Science is incapable of resolving the debate about treatments for childhood gender dysphoria.
If you relied exclusively on the legacy media for the news, you’d never know that, recently, the Catholic Medical Association, along with other faith-and-reason-based medical organizations, issued an open letter to the American Medical Association, American Academy of Pediatrics, and other medical advocates of “gender-affirming care” for minors suffering from gender dysphoria.
In the open letter, the CMA and its co-authors appeal to all medical professionals’ common interest in minimizing suffering and improving care for these children and adolescents through the unbiased appraisal of existing medical evidence regarding causes and treatments, pointing out that “respectful debate and disagreement provide a basis for furthering scientific inquiry.”
Indeed, the development of competing hypotheses among members of the medical community is the very process by which clinical concepts are challenged and either validated or disproven. That such open debate has not been permitted on such a controversial topic damages the scientific process, the trustworthiness of the medical community, and the welfare of the public.
Rather than foster a spirit of dialogue, the medical establishment has anointed a small cabal of subject specialists who issue authoritative treatment guidelines on the gender care of minors based upon their own expert opinion, foreclosing attempts at engaging in a free and open debate. Much as the broader legacy media does not give air time to news such as the counterpoint proffered in the CMA open letter, the editors of prominent journals—including JAMA and the New England Journal of Medicine—stifle viewpoints that deviate from the “gender-affirming” positions they espouse in their pages.
Readers who doubt this are invited to peruse the tables of contents of prominent medical journals for any articles expressing a divergent point of view. I recommend allotting ample time for this exercise, as diverging opinions on gender ideology in medical publications are rarer than hen’s teeth.
Indeed, the unquestioning unanimity among journal authors in defense of the purported benefits provided by social transitioning, puberty blockers, cross-sex hormones, and gender reassignment surgery—based on poor-quality observational studies and expert opinion—is uncharacteristic among medical academics, whose modus operandi usually requires a high degree of scientific rigor before issuing clinical treatment guidelines and recommendations.
As an illustration of the weak state of the science on this topic, a representative example of evidence used to support the use of pubertal suppression in adolescents relies on survey data derived from a data set of 27,000 transgender adults recruited by activist organizations, comparing self-reported mental health outcomes between a cohort of a mere 89 patients who received puberty-blocking medications in adolescence and those who did not.
Weak findings derived from such studies are used to recommend pharmacologic puberty suppression to delay pubertal changes in gender dysphoric adolescents, as a precursor to the initiation of “gender-affirming hormone therapy”—the use of cross-sex hormones to masculinize biological females and feminize biological males.
Contrast this poor quality of evidence with the stringent methodology behind the most recent changes to guidelines regarding the use of baby aspirin to prevent a first heart attack in at-risk adults, which derives its legitimacy, in part, on a systematic review of randomized controlled trials involving over 160,000 patients. While the risks of daily aspirin use are well known—primarily increased risk of bleeding—the long-term dangers of hormonal treatments to adolescents’ physical and mental health are not.
Given the potential for irreversible, enduring effects of hormonal treatments—including harm to cardiovascular health, stature, bone density, and reproductive capacity—the eagerness of medical experts to approve of aggressive interventions which carry a high likelihood of serious injury is perplexing. While disregarding sincere concerns about the risks of proposed interventions, the defenders of guideline author-experts dismiss criticisms of their methodology and conclusions as politically motivated attacks on the vulnerable youth whom they claim to champion.
One of the hallmarks of the concept of “evidence-based medicine” is the willingness to subject one’s claims to query and debate. Adherents to the scientific method must be open to impartially accepting the outcomes of ongoing investigation in the pursuit of truth; sincere scientists are unafraid of defending their hypotheses from legitimate challenge. After all, if investigators are earnestly following the dictates of natural law as revealed by science, then they should not fear scrutiny when it leads to an alternative outcome from that which they anticipated.
In the case of the clinical care of children with gender dysphoria, the authoritative public stances taken by the leaders of the medical and scientific community belie an intense activism hidden under the veneer of science. A tip-off to the partisanship of self-declared experts is their disinhibited public partnership with militant activist organizations in the creation and promotion of purportedly “evidence-based” pronouncements to guide clinicians and families of struggling children in the affirmation of the assumed “gender identity.” Granted, transgender activist groups, such as the Human Rights Campaign and World Professional Association for Transgender Health (WPATH), are free to espouse whatever views they wish and even use partisan maneuvering in pursuit of their aims.
However, unlike these political actors, professional medical organizations are bound by a fiduciary obligation to weigh scientific evidence in impartial service to the public at large. Nakedly partisan activist organizations have commandeered the leadership of leading professional medical associations to further a political and social agenda, making for awkward and unsavory bedfellows….