I want it to be explicitly clear what my intent here is.

Aly's article was a criticism of a lecture I gave to medical students almost 4 years ago. In that article, there are factual corrections of errors I made while speaking. I have openly admitted to these errors many times over the past few years. This was an informal lecture I gave to medical students. It was not intended to be recorded, uploaded to youtube and viewed half a million times. I was not responsible for its upload nor for the multitude of copies propagated from the original.

I never had a problem with Aly or anyone's criticism of my methods. In fact, I have spoken many times about how I have been grateful to her, her website, and her writings for educating me and others about the best available research on this topic.

The topic at hand is the care of transgender people, and it is something I care deeply about. For ten years I have cared for this patient population, and it has always been my goal to do the absolute best I can do for them. To that, I have adapted many things from many branches of medicine, or adopted methods or other methodologies from the publications online of various transgender women, Aly included.

I have previously given them credit for this, even stating that I only am where I am as I stand on the shoulders of giants like these women. I have even volunteered to help pay for the webhosting costs for their website as I enjoyed it so much. Yes, the people I am trying to "sue" right now for libel, I offered to pay to keep their website online as I thought it was such a great resource to the community. I offered to do this AFTER this article was written. It has subsequently been revised multiple times to its current version.

I have never had a problem with being criticized online. Many times in the past, I have had an opinion on a particular topic, posted it, was informed that I was terribly and horribly wrong and changed my opinion entirely. The "Lia Thomas" debacle is a prime example of this. I had a bad take, I listened, and I changed my opinion. I am just a man, I am fallible, and I am not transgender. I will never truly understand what it is like to be transgender, and so I will stumble and make mistakes along the way. I am more than happy to admit when I am wrong, as it is only by admitting we have made a mistake that we have any hope of getting it right.

There is a big difference between making a statement like, "Dr. Powers is incorrect in regards to his theory about estrone because X and Y and study example Z" and "Dr. Powers is unscientific, performs dangerous experimentation on his patients, and is not educated or an expert in this field".

One is a legitimate criticism of a scientific opinion that I hold, to which anyone is welcome to post whatever they want at any time.

Another is a direct attack on my character, my reputation, and my abilities as a physician.

For three years, I did not ask for that article to be removed. I didn't issue a takedown notice, I did nothing. It was only when in my attempts to actually improve on some of the things posted in that article that I was meeting resistance from institutions because of the article that I had a problem.

Effectively, while trying to publish research or work with an IRB, if an institution replies to me with "Well this article here on the internet says you're a reckless cowboy who hurts his patients, is unscientific, and is dangerous to the community" that is libel. It is an opinion statement put out by someone about me as a person, not my specific scientific findings. That article did demonstrable harm to my public reputation, and has actually resulted in inhibiting me from actually responding to the very criticisms it has.

Over the past two months, I tried to negotiate this with them. I have additionally attempted to have the old and outdated video taken down from youtube, as I wouldn't want some of the information in there to be propagated as some of it is in fact, factually incorrect. I am still waiting to hear back from various people/groups who have copies of it online about it being removed. Its not as easy to do a DMCA takedown as you think. (Update: it finally was taken down by the posting organizations, most copies at least). I did actually mispronounce Bicalutamide, guilty as charged. I welcome their criticism of my mispronunciation of a drug name.

But what I will not tolerate is someone defaming me as a physician and tarnishing my reputation. People are welcome to question my methods, but you cannot put defamatory statements about me and my medical care in writing that are damaging to my career. You cannot degrade me as a person, or mock the fact that I'm autistic. In my entire career, I have never been litigated against once. I've never even had a bad outcome. I work exceptionally hard to provide the best possible care to my patients, and I would never ever do something dangerous, reckless, or irresponsible to any patient of my practice and I never have. To imply that I have done so and continue to do so is false. My actual patients will speak on behalf of the care they have received, and there are countless of them out there who will say that they have massively benefitted from that care compared to what they previously received. I have enjoyed a good reputation in this regard because I have worked so hard to provide the absolute best possible trans care that I could. I literally have now created a 40mg/ml compounded estradiol cypionate that is dirt cheap for literally anyone to get a prescription for from their doctor. I am in the process currently of e-beam sterilizing the new custom pellets I developed with a compounding pharmacy so that transgender people can undergo a simple office procedure once every year or two and literally not have to think about their hormones other than that one visit. I am trying very very hard to provide exemplary care to my own patients and to improve the options they have in this country for treatment.

Again, I have no desire to antagonize this site as a whole. I've been generally overall quite thrilled with their existence and have benefitted greatly from their publications. I've made zero effort since that article was written to have it "taken down" until now. Never once did I care about it until the article, and defamatory statements about my character and medical practice began to actually cause me real life headaches and inhibit me from doing legitimate peer reviewed research.

