Concept of child sex changes 'escaped the lab' before being fully vetted

The experiment of using puberty blockers to perform medical sex changes on children “escaped the lab” while still in its innovative phase, and spread across the globe before there was any proof that it was either safe or beneficial, according to a team of experts.

In a recent paper titled The Myth of Reliable Research, Drs. E. Abbruzzese, Julia W. Mason, and Stephen B. Levine argue that since that lab leak, a “false narrative has taken root,” which is that child sex changes are “as benign as aspirin, as well-studied as penicillin and statins, and as essential to survival as insulin for childhood diabetes.”

The paper charts the history of the experiment of child sex changes from its beginning in an Amsterdam clinic in the late 1980s, when it was common to practice medicine based on expert opinion and often backed with minimal research. The term “evidence-based medicine” only began to emerge in the 1990s.

At the beginning, performing sex changes on children was an “innovative practice.” The innovative practice framework allows clinicians to “implement untested but promising interventions for a condition which, if left untreated, might have dire outcomes; when existing treatment options seem ineffective; and when the number of affected patients is small.”

At the time, the number of youth presenting to gender clinics was tiny.

The paper calls the innovative practice model of care “a double-edged sword,” because on the one hand, it can rapidly advance medical science but on the other, it has the potential to hurt individuals and societies by promoting a non-beneficial or harmful intervention.

Therefore, it is an ethical requirement that any new intervention developed under the innovative practice framework be moved to a high-quality clinical research setting that is capable of demonstrating the benefits of a given treatment outweigh the risks.

This is crucial in order to prevent “runaway diffusion”—the phenomenon in which the medical world mistakes a small innovative experiment as a proven practice, and a potentially non-beneficial or harmful practice “escapes the lab” and spreads rapidly into the general medical setting.

According to the authors of the paper, runaway diffusion is exactly what happened in pediatric gender medicine.

So-called gender-affirming care for children in the form of puberty blockers and cross-sex hormones quickly spread across the globe, without the necessary rigorous clinical research to prove that it was safe or beneficial.

According to Dr. Michael Biggs, Dr. Norman Spack, the clinician who introduced the protocol to the U.S. in 2007 recalls “salivating” at the prospect of treating minors with these experimental drugs.

No research demonstrated that the psychological benefits outweighed the cost of taking perfectly healthy adolescents and turning them into lifelong medical patients, robbing them of their fertility and putting them at an elevated risk of various serious medical conditions.

Abbruzzese et al. explain that the speed of the runaway diffusion “accelerated exponentially” as gender dysphoria went from being vanishingly rare prior to 2015 to something that impacts “as many as 1 in 10-20 young people.”

The team argues that the recent politicization of gender healthcare “has provided further fuel to the rapid proliferation” of adolescent sex changes, citing a recent proposal by the Biden administration to mandate healthcare entities to provide “gender-affirming” interventions to minors or risk loss of federal healthcare funding on the grounds of discrimination.

The remedy for “runaway diffusion” begins with systematic reviews of evidence, followed by the updating of policies and practices, and ending with harmful treatments being withdrawn, in a process known as “practice reversals."

The team accuses US medical associations of using their prestige to shield the practice of pediatric “gender affirmation” from the same scrutiny it has been put under in Sweden, Finland and England, nations that have undertaken systematic reviews of the evidence and found it to be so lacking that each has reverted back to the more cautious psychotherapeutic approach to treating these vulnerable young people.

The paper mounts a serious challenge to the original Dutch studies, considered the “gold standard” in the field of pediatric gender medicine. These studies form the foundation of “gender-affirming care” for minors, but according to Abbruzzese et al, they “suffer from such profound limitations that they never should have been used as justification for propelling these interventions into general medical practice.”

These limitations include the small sample size, the lack of control group, the number of patients lost to follow-up, and the fact that one teenager died following complications post vaginoplasty surgery.

Researcher Dr. Michael Biggs has suggested that this teen likely died as a direct result of the puberty blockers experiment because blocking a boy’s puberty prevents the genitals from developing and means that there isn’t enough penile tissue to create a neo-vagina during vaginoplasty, meaning the surgeon must use a section of the bowel. This extra step comes with an increased risk of necrotizing fasciitis, the complication from which the patient in the study died.

Then there is the bizarre decision made by the Dutch clinicians to switch the gender dysphoria questionnaires post transition, meaning a male at the beginning of the process would have been given a questionnaire with questions such as “does having an erection cause you to feel dysphoric?” whereas after hormones and surgery, that same male would be given the female questionnaire containing questions such as “does having a menstrual period cause you dysphoria?” Answering no to such questions would give the impression that the dysphoria had been resolved.

“The linchpin finding of ‘resolution of gender dysphoria’ is entirely invalid, since the homegrown gender dysphoria scale and its scoring mechanism were reversed after treatment, essentially guaranteeing a significant post-surgical drop in ‘gender dysphoria’ scores,” write Abbruzzese et al.

The only attempt to replicate the supposedly positive psychological outcome of the Dutch study was undertaken at the UK’s soon-to-be-closed Tavistock gender clinic, but the researchers concluded that there were “no changes in psychological function” and conceded that their results were “in contrast to the Dutch study.”

To conclude, Abbruzzese et al. state that “no other pediatric intervention of similarly drastic nature has ever been delivered at scale based such low quality of evidence,” arguing that the burden of proof is on those promoting the intervention, not on those concerned about the harms, and pointing out that the “history of medicine is replete with examples of ‘cures’ which turned out to [be] far more harmful than the disease.”


Image: Title: protect trans kids
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