Can a @WHO guideline on health for trans and gender diverse people be trusted when two of the WPATH execs at the center of the org’s own evidence-meddling scandal are on WHO’s committee? The central Q of my @bmj_latest: bmj.com/content/387/bm… First, a recap: WPATH guidelines formed the basis for subsequent “consensus” among US medical groups. Its 2022 Standards of Care (SOC) 8 was supposed to be the most “rigorous” to date, following evidence-based medicine guideline development process.

BREAKING: @PPFA, the largest provider of repro healthcare, is facing its first malpractice lawsuit brought by a former gender Rx patient claiming negligence. 1/thefp.com/p/how-did-plan… Plaintiff Cristina Hineman (who is a pro-choice lefty) told me of @PPFA “Everyone knows they don’t ask questions. They just give you hormones.” She made an appointment for just after she turned 18. After a year on T, she had her breasts removed. 2/

The world has had several weeks to digest The Cass Review, which prompted the UK to end puberty blocking Rx for gender distress along with a general reckoning across Europe. In the US, MD groups and media are still processing. My new @bmj_latest piece🧵1/ bmj.com/content/385/bm… I went to all the relevant US medical groups that have formed the reported “consensus” in support of the affirmative model. Most had nothing/little to say, except Scot Glasberg of @ASPS_News, who said the org is working on “high quality guidelines” but... 2/

If you’ve been dismissing criticism of “gender affirming care” as transphobic talking points from right-wing actors, straight from the anti-abortion playbook, I hope you read my latest deeply reported piece in @GlobeIdeas. 🧵1/ bostonglobe.com/2023/11/07/opi… I spent a year reporting on youth gender medicine for @bmj_latest and specifically investigated the evidence behind the “affirming” model of care that has become standard in the US, for which it is often claimed there is widespread medical consensus. 2/

https://twitter.com/writingblock/status/1628913412997791745

The @AmerAcadPeds is not the first medical association to issue far-reaching practice guidance that lacks robust evidence of benefit. But it may be the first to be sued for it. 🧵1/ Last week, the leading US professional group for pediatricians was named as a defendant in a lawsuit brought by a woman claiming damage from testosterone. One of her MDs, Jason Rafferty, is the lead author of AAP’s 2018 statement supporting the “gender affirmative care model” 2/

Last year, @AmerAcadPeds told me its 2018 policy statement on gender-affirming care–while not based on a traditional systematic review of the evidence–was based on “rigorous evidence review.” Now AAP has announced it will commission a systematic review. bmj.com/content/382/bm… Typically, in evidence-based medicine, strong recommendations follow systematic reviews finding high quality evidence that the treatments in question improve patient outcomes, says @GuyattGH. Existing reviews have found "low quality" evidence. Still, AAP reaffirmed its policy.

Gender-affirming care for adolescents in the US is frequently called evidence-based, even lifesaving. But there is little certainty in the evidence about the benefits of medical treatments, and growing professional concern about possible harms. My latest: bmj.com/content/380/bm… I tried to set aside the politics, get past the rhetoric, and report on the evidence. I asked research methodologists, experts in evidence-based medicine (including one of its founders) to examine the guidelines. Bottom line: consensus does not mean practice is evidence-based.