I have no desire to see Transfemscience taken down, I don't want to have to sue them, I don't want to have to do any of these things. But they have adamantly refused to take down multiple articles which contain statements that are flat out libelous, and are a character assassination rather than a criticism of my statements. They even had articles which had nothing to do with my methods but literally were just attacking my character and comparing me to awful other physicians.

You are welcome to call me whatever you want in the comments here, you're welcome to attack my methods, my theories, anything you like. You can say that I'm an egotistical narcissist, that I'm a moron, that I'm any name you want to call me. But if you in writing online state that I do things that hurt my patients, endanger them, or imply that I have committed malpractice, I will 100% go after you for that. I will do so politely at first, I will give you every opportunity to recognize that your words are libelous. I will reach out on multiple channels, and politely ask you to remove what you've published. But if you instead, attempt to make even more drama out of the situation and further defame me online, then what recourse do I have as a professional? This is my livelihood. My medical license, my reputation and my business are all real things that have been harmed by this. There have been people literally issuing complaints against my license because of untrue and defamatory statements published on their pages. These are people who have never once been seen by me as a patient, but have been whipped into a frenzy by their statements and who think that I somehow need to be punished for "hurting" people. This is unacceptable.

In short, I did not want things to get to this point. I did everything I possibly could to explain my situation to them, to demonstrate that I appreciated and respected their work, but this particular article was problematic and legally troublesome, and other articles were beyond the pale and completely unacceptable in any context.

To add to this, upon being informed of this in regards to another article, Aly opted to take that one down all on her own without a fuss:

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" Hi,

I've decided to compromise with you and take down the WPATH page as I felt that that request was reasonable. Taking down that page is actually something I've been vacillating back and forth on for quite a while now. However, I will not be removing the commentary/fact check article. I find your request that I do that to be surprising, unacceptable, and offensive frankly. As we've discussed before, I also plan to rewrite or revise that page if or when you release the next version of your transgender care presentation.

At this time, I'm not interested in speaking to you further. So please don't contact me again.

Good luck with your papers,

Aly "

​

So basically, I am presented with "Yeah okay, this one article was probably over the line legally, but I'm going to continue to issue defamatory statements about you until you release a new version of this lecture that corrects the factual errors in your first one".

This is unacceptable. I openly admit the factual errors in the initial article, I am not trying to defend them. My complaint is about the parts of the article that decry me as a person, as a physician, and the care that I provide to my patients. These are what are libelous. Everyone keeps asking what the libelous statements are, they aren't "Dr. powers mispronounced bicalutamide". But they are glaringly obvious if you read it. However, it is not in my best interest legally to lay these out online at this time, but anyone with a brain can see that there are two different issues here, and I'm not complaining about any criticism of my methods. (I've copied a few below at least to make my point)

In short, I did everything I could do here to rectify this problem peaceably, and they have chosen to create a giant dramatic explosion out of it, further damaging my reputation publicly with their claims. This is the very thing I sought to avoid, but they have now continued to do so willfully with no regard to the consequences of defaming a professionals reputation.

Again, to be explicitly clear, you can attack any method, statement, or whatever I have put out online at any time, including things that are outdated and that I have subsequently changed my mind on and now speak differently about. But you cannot defame my reputation as a physician, call me unscientific, dangerous, reckless, or any other statements which imply that I hurt my patients. That is not acceptable behavior in any community, and I will defend my reputation accordingly. I care deeply about this community, and I have only ever wanted to provide for them the best possible HRT plans that I could devise. I will not allow someone to imply that I am some threat to my patients and have to be stopped. Unfortunately, I was forced to use legal tactics here that I very clearly stated in my initial emails and Facebook messenger communications that I wanted to avoid. This was not a desirable outcome, but I will not allow someone to defame me publicly as they have done. Attack my methods, attack my science all you want, but you will not degrade me as a person, as a physician, or imply that I harm or are a threat to my patients.

- Dr Powers

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Edit: Examples of problematic statements, statements that are untrue, partially true, or flat out just disparaging to my reputation. It is one thing to criticize a theory I have, its another to put me down publicly as a physician and tarnish my good name or imply I do reckless or harmful things to my patients.

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This specific page had plenty of egregious statements, but it now also has been purged. It was literally awful, but I cannot find an archived form of it now as they have done damage control to eliminate as much as they can that was frank libel. It was fairly character assassination. If anyone can link me an archived version of this one, I'd sincerely appreciate it:

https://transfemscience.org/articles/wilson-powers-parallels/

This researcher literally caused the death of a patient, and they have an article up comparing me to him.

