The Lukewarm Perjury of Jack Turban: Abridged Version

This is a shortened version of a full set of notes on Jack Turban’s Declaration in Support of Plaintaiff’s Motion for a Preliminary Injunction in Brandt et al. v Rutledge et al. in the United States District Court for the Eastern District of Arkansas — or just the “Arkansas case” for short. This is a case where medical transition of minors has been legislatively banned and the whole matter has been brought to the courts to sort out. Jack has been brought in to offer his views on the topic and attempt to respond to the claims made by the state’s experts.

This part contains just the errors Jack made, the full one contains a lot more — including the few good points he made. All the citations are at the bottom of that document. It also contains the context of each statement which, when missing, makes the flow of the text below quite stilted. However, it’s an hour long read so I’ll leave that for those who want to learn more about the overall topic, not just what lies, errors and mistakes were put forth by Jack.

First, in the realm of pubertal suppression, there have been eight studies. The first was a longitudinal study of 55 transgender adolescents that found a statistically significant decrease in depression following pubertal suppression.

This is de Vries et al., 2014,¹ which was technically a study of 70 children diagnosed with Gender Dysphoria (of which only 32 have their depression scores investigated) rather than “transgender children”, in other words Jack is equivocating. That’s not technically lying, but it’s not a good start. Bringing up the borderline statistically significant depression scores is also quite misleading. Scores went from the “minimal” range to… well, there is no range below “minimal”, so they went from not being depressed to not being depressed.

He could also have brought up that this was an uncontrolled study, meaning that these small improvements could easily have been attributable to other factors, and that causation thus could not be established, or that the finding was only statistically significant for one sex. Or that one of the kids died as a result of medical transition. You could argue this is lying by omission, but I think he gets away with this one.

The second was a longitudinal cohort study of 70 adolescents who received pubertal suppression that found improvements in internalizing psychopathology (anxiety and depression), externalizing psychopathology (e.g., disruptive behaviors), and global functioning. Of note, some of the patients in this study appear to have also been included in the first study.

This is de Vries et al., 2011,² which is the same cohort as de Vries et al., 2014. The same issues as with the later paper were inherent in the study design: the relationship could not be established to be causal, nor were the findings particularly impressive. The findings reported in the paper are that the children went from “minimally depressed” to “minimally depressed” and from “generally functioning pretty well” to “generally functioning pretty well”. Why he brings up the anxiety scores at all is unclear to me, as the anxiety-specific measurement did not change to a statistically significant degree, let alone a relevant one.

With that said, let’s focus on the interesting part of Jack’s statement. He seems surprised and finds it noteworthy that the two studies of the same cohort has “some” of the same individuals. It is explicitly stated in the later paper that these are the same cohort. The only option I see is that Jack hasn’t actually understood the fundamentals of the papers he is citing.

It’s just very revealing about Jack’s self-identified “expertise”.

The fifth was a longitudinal cohort study of 50 adolescents who received pubertal suppression, gender-affirming hormones, or both, and that found a statistically significant decrease in depression for transgender females following pubertal suppression.

This is Achille et al., 2020,⁷ and it is where Jack starts taking some real liberties with the truth. One of these is that only 47 of the 50 had hormonal treatment, Jack is possibly confusing the number of participants with the number who received treatment. Although very minor, this was a false statement by Jack which could have been avoided had he been more familiar with the literature.

The rest of the statement is misleading, but not outright false. Jack sneakily focuses on only one out of twelve measurements. Eleven did not improve to a statistically significant degree, directly contradicting some of the previously mentioned studies.

The eight was a study of 201 transgender adolescents in which 100 received pubertal suppression along with psychotherapy and 101 received psychotherapy alone. The study found a statistically significant increase in global functioning for those who received pubertal suppression. Additionally, patients receiving pubertal suppression had greater improvements in global functioning compared to those who did not receive pubertal suppression, though this difference was not statistically significant, likely due to the study being underpowered.

