The evidence behind this surge in treatment

The BMJ reports gender dysphoria in young people is rising—and so is professional disagreement.

In a new report from The BMJ Investigations Unit, Jennifer Block, investigations reporter, looks into the evidence base behind this surge in treatment.

More adolescents with no history of gender dysphoria are presenting at gender clinics. For example, a recent analysis of insurance claims found that nearly 18,000 US minors began taking puberty blockers or hormones from 2017 to 2021, the number rising each year.

Meanwhile, the number of US private clinics focused on providing hormones and surgeries have grown from just a few a decade ago to more than 100 today.

It could be that there was a huge underserved population of adolescents suffering from gender dysphoria and getting no help, or it could be that a huge population of unhappy adolescents has latched on to “gender dysphoria” as the source and meaning of their unhappiness. It could also be a mix of both. But I think one thing we can say is: it seems very unlikely that the explosion in attention to “gender dysphoria” has done nothing at all to nudge unhappy adolescents into latching on to it.

In short the BMJ is wondering if the spike in adolescents taking blockers or hormones and the spike in the number of clinics might have something to do with social contagion.

Ya think?

American medical professional groups are aligned in support of “gender affirming care” for gender dysphoria, which may include hormone treatment to suppress puberty and promote secondary sex characteristics, and surgical removal or augmentation of breasts, genitals, and other physical features.

And that fact is sad and alarming and baffling. “Hello Jane/John, nice to meet you, you’re unhappy in your body? Well let’s get you started on puberty blockers. Next month we’ll talk about lopping off those tits/that dick. See you then!”

Three organisations in particular have had a major role in shaping the US approach to gender dysphoria care: The World Professional Association for Transgender Health (WPATH), the American Academy of Pediatrics, and the Endocrine Society, all of which have guidelines or policies that support early medical treatment for gender dysphoria in young people.

All because…what? I don’t know. What the reason for this stampede is I don’t know. These aren’t kids on Twitter, these are adult medial professionals, yet here we are. One answer could be “Because they’re right and you’re wrong,” but sadly another could be that the profession is subject to lurches into recklessness sometimes. Lobotomy is the go-to example.

These endorsements are often cited to suggest that medical treatment is both uncontroversial and backed by rigorous science, but governing bodies around the world have come to different conclusions regarding the safety and efficacy of certain treatments, notes Block. 

For example, Sweden’s National Board of Health and Welfare, which sets guidelines for care, determined earlier this year that the risks of puberty blockers and treatment with hormones “currently outweigh the possible benefits” for minors.

And NHS England, which is in the midst of an independent review of gender identity services, recently stated that there is “scarce and inconclusive evidence to support clinical decision-making” for minors with gender dysphoria, and that for most who present before puberty it will be a “transient phase,” requiring clinicians to focus on psychological support and to be “mindful” of the risks of even social transition. 

Pause pause pause.

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