The Trans Experiment: Legal Peril for Organizations

Updates to this article are posted at: https://refpac.org/the-trans-e...

Introduction

Herein I discuss legality issues with the Trans Experiment. Current research has summarized and expanded what is known, with what quality, and what is not known in Trans research. In the realm of law regarding experimenting on human subjects, medical ethics barriers were ignored or bypassed creating the current situation: a Trans Experiment being conducted on entire populations without controls, safety protocols, or independent review of the entire scope. To address this systemic failure of the medical system, tort litigation is necessary and appropriate. Quotes regarding the documentation of these issues in the Trans Experiment are from the following review paper: "Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults" by Stephen B. Levine, E. Abbruzzese& Julia M. Mason (https://www.tandfonline.com/do...)

The violations described are my opinion, and I reserve the right to change it pending further data.

At the bottom of this article is a draft letter for concerned community members to send to their area's schools and the administrators of any other organizations in which children socialize.

Medical Research Safety Introduction (https://biotech.law.lsu.edu/IE...)

The Federal Regulations

The National Science Foundation (NSF) and the Public Health Service (PHS), which oversees the National Institutes of Health (NIH), have slightly different definitions for misconduct. NSF defines misconduct as:

"(1) fabrication, falsification, plagiarism, or other serious deviation from accepted practices in proposing, carrying out, or reporting results from research; (2) material failure to comply with Federal requirements for protection of researchers, human subjects, or the public or for ensuring the welfare of laboratory animals; or (3) failure to meet other material legal requirements governing research." (45 CFR s 689.1)

The PHS defines misconduct as:

"fabrication, falsification, plagiarism, or other practices that seriously deviate from those that are commonly accepted within the scientific community for proposing, conducting, or reporting research. It does not include honest error or honest differences in interpretations or judgments of data." (42 CFR s 50.102)

One their face, neither of these definitions is unreasonable. Both depend on the notion of seriously deviating from accepted practices. (Since PHS fraud investigators are much more active than those at the NSF, the remainder of this articles deals with the PHS rules.) The problem is that "accepted practices" are not well defined, leaving considerable room for misunderstandings between researchers and investigators.

[EAJ Note: the PHS misconduct is presumed to be violated by all of the descriptions below in which an NSF violation is noted.]

The Trans Experiment

The American Academy of Pediatrics endorsed social transition in the absence of data showing its benefits or harms:

"There have been eleven research studies to date indicating a high rate of resolution of gender incongruence in children by late adolescence or young adulthood without medical interventions (Cantor, 2020; Ristori & Steensma, 2016; Singh et al., 2021). An attempt has been made to discount the applicability of this research, suggesting that the studies were based on merely gender non-conforming, rather than truly gender-dysphoric, children (Temple Newhook et al., 2018). However, a reanalysis of the data prompted by this critique confirmed the initial finding: Among children meeting the diagnostic criteria for “Gender Identity Disorder” in DSM-IV (currently “Gender Dysphoria in DSM-5), 67% were no longer gender dysphoric as adults; the rate of natural resolution for gender dysphoria was 93% for children whose gender dysphoria was significant but subthreshold for the DSM diagnosis (Zucker, et al., 2018). It should be noted that high resolution of childhood-onset gender dysphoria had been recorded before the practice of social transition of young children was endorsed by the American Academy of Pediatrics (Rafferty et al., 2018). It is possible that social transition will predispose a young person to persistence of transgender identity long-term (Zucker, 2020)."

