#No Evidence for Gender Affirmation

[thearbourist]

Children Are Bring Harmed - The Lack of Ethics in "Gender Affirming" Medicine

If you are violating one of the principles of human medicine – first do no harm – it may be wise to reconsider your position on ‘gender-affirming treatment’ regardless of how lucrative it is. “Children are being harmed. Young people are being harmed.  In many ways, this story is not new. From snake oil to thalidomide, from lobotomies to opioids, medicine has a long history of fake cures and…

[religion-is-a-mental-illness]

By: SEGM

Published: Aug 13, 2023

Near-zero regret” findings among adults suffer from a critical risk of bias and have low applicability to youth

Recent research published in JAMA Surgery evaluated satisfaction and regret among individuals who had undergone chest masculinizing mastectomy at the University of Michigan hospital. The average patient age at the time of mastectomy was 27 years; no patients who were under age 18 were allowed to participate in the study.

The participants reported high levels of satisfaction and low levels of regret at an average of 3.6 years following mastectomy. The study authors lauded the “overwhelmingly low levels of regret following gender-affirming surgery,” and framed their findings as in conflict with the “increasing legislative interest in regulating gender-affirming surgery,” referring to current legislative attempts to restrict or ban “gender-affirming” procedures for minors. Another group of authors provided an invited commentary on the paper, reinforcing the view held by the study authors, and asserting the presence of a “double standard:” “gender-affirming” mastectomies have come under undue scrutiny by states’ legislators, while other surgical procedures with higher regret rates do not appear to concern legislative bodies.

The study suffers from serious methodological limitations, which render the findings of high levels of long-term satisfaction with mastectomy among adults at a "critical risk of bias"—the lowest rating according to the Risk of Bias (ROBINS-I) analysis. ROBINS-I is used to assess non-randomized studies for methodological bias. The "critical risk of bias" rating signals that the results reported by the study may substantially deviate from the truth. The results also suffer from low applicability to the central issue the study and the invited commentary sought to address, which was whether legislative attempts to regulate “gender-affirming” surgeries are warranted in minors. Unfortunately, these highly questionable findings are misrepresented as certain and highly positive by both the study authors and the invited commentators, several of whom have significant conflicts of interest.

Below, we provide a detailed explanation of the key methodological issues in the study which render its claims untrustworthy and not applicable to the patient population at the center of the debate: youth undergoing gender reassignment. We also comment on the alarming trend: several prestigious scientific journals appear to have deviated from their previously high standards for scholarly work and instead have become vehicles for promoting poor-quality research, seemingly to influence judicial policy decisions rather than advance scientific understanding. We conclude with recommendations about how journal editors can restore the integrity of scientific debate and raise the bar on the quality of published studies in the field of gender medicine.

[ For in-depth analysis, see: https://segm.org/long-term-regret-satisfaction-mastectomy-critical-appraisal ]

SEGM Take-Aways

Although this study reports extremely high rates of satisfaction and low regret, the timeframe in which these outcomes were assessed is insufficient—just 3.6 years post-mastectomy on average. The sample is also highly skewed: 50% of the participants had mastectomies in the last 3.6 of the 30 years. This skewing of the length of time since surgery is expected, given the sharp rise in the number of people (especially adolescents and young adults) identifying as transgender and undergoing chest masculinization mastectomy. It is also a short time in which to assess regret, particularly since one quarter of study participants were younger than age 23 at time of surgery and the median age of first birth in the US is 30 years.

The conclusion of high satisfaction/low regret suffers from a critical risk of bias due to the high non-participation rate, important differences between participants and non-participants, and lack of control group. Problematically, the authors misuse the (critically-biased) results from adults to argue against regulations for irreversible body alternations for minors and do so with a decidedly politicized spin.

