Sasha Ayad's Newsletter, January 2025

The lawsuit against Dr. Johanna Olson-Kennedy, The Metaphor of Gender, The Death of Music Genres, and more...

Photo by Kelly Sikkema on Unsplash

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What’s on my mind…

You can either watch or read this section. The video is embedded below, followed by a text version.

The False Assumptions of Pediatric Gender “Medicine”

One of the most prominent advocates for pediatric gender interventions, Dr. Johanna Olson-Kennedy is being sued by a former patient for medical negligence. And by looking at the details of this lawsuit today, we’ll notice several false assumptions that are often found in pediatric gender “medicine” which harm patients and feed into this serious medical scandal. Today we’ll look at three of these bizarre and distorted assumptions, so that you can spot them, steer clear, and adopt a reality-based understanding of gender distress. In February’s newsletter, we’ll examine the other four.

Before we get started, please read the original reporting by Jesse Singal who broke this story for the Economist. He’s been one of the bravest and most meticulous reporters covering youth gender medicine. And also I referenced the work of Ben Ryan whose Substack is excellent and covers news on this topic in great detail.

First, meet Dr. Johanna Olson-Kennedy. She is an adolescent medicine physician and since 2012 she has been medical director of The Center for Transyouth Health and Development at Children’s Hospital Los Angeles. This is currently the largest and most well-known youth gender clinic in the United States. In 2015, Olson-Kennedy received 10 million dollars from the National Institutes of Health (NIH) to study outcomes of using puberty blocking drugs on youth. She had admitted to withholding the findings, then changed her story, but we’ll discuss that next month. She’s also a prominent WPATH member and she’s the president-elect of the US branch, USPATH. Olson-Kennedy is a well-known figure. She’s not an obscure doctor-gone-rogue, though I’ve heard her described as extreme and unhinged even by other “gender affirming” advocates. Nonetheless, she’s regularly quoted in major media platforms and has served as an expert witness in many cases, often against states in state-ban cases, in which she advocates for youth to receive gender interventions. She has reported giving cross-sex hormones to children as young as 12, and recommending mastectomy for 13 year-olds. Olson-Kennedy is named in this new lawsuit along with two others, a surgeon named Dr. Scott Mosser and a licensed therapist, Susan Landon.

The plaintiff is 20-year-old Clementine Breen, who was first seen by Olson-Kennedy at age 12. She claims that her mental health was not considered or managed properly, there was a lack of gatekeeping, and not nearly enough concern was given to the impact of puberty blockers on her bone health. This, the lawsuit claims, amounts to medical negligence.

Many people insist that nobody is rushing kids into gender medicalization. They say that the process to receive puberty blockers, cross-sex hormones, or surgery is always slow and careful. What Clementine has been through demonstrates that this is simply not true. As you’ll read, from the moment she began seeing the gender therapist and doctors named in the suit, Ms Breen was rushed into irreversible medical interventions with life-long consequences.

False Assumption #1: Discomfort with your biological sex always means you should transition

Clementine began to feel uncomfortable about being a girl around age 11. Prior to this, there had been a violent incident with her brother who has a severe disability, and Clementine had experienced sexual abuse at the hands of someone outside the family when she was a young child. When puberty arrived, she became unsure of her identity, her sexuality, and wondered if she might be transgender. By age 12, she just thought life might be easier as a boy.

Clementine had shared her distress with a guidance counselor (not Landon) who disproportionately gave attention to the gender piece. The counselor told Clementine’s parents that she believes their daughter is trans. With encouragement from the school and family, Clementine’s name and pronouns were changed. Seeking further support, her family brought her to her first appointment at CHLA with Dr. Olson-Kennedy in December of 2016 when she was 12 years old.

Before we go any further, I want to point out that diagnostic overshadowing is already at play before Clementine even steps foot in Olson-Kennedy’s gender clinic. Diagnostic overshadowing occurs when a person’s distress and symptoms are all attributed to one specific diagnosis while other mental health or medical issues are overlooked. For example, a patient is known to have an anxiety diagnosis and is experiencing chest pain. The doctor believes anxiety is the cause, when in fact, a real cardiac event like a mild heart attack or stroke has taken place and gone undetected. The anxiety diagnosis overshadowed the cardiac event. In the case of Clementine, the guidance counselor heard about a variety of very difficult life circumstances and past experiences, but of everything Clementine shared, the “trans kid” aspect took the spotlight. Perhaps it’s intriguing and exotic to imagine you’re working with a “trans kid”. Perhaps the counselor became worried about the vulnerability of gender-questioning kids and wanted to help Clementine address the issue right away. Either way, the novel gender identity questions takes precedence over other commonplace life stressors and mental health difficulties. At this early stage in the process, Ms. Breen didn’t actually qualify for a formal gender dysphoria diagnosis at all, making it even more remarkable to see this diagnostic overshadowing at work: any utterance of trans dramatically shifted the professional’s clinical behavior. This pattern continues at the first appointment with Olson-Kennedy at CHLA and later with Susan Landon, the therapist she recommended to Clementine. In the following brief clip, Clementine tells Billboard Chris about her first 30-minute appointment with Olson-Kennedy when she was 12 years old and whether or not her previous traumas and mental health history were discussed before interventions were recommended.

