Breaking the ideological logjam over transgender youth health
Well-informed people now understand that the rapid-affirmation model is an indulgence of ideologues at the expense of children’s physical and mental health
For years it was possible for a politically neutral, reasonably well-informed Canadian or American to believe that prescribing puberty blockers to “pause” natural physical changes in gender-confused children was an ethical means of soothing their distress. It was even possible to believe that without that pause, a child’s distress might lead to suicidal ideation. Thus there was a case to be made for rapid transition affirmation.
No more. Engaged observers are aware that the affirmation model has fallen out of favour in many European countries. The reasons why are spelled out in such documents as the Cass Review’s 2022 interim report in the United Kingdom, which resulted in the closure of England’s premier gender-identity clinic.
Recently, Finland’s Council for Choices in Healthcare recognized that medical transitions for minors is “an experimental practice,” and, like Sweden and England, has placed increased restrictions on youth access to hormones.
Well-informed people now understand that the rapid-affirmation model, which continues to hold sway in North America, is an indulgence of ideologues at the expense of children’s physical and mental health.
A child cannot begin treatment on puberty blockers without the prescription of an endocrinologist. These front-line physicians know that their fingerprints are all over the smoking gun in a coming iatrogenic medical scandal. But in the present climate, a refusal to prescribe based in conscience, however well-grounded in evidence, can lead to professional difficulties or even put one’s livelihood at risk.
My good friend Roy Eappen, an endocrinologist at a Montreal hospital, knows the risks of dissent, but a nagging conscience finally compelled him to speak out. Roy is an active member of the group Do No Harm (DNH), which opposes ideology-based medicine.
DNH, for example, sued Pfizer for excluding whites and Asians from its fellowship program, in violation of American civil-rights laws. And DNH child psychiatrist Dr. Miriam Grossman testified before the U.S. Congress, debunking many of the claims about childhood transitions that are being promoted as gospel by trans activists.
On June 28, the Wall Street Journal published an op-ed by Eappen and Ian Kingsbury, director of research for DNH. In measured but forthright words, they accused the U.S.-based Endocrine Society — a professional organization for endocrinologists that promotes gender-affirming youth care — of basing guidelines for care “on flimsy evidence,” falsely promoting them as “beneficial” despite “a growing body of evidence to the contrary.”
Attending an annual meeting of the Endocrine Society, the authors found that off the record, their peers shared their discomfort, and “rue (the society’s) elevation of transgender activism over medical expertise and patient needs.” During frank discussions at the meeting, it became clear to the authors that their colleagues were “afraid to voice their concerns,” which is the kiss of death to scientific advancement and correction.
Several European endocrinologists were also present to discuss their specialty’s latest research and treatments. “Those we spoke with,” Eappen and Kingsbury write, “expressed surprise that the U.S. hasn’t banned, or at least severely restricted, such treatments for adolescents and children.”
Most troubling is that even though the society’s own position statement on transgender health admits to “gaps” in knowledge, as well as the necessity for “large-scale studies across countries that employ similar care protocols,” it has embarked on what the authors call a “full-throated endorsement of gender-affirming care” with an “implied condemnation of anyone who holds differing views.”
Dr. Stephen Hammes, president of the Endocrine Society, responded swiftly with a letter to the editor implying that the Eappen and Kingsbury op-ed was “motivated by politics” rather than “scientific evidence.” Far from putting the dissidents in their place, though, the letter acted as an incentive to defend the scientific honour of professionals in the field who are outside the Endocrine Society’s jurisdiction, and are thus free to speak with impunity.
Thus, the WSJ published a letter from 21 researchers and clinicians from nine countries who vigorously challenged Hammes’ statement that, “More than 2,000 studies published since 1975” show that the affirmation model improves patients’ well-being and lowers the risk of suicide.
They write: “Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret.”
Which, they say, is why increasingly it is becoming the international norm for professional organizations to “recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.”
Furthermore, they write, the claim that transitioning reduces the risk of suicide “is contradicted by every systematic review, including the review published by the Endocrine Society, which states, ‘We could not draw any conclusions about death by suicide.’ There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.”
According to Leor Sapir, a Manhattan Institute fellow specializing in gender issues, “This is the first time international experts have publicly weighed in on the American debate over ‘gender-affirming care.’ ” Hopefully, by emboldening open disputation within the Endocrine Society and beyond, this intervention will break up the ideological logjam in Canada and the U.S. that is impeding a much-needed course correction.
Meanwhile, you may draw your own conclusions as to the more plausible message and the more reliable messenger in this dispute. On the one hand, 21 highly credentialed researchers from nine different advanced countries, many of them child psychiatrists and pediatricians, all arriving at the same conclusions independently; and on the other, a woke endocrinologist who, as co-director of a transgender care clinic, benefits financially from the rapid-affirmation model (a fact he did not disclose in his letter to the WSJ).