The only intellectually honest commentary is that we do not have good knowledge of the likely rates of detransition and regret following chest masculinization mastectomy, nor do we know how many people experience regret but remain transitioned. There is an urgent need for quality research in this area. Previously, detransition and regret rates were considered to be low: they may have indeed been low due to the much more rigorous screenings, or the results may have been biased by the notoriously high dropout rates that plague “regret” research. Regardless, there is now growing evidence of much higher rates of medical detransition.

A recent study from a comprehensive U.S. dataset with no loss to follow-up revealed a 36% medical detransition rate among females within just 4 years of starting hormonal transition. At least two recent studies suggest that average time to regret among recently-transitioned females is about 3-5 years, but there is a wide range. Much less is known about detransition among those who undergo surgery. A growing number of detransitioners now express regret associated with the loss of breastfeeding ability, with one case study detailing breastfeeding grief experienced some 15 years post-mastectomy.

The study and invited commentary exemplify three problematic trends that plague studies emerging from the gender clinics: problematic conflicts of interest of the authors; leveraging scientific journals to disguise politically-motivated pieces as quality research; and a conflicted stance by the gender medicine establishment on surgery for minors. We expand on each briefly below.

Conflicts of interest of study authors and commentators 

The significant conflicts of interest of the gender clinicians who study and report on the outcomes of “gender-affirming” interventions cannot be overlooked. These clinicians are conflicted financially, since their practices specialize in “gender-affirming” interventions, as well as intellectually. While conflicts of interest among experts are common, such experts should still attempt to be balanced in their discussions and should acknowledge and reflect on their conflicts of interest.

The interpretations of the data in the study is neither rigorous nor balanced, and both the study and the invited commentary have a decidedly political spin. Further, the invited politicized commentary does not disclose that at least one of the authors is a key expert witness opposing states’ efforts to regulate “gender-affirming” surgeries for minors. This role alone precludes the ability to provide a balanced commentary.

There is a fundamental problem with research emerging from gender clinic settings. The same clinicians provide gender-transitioning treatments to individual patients in their practice; serve as primary investigators and custodians of data used in research informing population health policies; and increasingly, provide paid expert witness testimony in courts defending the unrestricted availability of hormonal and surgical interventions for minors.

As a result, such clinicians cannot express nuanced perspectives. Since any balanced statements may be used against them in a court of law when they serve as expert witnesses, they must resort to the lowest common denominator of the "winner-takes-all" adversarial approach. Such an approach does not tolerate nuance. Unfortunately, this approach contributes to the erosion of the quality of the published work in the arena of gender medicine and accelerates loss of trust about the integrity of the scientific process.

Misuse of scientific publications to promote politically-motivated articles disguised as scientific research

That prestigious medical journals now serve as platforms for promoting misleading, politically motivated research that aims to apply a veneer of misplaced confidence in  highly invasive, irreversible treatment should worry everyone committed to evidence-based medicine and the integrity of science. Moreover, it impairs our ability to accurately assess and improve the long-term health outcomes of the rapidly growing numbers of gender-diverse and gender-distressed youths.

This is not the first time that a JAMA has been used as a platform for positioning advocacy for “gender-affirming” care as scientific research. In 2022, JAMA Pediatrics published a study that assessed bodily happiness in a group of subjects aged 14-24 three months after chest masculinization mastectomy. Despite the very short follow up and dropout rate of 13%, the authors argued that their findings supported the premise that there was no evidence to suggest that young age should delay surgery. They also asserted that their research would help dispel the misconception that such surgeries are experimental. The editorial commissioned to bolster the authors claims was descriptively titled, “Top surgery in adolescents and young adults-effective and medically necessary.”

Another troubling trend is the misuse of statistical tools to reframe research findings that contradict the author's own position. For example, a well-known study that claimed that access to puberty blockers reduce the risk of suicide disregarded the fact that individuals reporting use of puberty blockers use had twice as many recent serious suicide attempts as their peers who did not use puberty blockers. Like the finding cited above, the doubling of suicide attempts was not statistically significant due to a small underpowered sample—but the magnitude of the effect was striking and should have tempered the authors’ enthusiastic conclusion that puberty blockers prevent suicides. Another recent gender clinic study, widely and positively covered by major media outlets, claimed that puberty blockers and cross-sex hormones led to plummeting rate of depression—even though the rate of depression among youth taking those medications remained demonstrably unchanged. More information about problems with research originating from gender clinics is detailed in this recent analysis.

