We won! So much winning! Time for a victory lap!

I recap a major New York Times Magazine piece on the Skrmetti decision.

Adolescent gender medicine was never my primary interest on Twitter, but it was a topic that I followed closely because it involves so many of the things I love: ideologically hijacked institutions deeply invested in very bad ideas, poor quality, Lysenkoized science that can’t bear scrutiny, a sclerotic and exhausted lib blob (activists, Dems, academics, legacy media, NGOs) legitimizing itself via the continuous production of ersatz liberatory movements, Potemkin political spectacles put on to excite the emotions of Boomer libs, etc. I could go on, there’s so much that’s good here.

Before getting to my takes on the 11,000-word New York Times Magazine piece on the United States v. Skrmetti SCOTUS decision, let me speed run my general feelings about gender identity, gender medicine, and trans activism: I don’t find gender identity itself to be an interesting topic, I don’t believe that gender identity is real in any meaningful scientific sense, I do think of ‘gender identity’ primarily as a genre of social performance, I do think that the epidemiological phenomenon of transgenderism is explained primarily by technology (for both the pre-adolescent/ adolescent female population that frequently has comorbid psychiatric diagnoses and for the middle-aged high-IQ heterosexual male demographic), I do think that trans politics are better understood as a radical transhumanist project rather than as a conventional liberatory movement, I do think that transgender political activism is intrinsically authoritarian (if not totalitarian) in its insistence on compelled social participation in florid unrealities, I do think that girls and women have legitimate political interests in restricting how far transgender women can go in enacting their performances, I do think adolescent gender medicine has no meaningful evidentiary basis, I do think that people can suffer persistent, refractory gender dysphoria (and that people can become deranged by the internet), I do support well-designed experimental clinical research being performed that investigates treatments for gender dysphoria provided that subjects are assured all the protections that a formal research setting requires, and, finally, I am not opposed to people participating in whatever sorts of social performances they want provided that how those performances are received is negotiated privately on an interpersonal basis and not surveilled by the administrative state or other governmental or institutional authorities.

With that said, let’s jump in to the New York Times Magazine piece, ‘How the Transgender Rights Movement Bet on the Supreme Court and Lost,’ by Nicholas Confessore. This piece recaps the arc of contemporary trans activism culminating in the just-released SCOTUS Skrmetti decision which allows states to ban pediatric gender medicine and holds broad negative implications for trans activism as a whole. I think this piece is important not because it says anything new, but rather because it signals a major tactical retreat by the institutions. All of the institutions from legacy media to elite academic medicine to the Democratic Party to sundry NGOs and activist orgs had banked on gender identity as their generational liberatory centerpiece. Now, many of these institutions are formally on the record acknowledging that the Bad Things said by the Bad People over the past few years were at minimum mostly true. The primary purpose of the New York Times is to signal elite consensus (as Matt Taibbi said of the New York Times, ‘what we’ve got is a newspaper that catches real history spasmodically and often years late, but has the accuracy of an atomic clock when it comes to recording the shifting attitudes of elite opinion,’) and I don’t think the change in elite opinion that has occurred could be made any clearer than it is in this New York Times piece. The primary takeaway is that we WON. All the things that people were getting banned and maligned and harassed and threatened for saying a few years ago are now being integrated into lib consensus and conventional wisdom. We won.

There are some interesting specifics in the piece that I go into below.

(Note: When I say ‘we won’ I’m not trying to take any credit, I was just an onlooker - the ‘we’ I’m invoking are those of us who realized years ago what was going on and who were hoping that a change in elite lib consensus could be forced.)

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The NY Times piece follows an ACLU legal challenge of a Tennessee state law banning pediatric gender treatment with hormones and puberty blockers. The Biden administration signed on to support the ACLU before the case ended up going before the Supreme Court where it lost 6-3 with all 6 conservative justices voting against it.