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Here are others that I have archives of.

https://archive.ph/EcR4b

https://archive.ph/we15z

He seems to have little care for evidence-based medicine or practice or for the hierarchy of evidence, little proficiency with scientific research methods and statistics, and little respect for clinical practice standards and norms.

Powers is highly unscientific and holds many poorly supported beliefs about sex hormones and endocrinology.

Powers and his supporters don’t like what they are referring to as “WPATH” because the transgender medical community largely disapproves of him and his methods. In professional and research circles, he isn’t taken seriously. ...has referred to Powers as a “quack”.

Another is that his methods largely haven’t been evaluated in actual clinical studies in transgender people, for instance in terms of critical issues like effectiveness and safety. A third reason is Powers’s lack of credentials and professional engagement.

Although Powers is a physician, it wouldn’t surprise me if he has no research experience at all. Powers doesn’t get the approval or recognition he wants from the transgender medical community, so he’s turned against it. And the medical community largely ignores him and doesn’t bother to respond for all of the reasons above. At least at this time, Powers isn’t an important person in the transgender medical community

Normally, I try not to give consideration to personal qualifications when it comes to claims about transgender hormone therapy and instead evaluate such claims based solely on their veracity. And I’m not saying any of what I’m saying here to needlessly disparage Powers.

Why Powers feels the need to seek these things is an interesting character study for another day (note that I’m not alluding to his mild autism with that link but rather something else that should be readily apparent). I think it’s also important for people to ask themselves why Powers doesn’t simply join the rest of the transgender medical community and try to influence it from the inside with research and publications. It’s because that isn’t an easy or efficient way to get the appreciation he seems to want—which he readily receives right now with very little effort from his many transgender followers—and he currently doesn’t have that sort of professional capacity.

Powers is highly unscientific and holds many poorly supported beliefs about sex hormones and endocrinology.

Many of Powers’s ideas are simply false. They are based on flawed surface reading of the literature, poorly informed layperson theories, and/or unreliable anecdotal observations in lieu of quality scientific data. This applies particularly to his claims about feminization and breast development in transfeminine people.

I believe that the potential benefits of these approaches when used appropriately outweigh the potential harms. In contrast, and concerningly, Powers provides these approaches indiscriminately to all of his transfeminine patients—and frequently uses all three of them in combination.

Powers has claimed to be working on research and publications for years and his transgender followers have had high expectations in this regard. However, I wouldn’t look to Powers for such studies as it’s unlikely that he’ll actually deliver on these expectations. He isn’t a researcher and he doesn’t have institutional affiliation, so he doesn’t have the institutional review board (IRB) access and oversight that are required for real studies (Reddit; Reddit). His true research aspirations and publication plans appear to be limited to small case studies of three people or fewer (Reddit; Reddit), which would amount to little more than published anecdote and would hold little scientific weight.

Powers said that oral testosterone isn’t available in the United States. (I said this when that fact was still true)

Powers claims that estrone is implicated in the development of breast cancer and blood clots with estradiol. He essentially believes that estrone generated by estradiol is more important for these risks than is estradiol itself. But evidence in support of this notion is poor, and it is very likely a false notion. (this is flat out not true, and there is excellent data to show that parenteral estradiol methods have considerably lower risk than oral, which are correlated with estrone levels)

Powers presents a “neurodevelopmental estrone therapy” in which he argues that estrone causes gender dysphoria. Essentially, he argues that disproportionate conversion of estradiol into estrone due to 17β-HSD polymorphisms results in massive build up of estrone and excessive exposure of the fetal brain to estrogenic signaling, in turn resulting in feminization and transgenderism. He claims that this is “exactly what happens with diethylstilbestrol” as well—that is, excessive neurological estrogen exposure resulting in fetal brain feminization. This theory is complete conjecture and has no basis or support. It’s a rather naive idea honestly and I don’t think that such speculations should be shared. Powers does at least say to take the idea with a “grain of salt” in any case. With that said however, per recent findings, AMAB transgenderism with prenatal DES exposure is very rare, and hence this notion can be regarded as dubious likewise.

In many regards however, Powers’s approach shows a significant deficiency of scientific rigor.

I mean I could go on. There are multiple pages on that site which disparage not my scientific claims but my credentials as a physician and imply that I do harmful, unproven treatments on my patients which is just flat out not the case. I have never and will never provide care to my patient population which is not based in available research data and other prior treatments successfully performed on cisgender people.

Lastly, this statement on their site really says it all:

" All new articles on Transfeminine Science are informally peer-reviewed by fellow authors before being published to the site. "

Basically, they don't submit their own articles for journal review. They literally have each other "informally" review their own articles. This is like stating that the bible says X is true because it says so in the bible.

So effectively, they can state whatever they want about me, my methods, or my reputation and then subsequently "peer review" themselves for accuracy and present this to the public as fact.