In U.S. and Europe, Gender Ideology as “Settled Science” Is Crumbling

The cultural hegemony of the gender ideologists is crumbling. Europe is hitting the brakes on potentially harmful interventions for gender-dysphoric children such as puberty blocking, cross-hormone administration, and surgeries. In the U.S., an increasing number of states are passing laws or medical guidelines to protect children from potentially irreversible and life-shattering outcomes that the “detransitioners” are increasingly exposing. Lawsuits are being filed for the harm allegedly done to minors put on “gender-affirming” medical care.

A Controversial Field

Now, the British Medical Journal reports that the entire field remains controversial from medical and scientific perspectives. And just in the nick of time. Identifying as transgender is a social contagion that is consuming an increasing number of American youth:

More adolescents with no history of gender dysphoria — predominantly birth registered females — are presenting at gender clinics. A recent analysis of insurance claims by Komodo Health found that nearly 18 000 US minors began taking puberty blockers or hormones from 2017 to 2021, the number rising each year. Surveys aiming to measure prevalence have found that about 2% of high school aged teens identify as “transgender.” These young people are also more likely than their cisgender peers to have concurrent mental health and neurodiverse conditions including depression, anxiety, attention deficit disorders, and autism.

In the US, although Medicaid coverage varies by state and by treatment, the Biden administration has warned states that not covering care is in violation of federal law prohibiting discrimination. Meanwhile, the number of private clinics that focus on providing hormones and surgeries has grown from just a few a decade ago to more than 100 today.

As we have discussed repeatedly, teenage girls who identify as boys are having their breasts removed, facial-reconstruction surgeries on boys and girls who are still maturing are being performed, and even the occasional genital-reconstruction operation that results in life-long sterilization and sexual dysfunction are occurring. Rather than “life-saving individualized care,” as the ideologues call it, a good argument can be made that great harm is being done to these children — especially since many will cease being gender dysphoric by the time they reach maturity.

Radical, Not Settled

The story clearly indicates that this radical approach is not “settled science.” Many European countries are backing off from early medicalized care, as is New Zealand.

Independent research is showing that the “guidelines” for treating these children, for example, published by the Endocrine Society, are poorly supported by evidence:

The Endocrine Society commissioned two systematic reviews for its clinical practice guideline, Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: one on the effects of sex steroids on lipids and cardiovascular outcomes, the other on their effects on bone health.3233 To indicate the quality of evidence underpinning its various guidelines, the Endocrine Society employed the GRADE system (grading of recommendations assessment, development, and evaluation) and judged the quality of evidence for all recommendations on adolescents as “low” or “very low.”

The article notes that the affirmation recommendations raced ahead of the actual data:

Robert Garofalo, chief of adolescent medicine at the Lurie Children’s Hospital in Chicago and one of four principal investigators, told a podcast interviewer in May 2022 that the evidence base remained “a challenge . . . it is a discipline where the evidence base is now being assembled” and that “it’s truly lagging behind [clinical practice], I think, in some ways.” That care, he explained, was “being done safely. But only now, I think, are we really beginning to do the type of research where we’re looking at short, medium, and long term outcomes of the care that we are providing in a way that I think hopefully will be either reassuring to institutions and families and patients or also will shed a light on things that we can be doing better.”

And, the story notes that some of these kids are put on the transition train without adequate psychological exploration and in an unduly rushed manner:

[Pediatrician Sarah] Palmer says, “I’ve seen a quick evolution, from kids with a very rare case of gender dysphoria who were treated with a long course of counselling and exploration before hormones were started,” to treatment progressing “very quickly — even at the first visit to gender clinic — and there’s no psychologist involved anymore.”

Laura Edwards-Leeper, a clinical psychologist who worked with the endocrinologist Norman Spack in Boston and coauthored the WPATH guidelines for adolescents, has observed a similar trend. “More providers do not value the mental health component,” she says, so in some clinics families come in and their child is “pretty much fast tracked to medical intervention.” In a study of teens at Seattle Children’s Hospital’s gender clinic, two thirds were taking hormones within 12 months of the initial visit.

An Important Development

There is also a problem with informed consent:

Without an objective diagnostic test [to diagnose gender dysphoria], however, others remain concerned. The demand for services has led to a “perfunctory informed consent process,” wrote two clinicians and a researcher in a recent issue of the Journal of Sex and Marital Therapy, in spite of two key uncertainties: the long term impacts of treatment and whether a young person will persist in their gender identity. And the widespread impression of medical consensus doesn’t help. “Unfortunately, gender specialists are frequently unfamiliar with, or discount the significance of, the research in support of these two concepts,” they wrote. “As a result, the informed consent process rarely adequately discloses this information to patients and their families.”

This is an important development. The BMJ is a very mainstream medical publication — which is why its story admitting that this field remains controversial matters to the debate. Those who oppose mutilating gender-dysphoric children now have a new and powerful argument against the kind of mandatory gender-affirming-care approach that political, cultural, and media organs favor imposing.

Cross-posted at The Corner.