This is Costa et al., 2015,¹⁰ which Jack has gotten himself confused about. While there were a total of 201 adolescents diagnosed with Gender Dysphoria, Jack has gotten the two groups confused (101 were in the immediately eligible group). However, he has also misunderstood the format, as not all 101 received puberty blockers as part of the study, only 60 did.

In this particular case I have to put a large amount of blame on the authors, who after concluding they could not find a statistically significant benefit to puberty blockers still declared their study “confirms the effectiveness of puberty suppression”, in other words simply making up something contradictory to their data.

I’m not sure why Jack didn’t do some basic double checking of his numbers, it would have saved him from having factual errors in a document which he has sworn to a court is true and correct. Whether this is worth calling a lie, I can’t tell. My personal belief is that Jack simply does not know the literature anywhere near as well as he thinks he does and that he is out of his depth.

Dr. Regnerus’s assertion that “[there] would be no obstacle to randomized trials without placebo groups to compare different types, dosages, and methods of administrations of active treatments” is irrelevant, as such a trial would only tell investigators if one dose or administration of an intervention were superior to another.

This is not actually true, both because such information would be extremely interesting both if they found significant differences (in which case Jack would be proven right, and we could improve care overall) or if they did not find significant differences (in which case the effect may not be tied to the intervention and the placebo effect becomes a very relevant question).

It seems unlikely that Jack would consider the first scenario a bad thing, but the second one could certainly be threatening to him. If the dosage does not impact the outcome then you’ve essentially reinvented homeopathy. This would of course be hard to measure since the treatment comes with very noticeable effects, especially in the case of testosterone, but you could investigate the effect by offsetting the starting point in a crossover format.

The point is that there would certainly be ways to explore this issue even if Jack was correct, but he does not seem interested in them, nor is he interested in investigating whether he is correct in the first place.

All existing published data, along with clinical experience from around the world, point to the fact that gender-affirming medical interventions improve mental health for transgender adolescents. To take these treatment options away from families and their physicians is unconscionable and dangerous.

This is not actually true, both because Jack equates “transgender adolescents” with “gender dysphoric adolescents”, but also because a number of studies, generally larger and at less risk of bias ones, do not show benefits. There is also suggestion that benefits may be temporary. Jack is simply factually wrong when he categorically states “all”. If he instead said “a not insignificant number of short term, low quality studies”, he would be correct.

The state’s experts have incorrectly asserted that gender-affirming medical interventions result in a range of adverse outcomes. They asserted that gender-affirming medical interventions negatively impact sexual functioning when, in reality, research has shown that sexual functioning (along with romantic development) improves.

For this Jack offers Bungener et al., 2020.¹⁶ It does suggest that an encouraging amount of people who have received treatment continue developing, both romantically and sexually. That said, among those excluded were a number of refusals to take part, having been medically ineligible for surgery and also having died from medically transitioning, something generally considered bad for your sexual development.

Everyone in the study was rendered infertile, which has upsides and downsides. It is by definition loss of sexual function, but many young people will be very happy that they can not become or make someone else pregnant. This is something which often, but not always, changes with age.

They note that pubertal suppression resulted in delayed bone mineralization; however, a recent peer-reviewed article in the journal Pediatrics calculated the actual risk of an adverse clinical outcome from this (e.g., a fracture) to be extremely low (1–2% over 5–10 years and only with prolonged use of pubertal suppression past what is generally recommended by current guidelines).

The literature is quite consistent on the results here, which is why Jack does not dispute the outcomes itself, but instead chooses to downplay what it means. For this he offers Pang et al., 2020,¹⁷ a single case report of a fifteen year old male, where we can read the following: “This calculator is based on data from older adults who have gone through puberty; hence, how long density affects EF’s actual risk of fractures is unknown.” The authors note that “EF’s bone density has already fallen to the lowest 2.5 percentile. It can be expected to continue falling.”

