The Trans Youth Care Study project is a longitudinal study designed to evaluate the ‘gender affirming’ model in treating childhood gender dysphoria, which is where a child fails to conform to sex stereotypes, and verbalizes their confusion. Often, this is saying they are really a ‘girl’ or a ‘boy’ on the basis of clothing or activity preferences. This is not me derisively summarizing the definition, that’s pretty much what it is in the DSM(paywall):

“Gender Dysphoria in Children 302.6 (F64.2) A. A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1): 1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender). 2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire: or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing. 3. A strong preference for cross-gender roles in make-believe play or fantasy play. 4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender. 5. A strong preference for playmates of the other gender. 6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities. 7. A strong dislike of one’s sexual anatomy. 8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender. B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.”

See? Not a derisive summary.

Instead of telling young children that enjoying things stereotypically associated with the opposite sex does not mean you are in the wrong body, the gender affirming model ‘affirms’ the ‘gender’ the child says they are. Note that ‘gender’ here seems to be a byword for sex; gender is often inconsistently defined in the ‘gender affirming model’ depending on who the author of a particular paper is, but it is almost always tautological and confusing. It almost always seems to mostly amount to ‘personality’ and ‘sex stereotypes’. If the child is biologically female, for instance, but insists she is truly a boy, then the gender affirming model says that she should be affirmed as a boy, socially transitioned to a boy, and then when puberty hits, given ‘puberty blockers’, or gonadotropin-agonists (GnRHa), normally a drug like Lupron, which is prescribed off-label and originally intended for use in end-stage prostate cancer, and given ‘time to decide’ on their true ‘gender’.

Now, if you read that, you might think this ‘medical protocol’ was based on solid science and large base of empirical evidence, in order to justify medical treatment that will sterilize and possibly destroy any hope of sexual function for people who are under the age of consent for cosmetic reasons.

I am sorry to tell you the fact that this is not the case. The model itself originates from a small study done in the Netherlands . The ‘gender affirming model’ was originally known as the ‘Dutch Protocol’. The sample was small, and one subject in in a later study by the same researchers even died when a vaginoplasty surgery went wrong due to a post-surgical necrotizing fasciitis in the neovagina. This ‘treatment’ can kill. The Dutch study focused on the potential ‘sexual role change’ — i.e the desire of the adolescents involved to change their sex role. I suppose they considered that worth dying for. After all, they might:

“ …find it hard to live with a secret. Often[sic] have difficulties in connecting socially and romantically with peers while still in the undesired gender role”

Why would their gender role be a problem for social, nay, romantic connections?

This original study was funded by Swiss pharmaceutical company Ferring, which coincidentally makes a gonadotropin-agonist used as a puberty blocker, triptorelin. The authors presented this study at the 2006 ‘4th Ferring Pharmaceuticals International Paediatric Endocrinology Symposium’ in Paris, and Ferring supported it’s publication. I am sure that the fact they could make money off a new way of using their drug did not impact their desire to fund studies where an experimented upon young man died in a horrific manner from a needless cosmetic surgery that was supposed to fix his ‘gender role’.

The 2014 Dutch study that had a participant die during it’s period was a longitudinal study with fifty-five participants that assessed them three times throughout the process. The sample sizes in the Dutch studies are small, and this is a problem that affects most investigation into ‘gender affirming’ care for youth.

The Trans Youth Care study is also a longitudinal study, in a similar vein as the Dutch one, including the small sample sizes, which I will elaborate on below. The federal grant was given in 2015 by the NIH, names four principal investigators (PIs). The project leader is Johanna Olson-Kennedy, and the other PIs are Stephen Rosenthal, Robert Garofalo, and Yee-Ming Chan. One of the initial studies was ‘Creating the Trans Youth Research Network: A Collaborative Research Endeavor’, which describes creating a network to for the research project:

“Purpose: This article outlines the process of establishing the Trans Youth Care Research Network, composed of four academic clinics providing care for transgender and gender-diverse (TGD) youth. The Network was formed to design and implement research studies to better understand physiologic and psychosocial outcomes of gender-affirming medical care among TGD youth.” Methods: Formed in response to both the Institute of Medicine’s report recommendation for an increase of data concerning sexual and gender minority populations and a transgender-specific NIH program announcement, The Center for Transyouth Health and Development at Children’s Hospital Los Angeles, the Gender Management Service at Boston Children’s Hospital, the Child and Adolescent Gender Center Clinic at Benioff Children’s Hospital in San Francisco, and the Gender and Sex Development Program at Lurie Children’s Hospital of Chicago established a collaborative research network that subsequently designed a longitudinal observational study of TGD youth undergoing medical interventions to address gender dysphoria.” Results: Two cohorts, youth starting puberty blockers and youth starting gender-affirming hormones, are participating. Psychosocial measures that span multiple domains of mental and behavioral health are collected from youth and parents. Physiologic data are abstracted from patient’s charts. Baseline and follow-up data of this large cohort will be disseminated through conferences, abstracts, posters, and articles. Conclusion: Since initiation of funding in 2015, a total of 497 participants have been enrolled in TYC across the four sites; gonadotropin releasing hormone analogs (GnRHa) cohort youth (n=93), GnRHa cohort parents (n=93), and gender affirming hormone cohort youth (n=311). As the network moves toward data dissemination, its lessons learned have helped strengthen the current study, as well as inform future endeavors in this field.

Yes, they are now signalling their desire to medicate and medicalize ‘gender non-conforming youth’. Does your daughter want to wear shorts, play in the mud, and have short hair? These people think you need to pathologize and medicalize that.

It is crucial to mention here there is absolutely no control cohort. There are only cohorts examining different stages of ‘gender affirming’ treatment. They are not evaluating any other form of treatment for the problems of ‘transgender and gender-non conforming youth’. Do these children need this treatment? Is it more effective than placebo? This project is actively avoiding answering that question.

That poses huge problems. If, for example, there was a control cohort of gender dysphoric children who were given placebos or simply not ‘treated’ at all, and then they grew up into healthy, well-adjusted gay and lesbian adults, the jig may be up for these doctors. It would certainly destroy their careers if they were revealed to be wolves in sheep’s clothing, using homophobia to commit a medical experiment on the government’s watch and determine gender non-conformity by the bagginess of a child’s clothes.

A potential homophobic motivation is not idle speculation. Across the pond, English clinicians working in the Tavistock gender clinic worried they were simply practicing conversion therapy on gay children:

“They believe that physically healthy children are being medicated in response to pressure from transgender lobby groups and parental anxieties. So many potentially gay children were being sent down the pathway to change gender, two of the clinicians said there was a dark joke among staff that “there would be no gay people left”. “It feels like conversion therapy for gay children,” one male clinician said. “I frequently had cases where people started identifying as trans after months of horrendous bullying for being gay,” he told The Times. “Young lesbians considered at the bottom of the heap suddenly found they were really popular when they said they were trans.” Another female clinician said: “We heard a lot of homophobia which we felt nobody was challenging. A lot of the girls would come in and say, ‘I’m not a lesbian. I fell in love with my best girl friend but then I went online and realised I’m not a lesbian, I’m a boy. Phew.’ The specialists expressed concern at how little confusion over sexuality was explored when a young person requested treatment to change their body. “I would ask who they wanted to have relationships with, but I was told by senior management that gender is completely separate to sex,” a third female clinician said. “I couldn’t get on board with that, because it isn’t. Some people were transitioning their gender to match their sexuality.”

A control cohort would probably make this nasty little fact more obvious.

This is clear in their paper outlining the design of the longitudinal study that the project was granted money for, which doesn’t mention a control cohort at all. The lack of control cohort is problem number one from my point of view. There is no ‘watchful waiting’ cohort, which means that we have no other treatment to evaluate this ‘gender affirmation’ against. With no cohort undergoing ‘watchful waiting’, or god forbid, simply being left alone and not ‘transitioned’ at all, we have no idea whether this ‘treatment protocol’ is more effective than leaving kids be and not ‘affirming’ them. We also will not know what the long term side effects are compared to a baseline cohort of youth with gender dysphoria treated with watchful waiting or not treated at all, beyond the fact that the ‘gender affirmed’ children will certainly be sterile, and that some ‘gender affirming’ surgery can lead to patient death, like in the Dutch studies. That’s one hell of a ‘side effect’, no? This is very obvious when they outline their purpose:

“The study uses a longitudinal observational design to examine the outcomes of existing medical treatment protocols for gender dysphoria in two distinct cohorts: youth initiating puberty suppression and youth pursuing a phenotypic gender transition. Data on routine anthropometric and physiologic parameters are collected through chart abstraction, questionnaires, and research interviews in the 24-month study period. Audio computer-assisted self-interview and individual interview survey instruments are used to collect demographic, mental health, psychosocial, and behavioral data from parents and youth in the blocker cohort and only from youth in the gender-affirming hormone cohort at baseline and 6, 12, 18, and 24 months.” “Participant recruitment commenced in July 2016, and enrollment was completed in September 2018. A total of 90 participants were enrolled in the blocker cohort and 301 participants were enrolled in the gender-affirming hormone cohort. Findings based on baseline data are expected to be submitted for publication in 2019.”

