From Mother Jones last September:

Colleagues call Gordon Guyatt the “godfather” of evidence-based medicine.

Guyatt, a distinguished professor of medicine at McMaster University in Canada, has had sweeping influence on medical research: GRADE, the framework he helped pioneer to assess the evidence behind clinical recommendations, is a standard at more than 100 medical organizations, including the WHO. Before Guyatt, medicine relied much more on the judgment calls of senior clinicians; today, standardized research is increasingly central.

Guyatt was also, until August, a reluctant icon of the movement against trans health care.

Hang on. Let’s be clear. What are we meaning by “trans health care”? Health care for people who idennify as trans? Or health care that cures the disease of being trans? Or “health care” that assists people who are trying to look like the other sex?

His was by far the biggest name associated with the Society for Evidence-Based Gender Medicine (SEGM), a group known for casting doubt on the safety and efficacy of gender-affirming care by framing it as risky and supported only by “low-quality” evidence within the GRADE framework.

There, that’s clearer. Gender-affirming care is not the same thing as trans health care, which can mean just standard health care used by/for people who idennify as trans.

Speaking to me on a video call, the bespectacled doctor emphatically called it “an unconscionable use of our work to deny people gender-affirming care”—insisting that, until student activists at McMaster spoke out about the collaboration, he hadn’t been fully aware of SEGM’s involvement with the university’s research on transgender health care.

Good, that’s clear. Now all we have to wonder about is an adult doctor claiming there’s such a thing as “gender-affirming care.” Does lipstick count as gender-affirming care?

A key argument advanced by opponents of gender-affirming care is that its treatments are only supported by “weak” or “low-quality” evidence, as the SEGM–affiliated reviews and others have found.

The thing is, so are a lot of standard—and essential—medical interventions. Cancer drugs have a notoriously low-quality evidence base, including many FDA-approved treatments. Almost all nutritional guidelines are supported by what Guyatt’s system labels poor evidence. About five million youth have asthma in the United States—yet the evidence for medical guidelines for pediatric asthma care is regularly rated “poor” or “weak,” as are many of the treatments, which have indisputably saved countless lives. 

Ahhhh but there’s a crucial difference here. “Gender-affirming care” is not the same kind of thing as medical interventions. It’s an intervention, but not a medical one. It’s a thoughts intervention, a psychic intervention, an ideological intervention, an emotional intervention. It’s a fantasy-endorsing intervention, which is a pretty bizarre concept.

Mother Jones of course would not dream of admitting that.