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SEGM

@segm_ebm

May 10

New peer-reviewed study finds that the evidence base for pediatric gender medicine is weak: individual studies are inconsistent, and systematic reviews show no clear benefits. Guidelines that state or imply that medical transition is the standard of care aren't evidence-based. /1

The study is not a systematic review (a limitation that the authors note), but it provides a comprehensive overview about what's known about the evidence base underpinning youth gender medicine. /2
link.springer.com/article/10.100…

Studies originating from gender clinics tend to focus on measuring the magnitude of the hypothesized psychological benefits. There is less focus on studying the risks and harms. This new publication provides a succinct summary of expected harms, along with the rationale. /3

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SEGM

@segm_ebm

Mar 28

🧵Germany’s new GD guidelines represent a shift toward caution, by acknowledging that most youth with gender distress have temporary "gender non-contentedness" and should not be medically transitioned. Still, significant problems remain, as we explain in our Spotlight. Link⬇️ /1

The final Guidelines are the result of a year-long debate and revisions following the release of the earlier draft. The final recommendations are now more cautious, but core issues remain.

Chief among them: the guidelines are not evidence-based. /2

segm.org/German-guideli…

Originally, the Guidelines were intended to be “evidence-based.” However, the team abandoned its systematic reviews in 2020, and chose to rely on WPATH's. When WPATH suppressed its own systematic reviews, the guidelines lost the ability to claim the evidence-based "S3" status. /3

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SEGM

@segm_ebm

Feb 4

A new peer-reviewed article examining the criticisms of the Cass Review, just published. The authors found that the primary source of the criticism, a non-peer-reviewed paper published on the Yale Law School website, contains numerous inaccurate and misleading claims.
Link👇/1

The link to the article is below:

/2tandfonline.com/doi/full/10.10…

The authors of the new publication conclude:
"The Cass Review’s careful, balanced investigations and judgments were a comprehensive, evidence-based response to the controversies in this pediatric clinical arena. Recently-published critiques of the Review have contained incorrect or inadequately contextualized claims. Because accurate information about medical interventions is essential to informed consent, it is important to correct errors in potentially influential publications." /3

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SEGM

@segm_ebm

Dec 16, 2024

🚨 Italy's National Bioethics Committee (CNB) just updated its stance on puberty blockers (PB) for gender dysphoria. The November 2024 guidance states that PBs should only be provided after mental health internvetions failed, and only in the context of proper research trials./1

The Italian National Bioethics Committee's (CNB) key recommendations are:

* Puberty blocker prescriptions for gender dysphoria should occur only after the documented failure of psychotherapy or psychiatric interventions.

*All clinical assessments must be multidisciplinary, and decisions thoroughly documented.

*Clinical trials should follow the double-blind, randomized, controlled model, ensuring robust data.

*Use of puberty blockers outside clinical trials for this indication must adhere to the same rigorous criteria, with all data transmitted to a national registry. /2

The translated text, abstract (machine-translation):

The answer to the question posed by the Ministry of Health concerns strictly and solely the use of the drug in the context indicated by the question.

As a result of expert hearings and the evaluation of available literature, the CNB highlighted, in general, the insufficiency of scientific data on the use of puberty blockers and the need to strengthen them. Consequently, the CNB stresses the need for the Ministry of Health to take charge of funding independent clinical studies aimed at obtaining decisive data on the efficacy and risks of drug administration, of higher quality than those already carried out, which do not appear adequate to the objective.

From an ethical perspective, regarding trial design, the CNB recalls that the gold standard for clinical trials for drug approval is a double-blind, randomized controlled clinical trial. The CNB recommends that clinical evaluations should be multidisciplinary, and the prescription of tryptorelin should only occur following a finding of ineffectiveness of a psychotherapeutic/psychological, and possibly psychiatric, course. The decision-making process should always be thoroughly documented in all its steps.

Given the uncertainty about the risk-benefit ratio of triptorelin puberty blockade, the CNB would like to see prescriptions only within the scope of trials sponsored by the Ministry of Health.

Even where administrations occur outside of trials, that is, in the case of denial of consent or as a result of specific clinical evaluations by the physician that should always be documented, the CNB recommends that the same criteria indicated for trials be followed, and that in any case all data always be submitted to a dedicated registry. This is also in light of the fact that, at the moment, data on the use of tryptorelin reported by the regions (i.e., on its use during the period 2019-2023) are lacking and fragmentary.

The opinion was approved by a large majority of those present, with 4 of the non-voting members joining, and was accompanied by one dissenting note, one abstention note, and two explanations of vote, one of which was signed by 15 members, and the other by 7.
/3

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SEGM

@segm_ebm

Oct 31, 2024

A new investigation by @BMJ_latest examines the influence of top @WPATH officers over the development of new @WHO TGD (trans-identified and gender diverse) clinical practice guidelines for adults, which includes the vulnerable subgroup of young adults. /1 bmj.com/content/387/bm…

.@SEGM_EBM has repeatedly raised concerns about the robustness of the WHO guideline process, as @writingblock reports. /2
segm.org/world-health-o…

These concerns include a rushed guideline development process, biased panel composition, unmanaged conflicts of interest, and lack of transparency. /3
segm.org/WHO-TGD-Guidel…

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SEGM

@segm_ebm

Oct 22, 2024

The recent criticism of the Cass Review, misrepresented as "Yale critique," is not a genuine scientific effort but an attempt to influence U.S. litigation in youth gender medicine, new BMJ peer-reviewed paper by leading UK medical professionals finds. /1

segm.org/Cass_Integrity…

Last July, the so-called Integrity Project posted a "critique" of Cass Review. The authors, including notable gender medicine activists McNamara, Olson-Kennedy & Turban, alleged that the Cass Review is invalid as it "misuses data and violates its own evidentiary standards." /2

The Integrity Project’s “critique” of the Cass Review follows the same pattern established in the Project's earlier attacks on other evidence appraisals efforts. The Integrity Project's go-to tactic is to discredit the work by labeling it "misinformation" & "pseudoscience." /3

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