In a recent interview, Helen Joyce, Irish author of the book Trans: When Ideology Meets Reality, suggested that most people will eventually “move on” from gender ideology, but some “are going to be like the Japanese soldiers on the Pacific islands who didn’t know the war was over.”
Though Joyce was referring specifically to parents who have agreed to the medical transition of their children, her analogy is apt for doctor-activists like Jack Turban, Meredithe McNamara, and Johanna Olson-Kennedy who have tethered their careers, finances, and personal reputations to “gender-affirming care.” These doctors have made repeated, on-the-record, and in some cases sworn-under-oath assurances to judges, policymakers, journalists, and the general public that such treatment is evidence-based, “medically necessary,” and “life-saving” care. They have denounced their critics as bigots and ignoramuses who stand athwart an urgent civil rights cause.
Even assuming that these doctors privately harbor doubts about the positions they’ve taken, would they ever publicly admit that they are wrong? Or are they destined to live out their years like Imperial Japanese Army Lieutenant Hiroo Onoda and his subordinates, who fled to the hills of the Lubang Islands in the Philippines, remained bunkered in for 30 years after the war’s end, and dismissed any news of Japan’s surrender as Allied propaganda?
Make no mistake: the prospect of an Allied liberation of the occupied Western mind, at least on this issue, is becoming increasingly hard to dismiss. Major left-of-center news outlets, including the New York Times, now recognize that a legitimate scientific and ethical debate exists over “gender-affirming care.” This is perhaps too little, too late, but it is nevertheless an important development and one that should not be taken for granted.
In Alabama, a federal judge who previously had ruled against the state in a lawsuit over its age restrictions on hormonal interventions has now ordered the World Professional Association for Transgender Health (WPATH), which is involved in that litigation, to disclose internal communications related to the publication of its latest, and highly controversial, Standards of Care (SOC). In addition to eliminating its chapter on ethics, including a chapter on “eunuchs” and insisting that young children can have this identity, and claiming that a systematic review of the medical literature is “not possible” despite several European countries having conducted them, WPATH also decided to eliminate all age minimums for hormones and most surgeries just days after its most recent SOC edition was published. It’s reasonable to assume that at least some of the information contained in the communications now under judicial scrutiny will be damning to WPATH, its affiliated doctors, and the American gender industry at large.
Meantime, early signs suggest that the heated partisan polarization over pediatric sex-trait modification is cooling. Democrats in Texas and Louisiana recently broke with their party to vote in favor of, respectively, SB 14 and HB 648, which mandate age restrictions on hormones and surgeries. Despite “hostile activists” making “personal, and even racist, attacks against me as an African American woman,” said a choked-up Democrat, Shawn Thierry, who represents Texas’s 146th district, in a speech she delivered in the dying minutes of the Texas House floor debate over the bill, “I have made a decision to place the safety and well-being of all young people over the comfort of political expediency.”
And perhaps most significantly of all, on July 14, a group of 18 experts from Finland, Sweden, Norway, Belgium, Switzerland, France, and South Africa joined three American physicians in writing a letter criticizing the U.S. Endocrine Society for its approach to youth gender transition. This was a watershed moment in American transgender politics: the first time that international experts had publicly and directly weighed in on the U.S. debate over so-called “gender-affirming care.”
In their letter to the editor of the Wall Street Journal, titled “Youth Gender Medicine is Pushed Without Evidence,” the international experts pointed out that the Endocrine Society’s new president, physician Stephen Hammes, had made false claims about the evidence base for child sex-trait modification and the likelihood of suicide when these procedures are not made available to teenagers who want them. Even more embarrassingly, Hammes’s statements, made in response to an op-ed by the organization Do No Harm, contradicted the Endocrine Society’s own clinical practice guideline.
The letter is significant for a number of reasons, not least of which that it can—and should—be used in litigation to demonstrate that what U.S. “gender-affirming” doctors say about “settled science” and a strong consensus among experts is simply false. There is, in fact, disagreement about how to help children and adolescents who feel alienated from their bodies and reject their sex. Indeed, outside of North America, these debates seem to be moving gradually in the direction of skepticism that a justification for early physical intervention exists. “[M]ore and more European countries and international professional organizations,” the letter’s signatories write, “now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.”
Left unmentioned in the WSJ letter is the conflict of interest in which the Endocrine Society’s new president finds himself. Hammes is the co-director of a transgender clinic at University of Rochester Medical Center in New York and provides consultations for trans-identified adolescents seeking puberty blockers or cross-sex hormones.
The word “professional” in professional medical associations has two meanings. It can mean an association that acts in accordance with accepted high standards of conduct; it can also mean an association of professionals. The latter need not imply the former. Teachers, for instance, are professionals, but teachers’ unions often act unprofessionally, to the detriment of student learning—such as by protecting teacher jobs regardless of performance. Teachers’ union leaders do care about student learning, but when that goal conflicts with the interests of teachers as professionals, their incentives are to protect teachers’ interests. Medical associations like the Endocrine Society are the same way: the doctors who lead them care about patients, but as organizations, groups like the Endocrine Society have strong incentives to protect the interests of their members, even if that means going against evidence-based medicine.
Given this reality, what are the chances that, under Hammes’s leadership, the Endocrine Society will publicly second-guess its “gender-affirming” clinician members and agree to conduct or rely on a systematic review of evidence for the benefits and risks of hormonal interventions in youth? Probably the same likelihood that the National Federation of Teachers will call out Randi Weingarten for harboring views that are at odds with student learning.
Hammes, of course, is not the only Lieutenant Onoda in the medical field. In 2021, physician Jesse Ehrenfeld told NBC News that there was “no debate” about using puberty blockers, cross-sex hormones, and surgeries to help kids who feel alienated from their bodies. “These transition services and gender-affirming care for transgender patients are medically necessary. That’s what the science has demonstrated,” said Ehrenfeld.
Never mind that by that point, four systematic reviews of evidence—one each in Sweden and Finland, and two in the U.K.—had found that the evidence base for these procedures was exceptionally weak. Never mind that Finland’s main authority for evaluating the evidence base of health-care practices had acknowledged a year earlier that pediatric sex-trait modification was still “an experimental practice.” Ehrenfeld, who, at the time he made these comments, was “the first openly LGBTQ board member” of the American Medical Association, is the AMA’s newly elected president.
What are the chances that the most powerful doctors’ union in the U.S. will admit that its new president has made scientifically unfounded and medically irresponsible comments in the national press?
To be sure, there are important differences between Onoda and his present-day avatars. The real Onoda returned to Japan a hero. The new Onodas will go down in history as responsible for one of the worst medical scandals in U.S. history. The real Onoda had only a few opportunities to learn the truth about the war’s end; the new Onodas live in a society growing openly skeptical by the day of their ideas and practices. The real Onoda seemingly longed to return to Japan and did so after being reassured by his own former superior officer; the new Onodas are likely to respond to society’s mounting skepticism of “gender-affirming care” for minors by growing increasingly paranoid and living in ever-tightening echo chambers.
Above all, Onoda and his comrades had little influence over Japanese society from their position in the hills of Lubang. The new Onodas still hold sway over most Democrats, some federal judges, and incurious journalists. They hold positions of leadership in key social institutions and, along with their allies, will sooner see the integrity and reputation of those institutions destroyed than admit they did anything wrong. Human nature being what it is, one should not expect anything less.
Reform of gender medicine in the U.S. has a long way to go, and any declaration of victory is dangerously premature. But the very possibility of likening gender-affirming advocates to modern-day Onodas suggests a shifting of ground.