Gender medicine’s stance on pediatric surgery

More generally, the gender medicine establishment is in a curious state of internal conflict about its stance on “gender-affirming” surgeries for minors.  On the one hand, it has become common for advocates of “gender-affirmation” of minors to insist that surgeries for minors are not performed and anyone who suggests otherwise is spreading “scientific misinformation” and “science denialism.”  On the other hand, gender clinicians publish mastectomy outcomes for minors in major medical journals, and laud surgeries for minors as “effective and medically necessary.” It is not uncommon for these opposing claims to be made by the same group of researchers and clinicians, as they test various arguments, searching for the "angle" that is most likely to convince judges and juries--and public at large--that scrutiny of the practice of pediatric transitions, which is increasingly occurring in European countries, is not warranted in the United States.

Notably, none of the European countries that are enacting severe restrictions on the use of puberty blockers or cross-sex hormones for minors have ever allowed surgeries for youth under 18. That the U.S. gender affirmation professionals continue to fight regulation of these problematic procedures speaks volumes about how far the U.S. healthcare has drifted when it comes to "gender affirmation" of minors.

Final thoughts

While it is challenging to determine how best to reduce the temperature of the highly politicized nature of the debate in gender medicine, the editors of scientific journals can begin to restore balance by recognizing how far the field has drifted from the standards of quality scientific research, and begin to expand their circle of peer-reviewers to those with diverse views. Inviting those concerned with the state of gender medicine (and not just the practices’ advocates) into the peer-review and commentary process is the first essential step to improve the quality of research published in the field of gender medicine.

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The activists are predictably - and consistent with the superficiality of their own ideology - upset that anyone should look below the surface. It seems to be more troubling that anyone would notice the shoddiness of the research, than that the research is shoddy.

If this is supposed to be "healthcare," you would think that they would want the best healthcare, and be more alarmed at the misrepresentations of the study, than by people finding those misrepresentations.

Could it be that this is ideological rather than medical? 🤔

The conflicts of interest and funding sources alone are remarkable.

[icelogged]

i’m going to be alone again september <3 and i have to stay alive until november because im finally getting legal aid for [redacted] sooooo i think i’ll make it into 2024 ! i hope to see you all there :3 <3

[pyjamaenzel]

got an ask that I legitimately can't tell if it's trolling or not. Poe's Law.

fictional character may be a war criminal but god forbid I make a joke insinuating he might be a transphobe!

I'm wheezing. there are so many layers here.

-the fact that if you spend 5 seconds googling ER character model datamining you find out that it's false (this is the one thing that would make me say it's deliberate trolling except!! People are this stupid.)

-the idea that having a binary trans person as a lackey means Notorious Pompous Arse With Superiority Complex considers them Valid

-the idea that knowing about the existence of binary trans people is the same as knowing about non-binary people

-the fact that I got this intensely pedantic response to a silly comic I made about pedantry.

If this is a joke, congrats anon I love you you are the funniest person on this website. masterfully crafted. you have distilled tumblr down to its essence.

[frogeyedape]

Fact check: where the fuck did these numbers come from. See

Overall, 25 099 patients (52.3%) were aged 19 to 30 years, 10 476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged 12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients.

3215 patients (87.4%) aged 12 to 18 years underwent GAS and had breast or chest procedures

405 patients (11.0%) aged 12 to 18 years underwent genital surgery.

Above quotes are for data collected for 2016-2020.

