Swedish review concludes child sex changes are experimental, researcher ‘surprised’ by shortage of studies

“I am surprised by the shortage of studies in this field. We found no randomized trials, and only 24 relevant observational studies.”

Mia Ashton Montreal QC

A Swedish systematic review of the evidence for puberty blockers and cross-sex hormones for minors suffering from gender dysphoria has concluded that the treatment should be regarded as experimental and only be permitted in a strict clinical trial setting.

Professor Jonas F Ludvigsson, lead author of the review, expressed surprise at the shortage of studies in the field of pediatric gender medicine and the poor quality of the existing literature.

In the systematic review, researchers assessed more than 9900 abstracts from 15 scientific databases and found 24 relevant studies.

“In our review, we focused on psychosocial effects, bone health, body composition and metabolism, and therapy persistence in children [under 18] with gender dysphoria undergoing treatment with puberty blockers,” said Ludvigsson in a recent article. “I am surprised by the shortage of studies in this field. We found no randomized trials, and only 24 relevant observational studies.”

Ludvigsson added that earlier research contained “substantial limitations,” and the few longitudinal observational studies were hampered by small numbers and high attrition rates (participants lost to follow-up).

The review concluded that the long-term impact of hormone therapy on psychosocial health are unknown. Studies investigating the treatment protocol’s effect on bone health showed that while puberty blockers delay bone maturation and bone mineral density gain, this is partially recovered during cross-sex hormone therapy treatment.

Corresponding author, Professor Mikael Landén, believes his team’s work is important not only because of the sharp increase in the number of children seeking experimental sex changes, but also because of the change in the case-mix. Gender dysphoria in minors traditionally afflicted predominantly male children with an onset in early childhood, but around the mid-2010s, coinciding with the beginning of the modern trans rights movement, gender clinics began seeing a huge surge in adolescent girls whose gender distress started suddenly at puberty.

“We do not know what the natural trajectory is for these children,” said Landén.

Landén believes studies should focus on determining the rate of persistence for this new cohort of adolescents with the aim of finding which children are likely to continue to identify as transgender later in life. Historically, before affirmation and puberty blockers, the majority of children would desist and no longer wish to medically transition after puberty. There is currently no way to tell which minors will desist and which will persist.

“If predictors for persistence can be found, the second step would be to conduct clinical trials focusing on potential persisters in order to evaluate the beneficial and adverse effects of hormonal treatments,” added Landén. “Importantly, such studies need to follow patients for many years.”

The review notes one study of 720 children that indicated 98 percent persisted in their medical transition into adulthood, “which suggests that children generally continue with gender transition” once they have started on puberty blockers. Proponents of so-called gender-affirming care take this as evidence that these children are really transgender, but it could just as easily be evidence that puberty blockers prevent the natural desistance that would have occurred had the child been allowed to grow and mature.

“We know from internet-based surveys that detransitioning exists,” continued the review. “Studies that closely follow individuals who start [puberty blockers and cross-sex hormones] until at least age 30 are urgently needed.”

“Against the background of almost non-existent longterm data, we conclude that [puberty blocker] treatment in children with gender dysphoria should be considered experimental treatment rather than standard procedure. This is to say that treatment should only be administered in the context of a clinical trial under informed consent”, said Landén.

The findings of this review are in line with other systematic reviews conducted in Finland, Norway, and England. These nations have all reverted back to a cautious psychotherapeutic approach to treating this vulnerable young cohort. Several US states have followed suit and passed legislation limiting doctors from performing these procedures on minors, while some states have enacted laws to ensure children and adolescents with a poorly defined psychiatric disorder can obtain irreversible experimental interventions while still in a stage of identity development.


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