At the core of the Times piece is an apologia by anonymous Biden alums that details how the administration ending up hitching itself to such a losing and unpopular issue. (The key ACLU players are cagey and reticent and figure less prominently.) (There is now an entire sub-genre of journalism stocked with anonymous ex-Biden officials providing exculpatory accounts of how things went wrong: the Ukraine war, Biden’s ‘hidden’ mental decline, Dems finding themselves on the losing end of almost every 80/20 issue. Every lib I know reviles the Biden administration and blames it for Trump II - Biden alums must be really feeling the heat.)

So why did the Biden administration go all in on pediatric gender care? In the telling of the Times piece, Biden’s support was downstream from him being a good-natured, empathetic, and well-intentioned person; trans activism was understood intuitively as unfolding within a broader Boomer lib teleology that Biden was committed to:

Biden had been among the first Democratic politicians of his generation to embrace trans rights. His commitment was rooted in personal relationships — Sarah McBride, now the first openly transgender member of Congress, is a longtime family friend — and in campaign-trail conversations with trans people and their families, former aides told me. For Biden and many of his aides, protecting this vulnerable group was the natural next step toward full civil rights for all Americans.

In fact, the entire Biden administration was also good natured, empathetic, and well intentioned (although perhaps, due to an excess of virtue, credulous and easily led astray by an ‘expert’ and activist contingent):

As the Biden administration grappled with the new [state-level pediatric gender medicine] bans, several former aides and officials told me, officials there usually deferred to the L.G.B.T.Q. advocacy groups and the medical associations about the scientific questions around gender-affirming care. The administration’s top concern, according to two former aides, was that the bans were so broad that they might limit dysphoric children from even getting therapy. “The internal conversations were entirely about getting kids access to mental health care, and maybe puberty blockers,” one official said. “That is where the president’s head was on these issues: The Republicans are using the power of the state to stop kids who feel gross about their bodies from seeing a therapist.”

One of the main villains to emerge in the narrative presented by the Biden alums was Biden official and transgender woman Rachel Levine:

Among the administration’s most prominent public voices on gender-affirming care was Rachel Levine, the assistant secretary for health at the Department of Health and Human Services. Levine, a pediatrician and one of Biden’s two highest-ranking openly trans appointees, adopted a maximalist defense. In March 2022, as Alabama’s ban was winding through the Legislature, Levine’s office issued a fact sheet asserting that the treatments had proven clinical benefits for children and adolescents. That April, in a speech urging doctors to fight the bans, Levine seemed to go further, claiming that gender-affirming care broadly was “suicide-prevention care. It improves quality of life, and it saves lives. It is based on decades of study. It is a well-established medical practice.”

When Levine intervened in the development of a medical society gender care guide to eliminate lower age limits restrictions for pediatric sex change operations (!!!), we’re told the left hand had no idea what the right hand was doing:

Just as WPATH’s internal emails began trickling into public view, the Supreme Court announced that it would hear Skrmetti. Not long after, Levine’s requests to WPATH were reported by The Times. White House officials were blindsided, several told me. Though Levine would later tell Biden aides that she had been trying to protect the president, the West Wing saw it differently: Her request could suggest that the administration thought there should be no minimum ages at all. “Everyone was like, holy cow — did Rachel Levine really go out and lobby for 9-year-olds to get surgery?” one former Biden aide told me. (Levine’s spokesman says she based “all policy recommendations on the best available science.”)

We’re also told that the Biden officials ‘trusted the experts’ and had no idea there were any problems with research evidence supporting youth gender medicine until a formal review from the UK, the Cass report, was released in the spring of 2024:

Though still rare, transition surgery for minors was politically toxic. On the campaign trail, Trump had claimed that children were getting sex-change operations at school. Biden was fighting for re-election and scheduled to debate Trump later that week. The scientific debate around gender-affirming care had already been upended once that spring, after Hilary Cass, in a final report submitted to British health officials, declared pediatric gender medicine “an area of remarkably weak evidence.” Gender-affirming treatments were not being singled out for lack of rigor, Cass said in interviews, but rather stood out for their weak clinical basis even compared with other areas of pediatric medicine.

