From the Face of Pediatric Gender Medicine Comes a Quietly Radical Manifesto

Five decades ago, “Free to Be You and Me” preached a radical gospel of self-acceptance to children.The 1972 album, which would define the conscience of a new generation, sought to dismantle gender boundaries and other oppressive social codes. The album was the brainchild of singer Marlo Thomas, who wanted to teach her young niece to reject traditional American gender stereotypes. Yes, boys could play with dolls, just as girls could become engineers. And it was alright to cry.Today, Ms. Thomas is 86 and a very different nation is grappling with new philosophies about gender that have evolved a galaxy away from their quaint origins in second-wave-feminism. About one in 70 adolescents now identify as transgender. Annual new diagnoses of gender dysphoria, the feeling of distress when biological sex and gender identity feel misaligned, among minors more than doubled between 2019 and 2023. A wildly politicized storm, including high-stakes litigation, rages over whether at least some adolescents among them should be prescribed puberty blockers and cross-sex hormones and even provided with gender-transition surgeries.Marlo Thomas and children pose while promoting ‘Free To Be You And Me.’ ViacomStanding resolutely in the eye of this storm is Dr. Jack Turban, a University of California, San Francisco child psychiatrist. Barely two years out of his training, Dr. Turban, 34, has established himself as the face of pediatric gender medicine and is a favorite source of LGBTQ media watchdog GLAAD. Dr. Turban has muscled his way past more senior members of his field and into this position by championing children’s access to gender-transition treatment through prolific scientific and popular-press publishing, regular media appearances and a determined social-media presence. He also has a habit of attacking his perceived adversaries, in some cases loudly and in public. He goes after other perceived opponents behind the scenes. According to multiple sources, Dr. Turban has aggressively lodged complaints against them with their superiors or overseers.Now Dr. Turban is also an author, of “Free to Be: Understanding Kids & Gender Identity.” The book offers guidance for parents whose kids have come out as transgender, are questioning their gender identity, or are otherwise what’s known these days as gender diverse. While “Free To Be” pays no acknowledgement to the cultural touchstone from which it cribbed its title, the book preaches a similar gospel of radical acceptance of gender-based differences. Dr. Turban counsels parents about the harm of policing gender boundaries, even when their well-meaning aim is to help their children fit in.Yet the text otherwise reflects a sharply revised vision borne of a new progressive generation — one that’s eager to fully deconstruct the biological-sex binary. Some kids aren’t free to be themselves, Dr. Turban’s book asserts, unless doctors like him help put them on a pathway to change the sexed presentation of their bodies to match what in a July 8 New York Times opinion essay he called their “transcendent sense of gender.” Denying such treatment, he writes in his book, is cruel and inhumane.Dr. Marci Bowers, a specialist in gender surgeries, speculates in this video that biological males put on blockers at puberty’s onset and later given estrogen will never experience an orgasm.And yet plenty of loving parents, even liberal ones, resist a medical transition for their child, concerned that minors are too young to make such an irrevocable decision, especially if the treatment might render them infertile and they might eventually stop identifying as trans.In response to this ethical quandary, the book’s explicit guiding principle is: Listen to trans kids.Accordingly, the stories of trans and gender diverse children are Dr. Turban’s bedrock in “Free to Be.” He hopes these narratives will humanize such youths’ plight and undermine political attacks against their access to gender-transition treatment and gender-identity-corresponding single-sex bathrooms and sports teams.Dr. Turban presents his book as the authoritative account of pediatric gender medicine, an evidence-based parry against what he characterizes as harmful misinformation propagated by cynical political actors.Thus, the book’s implicit guiding principle is: Listen to me.So should parents trust this good doctor, as he so gently presents himself? The average reader, unversed in the byzantine and often bafflingly contradictory academic debate over pediatric gender medicine — and yes, there is substantive global debate, although it is often actively suppressed or simply kept quiet — could not hope to identify when Dr. Turban, in fact, misrepresents this scientific evidence.Consequently, most readers could not hope to realize that Dr. Turban has carefully curated his real-life examples, including three principal composite characters, to correspond neatly with the overly rosy and confident representation of such research findings that had become his trademark. Dr. Turban’s use of composites is ostensibly to protect privacy; but it also relieves him of any accountability from questions of whether he cherry picked from multiple children’s lives while omitting any inconvenient truths.Dr. Jack Turban promotes his views through regular media appearances. XCrucially, Dr. Turban, who routinely claims to be an authority on what counts as misinformation about this medical field, insists that pediatric gender-transition treatment “isn’t experimental.” And he asserts, as he has for Psychology Today, that “over a dozen studies” link blockers and hormones “to better mental health outcomes for adolescents” and that blockers in particular “can offer immense relief.”What the Harvard, Yale, and Stanford educated Dr. Turban