The followup study (which i believe op references) addresses the gap in cisgender affirming care vs trans & gender diverse (TGD) affirming care:

Gender-affirming health care aims to align an individual’s physical gender expression with their intrinsic gender identity. An example is breast reduction for cisgender males with gynecomastia. Recently, there have been increased legislative efforts restricting gender-affirming health care specifically for transgender and gender diverse (TGD) people.1 Proponents of these efforts express concerns that TGD minors may be too commonly using gender-affirming surgical procedures. Given stringent clinical standards for gender-affirming care,2,3 use of gender-affirming surgical procedures by TGD minors is expected to be low. However, there are limited national data; while 1 study provided national estimates, it did not capture minors under the age of 12 years and did not exclude procedures with clinical justifications outside of gender affirmation.4 Therefore, using a national dataset, we evaluated the extent to which TGD minors and adults received gender-affirming surgical procedures in 2019. Additionally, in line with a recent publication from bioethicists to acknowledge that gender-affirming care is used by people of all genders,5 we provide a novel characterization of the relative use of 1 gender-affirming surgery—breast reductions—by TGD and cisgender populations.

Note the following quote is for a single year in the US, 2019.

The rate of undergoing a gender-affirming surgery with a TGD-related diagnosis was 5.3 per 100 000 total adults compared with 2.1 per 100 000 minors aged 15 to 17 years, 0.1 per 100 000 minors aged 13 to 14 years, and 0 procedures among minors aged 12 years or younger (Figure 1). Of gender-affirming surgical procedures identified among adults and minors, 1591 of 2664 (59.7%) and 82 of 85 (96.4%) were chest-related procedures, respectively. Of the 636 breast reductions among cisgender male and TGD adults, 507 (80%) were performed on cisgender males. Of the 151 breast reductions among cisgender male minors and TGD minors, 146 (97%) were performed on cisgender male minors (Figure 2).

Fact check: there were 151 breast reductions in (insured) minors in the US in 2019, of which 146 (97%) were for cisgender male people. Among minors, the only surgeries identified as for gender affirming care specifically, 82 of 85 (96.4%) were chest-related procedures.

Furthermore (and supporting op's point):

In this cross-sectional study of a national insured population in 2019, there were no gender-affirming procedures conducted on TGD minors aged 12 years and younger, and procedures on TGD minors older than 12 were rare and almost entirely chest-related procedures. Additionally, when considering breast reductions among cisgender males and TGD people—a surgery that can be considered gender-affirming among both populations—most were performed on cisgender males. Thus, these findings suggest that concerns around high rates of gender-affirming surgery use, specifically among TGD minors, may be unwarranted. Low use by TGD people likely reflects adherence to stringent standards of gender-affirming care.2,3

When you look up gender affirming surgery it says 'a broad range of procedures that help transgender and non-binary people transition to their gender identity'.

Seems 97% had the same procedure.

[lavendulaconminatio]

Synopsis: The Cass Review on transgender care has been crucial in the UK, leading to the cessation of prescribing puberty blockers outside of research protocols. However, in the U.S., where the gender-affirming care model is standard, Cass's four-year investigation and final report have been ignored. The newly released Cass Review on transgender care for young people has been pivotal in the UK, where the prescription of puberty blocking drugs outside of research protocols has now ceased. The review concluded that the evidence on use of puberty blockers and hormones for children and teens experiencing gender related distress is wholly inadequate and called for a more holistic approach to care. Parents and their children are being misled in clinics all over the country. There is no evidence that giving puberty blockers followed by hormones and surgery is lifesaving care and there is mounting evidence that the harms outweigh the advantages. ...I'm already hearing from the boards of directors and trustees of some hospital systems who are starting to get nervous about what they've permitted. So I think that's going to accelerate change within American healthcare.

