Once Again, Advocates for Child Gender Transitions Resort to Flawed Research

A recent opinion article published in the Journal of the American Medical Association advocates for a comprehensive approach to preserve children’s access to gender medical interventions. In doing so, it argues that denying youth access to so-called “gender-affirming care,” which includes puberty blockers and cross-sex hormones, harms mental health outcomes, citing a study also published in JAMA.

There’s just one problem: that study did not show significant mental health improvements among youth treated with these interventions. 

The opinion piece, like countless others attempting to argue for these dangerous and unproven procedures, invokes faulty research to prop up its agenda.

Titled “Moving Beyond Statements to Protect Transgender Youth,” the article is authored by doctors at Connecticut Children’s Hospital, which performs gender surgical procedures and other medical interventions on children. The authors argue that children’s hospitals should form robust partnerships and engage with community stakeholders to fight attempts to restrict minors’ access to gender medical interventions.

Yet crucially, the authors hinge their claim on the idea that children need these irreversible interventions for the sake of their mental health.

“The longer care is delayed, the greater the negative impact to mental health,” the authors write, citing a 2022 study.

That study, authored by researchers affiliated with Seattle Children’s Hospital, one of the foremost practitioners of gender medical interventions for minors, claims to observe evidence that so-called “gender-affirming care” is associated with decreased depression and suicidality. A look underneath the hood, however, shows that the study is profoundly flawed.

The study compares two groups of youths, one receiving interventions including puberty blockers and cross-sex hormones, and the other not.

The research team observes no statistically significant changes in depression or suicidality among the treatment group from initiation to one-year follow up.

This fact, however, does not stop the Connecticut Children’s doctors from arguing that gender-affirming care is necessary for youth mental health.

Moreover, the study fails to explain why the comparison group did not receive these medical interventions; did they simply choose not to? This context is conspicuously absent.

However, the researchers do observe heightened depression and suicidality in the comparison group of youths. The researchers posit that this worsening mental health represents the counterfactual for what would have happened to the treatment group if they hadn’t received puberty blockers or cross-sex hormones. This assumption is flawed for two reasons. 

First, whether a child received blockers or hormones isn’t random. Rather, those patients with the worst mental health or declining mental health may have been denied access to puberty blockers and hormones due to their poor or declining mental health. Likely, their decline in mental health during the study period is totally unrelated to their not receiving blockers or hormones. 

Second, there is massive attrition from the comparison group, which featured 38 patients three months after the study commenced but just seven patients after one year, when the study concludes. Likely, patients whose mental health improved either became part of the treatment group or left the gender clinic altogether. Had they remained in the comparison group the results would have looked very different. 

It seems to be a recurring theme that arguments in favor of gender medical interventions for children invariably invoke deeply flawed research.

In fact, the study the doctors cite undercuts their own premise. The study instead shows that puberty blockers and cross-sex hormones do not significantly improve mental health outcomes.

Several European nations, including the United Kingdom, Finland, and Sweden, have recognized this, with each having conducted exhaustive reviews of the evidence and concluded that gender medical interventions for children have risks that outweigh the benefits. 

For instance, the United Kingdom’s Cass Report concluded that there is “remarkably weak evidence” behind the use of puberty blockers and cross-sex hormones to treat adolescents.

Unfortunately, as evidenced by the Connecticut Children’s doctors’ call to arms, the American medical field is still lagging far behind. 

This article demonstrates yet another example of advocates using faulty reasoning and porous research to advance an agenda that not only ignores the weight of scientific evidence, but is ultimately harmful to children.