Violated regulation by bypassing the research step: "(2) material failure to comply with Federal requirements for protection of researchers, human subjects, or the public or for ensuring the welfare of laboratory animals"

The Endocrine Society guidelines broadly applied recommendations based on low level evidence:

"The Dutch study subjects’ high level of psychological functioning at 1.5 years after surgery, which was the study end point, was an impressive feat. However, both of the studies suffer from a high risk of bias due to their study design, which is effectively a non-randomized case series—one of the lowest levels of evidence (Mathes & Pieper, 2017; National Institute for Health & Care Excellence, 2020a). In addition, the studies suffer from limited applicability to the populations of adolescents presenting today (de Vries, 2020). The interventions described in the study are currently being applied to adolescents who were not cross-gender identified prior to puberty, who have significant mental health problems, as well as those who have non-binary identities—all of these presentations were explicitly disqualified from the Dutch protocol. Despite these limitations, the Dutch clinical experiment has become the basis for the practice of medical transition of minors worldwide and serves as the basis for the recommendations outlined in the 2017 Endocrine Society guidelines (Hembree et al., 2017)."

Violated Regulations by bypassing the research step: "(1) fabrication, falsification, plagiarism, or other serious deviation from accepted practices in proposing, carrying out, or reporting results from research; (2) material failure to comply with Federal requirements for protection of researchers, human subjects, or the public or for ensuring the welfare of laboratory animals;"

Professional Medical Societies (at-large) endorse BELIEF in safety and efficacy of pediatric gender transition (WPATH in particular):

"It is common for gender-affirmative specialists to erroneously believe that gender-affirmative interventions are a standard of care (Malone, D’Angelo, Beck, Mason, & Evans, 2021; Malone, Hruz, Mason, Beck, et al:, 2021). Despite the increasingly widespread professional beliefs in the safety and efficacy of pediatric gender transition, and the endorsement of this treatment pathway by a number of professional medical societies, the best available evidence suggests that the benefits of gender-affirmative interventions are of very low certainty (Clayton et al., 2021; National Institute for Health & Care Excellence, 2020a; 2020b) and must be carefully weighed against the health risks to fertility, bone, and cardiovascular health (Alzahrani et al., 2019; Biggs, 2021; Getahun et al., 2018; Hembree et al., 2017; Nota et al., 2019). Recently, emphasis has also been placed on psychosocial risks and as yet unknown medical risks (Malone, D’Angelo, et al., 2021)."

"The most foundational aspect of the diagnoses of “gender dysphoria” (DSM-5) and “gender incongruence” (ICD-11), requisite for the provision of medical treatment, is in flux, as professionals disagree on whether the presence of distress is a key diagnostic criterion, as stated in the DSM-5, or is irrelevant, as is the case according to the latest ICD-11 criteria (American Psychiatric Association, 2013; World Health Organization, 2019). Further, these diagnoses have never been properly field-tested (de Vries et al., 2021)."

"There are no randomized controlled studies demonstrating the superiority of various affirmative interventions compared to alternatives. There isn’t even agreement about which outcome measures would be ideal in such studies."

"There are few long-term follow-up studies of various interventions using predetermined outcome measures at designated intervals. Studies that have been conducted are, at best, inconsistent. Higher quality studies with longer-follow-up fail to demonstrate durable positive impacts on mental health (Bränström & Pachankis, 2020a; 2020b)."

"Rates of post-transition desistance, increased mental suffering, increased incidence of physical illness, educational failure, vocational inconstancy, and social isolation have not been established."

"Numerous cross-sectional and prospective studies of transgender adults consistently demonstrate a high prevalence of serious mental health and social problems as well as suicide (Asscheman et al., 2011; Dhejne et al., 2011). Controversies about how to deal with trans-identified youth must consider the well described vulnerabilities of transgender adults."

"It is equally important to realize that to date, research about alternative approaches, such as psychotherapy or watchful waiting, shares the scientific limitations of the research of more invasive interventions: there are no control groups, nor is there systematic follow-up at predetermined intervals with predetermined means of measurement (Bonfatto & Crasnow, 2018; Churcher Clarke & Spiliadis, 2019; Spiliadis, 2019)."

