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

• 美国医学团体（WPATH、美国儿科学会和内分泌学会）支持为未成年人使用青春期阻断剂、跨性别激素，在某些情况下还包括手术，而瑞典和芬兰则转向以心理护理为先，并将手术限于成年人。
• 内分泌学会使用了正式的证据评级系统，并将其所有青少年建议的证据都评为“低”或“极低”，却有时仍作出强烈的建议。该评级系统的共同创立者Gordon Guyatt说，这应当很少见，并需要清楚说明。
• WPATH的2022年指南没有证据评级系统。指南专家Mark Helfand发现，有些表述与指南自己的研究评审人员“相矛盾”，这些评审人员把激素对生活质量、抑郁和焦虑影响的证据评为低质量。
• 美国儿科学会2018年政策声明的主要作者说，其过程不太算得上是对研究的正式综述。领先的证据综述机构Cochrane在专家审核后，拒绝发表一项拟议的青春期阻断剂综述。
• 麦克马斯特大学对61项研究综述的汇总（由佛罗里达州医疗补助机构，即公共医疗保险机构出资）发现，对于年轻人的阻断剂、激素和手术，存在“极大的不确定性”。
• 两项近期研究（英国一家全科诊所审计和美国军队药房记录）表明，20%至30%的患者可能在几年内停用激素，但这些测量的是停药，而不是后悔或去过渡。
• 临床医生描述了更快的医学治疗和更少的心理健康评估。在西雅图儿童医院诊所的一项研究中，三分之二的青少年在首次就诊后12个月内就开始使用激素。

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.