Cass’s report sent shock waves across the Atlantic. There was “no evidence” that gender-affirming treatments reduced the risk that trans teenagers would die by suicide, her review found. SOC-8’s adolescent chapter [the key expert society clinical guideline] lacked “developmental rigor.” And the much-cited consensus of medical associations was a mirage. Few of the groups endorsing gender-affirming care had actually conducted their own in-depth evidence reviews, her team found; instead, nearly all had relied on older Endocrine Society and WPATH [World Professional Association for Transgender Health] guidelines as the basis for their own recommendations.

It’s impressive that the Biden administration was able to remain so ignorant of concerns regarding the evidentiary basis supporting youth gender medicine all the way through 2024 given that a continuous white-hot culture war firefight had been raging on this subject since at least 2018 when Jesse Singal published his infamous piece in the Atlantic. I guess that when the Biden administration signed on to a radical liberatory project that framed pediatric sex changes as a civil rights matter, it didn’t feel due diligence required any meaningful scrutiny of just what the empiric rationale for this care was.

By July of 2024, the Biden administration finally began to diverge from Levine, the activists, and ‘the experts,’ making a determination that their position needed to be moderated somewhat:

There was now a dawning awareness within the administration, another Biden aide told me, that its allies in the L.G.B.T.Q. movement had overstated the medical case for pediatric gender-affirming care. Unwilling to abandon the broader cause of trans rights, and wary of arbitrating a contentious medical debate, aides drafted statements clarifying that Levine didn’t speak for the administration. “We believe these surgeries should be limited to adults,” the White House told one outlet.

In addition to providing a predictable exculpatory narrative for the Biden administration, the Times piece does veer onto uncomfortable terrain for libs. In describing the arc of the Tennessee case, the Times goes into details from a parallel Alabama youth gender medicine case that was further along. Discovery from the Alabama case revealed that key youth gender guideline recommendations (Standards of Care Version 8 or SOC-8) from the premier transgender medical society (WPATH or World Professional Association for Transgender Health) had been engineered for ideological and political purposes:

That material began emerging into view last summer, after lawyers for Alabama moved for summary judgment in favor of its ban — and in the process began to make public thousands of internal emails and other documents revealing how WPATH’s standards were drafted in the first place. What doctors and lawyers around the country presented as a set of meticulous scientific guidelines, the lawyers for Alabama argued, were drafted and contorted to win the very political and legal disputes in which it was now being brandished.

“While we value clinical expertise, the battle for legitimacy is being fought in controlled studies,” Eli Coleman, chairman of the SOC-8 team and a psychologist, wrote to colleagues in 2023 as Tennessee and other states were preparing to approve their bans. “All of us are painfully aware that there are many gaps in research to back up our recommendations.”

The Alabama case also revealed that WPATH had censored politically inconvenient evidence reviews that it had commissioned:

SOC-8 had asserted that “a systematic review regarding outcomes of treatment in adolescents is not possible.” Alabama’s legal filings, though, claimed that WPATH had tried to squelch some of its own findings on the question, fearing that they could be wielded against the expansion of transition care.

The group [WPATH] had contracted with Karen Robinson, an epidemiologist and evidence-based medicine expert at Johns Hopkins School of Medicine, to conduct systematic reviews for SOC-8’s authors. By August 2020, Robinson was preparing to submit to medical journals three manuscripts based on her reviews of hormone therapy for adolescents and adults. Within days, WPATH’s board approved a new policy mandating that it approve any study based on its data. In a subsequent email, Robinson told an official at the Department of Health and Human Services that her team’s research had produced “little to no evidence about children and adolescents” and complained that WPATH had been “trying to restrict our ability to publish” the reports.

