitioners. TransYouthCAN!’s short two-year duration is a major deficiency.

Canadian Gender Report commented in 2019, even before the TransYouthCAN! data results were available, that “No ethics review board in Canada, to our knowledge, has approved the use of puberty blockers or cross-sex hormones for the treatment of youth who would like to align their physical characteristics in youth experiencing gender dysphoria.”

SEGM has documented international safety concerns about the use of puberty blockers in youth experiencing gender dysphoria. (New Systematic Reviews of Puberty Blockers and Cross-Sex Hormones Published by NICE).

Policy Changes in Other Countries

International health jurisdictions are acting. The State of Florida recently joined Sweden, Finland and the UK by issuing guidance prohibiting medical procedures to “change the sex” of minors. In fact as of Aug 22, 2022 Florida has ended Medicaid reimbursements for “transgender care” including puberty blockers, hormone therapy and gender-affirmation surgery.

The National Academy of Medicine in France, cites Bernard Lane’s article, which reiterates Littman’s theory:

‘Whatever the mechanisms involved in adolescents – excessive engagement with social media, greater social acceptability, or influence by those in one’s social circle – this epidemic-like phenomenon manifests itself in the emergence of cases or even clusters of cases in the adolescents’ immediate surroundings. This primarily social problem is due, in part, to the questioning of an overly dichotomous view of gender identity by some young people.

In Germany 1218 scientists and doctors called on public service broadcasters to present biological facts and scientific findings truthfully saying, “We demand a departure from the ideological approach to transsexuality and a fact-based presentation of biological facts according to the state of research and science.”

The Cass Review found that “the current model was “not a safe or viable long-term option” for Children and young people.

The planned closure of the of the Tavistock Clinic in London, England based on evidence from the Interim Cass Report over fears for patient safety, has sent shockwaves throughout the world of gender medicine causing even the American Academy of Pediatrics (AAP) to be pressured by their membership away from the use of puberty blockers. For a complete discussion of the ethical gender treatment disagreements emerging at the AAP, read Stella O’Malley: At the American Academy of Pediatrics ‘Affirmation’-Based Gender Dogma is Finally Being Challenged. Liz Truss, the recently elected Prime Minister of Britain and leader of the British Conservative Party, appointed senior paediatrician Dr. Hillary Cass to report on the long-troubled Tavistock Clinic. It is not a stretch to say this decision won her a great deal of electoral support.

Days later the Wall Street Journal wrote,

“it now seems that AAP has muted their previous ‘affirmation only’ stance saying now that ‘pediatricians offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience. It means destigmatizing gender variance and promoting a child’s self worth. Gender affirming care can be lifesaving. It doesn’t push medical treatment and surgery.”

The National Library of Medicine Appendix D - Common Weaknesses in Study Designs also lists “loss of patients to follow-up” as another design weakness. We know that the TransYouthCAN! study launched intending to follow 300 patients but ended up with only 174 patients. They admit that their small numbers on which to draw conclusions about autism for instance is problematic.

Back in Canada, one of the original investigators and a leading expert in the field, Dr. Joey Bonifacio, left the TransYouthCAN! study. The National Post reported his concerns:

Canadian health care needs to “slow down” and not move patients so readily to medical transition. . . As well, some health-care providers misinterpret what is meant by “affirmative” care, the sector’s watchword and predominant approach. They think affirmative care is you follow whatever pronouns [patients] care to use and start medication as soon as possible . . . [but] the term means to holistically support the patient in their identities and needs and refrain from directing a child toward any particular identity or needless to say, medicalization . . . I do have the same concerns the Tavistock clinic faced.

Is this evident conflict of care the cause for his withdrawal from the TransYouthCAN! study?

Finally, the global expert in transgender research, Dr. Ken Zucker, cast doubt on the findings of the TransYouthCAN! study with this tweet:

(Theories on the Link Between Autism Spectrum Conditions and Trans Gender Modality: A Systematic Review.)

The Irreproducibility Crisis of Modern Science by David Randal and Christopher Weiser had this to say in The National Association of Scholars, “Why do researchers get away with sloppy science? In part because, far too often, no one is watching and no one is there to stop them.”

And furthermore 300 plus peer-reviewed, evidence-based studies have been collected in a paper called Puberty Blockers: Medicine or Malpractice by Lesbians Their comprehensive study should forever throw into stark relief the differences between evidence-based. peer-reviewed studies and ideologically constructed studies like TransYouthCAN!.

Written Publication of MEDICINE OR MALPRACTICE:

Oral presentation of MEDICINE OR MALPRACTICE:

The TransYouthCan team

Greta Bauer PhD, Margaret Lawson MD, Bob Couch MD, Jennifer Ducharme PhD, Stephen Feder MD, Shuvo Ghosh MD, Natasha Johnson MD, Daniel Metzger MD, Arati Mokashi MD, Daniele Pacaud MD, Mark Palmert MD, Annie Pullen-Sansfacon PhD, Joe Raiche MD, Elizabeth Saewyc PhD, Kathy Speechley PhD, Robert Stein MD, Francoise Susset PsyD, Julie Temple-Newhook PhD, John VanderMeulen MD, Ashley Vandermorris BS MD FRCPC.

The team on the TransyouthCAN project included 19 professionals from six provinces, almost half of whom are endocrinologists. The lack of multi-disciplinary teams and the preponderance of endocrinologists is one of the major problems articulated by the recent Cass Report in Britain.

While other western countries and experts within Canada are increasingly speaking out against the the medicalization of children who believe they are the sex they are not, the TransYouthCAN! study is using its questionable results to promote such medicalization. This disjunction has at last caused one national newspaper to call for change. The Canadian public is beginning to wake up thanks to the work of SEGM, Canadian Gender Report and finally the National Post.

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