Violated regulation by bypassing the research step: "(2) material failure to comply with Federal requirements for protection of researchers, human subjects, or the public or for ensuring the welfare of laboratory animals"

The Clinicians:: brief evaluations, inaccurately-informed consent, gender-affirmative model, minority-stress theory, inadequate education, reductionism, discounting evidence, propagating misinformation regarding suicide, high rate of desistance/natural resolution of gender dysphoria in children is not disclosed, destransitioners - iatrogenic harm:

"When uncertain parents of children and teens consult their primary care providers, they are usually referred to specialty gender services. Parents and referring clinicians assume that specialists with “gender expertise” will undertake a thorough evaluation. However, the evaluations preceding the recommendation for gender transition are often surprisingly brief (Anderson & Edwards-Leeper, 2021) and typically lead to a recommendation for hormones and surgery, known as gender-affirmative treatment."

"The informed consent process consists of three main elements: a disclosure of information about the nature of the condition and the proposed treatment and its alternatives; an assessment of patient and caregiver understanding of the information and capacity for medical decision-making; and obtaining the signatures that signify informed consent has been obtained (Katz et al., 2016). The current expectation that clinicians and institutions are required to thoroughly inform their patients about the benefits, risks, and uncertainties of a particular treatment, as well as about alternatives, has a long legal history in the United States (Lynch, Joffe, & Feldman, 2018)."

"Although following the informed consent model of care for hormones and surgeries for youth may diminish clinicians’ ethical or moral unease (Vrouenraets et al., 2020), we believe this model is the antithesis of true informed consent, as it jeopardizes the ethical foundation of patient autonomy. Autonomy is not respected when patients consenting to the treatment do not have an accurate understanding of the risks, benefits, and alternatives."

"Gender dysphoric children and teens can intensely occupy the belief that their lives will be immensely improved by transition. Clinicians who have embraced the gender-affirmative model of care operate on the assumption that children and teens know best what they need to be happy and productive (Ehrensaft, 2017). These professionals, responding to the youths’ passionate pleas, see their role as validating the young person’s fervent wishes for hormones and surgery and clearing the path for gender transition. In doing so, they privilege the ethical principle of respect for patient autonomy (Clark & Virani, 2021) over their obligations for beneficence and non-maleficence."

"Many of the gender-affirmative clinicians subscribe to the theory of minority stress – the supposition that the frequently co-occurring psychiatric symptoms of gender dysphoric individuals are a result of prejudice and discrimination brought about by gender non-conformity (Rood et al., 2016; Zucker, 2019), and that gender transition will ameliorate these symptoms. Some even claim that gender-affirmative care will successfully treat not only depression and anxiety but will also resolve neurocognitive deficits frequently present in gender dysphoric individuals (Turban, 2018; Turban, King, Carswell, & Keuroghlian, 2020; Turban & van Schalkwyk, 2018). These latter assertions have proven controversial even among the proponents of gender-affirmative interventions (Strang et al., 2018; van der Miesen, Cohen-Kettenis, & de Vries, 2018). The minority stress theory as the sole explanatory mechanism for co-occurring mental health illness has also been questioned in light of the evidence that psychiatric symptoms frequently pre-date the onset of gender dysphoria (Bechard, VanderLaan, Wood, Wasserman, & Zucker, 2017; Kaltiala-Heino, Sumia, Työläjärvi, & Lindberg, 2015; Kozlowska, Chudleigh, McClure, Maguire, & Ambler, 2021). Other clinicians recognize the limits of gender-affirmative care and are aware that youth with underlying psychiatric issues are likely to continue to struggle post-transition (Kaltiala, Heino, Työläjärvi, & Suomalainen, 2020), but, unaware of alternative approaches such as gender-exploratory psychotherapy or watchful waiting (Bonfatto & Crasnow, 2018; Churcher Clarke & Spiliadis, 2019; Spiliadis, 2019), these well-meaning professionals continue to treat youth with gender-affirmative interventions despite lingering doubts."