The purpose is to confirm things they already know and advocate or are paid to advocate for. If it was to actually evaluate the treatment protocol, they’d have a control cohort. That way their ‘outcomes’ could be measured against something. Later studies in this project admit that the empirical evidence for their treatment model is scant. But they don’t have a control cohort, because a control cohort would probably all grow into normal gay teenagers, which means their little conversion therapy scam would be exposed.

The lack of control cohort isn’t the only problem that plagues this project. The studies that were conducted with millions of dollars in federal funding are characterized by small sample sizes and sky-high drop out rates. One study purports to say that ‘top surgery’ in young women is effective and no one has any regrets, yet a third of those young women suffer permanent loss of nipple sensation, and 25% of the potential sample didn’t respond to attempts by the researchers to communicate. Two actively refused the survey. The study recruited young women who came into the clinic and were willing to engage — so detransitioners, who often drop out of gender clinics, would have been unable to report any regrets. All this tells us is about the girls a single gender clinic was able to contact.

How bad are these studies? One paper purports to establish the ‘utility of potassium monitoring in gender diverse adolescents taking spironolactone’. The paper is very short, and concludes thus:

“The generalizability of this study is limited by the relatively small sample size and the use of only one study site. Its retrospective nature introduces potential selection bias; for example, clinicians may have avoided spironolactone use in patients with premorbid conditions or prior hyperkalemia. Further studies with a larger sample size are needed to confirm our findings.

This study is meaningless. They have an extremely small sample size of 85 from a single clinic and they might have screened out patients who could potentially experience side effects anyway through selection bias. They have findings that need to be confirmed by other findings with a larger sample size.

That last sentence is an easy summation of many of the results of this project.

Another paper, which is also very short(are you detecting a theme here?), discusses fertility counselling:

“As public awareness of gender diversity has increased over the last decade, more transgender youth are seeking health care services to support medical transition. While gender-affirming hormones (i.e., estrogen for birth-assigned males; testosterone for birth-assigned females) are indicated to alleviate gender dysphoria [1], side effects include impairments in gonadal histology that may cause infertility or biological sterility [2–4]. Estrogen use by transgender women results in impaired spermatogenesis and an absence of Leydig cells in the testis [3]. Testosterone use by transgender men causes ovarian stromal hyperplasia [2,4] and follicular atresia [2]. Gonadal effects of hormones are thought to be at least partially reversible, and pregnancy has been reported in transgender men who have previously used testosterone [5]. However, thresholds for amount and duration of exogenous hormone exposure causing permanent negative effects on fertility have not been established. Thus, the World Professional Association of Transgender Health [1] recommends counseling regarding fertility and reproductive options before initiating hormone treatment.

Note the casual mention of sterility. Why do these seventeen and eighteen year old youth need fertility counselling, when their equipment is likely all in working order? It’s not like you’re giving them a purely cosmetic treatment that will sterilize them because they don’t conform to society’s expectations, or is it?

My least favorite paper that is part of the project describes the creation of a diagnostic survey, the ‘Parental Attitudes of Gender Expansiveness Scale For Youth’:

“Overall, the current study offers preliminary evidence of the factor structure, reliability and validity of the Parental Attitudes of Gender Expansiveness Scale for Youth (PAGES-Y). The PAGES-Y has research and clinical utility, demonstrating that it can assess experiences of parental acceptance and nonaffirmation simultaneously. Future research may use the PAGES-Y to determine how these experiences may relate to medical and behavioral health outcomes, aid in identifying priorities for therapeutic intervention, and yield a more nuanced understanding of how parental attitudes of gender expansiveness contribute to risk and resilience among gender-expansive adolescents.”

This is straight garbage. It amounts to ‘We established our survey is usable!’. No shit, Sherlock. Anyone with a copy of Surveymonkey can make a survey on ‘gender expansiveness’. It might take a PhD to get the government to fund it and for a journal to publish your paper on it, though.