In Olson-Kennedy’s notes from that first session, she writes that Ms Breen has only been “out” as trans for 3 months but also writes that she met the criteria for a Gender Dysphoria diagnosis, in which a cross-sex identity has been present for 6 months or longer.

That seems like a contradiction right? Why wouldn’t Olson-Kennedy recommend for Breen to come back in 3 or 4 months to see if the trans identity persists long enough to make the 6-month mark?

Well, according to one of the false assumptions of gender “medicine,” discomfort with your biological sex always means you should transition. Any cross-sex identity, of any duration, means you’re trans.

In my own work as an expert witness, I’ve reviewed cases similar to this one, and I’ve always been baffled by how quickly things change as soon as a child announces questioning their gender identity or being uncomfortable with their biological sex. It’s like a light switch. I’ve read it in the doctor’s or therapist’s progress notes: for months, they are relating to the patient as a typical teenage girl. But as soon as she mentions any vague discomfort with her sex or questions if she may be transgender, suddenly—like magic—the clinician quickly changes gears and everything thereafter is about validating the “trans kid,” sending her to trans support groups, helping her get a binder, and sending her off to a gender clinic. It’s swift, immediate, and I find it both robotic and disturbing. It’s almost like the clinician has become hypnotized by the mention of “gender.”

In the first meeting with Clementine, Olson-Kennedy orders the puberty blockers and notes that Clementine doesn’t suffer from any psychiatric comorbidity that would interfere with a diagnostic workup or the recommended “treatment.” How does Olson-Kennedy know this? She’d only spoken to the child for less than 30 minutes and hadn’t asked any questions about psychiatric comorbidities.

Perhaps it doesn’t matter. After all, discomfort with your biological sex always means you should transition.

False Assumption #2: Bodies have nothing to do with identity and bodies don’t matter

Gender doctors often prioritize the vague and esoteric internal identity while treating the real flesh-and-blood body like an object we can easily modify. It’s a Mr. Potato Head view of the human body. We’ll just elevate some hormone levels here, remove some body parts there. But the physical body can’t be changed so drastically (and in these particular ways) without serious health consequences. On the other hand, any distress, ambivalence, or questions about one’s biological sex are treated as immutable, concrete, and the very thing to be actualized through medical interventions. This doesn’t make much sense given that our identities are so complex, they evolve and change over time, and are malleable to so many factors and contexts. Why physically harm a healthy body based on an internal perception that may be fleeting and temporary? A Mr Potato Head doll has interchangeable plastic parts…but we’re human beings! It seems that many gender doctors and surgeons don’t make this distinction.

Olson-Kennedy, when defending early interventions for kids, like mastectomy (breast removal), once famously said that “if you want breasts at a later point in your life you can go get them.”

Olson-Kennedy’s notes included contradictory statements about the duration of Clementine’s dysphoria. She even wrote that she’d been endorsing a cross sex identity since childhood when it was clear from the rest of her notes that this is not true. Isn’t it frustrating that identity is malleable and may change? Problem solved: you can always just lie and pretend the patient has always had a stable, long-standing male identity!

Six months after starting puberty blockers, it was recommended that Clementine start testosterone. She reports having been reluctant, but Olson-Kennedy told her that beginning earlier would help her pass as male. The conveyor belt of interventions continues.

Next, when Clementine was still 13 years old, Olson-Kennedy, and therapist, Susan Landon wrote referral letters for Dr. Mosser to remove her breasts. Let’s take a closer look at this flippant treatment of the body and how the body is used as a vehicle to actualize identity.