never mentions is that to date, a half dozen systematic literature reviews — the gold standard of medical evidence—of such studies have found the supporting evidence behind pediatric gender-transition treatment weak and largely inconclusive. The most recent such analysis found “no conclusions could be drawn” regarding blockers’ impact on mental and psychosocial health.Nor does Dr. Turban mention that the health authorities in an increasing number of European nations have responded to these literature reviews by reclassifying pediatric gender-transition treatment as, indeed, experimental and sharply restricting pediatric access, in some countries to clinical trials only. What’s more, Dr. Kathleen McDeavitt, a psychiatrist at the Baylor College of Medicine, recently analyzed 14 key studies of pediatric gender-transition treatment that followed participants over time, including many on Dr. Turban’s list. She reached a markedly different conclusion in her review paper, published in June, than he does. Dr. McDeavitt found “inconsistent demonstration of benefit with respect to depression and suicidality” from providing gender-distressed kids with blockers, hormones or both. Some study authors, she further concluded, “articulated positive outcomes about hormonal interventions even in the setting of insignificant, small or negative findings.” Dr. Turban blames “comments in the media” for the suggestion that gender-transition treatment is tied to sexual dysfunction. This ignores the well-known fact that Dr. Marci Bowers, the president of the World Professional Association for Transgender Health, has speculated that orgasm may prove impossible for biological males put on blockers at puberty’s onset and later given estrogen. “We need to have our eyes open about it,” Dr. Bowers has said. Dr. Marci Bowers, the president of the World Professional Association for Transgender Health, is at the center of a firestorm over leaked internal communications from her organization. Marcibowers.comAnd as British journalist Hannah Barnes reports in the new U.S. paperback edition of her book, Time to Think, at a September 2022 WPATH symposium, Dutch researchers presented troubling findings from a small survey of 21 trans women (biological males) who started gender-transition treatment during adolescence: Two thirds of the cohort reported failing to orgasm within the past six months. Most stunningly, Dr. Turban suggests a radical policy change: that his field should consider doing away with the psychosocial assessments that WPATH advises for all minors seeking puberty blockers for gender dysphoria. He further gives the distinct impression that he believes it also would be best to abandon assessments for minors seeking cross-sex hormones. A prescription to gender-transition treatment, he strongly implies, should be as easy for children to obtain as Prozac. This follows a suggestion Dr. Turban previously floated on social media that children should be able to access puberty blockers without parental consent.It is difficult to know what Dr. Turban actually believes, since he is quite evidently playing both sides of the divide regarding the utility of these psychosocial assessments. In his recent Times opinion essay, he assured the public, citing his own recent journal article, that “medical guidelines say it is essential” to conduct such assessments among minors “before initiating any gender-affirming medical intervention.” And in a white paper he co-authored this month that lavished criticism on the recent landmark British report that found pediatric gender medicine is based on “remarkably weak evidence” (a body of evidence that, the paper never mentioned, includes Dr. Turban’s own work), he and his coauthors held up these assessments as an important mainstay of gender-transition treatment for minors.He also makes no mention in his book of the recent dramatic shift in demographics of minors presenting at gender clinics in Western nations. As recently as the late 2000s, this was a tiny group comprised largely of biological males who displayed marked gender incongruence starting in early childhood. Now these clinics are inundated by a ballooning population of predominantly natal girls, many of whom had no apparent early-childhood gender incongruence and first expressed a trans identity only in adolescence. Overall, today’s population has a much higher rate of psychiatric disorders and autism than in the recent past. Not only is Dr. Turban remarkably incurious in his book about these well documented shifts and their drivers, in his academic work he has outright denied that the sex-ratio flip has even occurred.Nor does Dr. Turban’s book make more than a cursory reference to the crucial subject of youths who have medically transitioned and then reverted to presenting and identifying as their natal sex. The word “detransition,” as this phenomenon is known, is glaringly absent from the book’s pages. Regarding the role of parents, Dr. Turban devotes a chapter to debunking dusty beliefs that errant mothers were to blame for a child’s transgender identity. Yet what otherwise shouts from between the lines of his book is that, in Dr. Turban’s view, a mother is most definitely to blame if she maintains a belief, as many do, that her child’s cross-sex gender identity is not a genuine reflection of their true self and instead is a manifestation of deeper psychopathology.Despite presenting his book as the authoritative bible on this subject, Dr. Turban ultimately leaves parents without the full picture about pediatric gender medicine. He does, however, sing a clear gospel throughout this text:Kids are free to be the opposite sex, but parents are not free to object.

From the Face of Pediatric Gender Medicine Comes a Quietly Radical Manifesto

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