An annoyingly overused phrase in modern bureaucratic lingo is “evidence-based,” which means that public policies should be backed by research and evidence showing their efficacy. No argument there—except that shoddy, agenda-driven “research” can be produced to justify a lot of things that turn out to be very bad ideas.
It’s common practice for federal bureaucrats to design and then publicize biased studies to promote their preferred policy. We outlined this practice in our new book, Deconstructing the Administrative State: The Fight for Liberty. The process is simple: (1) issue requests for research proposals slanted in favor of a particular outcome, (2) fund studies that reach the expected conclusions, and (3) cite that research in subsequent studies to claim that a “growing body of evidence” favors the preferred policy.
These techniques are now being deployed in a new area: treatment for gender dysphoria. Dr. Quentin Van Meter, an Atlanta pediatric endocrinologist with extensive experience in the science of gender dysphoria who trained at Johns Hopkins Hospital, states flatly that there is “zero point zero zero” evidence that the concepts of gender fluidity and gender identity have any scientific basis. But it takes a courageous physician to risk opprobrium and accusations of insufficient compassion by rejecting the new dogma.
Some doctors forge ahead with this “compassionate” (read: lucrative) care, but others are more cautious; they would welcome research into the physical and psychological effects of the “affirmation” therapy advocated by LGBT activists. Specifically, there is a clear need for research into the safety and efficacy of puberty-suppressing drugs and cross-sex hormones (testosterone and estrogen) administered to children and adolescents suffering from the mental illness of gender dysphoria. So the federal government, via the National Institutes of Health (NIH), is stepping in, funding a $5.7 million longitudinal study of kids who are treated with such therapies.
Unfortunately, multiple aspects of this study indicate that it is intended to produce evidence supporting a particular conclusion: that transgender affirmation therapy is safe and effective for gender-dysphoric youngsters. And once the federal government speaks, states and other institutions will fall in line.
Who’s Running the Study?
The selection of researchers to carry out the NIH study is the first signal that this might not be a truly objective undertaking. All of the four doctors and their clinics selected to conduct the research are strong advocates of affirming transgender feelings and using medical treatment to help kids transition to a more realistic impersonation of the opposite sex (since sex is determined by the chromosomes in each cell of the body, there is no such thing as an actual sex change).
The Child and Adolescent Gender Center Clinic at UCSF Benioff Children’s Hospital San Francisco, directed by Dr. Stephen Rosenthal, describes itself as offering “the mental health, medical, advocacy and legal expertise necessary to support a healthy transition.” Dr. Johanna Olson of Children’s Hospital Los Angeles opines that “[transgender] young people can really benefit from not going through the wrong [sic] puberty the first time.” Dr. Norman Spack of Boston Children’s Hospital describes treatment that harmonizes the psyche with the biological sex as “noxious.” And in his practice, Dr. Rob Garofalo of Lurie Children’s Hospital in Chicago employs irreversible cross-sex hormone treatment with children as young as fourteen, even though he admits he doesn’t understand the long-term consequences.
All four of these researchers, then, are deeply invested in affirmation therapy. The chances their study will find serious harm from these interventions are pretty slim.
Affirmation Therapies vs. Psychotherapy
UCSF physician Rosenthal touted the NIH study as necessary to address “a real lack of long-term data to effectively and safely guide the clinical care of [transgender] youth.” But multiple studies have shown the efficacy of psychological therapy to help gender-dysphoric children accept their biological sex, and the value of simply waiting for the child to outgrow the delusion. “Experts on both sides of the pubertal suppression debate agree that within this context, 80 percent to 95 percent of children with [gender dysphoria] accepted their biological sex by late adolescence.”
But affirmation therapies interfere with this process. What data are there about children who are treated with puberty blockers so that natural puberty, with its likely positive effects on their gender dysphoria, is short-circuited? A study from the Netherlands of seventy such children found that all of them went on to embrace a transgender identity—unlike the vast majority of children not given such treatment. According to the American College of Pediatricians (ACP),
This is a cause for concern. . . . To have 100 percent of pre-pubertal children choose cross-sex hormones suggests that the protocol itself inevitably leads the individual to identify as transgender. There is an obvious self-fulfilling nature to encouraging a young child with GD to socially impersonate the opposite sex and then institute pubertal suppression.
Apparently NIH and its newly funded researchers aren’t fazed by these results of existing studies.
Research has also established that administering cross-sex hormones after puberty-suppression creates a multitude of harmful physical effects (some certain, others potential). These hormones will render the patient infertile for life, since they prevent the maturation of gonadal tissue and gametes in both sexes. Relying on research from adults, which is the only type available with respect to cross-sex hormones, ACP lists other possible negative consequences:
it is most accurate to say that oral estrogen administration to boys may place them at risk for experiencing: thrombosis/thromboembolism; cardiovascular disease; weight gain; hypertriglyceridemia; elevated blood pressure; decreased glucose tolerance; gallbladder disease; prolactinoma; and breast cancer. Similarly, girls who receive testosterone may experience an elevated risk for: low HDL and elevated triglycerides; increased homocysteine levels; hepatotoxicity; polycythemia; increased risk of sleep apnea; insulin resistance; and unknown effects on breast, endometrial and ovarian tissues.