We can begin by taking a reality-based birds-eye view of gender dysphoria. As a thought experiment, let’s say Clementine actually met the diagnostic criteria, and had been severely gender dysphoric and expressing a cross-sex identity, not just for 6 months, but for many years. Still, and by definition, she could only wish to turn her female body into a boy’s body if she has a female body. Being female is a necessary condition to having the fantasy of becoming male and of having FtM gender dysphoria. This would mean Clementine is grappling with the real distress, events, circumstances and embodied experience of being female. How can this simple fact be glossed over so easily by gender clinicians? Wouldn’t it be of crucial importance to discuss Clementine’s female embodied distress and try to understand it? Instead, gender doctors operate as though we are disembodied “identities” that somehow got put into the “wrong body.” That we had our “sex assigned at birth.” But we are our bodies and our bodies are sexed and we have no option to experience consciousness or any aspect of our lives outside of our sexed bodies.

To demonstrate how pervasive this mind-body disconnect is for Johanna Olson-Kennedy, listen to this clip in which she tells “The Pop-Tart Story” at a Gender Conference:

Olson-Kennedy was asked by an enthusiastic person at the conference to tell this story, which he’d presumably heard before. And people loved it! This Pop-Tart analogy, which she was teaching to others, tells a child that her body is wrong. That it’s simply incorrect and mismatched, just like a Pop-Tart placed in the wrong-flavored box. This analogy encourages a painful mind-body split and disconnect. It teaches the child to have body image problems and to engage in serious cognitive distortions. This is the very kind of psychological distress that people spend years trying to heal after trauma and abuse. Why?

Why, instead, wouldn’t she explain that the girls in the bathroom are wrong. That just because she has short hair or certain clothes, it doesn’t make her not a girl, even if she looks a little different from her peers. Why, instead, wouldn’t she encourage the mother to take this up with the school to ensure they have safe and inclusive policies for students? In fact the child had it exactly right when she said “I’m a girl because I have this body.”

How distorted does your thinking have to be to look at that little girl’s situation and conclude that she is somehow actually a boy that was somehow born into the wrong-sexed body? That her body has nothing to do with her identity and her body doesn’t matter? This is a metaphysical belief, and not a reality-based way of understanding that little girl’s experience.

False Assumption #3: Dysphoria Physical Disease Model— Bodies that clash with “identity” must be corrected

The issue of mental health is front and center in Clementine’s case. The difficulties she was having before coming to the gender clinic were never examined or addressed, and, as we’ll review next month, her mental health severely declined after hormones and surgery too. This decline was rationalized away by her providers. But why wouldn’t a young patient’s mental health be considered important when providers are recommending the most consequential intervention conveyor-belt known to medicine?

Olson Kennedy was asked about this back in 2018 by Jesse Singal for his groundbreaking piece for the Atlantic in 2018. She told him, “I don’t send someone to a therapist when I’m going to start them on insulin.”

As deranged as it is, this single statement clearly demonstrates the false assumption here: that the body is diseased and must be corrected right away for the health and wellbeing of the patient. In this short clip, Olson Kennedy freely admits that her youth patients use drugs, are homeless and engage in prostitution. She also compares the risks and benefits of breast removal and genital surgeries:

Notice how she put the word sterilization in air quotes?

Notice how she said people “get super worked up about that”?

Notice how “that’s a barrier we have to overcome, and I think we’re going to”?

This perspective is alarmingly disconnected from reality. Next month we’ll explore some of the more personal context that might explain the distortions we just heard.

For now, I’d like us to engage in another brief thought experiment to help us understand this mindset. Imagine you’re a physician who encounters an adolescent boy who is hungry, homeless and depressed, who also happens to have diabetes. Giving him easy access to life-saving insulin is the least you can do to improve his physical wellbeing.

This is exactly how you think about alleviating gender-related distress. When a teen is uncomfortable with her biological sex, even if only for fleeting moments this is a marker that in fact, she is trans, on par with evaluating a patient for diabetes using a blood test. But this is self-report and it’s just as valid as bloodwork. If gender-distress is on par with diabetes and the treatment pathway is easy, safe, and absolutely life saving, then why wouldn’t you recommend hormones and surgeries? Maybe that’s why Olson-Kennedy thinks fertility is so inconsequential and talks about it in flippant terms we just heard: preserving life itself vs infertility? It’s a no-brainer, right?

Helen Joyce, in the brilliant way she always does, explained this well in a recent conversation with La Leche League founder, Marian Thompson. In discussing the idea of a trans woman (a male who identifies as a woman) she said something like: “if you manage to get this crazy idea in your head that it is possible for a woman to be born with a desperately tragic birth defect which is that she looks exactly like a man, then you would do anything to help that poor poor woman.”

