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This paper by @marcusevanspsyc about medical interventions for #trans youth has been making the rounds. It has some major issues, which I'll outline here. #medtwitter @jk_rowling https://www.cambridge.org/core/journals/bjpsych-bulletin/article/freedom-to-think-the-need-for-thorough-assessment-and-treatment-of-gender-dysphoric-children/F4B7F5CAFC0D0BE9FF3C7886BA6E904B
First, the paper claims that "rapid-onset gender dysphoria" is a new diagnostic category. The correction on the PLoS One paper about "rapid-onset gender dysphoria" clearly stated that it did not establish a new diagnostic category.
The paper also claims that "rapid onset gender dysphoria" makes up "a substantial proportion" of referrals to gender clinics. It provides no citation to back up this claim. There are no data showing that this is true.
It also states that most clinicians practice the "watchful waiting" approach. The "watchful waiting" approach refers only to prepubertal youth, who do not receive medical interventions under any clinical guidelines. The watchful waiting approach is irrelevant to this discussion.
The paper claims that most kids with gender dysphoria "desist" in their identification of transgender. This is again in reference to studies of prepubertal youth and irrelevant to the topic of medical interventions. "Desistance" is rare after the onset of puberty.
It states (without citation) that prepubertal social transitions send children "down a path" of continuing to identify as transgender (i.e. make them identify more strongly as transgender) and seek medical interventions. This is not true, as shown here: https://journals.sagepub.com/doi/abs/10.1177/0956797619830649
The paper claims that the affirmative model does not allow providers to "explore a child's underlying belief systems and motivations." That's not true. For instance, the @AACAP policy statement on conversion therapy clearly advocates for "open exploration"
https://www.aacap.org/aacap/policy_statements/2018/Conversion_Therapy.aspx
https://www.aacap.org/aacap/policy_statements/2018/Conversion_Therapy.aspx
None of these citations show that there are psychological determinants of gender identity. Some are completely unrelated to the topic.
The "research" section cites several interviews but ignores all studies showing favorable mental health outcomes for trans youth who receive medical interventions (eg deVries et al 2014, Costa et al 2015, Turban et al 2020, Achille et al 2020, Allen et al 2019, Kuper et al 2020)
Later, the paper again claims that a large number of individuals presenting to gender clinics have "rapid onset gender dysphoria." There is no citation to back up this claim.
Another claim with no citation.
The author and I share common ground that not all trans folks will desire medical interventions. In our recent study, only 17% of transgender folks reported ever wanting pubertal suppression. No one should force medical intervention on people. I'm not aware of anyone who does.
I also agree that if doctors are providing medical interventions without explaining risks and benefits, that would be unethical. Endocrine society guidelines clearly state providers must explain to patients risks and benefits of intervention. Every gender clinic I've seen does so