The duration of treatment at the time of study was well within the “current guidelines”, under the assumption that these are the guidelines from WPATH¹⁸ and the Endocrine Society¹⁹. If so, then this is an outright falsehood from Jack.

They claim that pubertal suppression and hormone therapy result in infertility, but such a categorical declaration is demonstrably untrue. Pubertal suppression does not impair fertility; research has shown that patients who received pubertal suppression for another pediatric indication, precocious puberty, had no impaired fertility.

To start off with, this directly contradicts studies Jack has previously cited, but most notable is the attempted bait and switch. What Jack states, rewritten more clearly, is that “Research has shown that under different conditions and different dosages, there was no impaired fertility.”

I would not want Jack anywhere near any patients if this is his actual understanding of the matter. He might just kill a patient by arguing that for another indication, chemotherapy is the correct answer. It is especially ironic since the drugs used in puberty suppression are also used for chemical castration.

Regardless of the irony, it is an incredibly weak argument. The usage in central precocious puberty will allow the child to enter puberty normally. The child then develops normally. Jack’s usage is the opposite, to prevent puberty from occurring when it should, with the child developing abnormally.

Similarly, a 2019 study for that fertility was similar between transgender men who had been on testosterone treatment and cisgender women.

This is incredibly disingenuous by Jack. These were not random “cisgender women” off the street, these were patients at a fertility clinic as Leung et al., 2019,²⁰ makes very clear: “Another limitation of our data is the selection of patients with infertility as our comparison group.”

The state’s experts report that gender-affirming medical care increases breast cancer risk. Studies have shown that transgender men (assigned female at birth) actually have lower incidences of breast cancer than cisgender women (also assigned female at birth) […] however, a second larger study did not detect an increased risk of breast cancer among transgender women compared to cisgender men. Of note, these studies did not examine whether study participants were taking gender-affirming hormones.

I don’t know what the original claim was, but de Blok et al., 2019,²² does report quite alarmingly increased rates among males treated with estrogen, and decreased rates among females who had been on testosterone. This is not surprising as, for obvious reasons, females who have had mastectomies are at lower risk of breast cancer.

The second study, Brown et al., 2015,²³ which Jack describes as “larger” initially seems comparable in size at 49,956 person-years versus 48,874. However, when we look at the data on page 195 that Jack claims doesn’t exist, we find that in terms of cross-sex hormones, the size is actually 17,247 person-years, or just above a third of the size of the “smaller” study.

The first study, which found an incidence ratio 46.7 times larger than expected, was both larger and much longer. Jack has previously (somewhat dubiously) called studies underpowered when they fail to find what he knows is there. To illustrate what an underpowered study actually looks like, this second study is a good example.

Jack’s claims about the two studies are plainly and (more importantly) verifiably false, and his desire to downplay a severe increase in breast cancer cases for males is worrying.

The state’s experts assert that pubertal suppression adversely impacts brain development; however, research has shown that pubertal suppression does not negatively impact executive functioning. Additionally, a 2020 systematic review and meta-analysis concluded that “current evidence does not support an adverse impact of gender-affirming hormone therapy on cognitive performance in birth-assigned either male or female transgender individuals”.

There is a very significant difference between saying that research has not shown that pubertal suppression negatively impacts executive functioning, which is true, and “research has shown that pubertal suppression does not negatively impact executive function”, which is a lie and also happens to be the option Jack went with.

The study he cites for this, Staphorsius et al, 2015,²⁴ does not have the ability to establish whether a causal link exists, so it can not support the claim that Jack makes. It is also a strange choice to bring up by Jack, as it found the suppressed group had significantly lower IQ than the unsuppressed group, but due to the design of the study, no real conclusions could be drawn.

The second citation, Karalexi et al., 2020,²⁵ has nothing to do with puberty suppression of children, and I am not sure why he brought it up. All but one of the studies it looked at were of adults, usually around the age of 30, and investigated their cognitive abilities after a very short amount of time, finding little difference. It doesn’t make sense to bring up this study for this claim, but I suppose Jack was getting desperate.

