The American Society of Plastic Surgeons (ASPS) has decided to challenge the "consensus" on the necessity of "gender-affirming care" for children. The ASPS “has not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria.” They acknowledge that there is “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions."
Most importantly, they conclude that “the existing evidence base is viewed as low quality/low certainty.”
As Leor Sapir at City Journal points out, "low quality/low certainty" is more than a description of how a study is created. It's a designation that means something very specific: "The true effect of an intervention is likely to be markedly different from the results reported in studies."
"As one expert in evidence-based medicine put it, low quality “doesn’t just mean something esoteric about study design, it means there’s uncertainty about whether the long-term benefits outweigh the harms," writes Sapir.
Last Friday, I reported on a class action suit by several transexual youths who are suing Planned Parenthood for the extraordinarily lax procedures they used to prescribe hormones to kids.
"The suits highlight just how backward the U.S. has become in hormonal and surgical interventions to transition gender-distressed young people with little in the way of examinations by mental health professionals or medical doctors," I wrote. European countries are lightyears ahead of the U.S. in treating transgender youth. They rely on psychotherapy and other non-surgical interventions to treat young people.
World Professional Association for Transgender Health (WPATH) is responsible for much of the pressure on professional societies to fall in line and join the "consensus" on treating gender-confused kids with drugs and surgery.
As the U.K.’s Cass Review pointed out, the World Professional Association for Transgender Health (WPATH) and the U.S. Endocrine Society were especially important in forging this consensus, and they did so by citing each other’s statements, rather than conducting a scientific appraisal of the evidence. The “circularity” of this approach, says Cass in her report to England’s National Health Service, “may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.”
Perhaps because it has never really depended on evidence, this doctor-group consensus has shown remarkable resilience in the face of major system shocks, including several whistleblowers, revelations from court documents that WPATH manipulated scientific evidence reviews, the Cass Review, a bipartisan commitment in the U.K. to roll back pediatric medical transition, and a growing international call for a developmentally informed approach that prioritizes psychotherapy over hormones and surgeries.
The Cass Review was a government committee made up of medical professionals and scientists on both sides of the transgender question. It was a devastating indictment of trans care for kids and led several European countries to re-examine their treatment regimen for minors afflicted with gender dysphoria.
"This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress," Dr. Hillary Cass, former president of the Royal College of Paediatrics and Child Health at the UK's National Health Service, writes in the forward of the review (emphasis by author).
Aware that WPATH suppressed systematic reviews of evidence while developing its latest “standards of care,” ASPS says that it “is reviewing and prioritizing several initiatives that best support evidence-based gender surgical care to provide guidance to plastic surgeons.” I also asked ASPS whether plastic surgeons share responsibility for determining the medical necessity of gender surgeries for minors. ASPS responded that surgeons are “members of the multidisciplinary care team” and as such “have a responsibility to provide comprehensive patient education and maintain a robust and evidence-based informed consent process, so patients and their families can set realistic expectations in the shared decision-making process.”
Instead of promoting an agenda, WPATH needs to get serious about stopping the agony of children. Not by cutting into them or giving them drugs whose long-term effects are unknown, but by treating them with proven psychiatric and, when necessary, pharmaceutical options.
Snake oil salesmen are back. Instead of riding around in a medicine wagon, they wear white coats and claim to be able to treat an extremely complicated condition. European doctors are treating the whole mind, addressing co-morbidities like self-harm, OCD, depression, and other psychological. American doctors largely sell snake oil and make grandiose claims about their treatments.
It's time for U.S. doctors to come out of the dark ages.