WPATH officials circulated the new policy in an email that fall to Robinson and SOC-8 authors, stating that any manuscripts based on her reports would now be “scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender health care.” At least one manuscript Robinson sought to publish never saw the light of day.

The Times using neutral language free of *moral clarity* to describe red-state legal scrutiny of elite scientific knowledge production represents an extraordinary reversal. The Times has been loathe to question scientific authority over the past decade, particularly when there were direct political stakes involved. Libs never tired of repeating the ‘believe science’ and ‘trust the experts’ mantras or labeling skeptics of institutional scientific narratives conspiracy theorists and misinformation peddlers. Now the tables have turned and the Times is forcing libs to watch how the sausage is made.

Perhaps the most surprising moment for me in the Times piece was an open acknowledgement that trans activism is animated, in part, by enthusiasm for radical transhumanist possibilities that pediatric gender medicine has the potential to reify:

In the relatively small community of pediatric gender medicine, physicians increasingly advocated a “gender-affirming” approach, in which clinicians should generally defer to a child’s self-declared identity. Some doctors, citing the risk of suicidal thoughts and behavior among trans youths, argued that failing to affirm a child’s expressed gender would put their life in danger. “We often ask parents, ‘Would you rather have a dead son than a live daughter?’” Johanna Olson-Kennedy, one of the country’s leading gender physicians, told ABC News…

Some doctors and activists went further. In a 2019 journal article, the trans bioethicist Florence Ashley argued that trans people, including “older teenagers,” should not require a formal diagnosis of dysphoria before gaining access to cross-sex hormones. Rather than relieving supposed distress, Ashley wrote, patients might be seeking “gender euphoria” or “creative transfiguration,” which “sees the body as a gendered art piece that can be made ours through transition-related interventions.”

This must come as a big shock to libs who, having just discovered that pediatric gender medicine has no good supporting empirical rationale, now must also contend with the fact that the civil rights advancement that they thought they were buying in to is in fact a purposeful transhumanist experiment being run on confused and mentally ill children that is indefensible by any reasonable moral or ethical standard.

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For those of us who have been following this subject for a while and who read Jennifer Bilek’s excellent piece in Tablet from 3 years ago, ‘The Billionaire Family Pushing Synthetic Sex Identities,’ there’s not much in the Times piece that comes as a surprise. The billionaire family at issue is the Pritzkers and includes Harvard board chair Penny Pritzker, Illinois governor and presidential hopeful JB Pritzker, and transwoman cousin Jennifer Pritzker who Wikipedia notes has three children, is ‘the world’s first transgender billionaire,’ and has earned a long list of military commendations. Pritzker charities have spread tens of millions of dollars across universities, medical entities, professional societies, and NGOs in support of adult and pediatric gender care, academic gender ideology programming, trans activism, and transhumanism. Bilek’s piece does a nice job of bringing into focus the web of entities that were meant to regiment lib opinion and makes a good case that the Biden alums have no excuse for their narrative in the New York Times that they were ignorant of what was going on until it was too late.

I started this poast by saying that I don’t find gender identity to be a particularly interesting topic but maybe I’ll walk that back a bit. Gender identity is interesting insofar that it straddles the divide between an old and a new left. When needed, gender identity could be successfully shoehorned into recognizable post-war leftist forms: Trans activism as a liberatory movement, gender as an identity with New Left revolutionary potential, gender as a source of sacralized gnostic knowledge, etc. But gender radicalism is also forward looking in imagining *new possibilities* as the old dispensations disintegrate. There’s been a lot said about how MAGA represents a forward looking new right. Will the left be preoccupied by gender-identity fueled trans humanist fantasies? We should take a victory lap and enjoy our win, but also keep our eyes peeled. The technology isn’t going away, we are less bound than ever before by traditional moral and ethical norms, and if we’ve learned anything the past few years it’s that the institutions can easily be put to any ends. The trans project is not fundamentally a civil rights issue - it could take many forms and may come roaring back sooner than we think.