What does ‘gender expansiveness’ mean, anyway? Does it mean becoming fatter and dying your hair blue? The mind boggles. According to Gender Spectrum, an activist group affiliated (either now or previously) to multiple scientists involved with this research, ‘gender expansive’ means:

An umbrella term used for individuals that broaden their own culture’s commonly held definitions of gender, including expectations for its expression, identities, roles, and/or other perceived gender norms. Gender-expansive individuals include those with transgender and non-binary identities, as well as those whose gender in some way is seen to be stretching society’s notions of gender.

I can’t believe they spent nearly six million dollars on this research. They could have spent $5.7 million on giving me a holiday in the Bahamas. It would have been better spent. I could have had a nice holiday, and hundreds of children wouldn’t be experimented on because of ‘stretching society’s notions of gender’. It’d be a win-win for everyone involved.

Because it turns out that spending nearly six million dollars on this stuff instead of my fantasy holiday to the Bahamas can produce some disturbing results, like this evaluation of ‘minority stress factors’ among ‘transgender and gender non-conforming youth’:

Overall, 33% (n = 36) of the sample met diagnostic criteria for MDD and 48% (n = 53) met diagnostic criteria for GAD. Those with high levels of internalized transphobia were significantly more likely to meet diagnostic criteria for both MDD and GAD. Those with low levels of gender identity appearance congruence were significantly more likely to meet diagnostic criteria for MDD but not GAD.

Nearly half these kids (who are 71% female and 71% white) have an anxiety co-morbidity and a third have a depression co-morbidity. Why do they have such high rates of anxiety and depression? Surely this is worth an explanation! Even though your sample size was tiny and consisted of barely over a hundred children! I guess it’ll just remain a big mystery.

The sample sizes are a huge problem. I’m repeating myself, I know, but how can we know the ‘factors affecting fertility decision-making among transgender adolescents’ when the sample size of the survey is 18 young people from a single hospital? That’s a convenience sample right there.

Frustratingly, this paper, ‘Advancing the Practice of Pediatric Psychology with Transgender Youth State of the Science, Ongoing Controversies, and Future Directions’ complains about the critics (which I assume includes people like us), ‘misconstruing their research’. I hope they don’t consider it ‘misconstruing’ when I point out that they contradict themselves literally a few paragraphs in:

“ Over the last decade, we have seen a sea change in approach to pediatric transgender care, with the gender affirmative model now widely adopted as preferred practice (Edwards-Leeper, Leibowitz, & Sangganjanavanich, 2016; Hidalgo et al., 2013). The gender affirmative model is based on findings that parental support is associated with improved mental health functioning among transgender adolescents (Simons, Schrager, Clark, Belzer, & Olson, 2013) and the expectation that earlier gender identity affirmation will result in decreased rates of psychopathology (Olson, 2016). Central to this paradigm shift away from pathologizing gender nonconformity is the belief that youth’s asserted gender identity, expressions, and related experiences are valid, and that youth should be supported to “live in the gender that feels most real or comfortable to that child” (Hidalgo et al. 2013, p. 286). But, as Edwards-Leeper and colleagues (2016) caution, translating an affirmative approach into a conceptual treatment model for TGNC youth is not an easy endeavor as clinical care with this population is inherently complex and exacerbated by the relative lack of empirical research to guide treatment.”

How do you base the ‘gender affirmative model’ on ‘findings that parental support is associated with improved mental health functioning among transgender adolescents and the expectation that earlier gender identity affirmation will result in decreased rates of psychopathology’ when you have a ‘lack of empirical research to guide treatment?’ Which one is it? How can you know what the treatment does when you have no ‘empirical research’ and clearly have no desire to get any, because otherwise you’d have a control cohort.

Oh and let’s not forget their ‘paradigm shift away from pathologizing gender nonconformity’ is written by someone who is pathologizing these children and prescribing them off-label medication for their gender nonconformity. Pot meet kettle.

I promised you I’d get to the complaining about critics, and here it is:

Among the most cited outcomes of TGNC children in the popular media is the statistic that roughly 80% of these children will not “persist” in identifying as transgender in adolescence and adulthood (Olson, 2016). Indeed, studies show that between 12% (Drummond, Bradley, Peterson-Badali, & Zucker, 2008) and 27% (Wallien & Cohen-Kettenis, 2008) of prepubescent children referred for gender identity disorder/GD continue to meet diagnosis for GD in adolescence. However, these studies have been criticized on a number of grounds, including: (1) authors classified children who were lost to follow-up as “desisters” although these children’s subsequent gender identity was never verified, thus amplifying the “desister” group;

Here’s the problem: the Trans Youth Care studies all have huge drop out rates. Uniformly. Some of the studies in this project have drop out rates approaching fifty percent. It is highly likely that young people lost to follow-up don’t want to engage with the people who thought they needed drugs because they didn’t conform to sex stereotypes. That these people seemingly don’t want to ask why they have such gigantic drop out rates even in their semi-handpicked convenience samples of patients they have treated should really tell you enough.

