Imagine that, in the past decade, many young people developed a serious illness — one that had previously been rare.
Let’s say there’s no consensus about how to diagnose or treat it, nor any way to discern who would grow out of it naturally or for whom it would be permanent.
Still, some parents and providers passionately support a specific, highly invasive medication. So does an advocacy group that creates the guidelines most Americans follow. That group engages an evidence-based medicine center at an esteemed university to conduct systematic reviews — the highest method of evaluating evidence, which tells us if the findings can be trusted and mapped onto the larger population.
But the systematic reviews find that the quality of research is very low; the true effects of the treatment are likely to be markedly different from the estimated effects. The medication may end up harming more kids than it helps, in devastating ways, and we can’t predict who would benefit.
Then let's say the advocacy group suppresses the findings, preventing the evidence-based medical experts from publishing them, and ignores them in their new guidelines. That medical and government organizations pressure the advocacy group to publish the faulty guidelines quickly and to remove all age limits for the medication. The new guidelines avow that the medication works, insisting they couldn’t conduct proper systematic reviews.
That is to say: Let's say they lie. Thousands of kids with this condition and their families never know the truth. That they proceed down the medical pathway, told by trusted clinicians that it is evidence-based and life-saving, and even that young people face imminent death without it.
Were this the case with almost any medical or psychological condition, this story would be a certified scandal. But when news broke last month that the advocacy group World Professional Association for Transgender Health had censored systematic reviews of so-called "gender-affirming" care at Johns Hopkins’ Evidence-based Practice Center — because the work did not reflect well on youth gender transition — it didn’t make waves.
It should have.
We have seen an exponential increase in the number of young people with gender dysphoria in the last 15 years. Before, gender dysphoria in youth was rare, found mostly in young boys, and it usually resolved on its own during puberty. Now it’s more common, especially among teen girls with no history of gender issues.
That shift, along with an increase in the number of detransitioners who regret transitioning, led several countries, including Finland and Sweden, to conduct systematic reviews.
They found what Johns Hopkins likely did, that: “existing scientific evidence is insufficient for assessing the effects of puberty suppressing and gender-affirming hormone therapy on gender dysphoria, psychosocial health and quality of life of adolescents with gender dysphoria,” per Sweden's health board.
These countries are crafting new, cautious guidelines, promoting therapy as a first-line intervention.
In April, England released its own systematic reviews, supplementing earlier ones. These were published as part of a 388-page report on youth gender care known as the Cass Review, which found there was "no good evidence on the long-term outcomes of interventions to manage gender-related distress.”
The World Professional Association for Transgender Health responded that they were “deeply concerned about the facts regarding the Cass Review’s process and content, as well as its consequences for the provision of care for trans and gender diverse youth.” They politicized and denied the science, batting it away.
So did a group of clinicians from Yale, UCSF and elsewhere, calling themselves “The Integrity Project.” They claim the Cass Review is based on “profound misunderstandings of the evidence base.”
This is a crazy-making case of gaslighting, accusing others of doing exactly what they themselves have done. These clinicians are personally, professionally and financially invested in "gender-affirming" care, with deep conflicts of interest.
Rather than acknowledge the problems with youth gender medicine and create our own cautious, evidence-based guidelines, our country turned what should be a scientific controversy into a political battle. When Republicans enacted bans on gender-affirming care for kids, groups like the ACLU sued. Democrats created sanctuary states for youth gender transition, while denying medical care medical care for detransitioners.
One of those lawsuits, brought on by bans against Alabama, led to the release of thousands of documents from the World Professional Association for Transgender Health. Those included emails detailing how the association engaged Johns Hopkins to conduct systematic evidence reviews for the eighth version of its Standards of Care, then tried to suppress their findings when they didn't like the findings.
The World Professional Association for Transgender Health developed a new review system: a checklist, demanding that reviewers hold the “intention to use the data for the benefit of advancing transgender health in a positive manner.” The new rules said that chapter leads from their own organization and “at least one member of the transgender community” had to be involved in the approval process.
In other words, they demanded biased science from an evidence-based medicine group.
Meanwhile, the organization pressured Johns Hopkins to suppress and not publish the systematic reviews that reflected negatively on so-called gender-affirming care. And Johns Hopkins complied.
The Standards of Care's eighth version was released with the false claim that a “systematic review regarding outcomes of treatment in adolescents is not possible.” Instead, it selectively summarized studies with positive findings, declaring only that “the data show early medical intervention…can be effective and helpful for many transgender adolescents seeking these treatments.”
All gender-distressed youth in America, and their parents, were told that these guidelines were “based on the best available science and expert professional consensus.”
And that was not true.
The truth is that the World Professional Association for Transgender Health’s guidelines were based on bad science, biases and politics. The truth is, there is no expert consensus about how to treat gender-dysphoric youth. That's partly why multiple countries have abandoned the association's standards of care and instead created their own.
If that isn't enough juice for a scandal, the released documents also showed that both Assistant Secretary of Health Dr. Rachel Levine and the American Academy of Pediatrics insisted that World Professional Association for Transgender Health remove age limit recommendations for most gender-affirming surgeries, including mastectomies and vaginoplasties — not because of science, but because the age limits “will result in devastating legislation for trans care.” This according to Levine’s own chief of staff.
Levine, a transgender woman, has repeatedly referred to these interventions as “lifesaving” and “medically necessary.” But we can all now plainly see that there is no good evidence to support those statements. Many experts publicly supporting the statements know them to be untrue. But families making decisions about how to treat youth gender dysphoria need to know the truth about the evidence, or lack thereof.
Democrats and Republicans, advocacy groups and activists need to stop funneling science through a biased lens. Every gender-distressed youth in America deserves this.
