LTE: Truth of gender-affirming care for youth still unclear

Photo by Sam Deeb

To the editor:

 

I am writing in response to the Marblehead Current’s June 28th article by NAGLY (North Shore Alliance for GLBTQ+ Youth) Director James Geissler “You are safe with me: Supporting the LGBT community with facts.”

The New York Times has indeed been irresponsible in printing information about transgender youth. It took them longer than it should have to provide unbiased information regarding the safety and efficacy of the “affirmative care model” guidelines for gender-dysphoric youth, as set forth by the World Professional Association for Trans Health (WPATH) and adopted by the American Psychological Association and the American Pediatrics Association. 

These guidelines, currently the gold standard for the treatment of gender-dysphoric youth in the U.S., include psychological as well as medical interventions. 

Geissler claims ”There are no ‘sides’ to facts,” and yet it appears as though there is indeed an activist side and a scientific side to interpreting the facts and debating policy based on facts. 

Activists in the U.S., such as Geissler, argue that the science is settled. Yet, the general consensus in a growing number of european countries including the U.K., Sweden, France, Finland, and Norway, is that there is currently not enough data, analysis, or “facts” to indicate the safety or efficacy of the so-called “Dutch Protocol” on which WPATH guidelines for minors are based. 

This is notable, considering these progressive countries were pioneers in offering gender-affirming care and medical transition for youth and adults, long before the United States adopted the treatment in earnest. https://www.theatlantic.com/health/archive/2023/04/gender-affirming-care-debate-europe-dutch-protocol/673890/.

In countries where the affirmative model has been systematically reviewed, the risks have been found to outweigh the benefits, prompting a rollback to a more cautious approach while more research is undertaken. 

The first line of treatment has been redirected to exploratory psychotherapy. Medicalization, including the use of puberty-blockers, cross-sex hormones, and invasive surgical interventions, has been scaled back dramatically and reserved for the most complex cases — often with the requirement of enrollment in a research study.

In the U.S., however, we seem to be doubling down on the WPATH guidelines without proper due diligence. What’s more, nuanced debate is being shut down by activists who liken scientific inquiry and systematic reviews of the evidence to hate speech. This is a very slippery slope. Disinformation campaigns are indeed targeting the LGB and transgender communities from the “LGBTQIA+ community” itself. (Note: I purposely separate “LGB” and “transgender” here out of respect for the many LGB and transgender people who do not endorse the “LGBTQIA+ community” as representative of their voices, opinions, activism, or identities).

I want to be very clear here, questioning activist narratives is NOT discrimination. This is about adherence to the principals and ethics of good science. Science is not partisan, facts are not partisan, but the narrative surrounding facts certainly can be. 

With an international teen mental-health crisis at hand, we all agree there are lives on the line in this debate. Young lives that we, as a society, are morally bound to protect. This is about the children, their parents, and their families, and about making truly informed decisions — whether it be at a doctor visit or the ballot box. 

There are many aspects to the issue of trans identity that we should, as a nation, be rationally debating. Feminism and the rights of women, sports and the rights of female and trans athletes, lesbian and gay rights and the juxtaposition of trans rights, and gender identity in school curricula, to name a few. 

But here I would like to shed some light in particular on the affirmative-care model and medical intervention for trans youth because the data is clear: We simply don’t know if affirmative care and medical interventions do more harm than good. 

I urge every citizen to dig deeper beneath the surface of the headlines, always question both sides of a debate, and think long and hard about what it means to not have enough data in order to make an informed decision. 

We must ask: How do we proceed if we really don’t know the answer? What are the benefits? What are the risks? And is caution warranted by evidence-based research really tantamount to discrimination? Below I have included some non-partisan, science-based references for readers to do their own due diligence, but this is just a start.

Personally I am disheartened by the lack of kindness and consideration shown to those of us who dare to speak out in support of thorough research and science, wherever it may lead. No one wants to see children harmed, particularly those at the margins who are struggling the most. 

I hope Marblehead journalists will take more care in covering all sides of crucially-important arguments in the future. The stakes are high and we cannot afford to “pick sides.” We just need to keep digging for the truth and reevaluating as soon as more evidence comes to light.

 

Sincerely,

Nyla DuBois

Marblehead

 

For further reading you can visit these non-partisan, research-based, and physician-led organizations: genspect.org and segm.org (Society for Evidence-Based Gender Medicine).

This article encapsulates the sentiment of my letter with many links to research: https://genspect.org/to-help-trans-identifying-kids-follow-the-science/.

 

Notes on countries referenced above:

Sweden: Sweden was the first country to introduce legal gender reassignment and has now drastically changed its affirmative-care protocol. https://segm.org/segm-summary-sweden-prioritizes-therapy-curbs-hormones-for-gender-dysphoric-youth.

United Kingdom: In 2020, following the court case of detransitioner Keira Bell, the National Health Service commissioned an independent review of gender-identity services for young people, led by Dr. Hillary Cass. The systematic review of current evidence concluded the affirmative model has more risk than benefit. Subsequently, the Tavistock child gender identity clinic was slated to shut down in spring 2023 (now postponed to spring 2024). https://cass.independent-review.uk/.

BBC journalist Hannah Barnes wrote an empathetic, highly-researched, unbiased and critically-acclaimed account of the Gender Identity Development Service (GIDS) and the Cass review in her recent book “Time to Think,” available on Amazon and other booksellers.

https://www.theguardian.com/books/2023/feb/19/time-to-think-by-hannah-barnes-review-what-went-wrong-at-gids.

France: In 2022, the National Academy of France advised caution in youth gender medicine, stating that “there is no test to distinguish a ‘structural’ gender dysphoria from transient dysphoria in adolescence. Moreover, the risk of over-diagnosis is real, as shown by the increasing number of transgender young adults wishing to ‘detransition.’ It is therefore advisable to extend as much as possible the psychological-support phase.”

https://www.academie-medecine.fr/la-medecine-face-a-la-transidentite-de-genre-chez-les-enfants-et-les-adolescents/?lang=en.

Norway: Upon systematic review of current guidelines, which closely resemble WPATH guidelines, the Norwegian Healthcare Investigation Board found puberty-blockers, cross-sex hormones and surgery for children and young people to be experimental, concluding that the current gender-affirming guidelines are not evidence-based and must be revised.

https://ukom.no/rapporter/pasientsikkerhet-for-barn-og-unge-med-kjonnsinkongruens/sammendrag.

Finland: In 2020, the country issued strict guidelines for treating gender dysphoria, which follow the original Dutch Protocol but with far tighter scrutiny than the WPATH guidelines currently used in the U.S. and Canada.

https://segm.org/Finland_deviates_from_WPATH_prioritizing_psychotherapy_no_surgery_for_minors?s=09.