"It is common for gender-affirmative specialists to erroneously believe that gender-affirmative interventions are a standard of care (Malone, D’Angelo, Beck, Mason, & Evans, 2021; Malone, Hruz, Mason, Beck, et al:, 2021). Despite the increasingly widespread professional beliefs in the safety and efficacy of pediatric gender transition, and the endorsement of this treatment pathway by a number of professional medical societies, the best available evidence suggests that the benefits of gender-affirmative interventions are of very low certainty (Clayton et al., 2021; National Institute for Health & Care Excellence, 2020a; 2020b) and must be carefully weighed against the health risks to fertility, bone, and cardiovascular health (Alzahrani et al., 2019; Biggs, 2021; Getahun et al., 2018; Hembree et al., 2017; Nota et al., 2019). Recently, emphasis has also been placed on psychosocial risks and as yet unknown medical risks (Malone, D’Angelo, et al., 2021)."

"Perhaps the single most problematic assumption held by some gender clinicians is that the young patients have simply been “born in the wrong body.” This assumption seemingly frees clinicians from having to contend with the ethical dilemmas of recommending body-altering interventions that are based on very low-quality evidence. Despite the principle of development that biology, psychosocial factors, and culture generate behavior, these clinicians may believe that atypical genders are created by biology. This reductionistic approach has been criticized repeatedly (Kendler, 2019)."

"A growing number of clinicians and researchers are noting that the dramatic rise of teens declaring a trans identity appears to be, at least in part, a result of peer influence (Anderson, 2022; Hutchinson, Midgen, & Spiliadis, 2020 Littman, 2018; Littman, 2020; Zucker, 2019). Some have noted yet another influx of trans-identified youth emerging during the COVID lockdowns, and have hypothesized that increased isolation coupled with heavy internet exposure may be responsible (Anderson, 2022). While the research into the phenomenon of social influence as a contributor to trans identification of youth is still in its infancy, the possibility that clinicians are providing treatments with permanent consequences to address what may be transient identities in youth poses a serious ethical dilemma."

"There is a growing recognition that rapid evaluations which disregard factors contributing to the development of gender dysphoria in youth are problematic. In November 2021, two leaders of the World Professional Organization for Transgender Health (WPATH) warned the medical community that the “The mental health establishment is failing trans kids” (Anderson & Edwards-Leeper, 2021). Frequently, evaluations provided by gender clinicians may only ascertain the diagnosis of gender dysphoria (DSM-5) or its ICD-11 counterpart gender incongruence, and screen for conspicuous mental illness prior to recommending hormones and surgeries. These limited, abbreviated evaluations overlook, and as a result fail to address, the relevant issue of the forces that may have influenced the young person’s current gender identity."

"Confirming the young person’s self-diagnosis of gender dysphoria or gender incongruence is easy. Clarifying the developmental forces that have influenced it and determining an appropriate intervention are not. Contextualizing these forces involves an understanding of child and adolescent developmental processes, childhood adversity, co-existing physical and cognitive disadvantages, unfortunate parental or family circumstances (Levine, 2021), as well as the role of social influence (Anderson, 2022; Anderson & Edwards-Leeper, 2021; Littman, 2018; 2021)."

"In sharing the information with patients and families, two key areas of uncertainty must be emphasized. The first one is the uncertain permanence of a child’s or an adolescent’s gender identity (Littman, 2021; Ristori & Steensma, 2016; Singh, Bradley, & Zucker, 2021; Vandenbussche, 2021; Zucker, 2017). The second is the uncertain long-term physical and psychological health outcomes of gender transition (National Institute for Health & Care Excellence, 2020a; 2020b). Unfortunately, gender specialists are frequently unfamiliar with, or discount the significance of, the research in support of these two concepts. As a result, the informed consent process rarely adequately discloses this information to patients and their families."

"Problematically, it is common for gender clinicians to emphasize the risk of suicide if a young person’s wish to transition gender is not immediately fulfilled. There is a significant amount of misinformation surrounding the question of suicidality of trans-identified youth (Biggs, 2022). Providers of gender-affirmative care should be careful not to unwittingly propagate misinformation regarding suicide to parents and youths. They should also be reminded that any conversations about suicide should be handled with great care, due to its socially contagious nature (Bridge et al., 2020; HHS, 2021)."