The state’s experts inappropriately applied studies of prepubertal children (who are not candidates for gender-affirming medical interventions under any existing clinical guidelines) with studies of adolescents (who, depending on age and other factors, may be candidates for various forms of gender-affirming medical interventions).

I have not gone over the state’s evidence in detail, so I don’t know how hard they pushed this, but there is a definite likelihood that they have overstated their case. The evidence regarding desistance among children at gender clinics is similar in strength to most evidence in this field: it is weak and uncertain. The applicability point that Jack makes is solid, although Jack is unlikely to bring up the reason for this which is that the populations that have been studied have very little in common with the current demographic.

Dr. Levine cites a paper by Dr. James Cantor in The Journal of Sex & Marital Therapy that criticized The American Academy of Pediatrics policy statement regarding the treatment of transgender youth. However, the paper does not criticize the use of pubertal suppression, gender-affirming hormones, or gender-affirming surgery for transgender adolescents.

Since Jack has no actual response to Cantor tearing the AAP a new one²⁶, he must argue it is irrelevant. However, Jack has previously argued that the AAP policy statement²⁷ itself is relevant. But now verifying its accuracy is irrelevant. Which way is it?

The state’s experts assert that a large number of adolescents who undergo gender-affirming medical or surgical interventions go on to regret treatment; however, this assertion is not backed up by extant evidence. In 2018, Amsterdam’s VUMC Center of Expertise on Gender Dysphoria published the rates of regret among their cohort of 6,793 transgender patients who had undergone gender-affirming medical and/or surgical interventions.

This is Wiepjes et al., 2018,³² which is notoriously poorly written, so I’m not sure how much blame I can put on Jack for not understanding it, and how much belongs to the authors. Even extracting the raw numbers from it is a complex process, for example 6,793 patients did not undergo “gender-affirming medical and/or surgical interventions” as Jack states. What Jack can be blamed for is pretending he does understand it, when he does not.

Among transgender women who underwent gender-affirming surgery, 0.6% experienced regret. Among transgender men who underwent gender-affirming surgery, 0.3% experienced regret. Several of those who experienced regret were classified as having “social regret” rather than “true regret,” defined in the study as still identifying as transgender but deciding to reverse their gender-affirming surgery due to factors like “the loss of relatives [being] a large sacrifice.”

This study was a medical records search for keywords related to regret, and only in cases of gonadectomy, not any “gender-affirming surgery”. However, only the records of people who had medically detransitioned (off CHT and on HRT) via the same clinic were investigated for regret. The authors note an enormous uncertainty in the form of 36% loss to follow up despite the result of gonadectomies being life-long medical dependency.

When Jack says 0.6% and 0.3% “experienced regret” he is simply saying something false. He may be doing this because he doesn’t know better and doesn’t understand the literature, but the alternative, that he is perjuring himself, certainly seems realistic as well.

Cases of initiating then discontinuing gender-affirming hormones like estrogen or testosterone continue to be at the case report level, suggesting that this is a rare occurrence.

I can think of studies where this has been documented, even relatively early in the literature, for example Smith et al., 2005,³⁴ where this occurred in 34 (15.3%) of cases. Perhaps, if Jack spent less time on Twitter blocking detransitioners, he might have known that this is the main reason that the commonly cited figures are unlikely to be accurate.

In a peer-reviewed manuscript that was named Best Clinical Perspectives Manuscript of the year by The Journal of The American Academy of Child & Adolescent Psychiatry, Dr. Alex Keuroghlian and I created a framework for understanding transgender adolescent patients who discontinue gender-affirming medical interventions.

This is Turban & Keuroghlian, 2018.³⁵ I can’t actually find any record of this award Turban claims for it, but on the assumption that it is correct, I can’t imagine it would be given based on the content of the paper as it contains factual errors and also features Jack’s trademark misunderstanding of what a convenience sample can and can’t tell you. Presumably this award would be similar to his 2020 Pediatrics award which was based on reader interaction, the click count.

