Summary

This BMJ investigation asks whether the US claim of medical agreement on treating gender distress in young people is backed by evidence. Block looks at the three most-quoted US guidance documents (from WPATH, the American Academy of Pediatrics and the Endocrine Society) and interviews experts on how they were made. Research reviews behind these guidelines rated the evidence for teenagers as low or very low quality, yet strong recommendations were made, and the pediatrics statement was not based on a formal review of the research. Meanwhile Sweden, Finland and NHS England were restricting medical treatment. It documents real weaknesses in the US guidelines and showed a major journal took the debate seriously. But it is journalism: the reporter chose the sources and examples, some figures (such as 20–30% stopping hormones) come from limited studies, and some readers called it biased.

Key findings

• Kelompok medis AS (WPATH, American Academy of Pediatrics, dan Endocrine Society) mendukung penghambat pubertas, hormon lintas-seks, dan, dalam beberapa kasus, operasi bagi anak di bawah umur, sementara Swedia dan Finlandia beralih mengutamakan perawatan psikologis dan membatasi operasi pada orang dewasa.
• Endocrine Society memakai sistem formal untuk menilai bukti dan menilai bukti untuk semua rekomendasinya bagi remaja sebagai 'rendah' atau 'sangat rendah', namun terkadang membuat rekomendasi yang kuat. Gordon Guyatt, salah satu pendiri sistem penilaian itu, mengatakan hal ini seharusnya jarang terjadi dan dijelaskan dengan jelas.
• Pedoman WPATH 2022 tidak memiliki sistem penilaian bukti. Pakar pedoman Mark Helfand menemukan pernyataan yang 'bertentangan dengan' peninjau penelitian milik pedoman itu sendiri, yang menilai bukti tentang efek hormon terhadap kualitas hidup, depresi, dan kecemasan sebagai berkualitas rendah.
• Penulis utama pernyataan kebijakan American Academy of Pediatrics 2018 mengatakan prosesnya tidak benar-benar dapat dihitung sebagai tinjauan formal atas penelitian. Cochrane, kelompok tinjauan bukti terkemuka, menolak menerbitkan usulan tinjauan penghambat pubertas setelah pemeriksaan pakar.
• Ringkasan University McMaster atas 61 tinjauan penelitian, yang dibiayai oleh badan Medicaid (asuransi kesehatan publik) Florida, menemukan 'ketidakpastian besar' tentang penghambat, hormon, dan operasi pada anak muda.
• Dua studi terbaru (audit praktik dokter keluarga di Inggris dan catatan farmasi militer AS) menunjukkan bahwa 20–30% pasien mungkin berhenti memakai hormon dalam beberapa tahun, tetapi studi-studi ini mengukur berhenti, bukan penyesalan atau berhenti transisi.
• Para klinisi menggambarkan perawatan medis yang lebih cepat dan penilaian kesehatan mental yang lebih sedikit. Dalam sebuah studi di klinik Seattle Children's, dua pertiga remaja memakai hormon dalam 12 bulan sejak kunjungan pertama mereka.

Conclusion

This investigative report from The BMJ concludes that despite claims of consensus, gender-affirming medical treatments for minors with gender dysphoria lack strong evidence-based support. Key findings include: (1) US medical organizations (WPATH, AAP, Endocrine Society) endorse gender-affirming care including puberty blockers, hormones, and surgeries, while several European countries (Sweden, Finland, France, UK) have moved to restrict medical interventions for minors, prioritizing psychological care; (2) systematic reviews commissioned by guideline bodies found evidence quality to be "low" or "very low," with experts criticizing the misapplication of "evidence-based" labeling to recommendations not meeting rigorous standards; (3) the surge in treatment of minors—particularly birth-registered females with no prior history of gender dysphoria—has outpaced research, with long-term outcomes unknown and detransition rates potentially as high as 20-30%; (4) clinical practice has shifted toward rapid medicalization, with concerns about inadequate assessment and perfunctory informed consent processes; and (5) prominent evidence-based medicine experts conclude that when rigorous systematic reviews find "we don't know," claims of certainty are not evidence-based, and consensus-based guidelines should not be called evidence-based.