[probablyasocialecologist]

The study itself is titled, “Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy,” and sought to study the rate of regret and satisfaction after 2 years or more following gender affirming top surgery. The study’s results were stunning - in 139 surgery patients, the median regret score was 0/100 and the median satisfaction score was 5/5 with similar means as well. In other words… regret was virtually nonexistent in the study among post-op transgender people. In fact, the regret was so low that many statistical techniques would not even work due to the uniformity of the numbers: In this cross-sectional survey study of participants who underwent gender-affirming mastectomy 2.0 to 23.6 years ago, respondents had a high level of satisfaction with their decision and low rates of decisional regret. The median Satisfaction With Decision score was 5 on a 5-point scale, and the median decisional regret score was 0 on a 100-point scale. This extremely low level of regret and dissatisfaction and lack of variance in scores impeded the ability to determine meaningful associations among these results, clinical outcomes, and demographic information. The numbers are in line with many other studies on satisfaction among transgender people. Detransition rates, for instance, have been pegged at somewhere between 1-3%, with transgender youth seeing very low detransition rates. Surgery regret is in line with at least 27 other studies that show a pooled regret rate of around 1% - compare this to regret rates from things like knee surgery, which can be as high as 30%. Gender affirming care appears to be extremely well tolerated with very low instances of regret when compared to other medically necessary care.

[...]

The intense conservative backlash, to the point of disputing reputable scientific journals, likely stems from the fact that reduced regret rates weaken a central narrative these figures have championed in legal and legislative spaces. Over the past three years, anti-trans entities have showcased political detransitioners, reminiscent of the ex-gay campaigns from the 1990s and 2000s, to argue that regrets over gender transition and detransition are widespread. Some have even asserted detransition rates of up to 80%, a claim that has been broadly debunked. Yet, research consistently struggles to find substantial evidence supporting this narrative. The rarity of detransition and regret is underscored by Florida's inability to enlist a single resident to bear witness against a lawsuit challenging the state's ban on gender-affirming care.

[thearbourist]

Differences Between "Gender Affirming Care" and Evidence Based Medicine.

TL:DR – The column on the left is activist dogma that has been pushed into the medical system.  The column on the right is what proper evidence based care looks like.

[religion-is-a-mental-illness]

By: Paul Terdal

Published: Jul 2, 2024

It’s understandable to want to help troubled kids. But the evidence simply isn’t there that unproven drugs and surgeries are what they need.

In our drive to eliminate health inequities, my fellow liberal Democrats and I are eager to help children who identify as transgender. This compassionate urge has led our state, Oregon, to fast-track Medicaid coverage of medical transition services for kids, including puberty-blockers, cross-sex hormones, and surgical removal of breasts and genitals. Yet I’m deeply concerned that in the push for equity, Oregon has ignored evidence, to the point of jeopardizing children’s health. I know from experience that my state can do better to ensure that kids get medically necessary care.

Oregon has long been a national and even international model for evidence-based medicine. I personally encountered my state’s strong commitment to medical science after my two young sons were diagnosed with autism in the late 2000s. At the time, few autism treatments were covered by insurance or Medicaid anywhere in America, so I worked with state leaders and a broader coalition to right that wrong. One key hurdle was Oregon’s Health Evidence Review Commission (HERC), which determines what treatments Medicaid covers and strongly influences the coverage of private health-insurance plans.

HERC held us to its customary high standards for quality of evidence. We organized testimony from some of the world’s leading experts on autism and submitted reams of peer-reviewed journal articles, all of which were rigorously scrutinized by HERC’s experts. We prevailed only after the U.S. Agency for Healthcare Research and Quality published a groundbreaking systematic review that supported the effectiveness of behavioral interventions for autistic children. In 2014, HERC approved Medicaid coverage of such treatments for children like mine. HERC’s wise focus on evidence steered patients and physicians away from risky and unproven interventions that were popular at the time, some of which, such as chelation therapy, reportedly killed autistic children. To this day, I’m grateful for the commission’s high standards.

Yet HERC hasn’t upheld the same standards for gender medicine. To its credit, the commission began looking at this issue in 2012, before gender dysphoria was on the social radar. At the time, based primarily on studies of adults over the age of 30, it concluded that there was “very poor evidence” of benefits of medical interventions for patients. Even so, HERC decided in 2014 to provide comprehensive Medicaid coverage for puberty-blockers, cross-sex hormones, and surgeries for anyone, including children, who identifies as transgender. In a strange departure from its own rules, HERC didn’t run these policies through its evidence-based-guidelines subcommittee. In my fight for autism coverage, that subcommittee was the most important part of the process.

