On Thursday, the U.S. Department of Health and Human Services released a report entitled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.” The report was commissioned as part of the Trump administration’s EO-14187, which called on HHS to issue a scientific review of “best practices” for treating pediatric gender dysphoria within 90 days. Unlike the messaging surrounding it, the report itself offers a careful, rigorous and sober analysis of the field of pediatric gender medicine. The report’s “umbrella review,” an overview of systematic reviews, determined that “the overall quality of evidence concerning the effects of any intervention on psychological outcomes, quality of life, regret, or long-term health, is very low.” The report’s ambitious scope, however, is not limited to assessing the quality of evidence. It addresses many of the field’s controversies, from the unexplained rise in trans-identification to ethical concerns raised by allowing minors to consent to irreversible procedures under false pretenses. Sections on harms and ethics make plain for readers what’s at stake considering the “unfavorable” risk/benefit profile of medical interventions. The report is not a polemic, however, and the authors do not make policy recommendations. Instead, their aim is to “provide the most accurate and current information available regarding the evidence base for the treatment of gender dysphoria in this population, the state of the relevant medical field in the United States, and the ethical considerations associated with the treatments offered.” Journalist Jesse Singal, reviewing the report for the Dispatch, muses that “The answer to over politicized science, however, is not more over politicized science. Thankfully, the authors of this new review seem to understand this and have published an important document that provides open-minded readers with a clear and nuanced overview of the debate.” For policymakers, parents, doctors, therapists and concerned citizens open to understanding how the U.S. went astray on this issue, the report is a must read.
In the Hill, Peter Sim contextualizes the release of HHS’ new literature review on best practices for treating sex-distressed youth. Sims provides readers with a primer on “evidence-based medicine” and explains how sex-denying procedures became implemented at scale because of regulatory failure and institutional capture. “The problem in gender medicine is that treatment guidelines and doctors make strong recommendations in favor of puberty blockers and cross sex hormones on the basis of low- or very low-quality evidence” Sim writes. Sim goes on to explain how gender medicine is propped up in the United States by guidelines issued by the Endocrine Society, the World Professional Association for Transgender Health and the American Academy of Pediatrics, all of which were deemed unreliable and unsuited for use in clinical practice by the UK’s Cass Review. “The forthcoming HHS review could provide an opportunity to move the debate on gender medicine away from partisan politics and back to science…anyone who cares about science and the well-being of young people should at least be prepared to read the review with an open mind” Sim concludes.
The department of Education’s Office of Civil Rights has determined that the University of Pennsylvania violated Title IX “by denying women equal opportunities by permitting males to compete in women’s intercollegiate athletics and to occupy women-only intimate facilities.” OCR issued a resolution agreement to the university, which would require them to fulfill certain conditions to resolve the violations within ten days, or risk referral for enforcement proceedings.
Alabama AG Steve Marshall is taking a victory lap after the plaintiffs in Boe v. Marshall decided to drop their challenge to Alabama’s “Vulnerable Child Compassion and Protection Act,” which prohibits pediatric medical transition for minors. “We fought back. We defeated a preliminary injunction and conducted court-ordered discovery into the so-called ‘standards of care’ that these groups claimed were evidence-based. What we found was devastating to the plaintiffs’ challenge: a medical, legal, and political scandal that will be studied for decades. Given the evidence we uncovered, it is no surprise the plaintiffs abandoned their challenge” Marshall said in a press release.
Citing “mounting political assaults” against the LGBTQ community, congressional Democrats reintroduced the Equality Act earlier this week. The act would amend the Civil Rights Act of 1964 and secure federal protections for sexual orientation and “gender identity” in employment, housing, education, public accommodations, jury service and federally funded programs. “Since day one of this administration, our authoritarian president and his lackeys have been trying to erase and endanger LGBTQ+ Americans by greenlighting discrimination in every aspect of daily life” Sen. Jeff Merkley of Oregon said in a press conference. Notably, while the Equality Act has been introduced before and previously passed the House on two occasions, it has never been voted on in the senate, and that remains unlikely to change with Republican control.
On Tuesday, the Ohio Supreme Court granted AG Dave Yost’s request to temporarily pause an appellate court decision which blocked enforcement of the state’s ban on sex-rejecting procedures for minors–specifically, cross-sex hormones and puberty blockers–allowing the law back into effect. The law will stay in effect as litigation continues to play out.
According to new guidance reviewed by the Telegraph, England’s National Health Service plans to screen all sex-distressed youth referred to gender clinics for neurodevelopmental conditions like autism, which complicate the diagnostic process. The guidance also calls for prioritizing psychosocial interventions and a “holistic” approach that considers a child’s mental health status, family context and history, and developing sexuality when weighing treatment options. The Telegraph notes that because gender dysphoria has been depathologized, clinic staff feel “a reluctance to explore or address” mental health conditions that might be driving the experience of dysphoria.
According to Outkick, Nike is bankrolling a five-year study on the impact of puberty blockers and cross-sex hormones on the athletic performance of trans-identified youth, ostensibly with the goal of eliminating performance gaps between the sexes to better promote “inclusive” sports participation policies. The authors point out multiple issues with the ideologically driven study. For one, they speculate that male athletic advantages will persist regardless of how early the interventions are initiated, citing skeletal and body type considerations. Two, they raise ethical concerns about studying practices with irreversible physical side effects in otherwise healthy children. “The potential physical and mental health risks of these interventions, especially in young, developing bodies, cannot be overstated…Puberty is a critical window for growth, bone density, and emotional maturation, and altering it with hormone blockers can lead to irreversible consequences — ranging from weakened skeletal health and infertility to heightened anxiety and depression” Dr. Nicole Saphier told Outkick.
According to Gender Clinic News, the Australian Society of Plastic Surgeons is awaiting the result of a petition requesting that trans-identified adults receive access to a suite of 28 “affirming” surgeries based on nothing but a diagnosis of “gender incongruence.” For context, unlike a diagnosis of gender dysphoria which includes distress as a key diagnostic feature, “gender incongruence” describes nothing but a perceived disconnect between one’s sex and “gender identity.” Critical feedback on the proposal captures one of the main issues with the incongruence framework: “feedback unsupportive of gender-affirming surgery all raised the concerns that gender-affirming care is often provided without a robust diagnostic process or long-term psychological therapy to address co-morbidities and potential reasons for experiencing gender incongruence such as internalized homophobia, body dysmorphia, neurodiversity and other trauma.” Other critics highlighted the low-quality evidence-base in support of “affirming surgeries,” issues with informed consent, and the possibility of detransition and regret. An update on the proposal is expected later this weekend.
Joseph Figliolia
Policy Analyst