ACP also notes that dysphoric adolescents who are placed on cross-sex hormones are likely to receive these treatments for years longer than the adult patients in these studies, and thus are likely to experience even greater negative consequences.
NIH’s abstract of the transgender study presents affirmation therapies as the standard treatment for gender dysphoria:
medical intervention is aimed at alleviating gender dysphoria and ameliorating potential negative outcomes. Existing strategies for treating transgender youth depend on the developmental stage at which these youth present for care. For those . . . in the early stages of pubertal development, treatment is aimed at suppressing their endogenous puberty in order to avoid the development of undesired secondary sexual characteristics that intensify the distress associated with gender incongruence. For those youth in later stages of puberty, the goal of treatment is to use cross-sex hormones in order to induce the development of desired secondary sexual characteristics that bring the body into closer alignment with the youth’s internal sense of gender.
According to NIH, this is the standard care for dysphoric youth. There is no mention of psychotherapy and letting natural puberty take its course. The appropriateness of affirmation therapy is assumed, not evaluated.
Serious Problems in the Design of the Study: No Control Group or Long-Term Follow-Up
The design of the study is similarly problematic. As described by UCSF, the study will include 280 youth from two age groups: younger children in early puberty, who will be administered puberty-blockers, and older adolescents, who will be given cross-sex hormones. Then the researchers will see how these protocols work out.
Notice any group missing from this lineup? A control group. Except in certain very limited circumstances, medical research studies are usually “randomized controlled studies,” which include a control group of study participants who don’t receive the therapies being evaluated. Comparing outcomes between a group that receives the therapies and one that doesn’t is the “gold standard” of research, in accordance with the Good Clinical Practices and Human Subject Protections required by the Food and Drug Administration for pharmacological studies.
True, not every medical research study involves a control group. For example, it would be considered unethical to deny potentially life-saving treatment to otherwise terminal patients. But absent such considerations, it’s common and recommended for researchers to employ randomized controlled studies.
For whatever reason, NIH decided not to go this route. Thus, if dysphoric children would have better outcomes from not receiving transgender affirmation treatment, we won’t know it from this study.
Another troubling design feature of the study is the time frame. The children will be studied for only five years. Presumably, if eleven-year-olds receive puberty blockers, are still generally satisfied with the treatment at age sixteen, and at that point show no adverse medical effects, the researchers will declare the therapy a success and recommend this treatment for transgender children.
Pediatric endocrinologist Van Meter considers this one of the worst features of the study. He maintains that children’s satisfaction with their “new sex” a few years after the therapy begins is essentially meaningless, especially when the study is designed to place the children and their families in a safe bubble in which their transgender identity is affirmed. The rubber will hit the road, Van Meter predicts, ten, twenty, or thirty years later, when the children become adults and realize they must live the rest of their lives struggling to fit into a society that will not reshape itself to accommodate their situation. And they must do this with infertility and potentially even life-threatening medical conditions resulting from the hormone treatments and, if they go on to have sex-reassignment surgery, with mutilated bodies.
Even though transgender affirmation is a relatively new phenomenon, many patients are already regretting their decisions as they proceed through adulthood. One study from Great Britain reviewed 100 other studies and found regret in 20 percent of post-SRS patients. Walt Heyer, who experienced SRS regret and now has de-transitioned to resume his life as a man, has reviewed the research and drawn the painfully obvious conclusion:
Fair-minded individuals would see the cumulative effect of the findings – 20 percent have regret, 41 percent attempt suicide, 90 percent have a “significant form of psychopathology,” 61 percent also have other psychiatric disorders and illnesses, 50 percent had depressive symptoms, 40 percent showed symptoms of anxiety – and be troubled by the push to surgery and transition as the first course of treatment for transgenders.
By stopping the study of dysphoric youth at five years, when many of the participants will still be in their teens and the rest in the earliest stages of adulthood, the NIH researchers can mask these tragic consequences that may appear later. The study will thus be able to trumpet the success of affirmation therapies and reassure doctors that they should adopt these practices. Subsequent research will cite these conclusions to build a body of “evidence” that will shape federal and state policies regarding treatment of individuals with gender dysphoria.
Children Are Casualties of the War on Science
If NIH were serious about finding the truth, it would be funding a very different kind of study. As it is, the agency is demonstrating the tactics of the so-called “war on science” that the Left continually decries. Contrary to popular belief, this war is being waged not by conservatives, but by politicized researchers within the federal research apparatus.
To protect the integrity of the science it funds, Congress should assert greater control over the programmatic spending of NIH and other federal research agencies. A good place to start would be to defund this transgender study in the next NIH appropriation bill. Doing so would show that Congress cares more about gender dysphoric children than it does about advancing the new sexual orthodoxy.
Without congressional action, the federal government and its agenda-driven medical allies will continue to push politically correct nonsense of the worst kind. The policies that will inevitably grow from this study will be foolish, yes, but in a way much worse than the usual foolish policies that develop from biased federal research. Such research usually harms taxpayers, industries, the Constitution, or all three; the NIH research will harm children. In fact, it may destroy their lives and the well-being of their families. “Compassion” indeed.
Jane Robbins is an attorney and senior fellow with the American Principles Project.