I’m confident the commissioners were trying to help people in what was then a unique situation. At the time, in 2015, the state estimated that very few patients would choose medical transition: according to NPR, “at least 175” patients per year, of all ages. NPR quoted HERC’s medical expert as estimating that the combined total cost for this coverage would be “up to $200,000 — for the whole state.” Yet by 2019, more than 7,500 Oregonians were receiving such treatment, at a cost of over $20 million per year. Based on my analysis of state data, hundreds of children have received some combination of puberty-blockers, cross-sex hormones, and surgeries. None of these procedures have gone through clinical trials to demonstrate their safety and effectiveness, and in the case of hormones, children are receiving drugs that haven’t been approved for such use by the FDA.

Amid this exponential rise, HERC in 2023 commissioned a thorough review of the latest studies. The draft report, which I obtained via a freedom-of-information request, found that the evidence was still very limited. For youth, the investigators reported that they were unable to find any systematic reviews — the key evidence we had to provide for autism coverage — with “extractable data” showing benefits of transgender treatments for children. The report also noted that many lower-quality studies can’t be applied to patients who seek a rapid gender-affirming transition, which is typically the case with children. The report was essentially Oregon’s version of the Cass Report, which the United Kingdom released in April.

Yet Oregon’s report was never finalized, and HERC staff didn’t even present their draft to the body’s 13 commissioners. Instead, after the state passed a law requiring the coverage of “accepted standards of care” for transgender treatments, HERC quickly endorsed guidelines from an advocacy group — without any analysis of the contents. The guidelines are highly aggressive yet based on low-quality evidence. Today, preteen Oregonians can be put on powerful chemicals without FDA approval, before moving on to surgeries as adolescents. These interventions can irreversibly alter their bodies and leave them less likely or even unable to have children of their own later in life. The risks to their physical and mental health are high and, crucially, not justified by existing proof of benefit.

Equity cannot be achieved by ignoring evidence and stripping away consumer protections from historically underserved people. While I deeply sympathize with the goal of helping struggling kids, we can’t accept shortcutting medical ethics — and we didn’t accept it a decade ago, with autism coverage. The ethical path is for HERC to define “accepted standards of care” based on the best science. Medicine is supposed to follow the evidence because health and well-being hang in the balance. The stakes are especially high for children. If we truly want to be equitable, Oregon will stop undermining children’s right to evidence-based medical care.

[ Via: https://archive.today/WcL66 ]

[starksnarks]

lol i made a comment on an instagram reel and i used the phrase "people with uteruses" and somehow it's gotten a few thousand likes and about 20 transphobes being like women?? you mean women?????? someone with a uterus is always a woman??????????? in the comment replies

[elierlick]

Yet another report found that the Cass Review was dangerously flawed. The Integrity Project at Yale concluded the review "obscures key findings, misrepresents its own data, and is rife with misapplications of the scientific method."

From the new report: "The Review also subverts widely accepted processes for development of clinical recommendations and repeats spurious, debunked claims about transgender identity and gender dysphoria. These errors conflict with well-established norms of clinical research and evidence-based healthcare. Further, these errors raise serious concern about the scientific integrity of critical elements of the report’s process and recommendations."

Read the full report here: https://law.yale.edu/yls-today/news/report-addresses-key-issues-legal-battles-over-gender-affirming-health-care

[telumendils]

i really want to emphasize the fact that many of these recent bills aimed at denying trans minors gender-affirming care have special exceptions built in to allow for nonessential surgeries on intersex children. they want to make sure doctors can continue pressuring parents into putting their intersex kids through procedures that have no evidence of benefits and are well known to cause harm (cw on these articles for discussions of intersex medical abuse/trauma).

these bills are not designed to protect children, they're designed to eradicate sex and gender diversity. they want to force both trans and intersex people into their binary little boxes and it will do immense harm to both groups.

