Thread by @justdad7

1/ In his embarrassing interview with Stella O'Malley and Mia Hughes, Gordon Guyatt repeated the claim that the Health and Human Services report on gender medicine used the McMaster reviews to justify the denial of care to transgender people.

2/ This is a misrepresentation of the HHS report, which does not make any policy recommendations. It does present evidence which could be used to justify a ban on pediatric gender medicine but this evidence goes well beyond the systematic reviews.
opa.hhs.gov/sites/default/…

3/ The HHS report conducted an umbrella review of all of the systematic reviews of pediatric gender medicine, and not just the McMaster reviews, to support the finding that the evidence of benefit is low certainty.

4/ The HHS review also considered the lack of reliable diagnostic standards for Gender Dysphoria and the lack of a clear rationale for treatment. It also noted that the natural course of childhood Gender Dysphoria is often towards resolution.

5/ The Report found that gender medicine was exceptional in providing treatments based on low certainty evidence for a condition with no objective diagnostic criteria which often resolves without treatment.

6/ It also discusses evidence on the risks of harm from gender affirming treatments which can be inferred from basic science and physiology. Not every conclusion requires and RCT. This is the so called "parachute principle."

7/ You don't need to do an RCT to conclude that jumping from a plane without a parachute is dangerous and you shouldn't need one to recognize that disrupting the natural course of puberty risks harm to fertility, cognitive development, bone development and sexual function.

8/ The HHS report considers medical ethics, which includes both the question of whether children and adolescents have the capacity to consent and the prior question of whether doctors should even offer to provide medical transition, when the risk/benefit profile is so poor.

9/ The Report also considers psychotherapy as a treatment and argues that it is not ethical to resort to high-risk medical treatment when the low risk alternative of psychotherapy has not been adequately explored.

10/ All of the above factors are relevant to guideline development and clinical practice. They could justify a strong recommendation against treatment in a guideline or a doctor refusing to offer treatment, but they do not, by themselves justify a legislative ban on treatment.

11/ However the review goes further and examines evidence, mainly from whistleblowers, that gender clinics are not even following the flawed WPATH standards and are endangering patients through lack of safeguarding.

12/ It also examines the extent to which major medical and mental health organizations have allowed policy decisions on gender medicine to be dictated by small groups of activists and suppressed sound scientific work and open debate.

13/ All of these factors have to be considered in the context of a given country's health care system. Policies that work in a small country like Finland, with a centralized national health system, may be ineffective in the very different context of the USA.

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