Gender Medicine Monthly
This is the inaugural edition of my newsletter, Gender Medicine Monthly, dedicated to sharing updates related to gender medicine, especially pediatric gender medicine and the affirmative model of care. At present, it is a monthly newsletter but may move to biweekly depending on the frequency of news updates pertaining to gender medicine.
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Here are some headlines and updates in gender medicine from the month of March (and the first few days of April) covered in this edition of Gender Medicine Monthly.
Pioneers of evidence-based medicine say that the gender-affirming model of care is not evidence-based.
A new study of 1,655 parent reports supports the Rapid-Onset Gender Dysphoria hypothesis.
WPATH is ordered to provide internal documents on pediatric medical transition guidelines.
Norwegian healthcare board proposed increased restrictions on such pediatric medical transition
A Belgian evidence-based medicine expert joins a growing list of international experts critical of the gender-affirming model of care.
Parent confirms St. Louis gender clinic whistleblower’s report.
Detransitioner Layla Jane filed an “intent to sue” against the medical group that transitioned her as a minor.
Updates in legislation in the United States restricting or banning pediatric medical transition services.
1. Pioneers of the evidence-based medicine (EBM) movement said the current guidelines for managing gender dysphoria in adolescents in the US are “untrustworthy” and not evidence-based.
Source: Gordon Guyatt’s Twitter 3/29/23 | BMJ 2/23/23
Professor Gordon Guyatt, a highly respected figure in the field of medical research methods and evidence evaluation, who is often referred to as the “father of evidence-based medicine,” said last week that the current guidelines in the US for managing gender dysphoria in adolescents are “untrustworthy.” He added that the guidelines do not provide cautious and conditional recommendations that are appropriate for such low-quality evidence.
The evidence-based medicine (EBM) movement emerged in the early 1990s as a response to concerns about the quality of medical practice and the reliability of medical research. Before EBM, medical practice was largely based on tradition, authority, and anecdote, with little emphasis on scientific evidence.
Guyatt and Professor Mark Helfand, another world-renowned leader in the EBM movement, recently spoke to the British Medical Journal (BMJ) on the quality of evidence used to support the gender-affirming model of care.
The affirmative model of care, otherwise known as “gender-affirming care” is a specific model of transition medicine adopted widely across the US that prevents medical professionals from questioning an individual’s self-reported transgender identity or exploring possible underlying factors causing their perceived gender dysphoria. The standard protocol for gender affirmation in minors involves administering puberty blockers, followed by cross-sex hormones, and then surgery if desired.
During the interview, Guyatt and Hefland highlighted that while "gender affirming care" is widely accepted among medical associations, it is not considered to be evidence-based. Instead, it is based on consensus among experts, which is not as consistently reliable as evidence-based approaches.
Evidence-based medicine (EBM) is considered a higher level of practice than consensus-based medicine (CBM) because it is based on a systematic and rigorous evaluation of the best available evidence. EBM seeks to identify the best available evidence from clinical studies, evaluate its quality, and apply it to clinical decision-making to improve patient outcomes.
In contrast, CBM relies on the collective experience and judgment of a group of experts, which may be influenced by personal biases, opinions, and other factors. While consensus can be a valuable tool in certain situations, it may not always be the most reliable method of making clinical decisions, particularly in the absence of high-quality evidence.
Guyatt found "serious problems" with the Endocrine Society guidelines, as the systematic reviews did not look at the effect of the interventions on gender dysphoria itself, which is arguably the most important metric. They also reviewed the WPATH guidelines, and found they lack a grading system to indicate the quality of evidence and are not transparent about commissioned systematic reviews. They conclude that trustworthy guidelines must be based on a systematic review of the evidence, and recommendations must be linked to the quality of evidence.
Significance: Proponents of the gender-affirming model of care frequently call the practice “evidence-based,” when in fact it does not meet the standards for evidence-based medicine (EBM). Rather, it is “consensus-based,” meaning “most experts agree.” However, as international support among experts is dwindling, even “consensus” is becoming less applicable.
2. New study provides further evidence for Rapid-Onset Gender Dysphoria hypothesis, challenging Gender-Affirming Care
Source: Archives of Sexual Behavior 3/29/23
A new study has further supported the rapid-onset gender dysphoria (ROGD) hypothesis, suggesting that an increase in gender dysphoria among adolescents is due to psychosocial factors such as mental health conditions and autism, rather than an increase in the acceptance of transgender identities in society. The study analyzed 1,655 parental reports, with over 90% of the participants being progressive, pro-LGBT rights parents. The study found that relationships between parents and children suffered following social gender transitions, and youth with mental health issues were more likely to take steps to transition. The study limitations include recruiting parents through a website for concerned parents, which may have led to biased parental reports.
Significance: Dr. Lisa Littman’s 2018 study, which coined the term ROGD, sparked severe backlash from proponents of gender-affirming care for challenging the premise of gender affirmation. This new study, which is six times the size of Littman’s original study, provides further evidence of the ROGD hypothesis.
3. WPATH has been ordered to reveal internal documents
Source: 1819news.com 3/29/23
The state of Alabama has issued subpoenas to the World Professional Association for Transgender Health (WPATH) requesting information on their process for creating position statements, treatment guidelines, and standards of care for transitioning treatments. The state also wants to know if WPATH considered literature reviews from other countries, their involvement in creating standards of care for other organizations, their review of literature related to transitioning treatments for minors, and their knowledge of pediatric transitioning treatments in Alabama. The state is attempting to determine whether WPATH's guidelines are ideologically driven or are backed by medical evidence.
