Lauren Dempsey, MS in Biomedicine and Law, RN, FISM News
An article published last week by The British Medical Journal (BMJ) highlighted the controversial and inconsistent treatment services for individuals — primarily children — with gender dysphoria and the political and social climate surrounding gender-affirming care that has left “little room for constructive dialogue.”
Dr. Kamran Abbasi, editor-in-chief of BMJ, wrote that while “aggressively argued views are nothing new in science and medicine,” the lack of constructive conversations around gender dysphoria treatment is leaving patients to suffer the consequences.
The goal of physicians and health care providers, Abbasi wrote, should be to “ensure that the strength of your management recommendations is in line with the strength of the evidence. But the weaker or the more disputed the evidence base, the harder it is to offer a clear way forward.”
The issues surrounding transgender treatment services are both social and political and medical treatments are often provided under the influence of prevailing ideology rather than evidence-based practice. Providing evidence-based care is essential in ensuring positive, long-term patient outcomes, yet the negative outcomes associated with gender-affirming care and medical or surgical transition are largely dismissed, despite their ofter life-long and irreversible nature.
Providing adequate and appropriate treatment is more difficult if the person seeking gender-affirming care is a child, making it more complex to provide “the best possible care,” Abbasi wrote.
The British Medical Journal is committed to focusing on the clinical evidence and scientific data that supports optimal treatment services and will continue “advocating against overdiagnosis and overtreatment — even when the state of the science disagrees with individual preferences,” Abbasi wrote.
TREATMENT DETERMINED BY CLINICIAN’S PREFERENCE
A separate independent review, led by Dr. Hillary Cass, former president of the Royal College of Pediatrics and Child Health and a pediatrician, has found that care for children with gender dysphoria in England is determined by clinician preference and “there is lack of consensus and open discussion about the nature of gender dysphoria which makes treatment difficult.”
The “existing research base is observational, and there is a lack of longer term follow-up data on outcomes for children and young people receiving hormone treatment,” the review found.
Dr. Cass reported that the healthcare community does not have a shared understanding of the cause of gender dysphoria, which has led to a lack of open discussion, and the “research that is available will continue to be interpreted from varying ideological standpoints.”
This lack of evidence-based research and communication has negative consequences for patients and does not give patients and their families the necessary information to provide informed consent. Furthermore, if medical organizations and healthcare providers are unwilling to discuss the underlying issues, there will not be meaningful or lasting change.
Cass’s complete report will be published later this year, but the interim report has highlighted specific measures and key elements that question current interventions that are being offered to minors.
EUROPE LEADING THE WAY IN REIGNING IN GENDER CARE FOR MINORS
European health authorities have continued to lead with forward-thinking, scientific reviews on the benefits and risks of medical and surgical gender-affirming care for children and adolescents. This approach has led Sweden, Norway, Finland, and the United Kingdom to restrict certain interventions. Children have to meet strict requirements according to policy and protocols to receive hormone replacement therapy and there is a greater focus on psychological evaluation and treatment as well.
US DIVIDED POLITICALLY OVER GENDER IDEOLOGY
Meanwhile, the United States continues to double down on gender-affirming care, having an extreme and unfettered position on interventions on a federal level, especially for children and adolescents with gender dysphoria. Some states, however, including Mississippi, Tennessee, Oklahoma, and Florida have passed laws or introduced legislation to prevent body-mutilating procedures and hormones for minors.
The Biden administration has vowed to push the extreme gender ideology forward, vowing to use federal funds to address “discrimination,” safeguard health care, and programs designed to prevent youth suicide, and will take additional steps to “advance LGBTQI+ equality” in the United States and is focused on preventing “conversion therapy,” while supporting gender-affirming care as a medical necessity.