Summary

WPATH's Standards of Care 8 (2022) is the world's most influential guideline for transgender healthcare. In this study, eight trained raters, doctors and therapists from several fields plus two experienced guideline experts, scored six chapters relevant to young people using the standard checklist for judging how well guidelines are made. The chapters scored poorly on rigour (how evidence was searched for, chosen and linked to advice), on practical usefulness and on independence from funders and conflicts. Overall quality was rated about 3.5 to 4 out of 7. Raters split evenly between recommending the chapters, recommending them with changes, and rejecting them. The findings echo the Cass Review's earlier rating. The study was funded by SEGM, and only eight raters took part.

Key findings

• 8명의 평가자(소아 호르몬 전문의, 성형외과의, 소아과의, 가정의, 심리학자, 정신과의사, 지침 전문가 2명)가 각각 WPATH 지침의 6개 장을 독자적으로 평가했습니다.
• 권고안 개발 과정에 대한 평가는 각 장에서 39~47%를 기록했으며, 증거 검색 및 선정 방법은 7점 만점에 약 1.5~2.5점에 그쳤습니다.
• 실용적 유용성은 28~40%로 가장 낮은 점수를 받았으며, 권고안의 실천 과정 점검 계획은 7점 만점에 1~1.5점으로 평가됐습니다.
• 재정 지원자의 영향력과 이해 상충이 어떻게 관리되었는지 불분명하여 독립성은 43~44%를 기록했습니다.
• 전체 품질은 각 장(청소년, 아동, 호르몬, 정신 건강, 가정의학관리, 수술)마다 7점 만점에 약 3.5~4점으로 평가됐습니다.
• 8명의 평가자 중 단 2명만이 수정 없이 해당 장을 권고할 것이라고 답했으며, 3명은 수정을 거쳐 권고하고, 3명은 권고하지 않겠다고 답했습니다.
• 연구資金: 본 연구는 SEGM의 지원을 받았으며, 연구자들에 따르면 SEGM은 연구 설계, 분석, 논문 작성에 관여하지 않았습니다. 주저자는 SEGM 자문을 수행한 바 있으며, 각 임상 평가자는 약 30-40시간의 작업에 대해 1,500달러를 받았습니다. 다른 지원资金来源은 없습니다.

Abstract

In 2022, the World Professional Association for Transgender Health (WPATH) released their guidelines, Standards of Care Version 8 (SOC8), which have been regarded as establishing standards for the management of transgender patients. To conduct a quality assessment of the WPATH's SOC8 using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, we recruited a diverse group of international health professionals as assessors, including six clinicians and two guideline methodologists, who were trained in the AGREE II tool and underwent a calibration exercise. They independently assessed six SOC8 chapters: adolescents, children, hormone therapy, mental health, primary care, and surgery. We summarized the ratings across assessors for all items to present the strengths and limitations of the guidelines. The evaluations identified that the SOC8 chapters had limitations in the AGREE II domains of applicability (ranging from 28% to 40% across chapters), editorial independence (ranging from 43% to 44% across chapters), and rigor of development (ranging from 39% to 47% across chapters). On a scale of 1 to 7 (7 = highest quality), the median overall quality score was 3.5 to 4 for all chapters. Two of eight assessors recommended using the guideline chapters, while three recommended use with modification, and three recommended not to use the reviewed guideline chapters due to methodological concerns. Evidence-based guidelines addressing the needs of transidentified people are urgently needed, but it is imperative that healthcare providers, researchers, and policymakers recognize and address the limitations present in these six SOC8 chapters.

Conclusion

The assessment found that WPATH's SOC8 guidelines have limitations in scientific and methodological rigour, applicability, and transparency in managing competing interests. Evidence-based guidelines addressing the needs of trans-identified children and adolescents are urgently needed, but uncritical adoption or endorsement of WPATH's guidelines may result in a disservice or even harm to this vulnerable population. Healthcare providers, researchers and policymakers should recognise and address the limitations of SOC8.