Thread by @SEGMtweets

SEGM has provided feedback on the draft WPATH SOC8 guideline, which is available on our website. We welcome WPATH's recognition of the profound shift in the incidence of gender dysphoria/gender incongruence and its presentation among youth. /1 segm.org/draft_SOC8_lac…

We also welcome WPATH's acknowledgement of the risk of inappropriate medical transition for youth, and the increased focus on psychotherapy assessments, since gender incongruence in youth can arise from multiple causes and may have multiple paths to resolution. /2

At the same time, we are disappointed by the significant methodological limitations of the draft SOC8 guideline. They are most evident in the guideline reporting, but these gaps also raise questions about the quality fo the methodological process used to produce this guideline./3

The SOC8 recommendation statements are not always clear and actionable. There is no strength of recommendation/certainty of evidence attached to them. There is no evidence synthesis attached to each of the recommendations. These issues significantly limit the guideline utility./4

SOC8 has a strong bias toward transitioning youth. It lowers the age of eligibility for medical interventions ( 14 for cross-sex hormones, 15 for mastectomies), but providers no practical guidance for how to conduct assessments to safeguard youth from inappropriate transition. /5

The users of the guideline are not provided with the information that most childhood gender incongruence naturally resolves with no intervention. Nor does it adequately address the profound uncertainty of transitioning adolescents whose trans identities emerged after puberty. /6

SOC8 has created home-grown terminology to replace standard terms. "Desistance" has become "fully discontinued gender diversity." "Early vs late onset of gender dysphoria," a key distinction in the Dutch protocol, has become "knowing one’s gender diversity earlier vs. later.”/7

There are also a number of internal inconsistencies. For example, SOC8 acknowledges that "social influence on gender ...may be an important differential,” yet claims,“probing the contribution of the environment on gender identity development... is clinically irrelevant.”/8

As the guideline is translated into other languages, the lack of proper reporting (e.g., lack of clear statements, ranking of recommendation strength, evidence synthesis), combined with the inconsistencies and non-standard terminology, will further limit the guideline utility. /9

With 2%-10% of youth self-expressing gender variant identities that make them eligible for hormonal and surgical interventions, an evidence-based treatment guideline is urgently needed. Unfortunately, the draft SOC8 does not meet this need./10