"There have been eleven research studies to date indicating a high rate of resolution of gender incongruence in children by late adolescence or young adulthood without medical interventions (Cantor, 2020; Ristori & Steensma, 2016; Singh et al., 2021). An attempt has been made to discount the applicability of this research, suggesting that the studies were based on merely gender non-conforming, rather than truly gender-dysphoric, children (Temple Newhook et al., 2018). However, a reanalysis of the data prompted by this critique confirmed the initial finding: Among children meeting the diagnostic criteria for “Gender Identity Disorder” in DSM-IV (currently “Gender Dysphoria in DSM-5), 67% were no longer gender dysphoric as adults; the rate of natural resolution for gender dysphoria was 93% for children whose gender dysphoria was significant but subthreshold for the DSM diagnosis (Zucker, et al., 2018). It should be noted that high resolution of childhood-onset gender dysphoria had been recorded before the practice of social transition of young children was endorsed by the American Academy of Pediatrics (Rafferty et al., 2018). It is possible that social transition will predispose a young person to persistence of transgender identity long-term (Zucker, 2020)."

"Comparing these much higher rates of treatment discontinuation and detransition to the significantly lower rates reported by the older studies, the researchers noted: “Thus, the detransition rate found in this population is novel and questions may be raised about the phenomenon of overdiagnosis, overtreatment, or iatrogenic harm as found in other medical fields” (Boyd, Hackett, & Bewley, 2022 p.15). Indeed, given that regret may take up to 8-11 years to materialize (Dhejne, Öberg, Arver, & Landén, 2014; Wiepjes et al., 2018), many more detransitioners are likely to emerge in the coming years. Detransitioner research is still in its infancy, but two recently published studies examining detransitioner experiences report that detransitioners from the recently-transitioning cohorts feel they had been rushed to medical gender-affirmative interventions with irreversible effects, often without the benefit of appropriate, or in some instances any, psychologic exploration (Littman, 2021; Vandenbussche, 2021)."

"Suicide among trans-identified youth is significantly elevated compared to the general population of youth (Biggs, 2022; de Graaf et al., 2020). However, the “transition or die” narrative, whereby parents are told that their only choice is between a “live trans daughter or a dead son” (or vice-versa), is both factually inaccurate and ethically fraught. Disseminating such alarmist messages hurts the majority of trans-identified youth who are not at risk for suicide. It also hurts the minority who are at risk, and who, as a result of such misinformation, may forgo evidence-based suicide prevention intervention in the false hopes that transition will prevent suicide."

"The notion that trans-identified youth are at alarmingly high risk of suicide usually stems from biased online samples that rely on self-report (D’Angelo et al., 2020; James et al., 2016; The Trevor Project, 2021), and frequently conflates suicidal thoughts and non-suicidal self-harm with serious suicide attempts and completed suicides. Until recently, little was known about the actual rate of suicide of trans-identified youth. However, a recent analysis of data from the biggest pediatric gender clinic in the world, the UK’s Tavistock, found the rate of completed youth suicides to be 0.03% over a 10-year period, which translates into the annual rate of 13 per 100,000 (Biggs, 2022). While this rate is significantly elevated compared to the general population of teens, it is far from the epidemic of trans suicides portrayed by the media."

"As the lead Dutch researchers have begun to call for more research into the novel presentation of gender dysphoria in youth (de Vries, 2020; Voorzij, 2021) and question the wisdom of applying the hormonal and surgical treatment protocols to the newly presenting cases, many recently educated gender specialists mistakenly believe that the Dutch protocol proved the concept that its sequence helps all gender-dysphoric youth. Although aware of the Dutch study’s importance, they seem to be unaware of its agreed upon limitations, and the Dutch clinicians’ own discomfort that most new trans-identified adolescents presenting for care today significantly differ from the population the Dutch had originally studied. These facts, of course, underscore the need for a robust informed consent process."

