January 27, 2023

Gender-affirming medicine: what good is evidence anyway?

In another article on the transgender issue, in the blog of The Hastings Center, three academics from NYU Grossman School of Medicine (including the well-known Art Caplan) contends that “Absence of Evidence Is Not Absence of Efficacy”. They note that there the evidence for gender-affirmative medicine is very weak:

Thus, in addition to lacking methodological rigor, the available data are not representative of the population. In other words, there is at best limited, poor-quality data from which to draw conclusions from systematic reviews.

True, they acknowledge, there have been no randomized controlled trials in paediatric gender care. But they would be unethical in any case. “Policies and legislation that restrict or forbid access to gender-affirming care have been shown to have life-threatening consequences. Thus, it could be morally dubious to allow one group access to puberty suppression and another group only psychological care.”

Yes, there may be some harms, such as infertility or loss of bone mass. But “the challenges of a parent of a dysphoric child [are] medical intervention now or suicide later?”

They conclude: “While evidence is greatly desirable, it may not be possible to create the studies that would generate it without harming those intended to benefit.”

In short, evidence can be dispensed with when the one fact that we do know, the crucial fact, is that children will commit suicide unless they get gender-affirming treatment.

But where is the evidence for that? According to the Society for Evidence Based Gender Medicine, trans-identifying youth do have a slightly elevated risk for suicide, but this could also be attributable to depression or autism. The suicide issue crops up again and again in discourse on trans-identifying children. If this is the keystone issue, it deserves to be researched thoroughly.