The Evidence Is In

Every systematic evidence review of pediatric gender medicine has reached the same conclusion: there is no credible evidence that the mental health of gender-distressed young people improves with social transition, puberty blockers, opposite-sex hormones and surgeries. Still, even gender medicine skeptics say more research is needed to determine best practices for treating gender dysphoria. Dr. Hilary Cass who oversaw the UK’s comprehensive review and famously found youth gender medicine to be built on “shaky foundations,” called for a clinical trial of puberty blockers. (Britain’s pharmaceutical regulator has put the trial on hold, citing ethical concerns about long-term risk of harm, including sterility.) The Washington Post editorial board endorsed the systematic literature review commissioned by the US Department of Health and Human Services, which also found studies supporting gender medicine to be shoddy. At the same time, the Post editorial urged new research to produce a study that could “once and for all” establish the benefits of the interventions—or lack thereof.

The latest study out of Finland may be it. The paper makes a sex realist want to scream, “When will we stop pretending that there may be a case for disrupting the endocrine systems and removing the body parts of vulnerable youth?” The Finnish study persuasively showed that the mental health of trans-identified children and young adults who medicalized not only did not improve—it got significantly worse. The Finns followed 2,083 patients who first sought treatment for gender distress before the age of 23, between the years 1996 and 2019. Each patient was matched with controls from the general population of the same age and from the same hometown. Finland keeps centralized medical records on all citizens from birth to death, so unlike many studies of gender patients in the US, there was no loss to follow-up.

Rather than asking patients to assess their satisfaction with gender interventions or rate their state of mind, the researchers looked at one objective marker—referrals for specialist-level psychiatric treatment, which in Finland is reserved for patients suffering serious mental illness. Primary-level clinicians handle less serious disorders and psycho-social issues. The study’s authors concluded, “Severe psychiatric morbidity is common among gender-referred adolescents and appears to be more prevalent in those referred after the recent surge in referrals.” The study’s big takeaway: “Psychiatric needs do not subside after medical gender reassignment.” Visits to specialist-level psychiatric practitioners rose dramatically in gender patients who were medicalized—from 9.8% to 60.7% for feminizing males and from 21.6% to 54.5% in masculinizing females. These figures do not include visits to gender clinics.

Many patients had already been seen by specialist psychiatrists before seeking treatment for gender issues. This led the researchers to surmise that “for some young people mental health challenges may manifest as concerns related to gender identity.” The researchers discounted the “minority stress” theory posited by advocates of medicalization, who blame trans-identified patients’ worsening mental health on discrimination. The Finns reasoned that given society’s greater acceptance of sexual minorities, one would have expected less psychiatric morbidity in the more recent patient cohort. The opposite was true. The youth who started to transition in recent years, in a more trans-accepting time, had more psychiatric problems. Predictably, proponents of medicalizing youth found fault with the paper’s limitations (it does not specify the conditions for which patients received specialist psychiatric treatment.) However, Ray Yuan Zhang, an expert in evidence-based medicine who contributed to the HHS review, called the Finnish study “almost the best we have up to now.”

The youth who started to transition in recent years, in a more trans-accepting time, had more psychiatric problems.

A gathering last month in Washington was testimony to the Finns’ hypothesis that mental illness is increasingly manifesting in claims of a trans identity. Seventy detransitioners, formerly trans-identified individuals who now accept their biological reality, came together on Detrans Awareness Day for a conference titled, “Living Beyond Transition.” The organizer was Genspect, an international advocacy group that promotes non-medical treatment for gender distress. The detransitioners candidly shared their mental health history before attempting transition—OCD, autism, ADHD, trauma and internalized homophobia. Most were young adults who had been led to believe the reason for their mental distress was that they were “born in the wrong body.”

Surprisingly, the first speaker was 70-year old Jessi Harris, who started living as a man in 1987 because, she said, it was just too hard going through the world as a butch lesbian. Harris was evicted from her home, fired from jobs and under threat of losing her daughter. Though she was able to pass, Harris says she never thought of herself as a man. Then, after a quarter century on testosterone, she suffered the first of five heart attacks—surely a data point for those seeking more evidence of medical safety and efficacy. After she retired, Harris dropped the fiction of a male identity.

