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Achille, C., Taggart, T., Eaton, N. R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T. A. (2020). Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results. International Journal of Pediatric Endocrinology, 2020(1), 1-5.
Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Suicidality and well-being among transgender youth after gender-affirming medical interventions. Clinical Practice in Pediatric Psychology.
Cantu, A. L., Moyer, D. N., Connelly, K. J., & Holley, A. L. (2020). Changes in anxiety and depression from intake to first follow-up among transgender youth in a pediatric endocrinology clinic. Transgender Health, 5(3), 196-200.
Chew, D., Anderson, J., Williams, K., May, T., & Pang, K. (2018). Hormonal treatment in young people with gender dysphoria: a systematic review. Pediatrics, 141(4).
Costa, R., Dunsford, M., Skagerberg, E., Holt, V., Carmichael, P., & Colizzi, M. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. The journal of sexual medicine, 12(11), 2206-2214.
De Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696-704.
De Vries, A. L., Steensma, T. D., Doreleijers, T. A., & Cohen‐Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow‐up study. The journal of sexual medicine, 8(8), 2276-2283.
Kuper, L. E., Stewart, S., Preston, S., Lau, M., & Lopez, X. (2020). Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics, 145(4).
Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3).
Sorbara, J. C., Chiniara, L. N., Thompson, S., & Palmert, M. R. (2020). Mental health and timing of gender-affirming care. Pediatrics, 146(4).
Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA network open, 5(2), e220978-e220978.
White Hughto, J. M., & Reisner, S. L. (2016). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender health, 1(1), 21-31.

A reading list! There was more, but this is a good place to start digging into the literature.
 
borne_before said:
Why?

From Julia Galef, who collects unpopular ideas "Even though I disagree with many of these ideas, I nevertheless think it’s valuable to practice engaging with ideas that seem weird or bad, for two reasons: First, because such ideas might occasionally be true, and it’s worth sifting through some duds to find a gem."

Her lists are pretty interesting: Unpopular ideas about social norms
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If the idea is a dud or bad/harmful, then engagement could have the unintended consequence of legitimizing that idea or shifting the Overton window.
 
www.bmj.com

Gender dysphoria is rising—and so is professional disagreement - BMJ Group

Gender dysphoria in young people is rising—and so is professional disagreement Is there an evidence-based standard of care in the US? More children and adolescents are identifying as transgender and offered medical treatment, especially in the US. But some providers and European authorities are...
www.bmj.com www.bmj.com
 
tr said:
How will you know if the idea is dud/bad/harmful if you exclude a priori any possibility of collecting relevant evidence?
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That assumes no evidence gathering. I can look at the available evidence and can determine that Blanchard's, detransitors, and non-affirming care have no place in a thread about the efficacy of gender-affirming care. Individuals are free to bring these up but those same individuals shouldn't be surprised by the invalidating response it receives/deserves.
 
Heist said:
www.bmj.com

Gender dysphoria is rising—and so is professional disagreement - BMJ Group

Gender dysphoria in young people is rising—and so is professional disagreement Is there an evidence-based standard of care in the US? More children and adolescents are identifying as transgender and offered medical treatment, especially in the US. But some providers and European authorities are...
www.bmj.com www.bmj.com
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That article (really, letter to the editor) has a profound lack of data. For example, it somehow concludes that adolescents going to gender dysphoria treatment centers "have no history of gender dysphoria."
 
Heist said:
So then everything else in this long article is incorrect also?
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I commented on this article in the other thread. It is a position statement, not a research article. I'm not saying that the position is good or bad, just that it is a position statement, not a research article.
 
Heist said:
So then everything else in this long article is incorrect also?
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If you think this is "long" think that medical professionals and psychologists have a different view of what "long" means in reference to journal articles. I cut and pasted it into WORD, and it's 2 pages, double-spaced. 701 word count. I think my reply to it on the other post may have been longer!

Regardless of where it's published, it's journalism- not research. That doesn't mean it's bad or good, but it is what it is.

ETA- I also don't see an author listed or a byline, other that "BMJ Newsroom." The article cites "Jennifer Block, investigations reporter" but it doesn't make it clear where who is actually writing what we are reading.
 
