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Gender Affirming Care in Exile: Origins

May 25, 2026
Chris Aiken, MD and Kellie Newsome, PMHNP

It's 1979, and Johns Hopkins has just shut down the first gender surgery clinic in the US. But investigations into the biological roots of gender identity are about to reopen those doors — and reshape how medicine thinks about sex, gender, and who gets to decide.

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Gender Affirming Care: Fall of the House of Hopkins

May 18, 2026
Chris Aiken, MD and Kellie Newsome, PMHNP

In 1966, Johns Hopkins opened the first gender surgery clinic in the US. Thirteen years later, a single study shut it down. We examine what the research said, what it didn't say, and how new standards of care emerged from the ashes.

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Gender Affirming Care in Exile: Targeting the Leader

May 11, 2026
Chris Aiken, MD and Kellie Newsome, PMHNP

The president of the US branch of WPATH built one of the largest youth gender clinics in the country, then watched it close under political fire. Now she's facing a malpractice lawsuit from a former patient. We examine the unpublished study at the center of the controversy.

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When Social Withdrawal Becomes Invisible Pathology

May 8, 2026
Daniel Carlat, MD

Have you ever heard of hikikomori? Literally: "pulling inward."

First described by Japanese psychiatrist Tamaki Saito in 1998 — and for decades assumed to be a uniquely Japanese problem. 

It isn't.

A 2025 meta-analysis of 19 studies and 58,000+ participants found cases across Europe, North America, and beyond. US estimates put prevalence around 2–3%. Roughly 1 in 40 Americans.




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Clinical Update

Helping Patients Tolerate Anti-Manic Treatments

May 7, 2026
Chris Aiken, MD

Chris Aiken, MD. Editor-in-Chief, The Carlat Psychiatry Report. Assistant Professor, NYU Langone Department of Psychiatry. Practicing psychiatrist, Winston-Salem, NC.

Dr. Aiken has no financial relationships with companies related to this material.

Mania requires rapid treatment, but side effects often undermine adherence. Learn practical strategies to improve tolerability and when to consider off-label or behavioral options.


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Gender Affirming Care in Exile: The Trials

May 4, 2026
Chris Aiken, MD and Kellie Newsome, PMHNP

Medical societies are reversing decades of support for gender-affirming care in youth — but is it the science driving the shift, or the politics? This episode walks through the evidence, from randomized trials to regret rates, and finds a more complicated picture than either side presents.

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