The state’s experts repeatedly claim that the “watchful waiting” model of treating gender dysphoria involves not offering gender-affirming medical interventions to transgender adolescents. This is false. The “watchful waiting” model refers to the treatment of pre-pubertal youth, who are not offered gender-affirming medical interventions under any existing medical guidelines. In fact, the “watchful waiting” model was first described by clinicians at The Center for Expertise for Gender Dysphoria at VUMC in Amsterdam, the very first clinic that first developed the use of pubertal suppression for transgender adolescents.

Watchful waiting is a fairly broad term, which has been used in different ways for a long time. The term does not originate in this field, but has been used to describe some approaches to childhood gender dysphoria, centered around non-intervention.

When Jack says “this is false” he is simply incorrect. He mentions the Dutch model as an early form of it, but seems to miss the fact that gender-affirming medical interventions were only offered to post-pubescent adolescent, based on the age limit of 16 and that simply “adolescents” were not offered gender-affirming medical interventions.

Though the precise etiology of gender identity has yet to be identified, these studies together all establish that there is a strong innate biological basis for gender identity among transgender people.

This is simply incorrect. Very limited investigation, not controlled for major confounding factors, identifying a possible genetic component is not a “biological basis” by any means. Had the evidence existed, this would have been the time to present it.

This is all rather academic, of course, as Jack cannot under any circumstances be specific, as if a measurable and innate biological basis existed it could then be used for gatekeeping purposes. For this reason Jack would not actually make a strong case here even if the evidence existed.

The state’s experts claim that the “error rate” for gender-affirming surgery is unknown. However, as described above, a large cohort study from The Netherlands showed that rates of regret following gender affirming surgery are low (0.3–0.6%), and many of these cases do not represent “true regret” as explained above.

And as explained above, this study shows nothing of the sort. Jack’s fundamental lack of understanding of what this study can and can’t say is worrying, as the implications of misusing it to make an erroneous point can be quite severe.

To illustrate this, in the format of the study anyone who committed suicide would not be considered for regret, despite being an obvious candidate for investigation. There is actually a related paper⁴² on this, from the same clinic, which Jack may or may not be aware of.

There have been two studies examining the impact of gender-affirming chest surgery on the mental health of transgender adolescents specifically. The first was a case series of 68 transmasculine adolescents and young adults that found a reduction in scores on a novel unvalidated chest dysphoria scale.

This is not true, there are actually at least four papers that match the criteria Jack sets here. Presumably Jack simply does not know the literature very well as this would be a very silly thing to perjure yourself about.

The paper here is Olson-Kennedy et al., 2018.⁴⁸ It featured a wide range of ages and is notable for not really following any guidelines. For example, two 13 year-olds had mastectomies which seems completely incompatible with the extensive caution Jack described.

It is also worth noting that the paper found that youth receiving cross-sex hormones steadily increased on the unvalidated chest dysphoria scale, a possible association which is completely neglected in all research on the topic. The idea that masculinizing treatment may make remaining feminine characteristics stand out more seems obvious to investigate and consider for future research.

The state’s experts repeatedly label gender-affirming medical interventions for adolescents “experimental.” In ascribing this term to gender-affirming medical interventions, they primarily rely on the fact that pubertal suppression and gender-affirming hormones do not have FDA indications for gender dysphoria specifically, but rather for other indications.

Jack notes that the state’s experts “primarily” relies on this, which is not really true. It is one of the things they bring up, and the only one Jack will discuss, but there are plenty of reasons to consider them experimental. When Jack describes “other indications”, he neglects to mention that these indications are for the other sex. There are no indications where you would administer female levels of estrogen to a male, or male levels of testosterone to a female.

