By Tom Jefferson and Carl Heneghan | Trust the Evidence
In February 2019, we wrote about a delicate problem: Gender-affirming hormones in children and adolescents.
We wrote about gender dysphoria, a growing problem in Europe and the stages of “treatment” proposed by international guidelines:
And then proceeded to do what we do for a living: look at the evidence from systematic reviews, focussing on the most up-to-date and most of all, we looked at the quality of the 16 studies in the reviews.
We listed the presumed benefits and possible harms of interventions for stages 1 and 2, with stage 3 (surgery) being irreversible.
We concluded that the evidence for interventions for both stages was very low quality. Still, the range of psychological and physical harms induced by the hormones was likely to be high.
All this would matter less if these were offered to individuals who could make up their minds, but they were offered to people as young as 12.
In any case, we concluded that none of these hormone interventions should be offered outside clinical trials, of which there were none in the reviews we identified.
We wrote: ‘The development of these interventions should, therefore, occur in the context of research, and treatment.’ Our conclusions were reported in the Times. The work was also worthy of a BBC Panorama programme.
However, our work drew a complaint to the Editor in Chief of the BMJ, enough to close down our work in that outlet.
Well, four years after all this, NHS England has come to the same conclusions:
“Puberty suppressing hormones will not be prescribed to under 18s for gender dysphoria, except in exceptional circumstances, because of a lack of evidence to support their safety or clinical effectiveness. Puberty blockers will only be accessible to children as part of research, interim guidance states. As such, a study into the impact of puberty suppressing hormones on gender dysphoria in children and young people with early onset gender dysphoria is being developed by NHS England’s new national children and young people’s gender dysphoria research oversight board.”
The tale shows that we found poor-quality evidence wherever we looked, which appears to be a problem swept under the table.
EBM applied correctly will eventually come up with the right answer, especially in the matter of harms that most people are uncomfortable with. What matters now is how many children have been harmed in the intervening four years it took NHS England to review the evidence and come to the same conclusion.
Related
The dangers of gender-affirmative care
We have legal age limits for driving, voting, and having sex, why not for transgender treatment?
US & UK doctors warn against hormones/surgery for trans-identified kids
