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).


References

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



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