Prescribing FDA approved medications without specific FDA indications for the condition being treated is common in pediatrics. It is referred to as “off-label” prescribing. The American Academy of Pediatrics has explained that “it is important to note that the term ‘off-label’ does not imply an improper, illegal, contraindicated, or investigational use.” They go on to explain that “off-label use of medications is neither experimentation nor research.”

While it is true that off-label prescriptions are not uncommon, Jack is quoting this AAP statement⁵² out of context. This is a great way of determining ignorance from malice, as the act of leaving out parts that disagree with you shows that you are aware of them.

The exact sentence is “In most situations, off-label use of medications is neither experimentation nor research” which is followed by advice on how to handle the situation. It discusses sound medical evidence (which does not exist here, as a small number of uncontrolled studies that disagree with each other certainly does not constitute sound evidence), and risk-benefit analysis (which for this use are both unknown).

The Littman study was an anonymous online survey of the parents of transgender youth, recruited from websites where this notion of “social contagion” leading to transgender identity is popular.

It is accurate to say that Littman’s study is an advocacy group recruited anonymous online surveys of parent’s reports. Jack has already used several advocacy group recruited anonymous online surveys to support his own case, making this somewhat of a double standard. The only difference is that the ones he wanted to keep supported him and the ones he did not want to keep did not.

I’m personally fine with throwing out all low quality evidence, or with keeping it and not attributing any certainty to it. Only keeping the low quality evidence you like and disregarding the low quality you don’t like, however, is — as the state’s expert argues — a perfect example of confirmation bias.

As detailed above, there is no evidence that gender dysphoria or transgender identity are results of “social contagion”. It is true that there has been an increase in referrals to gender clinics over the past few decades. This has coincided with increased visibility of transgender youth in the media.

There has not been an increase “over the past few decades” but rather in one decade. The GIDS in the UK reported a 4400% increase in ten years. The difference from year to year before that can be counted on one hand. This pattern has been seen in every gender clinic that has published this sort of data.

Of note, not all adolescents who present for treatment ultimately go on to receive gender-affirming medical or surgical interventions. In fact, in a large study from The Netherlands, the percentage of transgender people who presented for evaluation who actually started any kind of gender-affirming treatment decreased over time.

This is Wiepjes et al., 2018, again, which Jack simply does not understand. The suggestion of the authors that this may relate to media attention and the internet is quite silly as the rate has stayed roughly the same since 1990, the decrease Jack mentions really only exists from 1975 up to the 1990s. If you were to start from the year 2000, the rate has actually increased.

In summary, the current scientific consensus is that the increase in referrals to gender clinics is due to decreased stigma towards transgender people in recent years, along with an increase in awareness among the general population that gender-affirming medical interventions for transgender adolescents exist, and an increase in insurance coverage for these interventions.

This is a strange thing to write, because not only is this not the “scientific consensus” at large, it’s not even the consensus among the papers that Jack has cited.

Dr. Hruz cites a paper by Rider et al. as showing that racial minoritized adolescents are more likely to access gender-affirming medical care. However, this study did not examine access to gender-affirming medical care, but rather visits to the school nurse’s office, preventative medical check-ups, and dental visits. Studies that have examined access to gender-affirming medical care for transgender adolescents have found that racial minoritized patients are under-represented among those who access care.

Jack seems to fundamentally misunderstand the point Hruz is making, which is that in the high quality sample of Rider et al., 2018,⁶⁰ ethnic minotrities were overrepresented as trans-identifying. Not whether they visited a school nurse more or less often. This is a very strange response to Hruz’s argument.

The paper Jack mentions is Lopez et al., 2018,⁶¹ which deals with a specific medical intervention at a small number of clinics, for a trans-identifying sample of about a hundred. The intervention is also by far the most expensive one, which would skew results away from ethnic minorities. Jack really hasn’t thought this one through.

