Top British medical journal says US approach to child sex changes is not 'evidence-based'

"The risk of over treatment is real."

Mia Ashton Montreal QC

The prestigious British Medical Journal (BMJ) has called the American model of gender-affirming care for minors not "evidence-based” and at risk of harming young people through "overtreatment," leading some trans activists to make accusations of transphobia and alarmism.

An investigation by The BMJ found that more and more young people in the US are being offered medical and surgical sex change interventions, sometimes bypassing psychological assessment and counselling, said BMJ Editor-in-Chief Kamran Abbasi in an article published March 9.

According to Abbasi, this practice of immediate affirmation and placing children straight onto a medical pathway involving puberty blockers and cross-sex hormones is supported by guidance from medical societies and associations, but he reports that a closer inspection of such guidance reveals the strength of the clinical recommendations “is not in line with the strength of the evidence.”

“The risk of over treatment is real,” Abbasi stressed.

The American Academy of Pediatrics (AAP) has been ignoring calls to justify its decision to endorse gender-affirming care for minors in its 2018 position statement. According to sexologist James Cantor, the AAP statement, drawn up by an activist subcommittee misrepresented entire literatures and the authors “told neither the truth nor the whole truth, committing sins of commission and omission, asserting claims easily falsified by anyone caring to do any fact-checking at all.”

Abbasi points to the evidence presented by Dr. Hilary Cass last year in her interim report of the independent review of the England’s pediatric gender service. Her findings question the evidence for affirmation, puberty blockers and cross-sex hormones and the final report due later this year is expected to recommend a focus on psychological support for this vulnerable cohort of young patients.

Abbasi noted similar shifts are evident in other countries, such as Sweden, Finland, and most recently Norway, where severe restrictions have been placed upon sex change interventions for minors.

“If we have the best interests of young people at heart, then surely our duty is to offer evidence informed care? And, if the evidence base is weak, we must provide the necessary support to young people as well as prioritising research to answer questions on issues that are causing a great deal of distress, much of which is amplified by social media,” concluded Abbasi, who called taking this route “essential” because an “evidence void” exposes people to over treatment.

But trans activists were quick to condemn the article, with many calling it transphobic and alarmist, and suggesting it comes from a place of prejudice.

The Pride In Surgery Forum tweeted to say that “this ‘investigation’ reflects current prejudices and alarmism about trans people, treating their treatment and survival as a mere debate.”

Trans activist group Trans Actual UK said it was disappointed to see such an article published in The BMJ, arguing that “there is a crisis in trans healthcare in the UK in that the system is not fit for purpose and because trans inclusive medicine isn’t included in the curriculum.”


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