24 July 2023
"All systematic reviews of the evidence to date, including one published in the Journal of the Endocrine Society
have found that the evidence for the mental health benefits of hormonal interventions for minors is of low or very low confidence," explain the signatories of the petition. ALEXEY KUZMA KLEMENTIEV/Alexey Kuzma/Stocksy - stock.adobe.com
TRIBUNE - Some twenty doctors and researchers from nine countries are warning of the lack of scientific consensus on gender transitions in children. In this article published in English in the Wall Street Journal, they also explain that psychological support should be preferred to hormonal and surgical treatments.
As experienced professionals involved in the direct care of a growing number of young people with diverse gender identities and the evaluation of medical evidence, we were surprised by the statements made by the Endocrine Society (an American-based international medical and scholarly society for basic and clinical research in the field of endocrinology) on the state of evidence for gender-affirming care for young people ("Letters", 5 July).
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Stephen Hammes, president of the Endocrine Society, writes: "More than 2,000 studies published since 1975 paint a clear picture: gender-affirming care improves the well-being of transgender people and people of diverse gender identities and reduces the risk of suicide." This claim is not supported by the best available evidence.
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All systematic reviews of the evidence to date, including one published in the Journal of the Endocrine Society, have found the evidence for the mental health benefits of hormonal interventions for minors to be of low or very low confidence. In contrast, the risks are significant and include infertility, lifelong dependence on medication and regret anxiety. For this reason, more and more European countries and international professional organisations are now recommending psychotherapy rather than hormones and surgery as the first-line treatment for young people with gender dysphoria.
Regrettable politicisation
Dr Hammes' claim that gender transition reduces suicides is contradicted by all the systematic reviews, 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 hormone transition is an effective suicide prevention measure.
The politicisation of transgender healthcare in the US is unfortunate. The way to combat it is for medical societies to align their recommendations with the best available evidence, rather than exaggerating the benefits and downplaying the risks.
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Transgenderism has been heavily politicised, on both sides. Some will justify any hormone replacement intervention for any young person who has been identified as possibly suffering from gender dysphoria. This attitude is dangerous, because only a minority of people identified in this way actually qualify for this diagnosis. On the other hand, there are those who would not accept any hormonal intervention, whatever the specific characteristics of each patient.
Endocrinologists are not psychiatrists. We are not the ones who can identify people suffering from gender dysphoria. It's not a question of opening the floodgates and offering an often irreversible treatment to everyone likely to have problems with their sexuality, but of determining who would really benefit from it.
* Signatories: Riittakerttu Kaltiala, professor at the University of Tampere; Laura Takala, psychiatrist; Richard Byng, professor at the University of Plymouth; Anna Hutchinson, clinical psychologist; Anastassis Spiliadis, director of ICF Consultations; Angela Sämfjord, doctor; Sven Román, psychiatrist; Anne Wæhre, doctor; Patrik Vankrunkelsven, professor at the Catholic University of Louvain and honorary senator; Sophie Dechêne, psychiatrist; Beryl Koener, psychiatrist; Céline Masson, professor at Picardie Jules Verne University, psychologist and co-director of the Petite Sirène observatory; Caroline Eliacheff, psychiatrist and co-director of the Petite Sirène observatory; Maurice Berger, psychiatrist; Daniel Halpérin, paediatrician; Reitze Rodseth, professor at the University of Kwazulu-Natal; Janet Giddy, physician and public health expert; Allan Donkin, physician; Stephen B. Levine, professor at Case Western Reserve University; William Malone, professor at the Idaho College of Osteopathic Medicine; Patrick K. Hunter, professor at Florida State University, paediatrician and bioethicist; Jesus L. Penabad, physician.