Violations on a case-by-case (institution-by-institution) basis where documentation shows that the Clinician(s) had poor education, experience, and/or training for how they handled patients (obtained during Discovery phase of a lawsuit): "(1) fabrication, falsification, plagiarism, or other serious deviation from accepted practices in proposing, carrying out, or reporting results from research; (2) material failure to comply with Federal requirements for protection of researchers, human subjects, or the public or for ensuring the welfare of laboratory animals; or (3) failure to meet other material legal requirements governing research." At issue is whether they were independently conducting research, in the sense of how research is defined. Otherwise the issue falls under malpractice. It has been reported that detransitioners cannot sue their Clinicians for malpractice as the treatment was "experimental". If that is the case, then the violation falls under research.

Schools and other child activity organizations can face litigation now with regard to parental informed consent (see attached draft letter):

"There have been eleven research studies to date indicating a high rate of resolution of gender incongruence in children by late adolescence or young adulthood without medical interventions (Cantor, 2020; Ristori & Steensma, 2016; Singh et al., 2021). An attempt has been made to discount the applicability of this research, suggesting that the studies were based on merely gender non-conforming, rather than truly gender-dysphoric, children (Temple Newhook et al., 2018). However, a reanalysis of the data prompted by this critique confirmed the initial finding: Among children meeting the diagnostic criteria for “Gender Identity Disorder” in DSM-IV (currently “Gender Dysphoria in DSM-5), 67% were no longer gender dysphoric as adults; the rate of natural resolution for gender dysphoria was 93% for children whose gender dysphoria was significant but subthreshold for the DSM diagnosis (Zucker, et al., 2018). It should be noted that high resolution of childhood-onset gender dysphoria had been recorded before the practice of social transition of young children was endorsed by the American Academy of Pediatrics (Rafferty et al., 2018). It is possible that social transition will predispose a young person to persistence of transgender identity long-term (Zucker, 2020)."

"Informed consent for social transition represents a gray area. Evidence suggests that social transition is associated with the persistence of gender dysphoria (Hembree et al., 2017; Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013). This suggests that social gender transition is a form of a psychological intervention with potential lasting effects (Zucker, 2020). While the causality has not been proven, the possibility of iatrogenesis and the resulting exposure to the risks of future medical and surgical gender dysphoria treatments, qualifies social gender transition for explicit, rather than implied, consent."

Potential violation in the event of socially transitioning a child without explicit parental informed consent: any number of parental rights laws.

Medical practitioners fail to evaluate recommendations from Clinicians:

"The quality of evidence underlying the practice of pediatric gender transition is widely recognized to be of very low quality (Hembree et al., 2017). In 2020, the most comprehensive systematic review of evidence to date, commissioned by the UK National Health System (NHS) and conducted by the National Institute for Health and Care Excellence (NICE), concluded that the evidence for both puberty blocking and cross-sex hormones is of very low certainty (National Institute for Health & Care Excellence, 2020a; 2020b)."

"According to the NICE review of evidence for puberty blockers, the studies “are all small, uncontrolled observational studies, which are subject to bias and confounding, and are of very low certainty as assessed using modified GRADE [Grading of Recommendations, Assessment, Development and Evaluations]. All the included studies reported physical and mental health comorbidities and concomitant treatments very poorly” (National Institute for Health & Care Excellence, 2020a, p.13). NICE reached similar conclusions regarding the quality of the evidence for cross-sex hormones (National Institute for Health & Care Excellence, 2020b)."

"Problematically, the implications of administering a treatment with irreversible, life-changing consequences based on evidence that has an official designation of “very low certainty” according to modified GRADE is rarely discussed with the patients and the families. GRADE is the most widely adopted tool for grading the quality of evidence and for making treatment recommendations worldwide. GRADE has four levels of evidence, also known as certainty in evidence or quality of evidence: very low, low, moderate, and high (BMJ Best Practice, 2021). When evidence is assessed to be “very low certainty,” there is a high likelihood that the patients will not experience the effects of the proposed interventions (Balshem et al., 2011)."