WPATH has claimed that the state's requests for internal documents infringe on its First Amendment rights, impose an undue burden, and are not relevant to the plaintiffs' case. A judge ruled that the state's requests were "unquestionably relevant" and imposed "no undue burden" on WPATH's First Amendment rights.
Significance: WPATH’s “Standards of Care” are “meant to provide the gold standard” in gender medicine, and are widely used by gender clinics all across the United States and internationally. However, WPATH has faced growing backlash and has been criticized as ideological, unethical, and unscientific. Access to internal documents could provide valuable insights and help undermine the perception of WPATH as an authoritative figure in the field of gender medicine.
4. Norwegian healthcare board proposed increased restrictions on pediatric medical transition
Source: Ukom.no 3/9/23 BMJ 3/23/23
The Norwegian Healthcare Investigation Board (NHIB/UKOM) has concluded that current guidelines for gender-affirmative care for children and young people in Norway are not evidence-based and must be revised. The report calls for future guidelines to rely on a systematic review of evidence and restrict all hormonal and surgical interventions to research settings to ensure clear protocols, safeguarding, and adequate follow-up. The report criticized the lack of specificity in the current guidelines for assessment and determination of medical necessity for risky and irreversible interventions provided to youth whose identities are still forming. The report notes the rapid rise of gender dysphoria in adolescents, especially females, and the high burden of mental illness and a high prevalence of neurocognitive conditions in affected youth. The recommendations align with changes among growing numbers of European countries aiming to safeguard youth from harm by sharply restricting youth gender transitions.
The Society for Evidence-based Gender Medicine (SEGM) broke the news about Norway on Twitter with an English translation of the announcement and Jennifer Block interviewed NHIB’s medical director for the British Medical Journal (BMJ).
Significance: Finland, Sweden, the UK, and the state of Florida have previously conducted systematic reviews of the available evidence and concluded that the risks of pediatric medical transition far outweigh any purported benefits. This resulted in the closure of prominent gender clinics, strict restrictions on the use of cross-sex hormones, and a ban on gender-related surgeries for minors.
Medical organizations in France, Australia, and New Zealand have also moved away from recommending early medical intervention for gender dysphoria in adolescents.
The most prominent US-based medical organizations in favor of gender-affirming care lack evidence to back up their position and depart from a growing international consensus.
5. A Belgian evidence-based medicine expert said he would “toss [WPATH’s guidelines] in the bin.”
Source: Vrt.be 3/29/23 | SEGM Twitter 3/31/23
Dr. Patrik Vankrunkelsven, the Director of the Belgian Center for Evidence-Based Medicine (CEBAM), criticized the current "gender-affirming" treatment approach for minors with gender dysphoria as not evidence-based, particularly with respect to the use of puberty blockers recommended by WPATH guidelines. Vankrunkelsven stated that if CEBAM were to review the WPATH guidelines, they would "toss them in the bin." The criticism was made in the context of a TV program discussing the exponential increase of teenagers referred to Belgian gender clinics and the international debate on the best treatments.
Significance: Norway, Italy, Australia, and Spain's medical experts have also recently raised similar concerns, as well as Finland’s leading expert on pediatric medical transition. Finland, Sweden, and the UK, have conducted systematic evidence reviews and abandoned the affirmative model of care.
6. Parent confirms St. Louis gender clinic whistleblower’s report
Source: The Free Press 4/3/23
In February 2022, Jamie Reed, a former case manager at the Transgender Center at St. Louis Children’s Hospital gave a shocking account of the center's treatment of young people with gender dysphoria. Identified only by her first name, Caroline, the mother of a teen boy who attended the clinic, recently spoke out to confirm that her experiences matched the whistleblower's descriptions.
Caroline's 14-year-old son received a Supprelin implant, a puberty blocking drug, which was supposed to relieve his perceived gender dysphoria, but instead appeared to cause a decline in his mental and physical health. After seven months on the blocker, he was hospitalized for suicidal thoughts and began taking several drugs for depression and anxiety. Caroline demanded the immediate removal of the blocker, but the doctors disagreed.
Missouri Attorney General Andrew Bailey and Senator Josh Hawley launched investigations into the St. Louis gender clinic and opened up a form for parents to submit tips.
Significance: Since Jamie Reed’s whistleblower report generated widespread news coverage, a local newspaper called the St. Louis Post-Dispatch has published parent testimonials in support of the gender clinic. Caroline’s story helps to balance the coverage and lends support to Jamie Reed’s statements.
7. New Detransitioner Announces Intent To Sue For Childhood Medical Transition
Source: Reality’s Last Stand 3/17/23
A young detransitioned woman named Layla Jane is seeking justice from the medical group and hospital that facilitated her medical transition between the ages of 12 to 17. She underwent puberty blockers, cross-sex hormones, and a double mastectomy at 13 years old. Layla’s legal representation is accusing the Permanente Medical Group and Kaiser Foundation Hospitals of "gross negligence" for allowing experimental treatment on minors. They allege that Layla’s doctors medically "affirmed" her without meaningful evaluation, failed to disclose the health risks of treatment, and emotionally manipulated her parents. Layla experienced significant mental health and behavioral challenges as a child, and at the age of 11 she started identifying as transgender. She eventually realized that she was not transgender and stopped receiving testosterone injections.
Significance: Layla Jane is the eighth detransitioner globally to bring legal action against her medical providers, but the second detransitioner to bring legal action against the providers that transitioned her as a minor.
8. Updates in legislation in the United States
As of March 2023, 30 states have restricted access to pediatric medical transition services. Several bans proposed in 2023 would limit access to care for older youth up to age 26. See UCLA’s full March 2023 report, which includes over 126 bills filed this legislative session.
Axios published a helpful reference guide and map on the states that have or are introducing bills that ban or restrict pediatric medical transition services.
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