Debate on Gender-Affirming Care Hushed by Advocates

Supporters of transgender medical treatments, often described as “gender-affirming care,” seem to prioritize silencing detractors over discussing the scientific aspects. One writer involved in the Department of Health and Human Services (HHS) report on this topic suggests he understands this tendency.

In May, HHS released a detailed analysis of medical transitions for minors, concluding that the evidence supporting the benefits of “gender-affirming care” is “extremely weak.” They reached out to medical professionals and organizations advocating for these treatments for peer review. However, two out of the three pro-transgender groups declined to participate, and the third didn’t appear to thoroughly engage with the report.

This exchange is highlighted in a supplement to the final review that was published recently.

Leor Sapir, a senior fellow at the Manhattan Institute and contributor to the review, remarked that the HHS had provided advocates a chance to critique the findings and point out potential oversights. However, the supplement indicates that no significant errors were identified.

“Maybe that’s why proponents of these contentious treatments tend to engage in smear tactics rather than meaningful dialogue,” he added.

The HHS Review

This review, commissioned by President Donald Trump in January, found that most children experience a natural resolution of gender dysphoria, which is the uncomfortable feeling of identifying with a gender different from their biological sex.

It emphasizes that medical interventions for transgender youth carry serious risks, such as sterility and reduced bone density, while also noting a dearth of research into non-medical treatments for gender dysphoria.

The review does not serve as a clinical guideline; instead, it suggests that experimental “gender-affirming care” could potentially do more harm than good for minors.

The APA Questions Methodology

HHS reached out to several organizations, including the American Academy of Pediatrics (AAP), the American Psychiatric Association (APA), and the Endocrine Society, all of which have criticized the May review.

While AAP and the Endocrine Society declined to participate, the APA did offer a response, which was methodically countered by the reviewers.

Although the APA criticized the review’s methodology, the HHS reviewers pointed out that their concerns were addressed in an appendix that outlines the methodology in detail. Moreover, two independent academics found the review’s practices to be sound.

The reviewers stated that the APA’s criticisms might stem from not fully engaging with key parts of the review. They also noted that of the 16 studies the APA cited as overlooked, 12 were actually included in the review, while three others were irrelevant to youth outcomes or gender medicine.

Mistaken Assumptions

The APA criticized HHS for not examining possible negative effects on minors who do not receive transgender interventions. The reviewers argued that no credible evidence indicated any benefits from these interventions, thus, they found no basis to suggest significant harms from withholding them.

Furthermore, they took issue with the APA’s implication that puberty is somehow problematic, a notion they firmly oppose.

The Cass Review

The APA also contended that the HHS review overlooked significant findings from Dr. Hilary Cass’s comprehensive 2020 study, which indicated that, for some youth, transitioning might be the best option.

However, the HHS reviewers clarified that the APA misrepresented Cass’s conclusions; her insights were part of broader clinical considerations rather than a definitive endorsement of transitioning.

Ultimately, the Cass Review showed weak evidence supporting medical interventions, indicating a lack of ability to predict which youth might embrace a transgender identity long-term.

The State of Transgender ‘Medicine’

Johan C. Bester, a professor at St. Louis University, expressed concern about the current state of transgender medicine, alleging that practitioners often start with a bias toward medical interventions first, then seek evidence to back their beliefs.

Recent events, such as the revocation of accreditation for a course discussing the dangers of “gender-affirming care” due to activist pressure, seem to align with Bester’s observations. Activists even likened questioning “gender-affirming care” to the actions of the Ku Klux Klan.

While advocates may criticize the findings of the HHS report, it’s notable that they were offered an opportunity to engage, yet largely failed to do so meaningfully.