Dr. Hruz states that “There are no reliable radiological, genetic, physical, hormonal, or biomarker tests that can establish gender identity or reliably predict treatment outcomes.” This is true of nearly all psychiatric conditions. If Arkansas were to use this standard to outlaw medications, it would outlaw selective-serotonin reuptake inhibitors like Prozac, Lexapro, and Zoloft for major depressive disorder and generalized anxiety disorder. It would also outlaw all anti-psychotic medications for schizophrenia. This is an unreasonable standard that would leave essentially all patients with mental health conditions without medical care.

Somewhat unexpectedly Jack included an actual straw man argument, completely wasting everyone’s time. At no point did Hruz propose this as a standard to outlaw any treatment, and even if he had, the comparison is nonsensical since those medications are supported by high quality research, meaning they have multiple legs to stand on.

The second NICE report addressed the evidence regarding gender-affirming hormones. This report concluded, “results from 5 uncontrolled, observational studies suggests that, in children and adolescents with gender dysphoria, gender-affirming hormones are likely to improve symptoms of gender dysphoria, and may also improve depression, anxiety, quality of life, suicidality, and psychosocial functioning.

This is an accurate quote from the report⁶³ but it’s taken out of context, something Jack would be well aware of. The statement is immediately followed by the caveat “All results were of very low certainty using modified GRADE.” — in other words, the studies reported positive findings, but the process to ensure the findings were reliable showed they were not.

It also states “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.” which Jack also chose to leave out.

The state’s experts also cite another non-peer-reviewed report from Sweden’s Statens Beredning for Medicinsk Och Social Utvardering (SBU), which translates to The Swedish Agency for Health Technology. The report only examined studies published prior to September 19, 2019. It thus did not review a number of key studies, described above, that found gender-affirming medical interventions for transgender adolescents improve mental health, including Turban et al. 2020 Pediatrics, Van der Miesen et al. 2020 Journal of Adolescent Health, Achille et al. 2020 International Journal of Pediatric Endocrinology, and Kuper et al. 2020 Pediatrics.

Not content to just butcher authors names, Jack decided to drop the umlauts from this agency’s name, they’re actually called Statens Beredning för Medicinsk och Social Utvärdering (which copies and pastes just fine from their website). It also does not translate to that as their website makes clear — it’s the “Swedish Agency for Health Technology Assessment and Assessment of Social Services”.

For this report⁶⁵, he seems to have identified a rough date when the search was performed, although he states “September 19, 2019” while the report itself says “6 September 2019”. It’s largely inconsequential but it does say something about how serious Jack is about this, seemingly not double checking anything.

It also failed to review a key paper that was published prior to 2019 that found improvement in internalizing psychopathology (anxiety and depression) externalizing psychopathology (e.g., disruptive behaviors), and global function that I note above, namely de Vries et al. 2011 Journal of Sexual Medicine.

The report explicitly states their reasoning for this in the report, which was that the same cohort (which Jack is apparently unaware of, suggesting he simply does not understand what the papers say) was included in the 2014 paper, which in turn was included in the review and report.

Since the report is in a language Jack does not speak, it seems plausible that he did not even attempt to understand it, but simply searching for “de Vries” in the document shows that the later paper was included. Potentially Jack thinks that if you report on the same findings multiple times, it counts double. That would certainly explain his approach to the 2015 USTS.

I’m not sure what to make of Jack Turban’s statement. It contains many factual errors, some attempts at deception and a lot of misinformation. It includes quotes taken out of context which prove that Jack has read what he needs to know that his statement is in fact not “true and correct”.

I don’t think it’s worth pursuing any perjury claims here as the whole case is a mess from all sides. I do think I’ve learned something about the way Jack props up his beliefs, the limitations of his understanding and the blind spots he has developed to keep the cognitive dissonance at bay.

Perhaps most importantly, his statement highlights which questions he simply can’t answer when the stakes are high. If there were answers, they would have been provided. If there was anything of substance behind the equivocations and the conflation of sex and gender, this would have been the time to show it — and it simply wasn’t there.