17 January 2023

Looking on the bright side vs. misrepresenting evidence: WPATH review of outcomes of medicalized minors

The health care systems of the U.K., Finland, and Sweden have each conducted systematic, comprehensive reviews of the safety and effectiveness of puberty-blockers and cross-sex hormones on adolescents with gender dysphoria.  Such reviews are the standard procedure when developing health care policy.  All three reviews concluded that there is little evidence of benefit off-setting the known and unknowns risks of medicalized transition of minors.

In updating its Standards of Care (version 8), WPATH published its own review of effectiveness (Baker et al., 2021).  Unlike Europe, however, that review did not include safety in the scope of the review and came to this very positive (if qualified) conclusion about effectiveness:

If one wanted simply to advocate for medicalized transition, one would just quote the highlighted portion of the abstract and call it a day.  A good researcher, however, would continue to the actual data tables to search for the source of the contradiction.

That source wasn't hard to find.  The article showed the outcomes across three tables, one each for transition results on quality of life (QOL), on depression, and on anxiety:

Table 2. 

Effects of Gender-Affirming Hormone Therapy on Quality of Life Among Transgender People

Table 3. 

Effects of Gender-Affirming Hormone Therapy on Depression Among Transgender People

Table 4. 

Effects of Gender-Affirming Hormone Therapy on Anxiety Among Transgender People

In short, the research included eight analyses of effectiveness on children: four showing improvement, and four showing failure to improve.  Yet, instead of describing these results as "mixed" or "inconsistent," the abstract reads "Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety."

To the authors' credit, the article did include another important result, one which I have yet to hear applied in discussions of the issue: "It was impossible to draw conclusions about the effects of hormone therapy on death by suicide" (Baker et al., 2021, p. 12).


Achille, C., Taggart, T., Eaton, N. R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T. A. (2020). Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: Preliminary results. International Journal of Pediatric Endocrinology, 8.

Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021). Hormone therapy, mental health, and quality of life among transgender people.  Journal of the Endocrine Society, 5. https://doi.org/10.1210/jendso/bvab011  

de Vries, A. L. C., Steensma, T. D., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8, 2276–2283.

de Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134, 696-704.

López de Lara, D., Pérez Rodríguez, O., Cuellar Flores, I., Pedreira Masa, J. L., Campos-Muñoz, L., Cuesta Hernández, M., & Ramos Amador, J. T. (2020). Psychosocial assessment in transgender adolescents. Anales de Pediatría, 93, 41–48.

WPATH (2022). Standards of Care, version 8. https://www.wpath.org/soc8

1 comment:

  1. Have you heard about that genetic study showing that the age at average conception over prehistory has been about 23? I was thinking that this could be used to estimate the age ancestral girls had their first pregnancy. If the age at average conception for various modern HGs were computed we could see which ones are closest to the ancestral value of 23.

    In the !Kung and Hadza girls have menarche at about 16 and their first conception about 20, so the average conception must be much higher than 23 and closer to 30. What we see in these tribes is probably not as representative of the ancestral reproductive pattern as many anthropologists believe. The girls in these tribes seem to be suffering delayed menarche due to living in poor habitats. Ancestral humans appear to have evolved in the fertile African wetlands eating a diet of predominately meat. They were better nourished than the !Kung and Hadza and the girls almost certainly had menarche earlier.

    At one point in prehistory the average went down to 21. This is clearly not compatible with the first conceptions happening at about 20. The average can't be the same as the first unless all the girls were having just one baby and then dying or hitting menopause. Completely unrealistic, of course.

    In the Pume tribe in the Amazon girls have menarche at 12 and first conception about 14. The age at average conception for this tribe probably works out to be close to 23. I haven't rigorously analyzed any statistics at this point, I'm just ballparking it and my hunch is that this reproductive pattern, menarche at 12 and first conception at 14, is probably closer to that of ancestral humans.

    The age that ancestral girls started reproducing is relevant to the evolution of men's sexual preferences. Since humans form long-term bonds and men try to monopolise the fertile years of the females, we'd expect men to have evolved an instinctive preference for females just prior the beginning of their reproductive lifespan. If this was at 20 in ancestral times men would have a preference for females just under 20. If it was 15, we'd expect men to have an instinctive preference for females a little under 15. I believe the evidence points to the latter though it's difficult to discuss this in public due to our taboos over attraction to minors.

    Link to study: https://pubmed.ncbi.nlm.nih.gov/36608127/