Thread by @Bernard_Lane

"Rather than weaponizing child protective services against loving families, child welfare agencies should expand access to gender-affirming care for transgender children." President Biden on Texas classifying medicalised gender change as "child abuse". 1/
whitehouse.gov/briefing-room/…

.@POTUS stated that "respected medical organizations have said that access to gender-affirming care for transgender children can benefit mental health, lower suicide rates, and improve other health outcomes".

But there is not really good evidence to support "gender-affirming care" -- i.e. gender change with puberty blockers & cross-sex hormones -- according to Sweden's National Board of Health & Welfare, armed with results of an independent expert review.

https://twitter.com/Bernard_Lane/status/1498753909707268097?s=20&t=HrPeyla_ZQzwOGcwCY1AKg

Sweden is not alone in adopting a more cautious stance on youth gender clinics & life-altering hormonal drug treatments. Mainstream media has largely ignored this debate, framing gender medicine as a human right for teens who are experts in their trans identity.

But experts such as Dutch psychologist Thomas Steensma are worried. His concern is that gender clinics around the world have "blindly adopted" the 1990s "Dutch protocol" of blockers followed by hormones & surgery, without doing their own research.
theaustralian.com.au/nation/dutch-e…

One country that did carry out its own research was Finland, which in 2020 issued new, cautious guidelines recommending psychotherapy, not hormonal drugs, as the first-line treatment for youth gender dysphoria (distress over one's biological sex) .
segm.org/Finland_deviat…

A Finnish review found the evidence for applying the Dutch protocol to current patients was "minimal, actually non-existent". Today's typical patient has onset of dysphoria in adolescence, not in early childhood, as it used to be in the Dutch clinic.

https://twitter.com/Bernard_Lane/status/1493174259157372931?s=20&t=HrPeyla_ZQzwOGcwCY1AKg

In the UK, the National Institute of Health and Care Excellence concluded the evidence for using puberty blockers with gender dysphoric youth was of "very low certainty". The NICE findings will inform a review of youth gender medicine by Dr Hilary Cass.
bbc.com/news/health-56…

A review by Oxford University's professor of evidence-based medicine, Carl Heneghan, concluded that hormonal treatments of minors "remain largely experimental". He said the evidence "does not support informed decision-making and safe practice in children".
blogs.bmj.com/bmjebmspotligh…

In 2018 the journal Pediatrics published the "first systematic review" of hormonal treatment of adolescents found there was only “low-quality evidence” that puberty blockers & opposite-sex hormones did what they were supposed to do physically.

Evidence on the “psychosocial and cognitive impact [of these treatments was] generally lacking” & while blockers appeared to help depression they had "no significant effect" on gender dysphoria symptoms.
pubmed.ncbi.nlm.nih.gov/29514975/

In Australia & NZ, the psychiatry college shifted from endorsement of a gender-affirming treatment guideline to an admission of the "paucity" of good evidence & lack of agreement whether the "child-led" affirmative model should even be used with minors.
ranzcp.org/news-policy/ne…

Also in Australia, the National Association of Practising Psychiatrists issued a statement urging psychotherapy as the first-line response to young people struggling with gender issues.
napp.org.au/2022/02/managi…

The NAPP warned there was no good, long-term evidence to support the Dutch protocol hormonal treatments, which "are not fully reversible & can cause [young people] significant adverse effects on physical, cognitive, reproductive & psychosexual development".

As well, Westmead hospital researchers in Australia's biggest state, NSW, published a paper warning that the politicised treatment climate put gender clinicians under pressure to enable "conveyor belt" medicalisation of children.

The Westmead team argued a simplistic focus on gender alone “is likely to promote a healthcare delivery model that dehumanises the child by not examining the child’s and family’s lived experience & that promotes medical solutions … for a problem that is much more complex".

They cited regretful detransitioners & said there was “no reliable way of ascertaining whether a child’s decision to engage in irreversible medical interventions ... would prove to be ‘right’ or ‘wrong’ in the long term for that particular individual.”
journals.sagepub.com/doi/full/10.11…

All this is in conflict with breathless media reports of claims by some gender clinicians & medical bodies that hormonal treatments are "lifesaving". The evidence goes unexamined in a culture war for "trans rights" in which any scepticism is framed as an "attack on trans kids".

In this toxic climate of activism, most health professionals who are worried about youth gender clinics stay silent, rather than risk "cancellation" & destruction of their careers. But clinicians who have looked at the evidence & expressed their concern are not "anti-trans".

They honestly report the results of independent reviews & collaborate on more cautious treatment policy because they take the Hippocratic Oath seriously & want to prevent medical & psychological harm to vulnerable young people.

Prominent among these concerned health professionals are gender clinic insiders who believe that careful, individualised medical transition can bring benefits, but are alarmed by a trend of rushed medicalised & a lack of thorough assessment.

They include US gender clinicians Dr Marci Bowers, Dr Erica Anderson & Dr Laura Edwards-Leeper.

See here bariweiss.substack.com/p/top-trans-do…

And here washingtonpost.com/outlook/2021/1…

A parting shot. Many will agree with President Biden that medicine should not be politicised. But doesn't that principle also apply to the campaign for laws against "conversion therapy", when those laws potentially entrench gender medicalisation & ban ethical talking therapy?

In 2018 the journal Pediatrics published the "first systematic review" of hormonal treatment of adolescents & found there was only “low-quality evidence” that puberty blockers & opposite-sex hormones did what they were supposed to do physically.

And now France has joined the cautious club of countries.

Thread

https://twitter.com/Bernard_Lane/status/1499533727491575808?s=20&t=hxLz5CXUFHIqCXYLY3x5yQ