Olson-Kennedy seems to believe precisely this, but about Clementine having been born a boy with a tragic birth defect of looking exactly like a girl.

Bodies that clash with identity must be corrected.

Clementine, at age 14 underwent a double mastectomy with Dr Mosser, who apparently didn’t even meet with her until the day of surgery, for a quick 30 minute exchange.

There’s much more to say about Clementine’s story, so in February we’ll take a closer look at what she experienced after hormones and surgery and how gender clinics make sense of mental health complications or worsening outcomes after these supposed “medically necessary” interventions.

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What’s on my radar…

BIG Announcement about Wider Lens and my new project, The Metaphor of Gender!

A few weeks ago, Stella and I announced that weekly episodes of the podcast are coming to a close in early February, 2025. After our last public episode, we will be moving into some other exciting projects, both shared and solo. Stella will be joined by Bret Alderman and Mia Hughes to continue exploring the cultural shifts related to gender and even broader patterns in society.

But I am going in a completely new direction for my solo project...

In my new YouTube Channel, The Metaphor of Gender (T-MOG), identity goes beyond the literal. We'll use radical curiosity and surprising psychological insights to help viewers understand themselves better and skillfully navigate the real world.

This will be a channel specifically for adolescents and young adults who are experimenting with identity but don't see their full experience reflected in either trans activist or gender critical content.

It's a channel for the creatives, the over-analyzers, the deep feelers, and the might-be-skeptics. It's for the gender benders and the gender burnouts.

It's a channel where all ideas are allowed. On T-MOG, we don't let slogans and mantras block our natural curiosity.

Here are some examples of questions we'll explore together:

• What makes gender a metaphor, and what are the implications for your life?

• What drives our search for personal identity?

• What can psychological concepts like Social Influence, Sunk Cost Fallacy, and Locus of Control teach us about identity development?

• How do neurodivergence and gender dysphoria interact and how can you make wise decisions when you experience both?

• Help! Your parents think you're "brainwashed" and this feels really hurtful.

• What is "internalized transphobia" (analysis of a Trans Reddit thread) and what does it do to your doubts about transition?

• Yes, some kids have ROGD, but you're True Trans...right?

• What is an acceptance-based personal identity vs a denial-based personal identity? How can you build your identity to have MORE freedom, choices, and options in the real world?

What do you think? Do you have video ideas? Let me know - I’m very excited to hear from you!

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What’s new in my Parent Membership Group on SubscribeStar…

Topic Video:

Desistance + Detransition

• understanding gender dysphoria diagnosis, and psychological and physical “detransition” - what patterns to look out for, ways to facilitate your child’s return to birth-sex identity and what barriers get in the way if someone wants to detransition

Live Q+A:

• desisted 17-year-old daughter sometimes adopts trans mannerisms after hanging out with friends

• help us understand some of the trans words and jargon that our child may find important

• can you help me convince my daughter to stay in therapy?

• what's my experience with parents of estranged adult children?

• what reading material do you recommend for parents of estranged adult children?

• what should we do about our son wearing a skirt and shaving his legs?

• gender behaviors as maladaptive coping mechanisms

• my daughter has doubts about medicalization, how can I help her learn about the risks?

• my daughter got upset when I suggested she try to be "more mainstream" after friends pulled away

• do you know any supportive therapeutic boarding schools that don't simply "affirm" gender?

• using birth control pills to stop a dysphoric girl’s period

• what do ROGD girls think when they look in the mirror?

To hear this conversation, you can join the Q+A tier of my Parent Membership Group here.

Don’t forget that you can always view short clips of Topic Videos and other educational videos on my YouTube Channel.

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What’s on my nightstand, in my headphones, or on my TV…

Long before GWL had snazzy graphics or professional animations, we were a homemade, self-produced show. Nonetheless, we had truly incredible guests all the way through, and one moment from the “early days” that really stood out was from Dr Az Hakeem’s first interview in February, 2022. Az tells us how he, as a committed former-goth in his teen years, has been charting the trajectory of Goth in 5 phases. In Goth mark 1, 2, and 3 he describes the evolution in preferred bands, aesthetics, and of course, the guys’ lipstick. He also points out the social contagion element: “There was a pandemic of Goths in our school - everybody was Goth.”

Az points out that historically, youth subcultures have been embedded in music. The music was the identity - rock, punk, mod, etc…

Then social media arrived and it took over from music as the “substrate of your identity.”

Goth Mark 4, he says, was Emo

And Goth Mark 5, he says is ROGD/Nonbinary.