(2) authors may have conflated two distinct groups of children through flawed methodology by classifying gender-nonconforming children in the same group as those with more severe GD; and (3) authors used the decision to pursue medical intervention as the outcome variable to signify persistence; however, we know that not all transgender individuals are able to pursue and/or desire medical interventions”

The thing with the bolded part here, and this is the part that gets me the most, is that this very conflation is done by these authors! Their definition of ‘transgender and gender non-conforming’ is identical that they effectively treat them as synonyms! They refer constantly to ‘transgender and gender non-conforming’ youth. They conflated those two populations themselves, and in the process medicalized anyone who isn’t conforming to gender stereotypes. How does someone who is ‘gender non-conforming’ have mild gender dysphoria? Do I need to tell Ellen DeGeneres of her hereto unknown ‘mental issue’ of gender dysphoria because she likes wearing sweater vests, having short hair, and talking about her wife on national television?

But wait! There’s more! The first baseline report of the ‘physiologic response’, which I have previously covered, features among other things, a near fifty percent drop out rate!:

Results: Of the initial 101 participants, 59 youth had follow-up physiologic data collected between 21 and 31 months after initiation of hormones available for analysis. Metabolic parameters changes were not clinically significant, with the exception of sex steroid levels, intended to be the target of intervention

That’s a one hell of a drop out rate. Where did the other 42 go? That’s 41% of your sample! I know about the other ‘41%’, but that’s a garbage statistic. Where did they all go? Did they all accidentally end up on the island in Lost, or is something else going on?

Speaking of small sample sizes, another paper, ‘Ethical Considerations in Fertility Preservation for Transgender Youth: A Case Illustration’, written by Diane Chen, who is from Lurie’s gender clinic and seems to specialize in such things, consists of two case studies.

Deeply homophobic studies, too:

“As soon as Ryan learned there was an option for him to have biological children without physically carrying a child to term, he consistently expressed interest in pursuing FP. Ryan reasoned that because he was attracted exclusively to women, his future partner could serve as a gestational carrier. Both parents clearly communicated that they considered decisions about parenting and fertility to be personal. Thus, they deferred decisions about FP to Ryan, telling him they would fully support any decision he made, including financial support for FP. Ryan and his parents were referred for consultation with an adult reproductive endocrinologist who provided more detailed information about the oocyte harvesting process”

No one in this case study bothered to try and tell ‘Ryan’ that it was okay to be gay, seemingly. ‘Peter’ the second case study can totally consent to treatment despite being a minor and despite the following:

“Peter’s psychological history was significant for generalized anxiety disorder and oppositional defiant disorder diagnosed at age 8. He was referred for neuropsychological testing at age 9 due to academic decline and concerns for inattention. Results revealed above average IQ and mostly above average academic skills with weaknesses noted in math fluency and written expression. Results also identified problems with inattention and executive functioning. Peter was subsequently diagnosed with ADHD, inattentive type, and learning disabilities in math and writing. He met with a psychologist for therapy as needed from age 8 to 15 and was prescribed stimulant medication by a child psychiatrist starting at age 12. At the time of presentation to GSDP, many of Peter’s past diagnoses had resolved — he met criteria for Gender Dysphoria and ADHD, predominately inattentive presentation. While Peter had recently realized his transgender identity, he had a longstanding history of gender nonconformity and gender questioning since childhood. Peter shared that he “felt more like a guy” during elementary school but did not share these feelings because “I was really shy at the time and thought that my feelings weren’t normal.” He “hated” wearing girls’ swimsuits and yearned to wear swim trunks and “go topless.” Peter also consistently assumed male gender roles online, choosing male avatars for videogames since age 14. Shortly after realizing his transgender identity and seeing his parents’ support, Peter had the opportunity to experience life “as a guy” during a 2-week summer camp with peers who were unaware of his gender history. After this experience, Peter had no desire to “hide” who he was any longer, and amended his initial timeline for transition from after high school graduation to “as soon as possible.” Peter’s co-occurring ADHD was effectively managed by stimulant medication and did not challenge his decisional capacity. While he was diagnosed with learning disabilities in math and writing, we did not expect this to compromise his decision-making ability. In fact, past cognitive testing revealed above average IQ, which is positively correlated with decisional capacity (Elbogen et al., 2007). Discussions about hormones, parenting desires, and FP procedure and costs occurred over multiple sessions across several months with both medical and behavioral health providers. Peter demonstrated an accurate understanding of the potential long-term impact of testosterone on fertility.”