Harris’s story is a sad commentary on society’s intolerance of gender non-conformity. Younger panelists made clear that all the years of pride parades and rainbow flags have not made society any more accepting of those who defy sex stereotypes. Now, though, it’s not just bigoted landlords and employers telling gays and lesbians their lifestyle and tastes are unacceptable. A therapist told detransitioner Jonni Skinner, an effeminate young man, that because of his mannerisms he might be “trans.” She told him he wouldn’t be attractive to other gay men and would more likely find a partner as a “woman.” He heard the same line from his endocrinologist. Skinner’s years on puberty blockers and opposite-sex hormones beginning at age 13 left him anorgasmic and with a host of health problems, including chest pain, depression and ulcers of the bladder. Yet more data points for the evidence seekers. Like others who testified, Skinner will be a lifelong medical patient.

Inevitably, a political undercurrent ran through the detrans conference, which took place in a hotel a stone’s throw from the US Capitol. The Trump administration sent two officials to underscore that the new sheriff in town was busting up the Biden administration’s trans party. (President Biden expanded access to gender medicine and reinterpreted Title IX protections to include anti-discrimination on the basis of “gender identity.”) The keynote speaker at the event was Andrew Ferguson, chairman of the Federal Trade Commission. The FTC has a mandate to go after consumer fraud and the agency is now looking into whether the American Academy of Pediatrics, the Endocrine Society, and the World Professional Association for Transgender Health (WPATH) made false claims to market treatments for gender dysphoria. For the detransitioners who lost body parts, fertility, sexual function, and years wasted on a futile attempt to “change sex,” the medical and surgical interventions surely did not improve their lives, as promised. Ferguson assured them that under the Trump administration, “Today your voice is heard. Your experience will inform our public debates and our policies.”

Later, HHS Assistant Secretary Brian Christine told the audience he had signed a public health message “to inform healthcare providers, families, and policymakers that the evidence does not support claims that puberty-blockers, cross-sex hormones and surgeries are safe and effective treatments for pediatric gender dysphoria.” Ironically, the current administration—which has terrifyingly upended norms in so many other spheres—is leading the country out of the gender crazy town the Democratic Party helped build. The conference booed when Admiral Christine, predictably, mentioned his predecessor at HHS—Rachel/Richard Levine, a trans-identified male pediatrician. Levine zealously promoted the medicalization of gender-confused kids and notoriously pressured WPATH to drop all age minimums for medical and surgical interventions from its guidelines. At HHS, Levine assiduously ignored the findings of the Cass evidence review and invoked the debunked suicide myth to justify interventions that harm healthy children’s bodies. Christine contrasted himself with Levine and quipped, “I stand before you a man in a man’s uniform.” (HHS assistant secretaries for health carry the rank of admiral as leaders of the US Public Health Service Commissioned Corps.)

The day’s final speaker was researcher Mia Hughes who wrapped up the conference with her big picture prescription for ending this medical scandal. Hughes identified the fallacious claim on which gender medicine is based—the notion that a child can be born in the wrong body. This, she says, has become an “overvalued idea” promoted by schools, the media, doctors, activists and government institutions. What’s needed now, according to Hughes, is for society at large to detransition ideologically. “We must stop pretending that a new type of human being has been discovered, that a serious psychiatric disorder is a healthy, innate trait. We must stop pretending that amputating healthy body parts is medicine for anyone of any age. And we must stop pretending that becoming a lifelong medical patient is a human right, something to be encouraged and celebrated.” Hughes concluded, “As history shows us, it’s hard for people to let go of false beliefs.”

The current resident of the White House is no doubt making societal detransition even harder. With even former Georgia Congresswoman Marjorie Taylor Greene now urging his removal from office, liberals who cling to the “trans rights” cause are loath to take Trump’s side on any issue. But they must look past politics on this one. The Democratic politicians, the medical societies, educators and journalists who spread and profited from the trans contagion must summon the courage of the detransitioners and examine the already abundant evidence against gender medicine and shut it down once and for all.

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