from Transgender Trend
On May 1st the US Department of Health and Human Services (HHS) published a groundbreaking Review of Evidence and Best Practices in the Treatment for Pediatric Gender Dysphoria. The HHS review draws extensively on the Cass Review and strengthens its findings: that there is very low quality evidence to support the use of blockers and hormones, including the claim that ‘gender affirming care’ is life-saving. But it goes much further.
- The Cass Review research team conducted systematic reviews of peer-reviewed research studies; the HHS Review is an ‘umbrella review’ of all relevant systematic reviews, including those from the Cass Review.
“The umbrella review found that the overall quality of evidence concerning the effects of any intervention on psychological outcomes, quality of life, regret, or long-term health, is very low. This indicates that the beneficial effects reported in the literature are likely to differ substantially from the true effects of the interventions.” [p. 13]
- Whereas the remit of the Cass Review was restricted to clinical practice (specifically at the Tavistock GIDS) and medical research, the HHS Review includes the critical subject of medical ethics.
“A natural response to the absence of credible evidence is to call for more and better research. Even if high quality research such as randomized controlled trials on pubertal suppression or hormone therapy were feasible, however, conducting it may conflict with well-established ethical standards for human subjects research.” [p. 16]
- The Cass Review systematically reviewed the evidence for blockers and hormones and found there is ‘very low certainty’ evidence of benefit. The HHS Review extended the scope of the research by investigating studies and medical knowledge outside of paediatric gender medicine to examine evidence of the significant harms and risks of these treatments. The review found that the risk/benefit analysis does not support a puberty blockers study.
“Some of the plausible harms of PMT are serious. The likelihood of infertility when puberty blockers (PBs) are provided at the early stage of puberty and followed by cross sex hormones (CSH) does not have to be demonstrated in a clinical trial. This is because the mechanism is well-understood and conducting a trial would amount to an unethical “parachute test.”
“Analysis of all available data described in this section of the Review suggests that the risk/benefit profile of medical and surgical interventions for children and adolescents with GD is unfavorable.”