Why does wanting to bathe topless or wear swim trunks make you a man inside?



And yes, it is another lesbian who’s successfully been turned into a facsimile of a straight man:

“He underwent gender-affirming chest reconstruction at age 18, which further alleviated dysphoria. Peter also has had two romantic relationships with young women. Approximately two years after starting testosterone, Peter expressed some regret during a therapy session that he had not pursued FP. He shared that since his body dysphoria improved, he has felt more comfortable exploring his sexuality and developed more serious romantic relationships that involved “thinking about the future.” In particular, Peter’s girlfriend at the time expressed interest in the possibility of using the same sperm donor to fertilize both Peter’s and her own oocytes in the future.

Why is it okay to tell these young butch women that they’re really men?

I have left the best of the studies for last. One of the papers that was funded by the grant is a ‘narrative review’ of ‘gender treatment’ at the Lurie gender clinic. It sums up this whole project as follows:

This research is a direct response to the Institute of Medicine report calling for such studies as well as the needs of clinicians and patients. Results from this study have the potential to significantly impact the medical and mental health services provided to transgender youth by making available rigorous scientific evidence on the impact and safety of early treatment based on the sexual development stage. Ultimately, we aim to understand if early medical intervention reduces the health disparities well known to disproportionately affect transgender individuals across their lifespan”

There IS NO CONTROL COHORT. And you’re forgetting the model of ‘watchful waiting!’. How do you know you’re not making it worse?

‘Rigorous scientific evidence’ my ass!

Previous readers may remember ‘gender euphoria’ appearing in autogynephila fetishist forums, describing arousal from wearing women’s clothing. Here the term makes an appearance in connection with children, describing a support group for teenagers:

“Gender euphoria therapy group In 2016, program psychologists developed a weekly therapy group for transgender and gender-questioning adolescents. The group is guided by a social cognitive model with topics germane to this age group, including gender identity exploration, expression, and disclosure, family relationships, adaptive coping, social and medical transition, and dating and relationships.”

Of course, I saved you the best for last. Also the part that follows into the next article segment. Everyone wins!:

“Lurie Children’s Gender and Sex Development Program Development GSDP was established in July 2013 through a 3-year start-up gift from a private philanthropic foundation. The multidisciplinary team of pediatric specialists initially included an adolescent medicine physician, an endocrinologist, and two clinical psychologists, as well as a program manager (PM) with a Master’s-level background in education. The program supported its psychologists in receiving extensive training and consultation with renowned psychologists from academic gender centers that serve gender-diverse youth from early childhood through young adulthood. Together with published descriptions of pediatric gender clinics in the United States1,4 and the Netherlands,2 these trainings informed the development of GSDP’s core behavioral health services. In October and November 2013, two additional clinicians with transgender health expertise joined the team — an adolescent medicine physician and a child–adolescent psychiatrist, respectively, which allowed for expansion of clinic hours and service offerings. In January 2015, a social worker was hired primarily to aid families in locating community resources in the context of our PM’s expanding role in community outreach efforts. Finally, in December 2015, an Advanced Practice Nurse (APN) specializing in adolescent medicine was hired to coordinate clinical research efforts and support physicians in provision of medical care. Financial support for GSDP consists of clinical revenue, institutional support, and philanthropic funding. All medical services are supported through clinical revenue. Behavioral health services outside of gender development clinic (GDC) are supported through clinical revenue, with psychologists’ time in GDC supported through institutional “buy out.” Philanthropic support funds the following: (1) PM’s salary, (2) protected research and program development time (10–50%) for each GSDP specialist, thereby increasing our capacity to develop adjunctive programming, and (3) service provision for uninsured or underinsured patients on a case-by-case basis.”

Want to know why that’s significant?

The ‘philanthropic support’ is from Jennifer Pritzker, that right-wing billionaire I told you about. Pritzker is paying for the program manager and subsidizing research time for specialists involved in the program — including Robert Garofalo, one of the primary investigators listed in the grant.

Why don’t we learn more about that grant?