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The nation’s public-health establishment lost all credibility during the Covid era by either ignoring or politicizing scientific data. But health bureaucrats seem to have learned nothing. With respect to the highly charged issue of gender dysphoria, they continue to substitute politics for science when necessary to advance the leftist narrative.
The Department of Health and Human Services (HHS) recently released an official document designed to enshrine experimental medical interventions as the standard treatment for transgender-identifying children. Prepared by HHS’s Office of Population Affairs (OPA), the document is a political statement unmoored from actual medical research.
According to “Gender-Affirming Care and Young People,” medical interventions such as puberty-blocking drugs, wrong-sex hormones, and surgical mutilation are “crucial to overall health” of young people confused about their sex. (For what it’s worth, OPA falls under the supervision of Dr. Rachel Levine, a man who identifies as a woman.) The document complements a proposed rule announced by HHS in March, mandating insurance coverage for such “gender-affirming care.”
But the claims made in HHS’s new release have been deftly dismantled by an organization of physicians and scientists who still care about reality, and about ethical medical practice. The Society for Evidence Based Gender Medicine (SEGM) — which exists “to promote safe, compassionate, ethical and evidence-informed healthcare for children, adolescents, and young adults with gender dysphoria” — points out that HHS’s discussion is deeply misleading and indeed dangerous.
SEGM identifies seven serious misrepresentations of fact crammed into the two-page HHS document. Most of these involve cherry-picking, distorting, or simply ignoring the results of studies on the many facets of so-called gender-affirming treatment.
HHS Mischaracterizes Studies
For example, HHS flatly mischaracterizes a study that failed to find any benefits of “social transition” (presenting oneself as the opposite sex, with a new name, hairstyle, dress, etc.). As SEGM notes, the HHS document cites that study for the opposite conclusion, “wrongly assert[ing] that social transition improves functioning.” HHS presumably assumes readers won’t read the actual study and thus will accept the agency’s false claims about its findings.
SEGM identifies other falsifications of the supposed mental-health benefits of wrong-sex hormones and surgeries. HHS’s “claims of benefits coming from cherry-picked studies do not hold up when the entire body of evidence is properly evaluated in a systematic and reproducible way,” according to SEGM.
The design of the studies cited by HHS made it impossible to link medical interventions and improved mental health, SEGM observes. By contrast, multiple European studies “concluded that there is a lack of convincing evidence for the mental health benefit for children and adolescents of either puberty blockers or cross-sex hormones.”
SEGM notes, in fact, that the Swedish health authority warned that “the risks of puberty suppressing treatment . . . and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases.”
HHS ignored all this research, which would have led honest medical professionals to at least acknowledge the scholarly debate about the wisdom of these interventions. But HHS isn’t run by honest medical professionals. It’s in the grip of ideologues determined to drive troubled children and their families into the clutches of the trans industry.
Dishonest Use of Data on Suicide
SEGM also criticizes the HHS document for dishonesty about the related issue of suicide among trans-identifying youth. In claiming alarmingly high rates of suicidal ideation in this population — a claim routinely used to pressure desperate parents into consenting to dangerous medical interventions — HHS relies only on “a low quality, non-probability online survey.”
In fact, SEGM reports, “recent research from one of the world’s largest pediatric gender clinics estimated the rate of suicide in trans-identified youth as 0.03% over a 10-year period, which is comparable to youth presenting for care with mental health problems.”
Even more critically, despite HHS’s strong implication that drugs, hormones, and surgeries reduce suicide rates, SEGM clarifies that “no study to date has demonstrated that transition reduces the rate of serious suicide attempts.” Is HHS afraid that telling the truth about suicide will make parents less likely to place their troubled children on the trans-industry conveyor belt?
Puberty Blockers Are Not Fully Reversible
The mendacity of HHS extends beyond misrepresenting or ignoring studies. For example, the document states, without supporting citation, that puberty blockers are fully reversible (i.e., natural puberty will resume once the drugs are discontinued). But SEGM warns about the utter dearth of research supporting this claim. In fact,
concerns have been raised that puberty blockers are psychologically irreversible (since over 95% of all treated youth proceed to cross-sex hormones), that they may harm bone development, may permanently alter the brain, that it is not yet known how they affect other vital organs, all of which undergo significant structural changes during uninterrupted puberty.
Once again, public-health agencies in Europe are more honest. As SEGM reports, Britain’s National Health Service says that “[l]ittle is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”
But ignoring the risks of these interventions is HHS’s modus operandi. SEGM calls out the HHS ideologues for mentioning only the supposed (in some cases imaginary) benefits of interventions while failing to mention documented risks to bone development, cardiovascular health, and the mental health of patients who later regret their transition decisions.
Sterility Expected After Trans Treatments
SEGM particularly targets HHS’s failure to mention the effect on reproductive health, which is supposed to be the focus of Levine’s Office of Population Affairs. “When puberty blockers are administered in early puberty and followed by cross-sex hormones,” SEGM notes, “sterility is expected.”
HHS is silent about this potentially devastating consequence. Nor does it acknowledge the “serious ethical questions about whether adolescents can be considered competent to waive their future reproductive rights at an age when they are unlikely to be able to appreciate or predict the importance of fertility to their adult selves.”
Ethics, it appears, is not HHS’s strong suit.
HHS also misleads in stating that mutilating surgeries are “typically used in adulthood or case-by-case in adolescence.” In fact, as SEGM notes, draft recommendations from the influential (though highly politicized) World Professional Association for Transgender Health (WPATH) urge broad availability of mastectomies to patients at age 16.
Even worse, patients as young as 13 had their healthy breasts removed as part of a study funded by the National Institutes of Health – i.e., by you and me through our tax dollars. The HHS bureaucrats who prepared this report surely knew this, but distort the facts.
This HHS document, then, is a farce. As SEGM summarizes, HHS inadequately reviewed the scientific literature, issued “biased recommendations that do not acknowledge the low quality of evidence,” failed to solicit input from professionals and patients whose experiences contradict the government narrative, and utterly ignored possible alternatives to medical interventions, such as psychotherapy. The result:
This incomplete representation of the relevant issues is likely to mislead the public to believe that this is the best and only alternative, particularly when no other alternatives are mentioned. The public is also likely to erroneously assume that the risks of affirmative care are low. Patients and families are not capable of providing valid informed consent when the information they receive is inaccurate and incomplete
If the public-health establishment wants to rehabilitate its tattered reputation after the Covid debacle, this isn’t the way to do it. Health policy is too important to be entrusted to political hacks.
Jane Robbins is an attorney and a retired senior fellow with the American Principles Project in Washington DC. In that position she crafted federal and state legislation designed to restore the constitutional autonomy of states and parents in education policy, and to protect the rights of religious freedom and conscience. She is a graduate of Clemson University and the Harvard Law School.