This revelation was a major lightbulb moment for many listeners.

I was never goth. I was never emo.

My own music favorites have different influences. My mom was a James Brown and Motown fanatic. My father listens to mostly classical. Both my parents listened to Egyptian music when I was a child. I became a hip-hop head for most of my youth and later branched out into related genres, reggae, dance hall, R&B, neo soul, house, salsa, electronic, pop, and a little grunge. Anything that makes me want to dance or sing out-loud can end up on repeat. Then, I reconnected with my love of Arabic music when Middle Eastern dance plunged me into a rich obsession with Egyptian classics and the beloved greats like Um Kulthoum and Abdel Halim and introduced me to brilliant new percussionists and artists from the Arab world.

All this to say, I’ve probably never heard much of the music Az is describing here. But the message rings loud and clear. I have often wondered, “are there still niche musical genres with dedicated fans who stay true to their subculture?”

It doesn’t seem so…

Then I came across the following video by Rick Beato talking about this exact issue. Apparently the hunch was right: there is a death of the Music Genre.

Interestingly, there are certain bands and artists who may be signaling “queer inclusivity” like Halsey, Panic! At the Disco, Cavetown, Ryan Cassata, boygenius, and others with explicitly trans-themed lyrics.

Beato explains how changes in the music industry have slowly killed the strict rigidity of music genre. I hope you find this video as fascinating as I did!

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What’s on our podcast…

Last month’s episodes of Gender: A Wider Lens ….

Life After Mumford & Sons with Winston Marshall We welcome Winston Marshall, former banjoist for Mumford & Sons, to discuss the personal and professional fallout following his tweet about Andy Ngo's book Unmasked. He opens up about navigating censorship, conformity, and the immense power of social media in shaping public discourse. Winston reflects on the pressure artists face when balancing personal beliefs with industry expectations, and how political events influence cultural movements. In this conversation, Winston shares his experience being thrust into an online firestorm and the deeply personal decision to step away from the band he cherished for over a decade. His choice emerges as an act of integrity, demonstrating the courage it takes to embrace authenticity and stand against the tide of groupthink.

The Trans Inclusion Controversy That Took Over La Leche League w/Helen Joyce & Marian Tompson In this special episode, we pass the mic to honorary guest host, journalist, author, and feminist campaigner, Helen Joyce, who interviews Marian Tompson, in connection with Joyce’s recent article about Marian in The Times, "Why I Quit the Breastfeeding Charity I Founded Over Trans Ideology." Tompson, along with six other mothers, founded the global breastfeeding support network, La Leche League, in 1956. In November 2024, Tompson resigned from both the organization and its Board of Directors, believing it had strayed from its original mission to support biological mothers in breastfeeding.

We Have a BIG Announcement! Stella and I share the news of our new projects and the end of an era of weekly episodes of Gender: A Wider Lens.

Are Puberty Blockers the Next Consumer Fraud Scandal? with Glenna Goldis With extensive knowledge of gender medicine and consumer fraud, attorney Glenna provides a comprehensive analysis of pivotal legal cases and controversies in the U.S., breaking down complex legal language into accessible insights. She brings her expertise and unique perspective on the evolution of gender medicine. She also examines consumer fraud allegations against the American Academy of Pediatrics, using her legal expertise to shed light on the broader societal and legal implications of these claims. Glenna further explores the policy proposals and political impact surrounding pediatric gender medicine, particularly focusing on statements from political leaders, including president-elect Donald Trump, and the potential effects of such policies on real-world practices and legislation.

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I am available for one-on-one parent consultations. You can learn more about what these sessions entail, plus view my availability on my Substack.

Often I am booked quite far in advance, but if you are a Founding Member of this Substack, you will get priority booking.

In the meantime…

Here’s one thing to try…

Prioritize your wellbeing in 2025

Gender issues have a way of bulldozing a family. While enormous amounts of energy are spent on trying to help a teen or young adult, parents often “drop everything” in service of their new rescue mission.

When there is an urgent or distressing situation in the family, it becomes more important than ever to mind your own wellbeing. You can care well for yourself while also engaging in the important work of parenting.

I know that some circumstances require urgent and pointed changes in your life and the life of your family. However, I’ve met many families that remain in a state of paralysis, depression, or stagnation even when the time for swift action has long passed.

What are the activities or hobbies that make you feel most vibrant?

What did you put on the back burner when your family started to struggle?

Who are the friends and loved-ones that you trust but haven’t invested much time in lately?

Orient yourself properly for the road ahead, whatever it may hold.

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