[batboyblog]

I'm seeing a worrying amount of idiots on tumblr dot com push that "Kamala hates trans women" and I am losing my mind at how they are pushing it, constantly, saying she is a proven transmisogynist, despite it being a complete lie and her actively working behind the scenes to help trans women in prison. Is there like, sources that could help debunk this shit because I'm at my wits end as these people scream and cry and vomit trying to get biden to drop out but then are like "eghhhh still don't wanna vote for a transphobic cop..." when she's NEITHER-

Isn't the internet wonderful? first rule NEVER examine your priors! ALWAYS! hang onto whatever the first hot take you had on a subject to THE DEATH!

"Kamala is Transphobic!" over here in reality

past that trans and LGBT rights groups have been quick to endorse her like

Advocates for Trans Equality

Human Rights Campaign

just today 1,100 LGBT celebrities, lawmakers and leaders endorsed her

“The intersection on the issue of reproductive care and trans care, and the ability of families to be able to have care for their children and their families, is really, again, an intersection around attacks that are on an identity,” -Vice-President Harris, 2023

any ways the root of the idea she's transphobic comes from one case in 2015. Two inmates in the California State Prison system sued to get GRS, which as inmates would have been covered by the Prison system. It's worth noting here, both women got what they wanted, one was paroled and got the surgery covered by California Medicare while the other serving a life sentence was ultimately covered by the prison system.

Two things are important to bear in mind here, 1. Part of the job of California Attorneys General is to defend the state when it is sued, thats the job, 2. It seems early on in the case Harris was not personally aware of it, about 1,000 lawyers work in the Cali AG's office and so the AG cannot be personally aware of every case, and check this quote from the Lambda Legal lawyer handling the case:

“The California AG’s office shifted its handling of these cases significantly after now-Sen. Harris took over,” Renn said. “Initially there was language in briefing for the state that glaringly misunderstood the medical necessity of transition-related medical care and was patently offensive. But then, there was a dramatic change, which seems to have gone along with important policy shifts.”

Link

in 2019 Harris talked about the case and working after it was settled to change the policy of the California State Prison system

"When that case came up, I had clients, and one of them was the California Department of Corrections. It was their policy. When I learned about what they were doing, behind the scenes, I got them to change the policy," Harris said.

"I commit to you that always in these systems there are going to be these things that these agencies do. And I will commit myself, as I always have, to dealing with it," Harris said.

Any ways Harris can consistently spoken out for and supported Trans people, banned the hateful Trans panic defense when she was AG, in the Senate supported the Equality Act, during her 2020 campaign for President she drew attention to the hate crimes against black trans women while holding herself accountable for the 2015 case. As Vice-President she drew fire voicing support for Dylan Mulvaney during the hellish Bud Light backlash. Her Husband Doug was tapped to host the first ever White House Trans Day of Remembrance

basically you're looking at a great ally who clearly supports trans rights, who was involved in a case, which involved two people who got the surgeries they were looking for paid for by the State of California, close to 10 years ago now, there's evidence that both she moved the case in a better direction when she took over it and also that she changed the polices of the state to before more gender affirming.

[charliejaneanders]

Some have already admitted that KOSA will be used to censor LGBTQ content, especially that which relates to gender-affirming care. 29 Armed with cherry-picked and selectively interpreted studies associating trans content with “anxiety, depression . . . and suicidal behavior,” an ambitious attorney general will claim that ��evidence-informed medical information” 30 requires that platforms prohibit minors from viewing such content under KOSA’s duty of care.

They're claiming that KOSA has been fixed. It hasn't been. Please read this detailed explanation of what's wrong with the current version of the bill and then CALL YOUR REPS.

[floral-ashes]

🚨 Important new article on gender self-determination as a medical right in CMAJ! I argue that people have a right to gender-affirming care and that many common barriers aren’t justified by evidence. Trans health needs to centre human rights more! 🏳️��⚧️

(Audio version.)