Thread by @JLCederblom

If you've read one of these, you've read them all, but I'll do some quick thoughts on it regardless.

nejm.org/doi/10.1056/NE…

"Gender identity - the deeply felt internal sense of oneself as male, female, or somewhere else on the gender spectrum - may or may not align with the sex one was assigned at birth."

Male and female is not a spectrum. Stop conflating sex and gender.

"When it does not align, the umbrella term “transgender” is often used to denote this incongruence."

The article will include a citation that uses an incompatible definition. The authors will not acknowledge or explain why they use this shell game trick.

"Decisions regarding the appropriate treatment [...] are guided by evidence- based standards put forth by organizations such as the Endocrine Society, the WPATH, and the AAP."

None of those have evidence-based guidelines. One has evidence analysis included: all low quality.

"Each person has their own gender journey, and there is no one-size-fits-all approach to this kind of care."

Sometimes this "gender journey" includes lifelong medicalization and sometimes it includes death, like in one of the studies the authors will cite later.

"Dutch physicians recognized that transgender children tended to face mental health challenges during adolescence..."

This is such a dirty way of trying to avoid the difference between childhood and adolescent onset, and comorbidity.

"[GnRHa] have well-known efficacy and side-effect profiles, and their effects are reversible."

A citation would be nice for that. This stuff does not fly anymore, as we now know bone and genital stunting are severe and at most partially reversible.

Of course, they could claim they are right on a technicality: all of those are secondary effects. If that is the plan, it is very dirty again.

"The Dutch-developed treatment model was shown to result in long-term improvements in the well-being of adolescents with gender dysphoria..."

No, it showed some promise in a single, small, uncontrolled short term study. Don't overstate it.

"...use of hormone therapy is associated with improved quality of life, reduced rates of depression, and decreased anxiety among transgender people.", for which they offer academic.oup.com/jes/article/5/… as a citation.

This is the recent review funded by WPATH for its next set of guidelines (the first to be evidence-based, in their own words). It found only low quality evidence, a lot of which found no benefit at all, and some of which found great benefits.

It also highlights the absurdity of the state of this field: despite covering 50 years, it only found 20 studies. It also found the evidence regarding suicide to be completely insufficient. Remember that when the authors later call it "live-saving treatment".

"Young people who receive such gender-affirming care report improvements in their overall well-being, and their level of well-being is generally in line with that of their cisgender peers - and sometimes it’s higher."

Remember that part about gender journeys and death?

The study cited had the gender journey of a child end in adolescence, as they died in agony following complications of their surgery. That person did not get to report their outcome, nor did the ones who developed significant morbidity during their hormone treatment.

The ones who dropped out of treatment or refused to respond were also excluded. This is called having your thumb on the scale. This simply states that "the people who had good outcomes had good outcomes".

Those "good outcomes" were also quite modest in that study.

"...one study found that transgender adults who had had access to puberty suppression during adolescence had lower odds of suicidal ideation than those who wanted such treatment but hadn’t received it."

Guess the study! Is it Turban? Of course it is, always the 2015 USTS.

It has been torn apart many times, of which link.springer.com/article/10.100… is the most accessible and a good read for anyone interested in this stuff.

"The law’s name [Save Adolescents from Experimentation] implies that following evidence-based guidelines while working closely with patients and families is a form of experimentation."

Your misrepresentation of the guidelines as "evidence-based" is simply false.

"The law references inaccurate information about the care of gender-diverse young people, stating that genital surgeries are being recommended for people younger than 18."

Interesting. Let's see what the text says.

"Genital and nongenital gender reassignment surgeries are generally not recommended for children, although evidence indicates referrals for children to have such surgeries are becoming more frequent"

Interesting, indeed.

Why did the authors remove the "nongenital" part? Could it be because they are obfuscating little liars who don't care about the truth here?

They definitely know that non-genital surgery is by far the most common trans-specific surgery for minors, in the form of mastectomy.

They also likely know that the WPATH guidelines explicitly states "Chest surgery in FtM patients could be carried out earlier" and they want to keep the discussion as far away from that as possible, because they know. There is no doubt that they know.

"...multiple studies have revealed long-term positive outcomes for transgender people who have undergone puberty suppression."

Their citations here are de Vries et al. 2014 and Turban et al. 2020 again, both of which feature significant bias and do not establish causation.

"It strips power from patients and families who are already marginalized."

The job of medicine is not to distribute power, it is to improve health.

"And although the stated purpose of the legislation is to protect adolescents, we believe that criminalizing what has been shown to be lifesaving treatment will do the opposite - and that the consequences could well be tragic."

Their own citation already shot down "life-saving".

I feel like I've read this same text 20 times from different authors. There is never anything new nor is there anything honest in these articles. Cheap tricks, false citations and rhetorical devices.

It is not news that NEJM is no longer a serious journal, but it's still sad.