"In the context of providing puberty blockers and cross-sex hormones, the designation of “very low certainty” signals that the body of evidence asserting the benefits of these interventions is highly unreliable. In contrast, several negative effects are quite certain. For example, puberty blockade followed by cross-sex hormones leads to infertility and sterility (Laidlaw, Van Meter, Hruz, Van Mol, & Malone, 2019). Surgeries to remove breasts or sex organs are irreversible. Other health risks, including risks to bone and cardiovascular health, are not fully understood and are uncertain, but the emerging evidence is alarming (Alzahrani et al., 2019; Biggs, 2021)."

Violations: At present unknown as the author is not fully informed on malpractice law. That such major life-altering treatments are undertaken on physically healthy patients warrants investigation.

News and Social Media Companies role in transmitting information recruiting participants/supporters for the Trans Experiment and/or suppressing valid concerns:

"A growing number of clinicians and researchers are noting that the dramatic rise of teens declaring a trans identity appears to be, at least in part, a result of peer influence (Anderson, 2022; Hutchinson, Midgen, & Spiliadis, 2020 Littman, 2018; Littman, 2020; Zucker, 2019). Some have noted yet another influx of trans-identified youth emerging during the COVID lockdowns, and have hypothesized that increased isolation coupled with heavy internet exposure may be responsible (Anderson, 2022). While the research into the phenomenon of social influence as a contributor to trans identification of youth is still in its infancy, the possibility that clinicians are providing treatments with permanent consequences to address what may be transient identities in youth poses a serious ethical dilemma."

[EAJ: My personal experience has been that social media blogs that are self-identified left-leaning will ban users posting links to data and research regarding the issues above. This phenomenon should be measured for its impact on the availability of quality information to gender-questioning teens. Algorithms on social media platforms in general and the lack of news reporting on the poor quality of data underlying the Trans Experiment should also be measured.]

Violations: At present unknown as the author is not fully informed on the range of applicable laws. At issue is whether members of the media organizations were aware of the correct information regarding critical aspects the Trans Experiment and chose to censor or misrepresent it.

Draft Letter from Parents & Concerned Members of the Public to Schools and other Children's Activity Organizations

To legally notify school districts, you need to go to the school district's website, find the Superintendent (or equivalent) & send (a) an email with read receipt and (b) a certified letter that includes this letter and the printed out article, "Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults" by Stephen B. Levine, E. Abbruzzese& Julia M. Mason (https://www.tandfonline.com/do...). Then do the same for each of the school district's board members (elected). Their emails may not be available in which case you ask the Superintendent to forward the email.

[Date & Letter front matter]

Dear [Superintendent name],

I would like to officially notify you that the school district's policy regarding students with gender issues needs to take in account parental informed consent. As the attached scientific review paper states, "Informed consent for social transition represents a gray area. Evidence suggests that social transition is associated with the persistence of gender dysphoria (Hembree et al., 2017; Steensma, McGuire, Kreukels, Beekman, & Cohen-Kettenis, 2013). This suggests that social gender transition is a form of a psychological intervention with potential lasting effects (Zucker, 2020). While the causality has not been proven, the possibility of iatrogenesis and the resulting exposure to the risks of future medical and surgical gender dysphoria treatments, qualifies social gender transition for explicit, rather than implied, consent."

The body of the paper generally explains the experimental nature of Trans research and the need for parents and patients to receive complete information regarding the state of the Trans Experiment when making permanent life/health-altering decisions. The primary issue is that it is EXPERIMENTAL. School districts have no role in conducting scientific research of this nature, and school district policy must reflect this. This letter is to make you aware that the district is now liable if students are permitted to socially transition without explicit informed consent from his/her parents/guardian.

Sincerely,

[Your name & Letter back matter]

When you send this information to the organizations, please forward the documentation to us here at Referee PAC (with read receipt):

info@refpac.org

Elizabeth Jensen, PhD, PE, CSP
Referee PAC, Treasurer
https://refpac.org