Lack of Evidence for Mental Health Benefits of ‘Gender-Affirming Care’ for Minors, Say Medical Experts

Proponents of this approach to helping children with gender dysphoria argue that a significant number of studies have shown that it benefits mental health. In fact, one individual did just that in a letter to the Wall Street Journal, in which he claimed thousands of studies have proven the efficacy of “gender-affirming care.”

Stephen R. Hammes, M.D., president of the Endocrine Society, wrote a letter arguing in favor of this approach, accusing critics of ignoring “scientific evidence and the conclusions reached by the American Medical Association,” and other groups:

Roy Eappen and Ian Kingsbury’s op-ed “The Endocrine Society’s Dangerous Transgender Politicization” (June 29) ignores scientific evidence and the conclusions reached by the American Medical Association, the American Academy of Pediatrics and other reputable medical organizations. More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.

Based on this evidence, the Endocrine Society developed our clinical-practice guideline through a rigorous process adhering to the Institute of Medicine’s highest standards of trustworthiness and transparency. All 18,000 members had an opportunity to be heard during our extensive vetting process. Based on much of the same evidence, federal judges in Tennessee, Kentucky and Florida have joined the Arkansas judge in striking down bans on lifesaving gender-affirming care.

On the other hand, opponents of “gender-affirming care” argue that the evidence for the mental health benefits of hormonal interventions for minors is of low certainty, and the risks, including sterility and lifelong dependence on medication, should be considered. WSJ published another letter on Thursday repudiating Hammes’ arguments:

As experienced professionals involved in direct care for the rapidly growing numbers of gender-diverse youth, the evaluation of medical evidence or both, we were surprised by the Endocrine Society’s claims about the state of evidence for gender-affirming care for youth (Letters, July 5). Stephen Hammes, president of the Endocrine Society, writes, “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.” This claim is not supported by the best available evidence.

Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret. For this reason, more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.

Dr. Hammes’s claim that gender transition reduces suicides is contradicted by every systematic review, including the review published by the Endocrine Society, which states, “We could not draw any conclusions about death by suicide.” There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.

The letter, which was signed by 21 medical professionals, also lamented the “politicization of transgender healthcare in the U.S.” but argued that the most effective way to address it is “for medical societies to align their recommendations with the best available evidence–rather than exaggerating the benefits and minimizing the risks.”

Contrary to the claims made by proponents of “gender-affirming care,” there has not been enough evidence showing that this method improves the mental health of children suffering from gender dysphoria. In fact, a study conducted in Sweden revealed a troubling truth: Individuals who received “gender-affirming care” as minors were found to be significantly more likely to commit suicide as adults. These findings highlight the lack of compelling evidence showing that subjecting children to these treatments improves their mental health.

The medical professionals’ letter serves as a reminder that caution should be exercised when it comes to making decisions about the healthcare of minor children. While it is important to acknowledge and support individuals experiencing gender dysphoria, it is equally crucial to ensure that the treatments provided are based on solid scientific evidence and prioritize the long-term well-being of these individuals. The problem with the pro-transing crowd is that they don’t care about any of this. Their motives are as political as they are monetary. It has little to do with helping children.

Rather than rushing to embrace gender-affirming interventions, a more cautious and comprehensive approach should be taken. Indeed, in the past, the most common approach, referred to as “Watchful Waiting,” involved talk therapy and a wait-and-see approach. This is because the overwhelming majority of children who deal with gender dysphoria wind up growing out of it without the use of medical or surgical treatments. This is why so many European countries, which had been using the “gender-affirming care” model for decades, are starting abandon the practice.

Alternative approaches, such as psychotherapy, should be explored as viable options for supporting gender-diverse youth, considering that they do not carry the same risks and potential long-term consequences as medical interventions. Unfortunately, those who want more children to be transgender are not willing to consider evidence disproving their narrative. Until this movement is defeated, there will be more children harmed.