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ClinicalABA said:
If you think this is "long" think that medical professionals and psychologists have a different view of what "long" means in reference to journal articles. I cut and pasted it into WORD, and it's 2 pages, double-spaced. 701 word count. I think my reply to it on the other post may have been longer!

Regardless of where it's published, it's journalism- not research. That doesn't mean it's bad or good, but it is what it is.

ETA- I also don't see an author listed or a byline, other that "BMJ Newsroom." The article cites "Jennifer Block, investigations reporter" but it doesn't make it clear where who is actually writing what we are reading.
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You're right. I had a much longer article and didn't realize this wasn't it. I will try to look for the one that is actually long 😁
 

Most people that detransition do so on a temporary basis. The rates of gender affirming care regret, as a result of gender dysphoria being miss DXed, are still being reported as being pretty astronomically low.

Fact of the matter is, with the data we have right now, gender affirming care is displaying pretty solid clinical results with non-ordinarily low regret rates. Most surgeons would blush at some of these treatment regret rate stats, of course you're not finding people going out in the streets and protesting against emergency colon surgery for having higher regret rates (Decisional Regret Among Patients Undergoing Colectomy : Diseases of the Colon & Rectum).

I guess my bigger question is when does the burden of proof begin to fall on the "other-side" for finding evidence to be against gender affirming care? I get the need for contradictory evidence and ideas, but at what point are you the equivalent of being one of the 5 climate scientists that are calling BS on global warming?

To be clear I don't think we're at the last example quite yet, but I'd be shocked if we weren't in as little as 10 years. I'm sure we'll have more official studies done on this but I think the "more trans kids" thing can be explained the same way we saw higher rates of gay people as the social climate became more accepting.
 
The Cinnabon said:
I guess my bigger question is when does the burden of proof begin to fall on the "other-side" for finding evidence to be against gender affirming care? I get the need for contradictory evidence and ideas, but at what point are you the equivalent of being one of the 5 climate scientists that are calling BS on global warming?
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This is a caricature. I don't think any serious professionals are "against gender affirming care". The devil is in the details: what sort of care, and at what time, for which individuals?

Gender affirming care spans a gamut from supportive mental health care through temporizing measures like puberty blockers, to invasive, irreversible surgical and/or endocrinological interventions that will commit the patient to a lifetime of exogenous hormone treatment, which comes with other long term health risks, to maintain.

Any of these interventions can be appropriate for some individuals, but how to determine which individuals need which type of care at which time is nontrivial.

The whole issue is made very sticky by the fact that adolescence is a critical choice point for some irreversible commitments one way or the other, but also represents a time of shifting self-concepts and experimentation with identity across the board, not only with respect to gender.

I don't think a 'one size fits all' approach is useful here. The fact that detransitioners have unfortunately been used as a political football is not a reason to ignore the important questions of how best to identify which individuals would benefit most from which types of care and, critically, at which developmental time points.
 
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I think it may be important to present broad categories of gender affirming care. These are purely my thoughts:

Social: Many folks who identify as trans or non-binary stay in this category their whole life. No hormone therapy. No surgery. They use other signifiers of gender like their pronouns, clothing, makeup, etc. Professionals can create a welcoming environment by not making assumptions about pronouns/using appropriate pronouns, having bathroom policies that aren't antagonizing, training staff to be knowledgeable about health disparities, etc. You may also be asked to help with getting some legal documents changed, but some of these have to be signed off by medical doctors. If you're unwilling to do that, know who does, so they're not left having to start the process of finding a provider from scratch.

Hormone therapy: This can look a few different ways, but basically folks can block certain hormones or increase hormones. We do this across all kinds of folks, trans and cis. If a kiddo starts puberty super early, they can be prescribed puberty blockers. If a kid is small, they can be given growth hormones. Psychology is rarely involved here. We get called in more often when there is a discussion around gender dysphoria and identity struggles. We assess for gender dysphoria, evaluate other mental health difficulties, etc. Typical assessment/psychotherapy stuff. Psychology probably isn't going to be asked to do much beyond this. In younger folks, you're mostly going to run into puberty blockers and social transitioning. You might get asked to sign a support letter for an insurance company who doesn't want to pay for it without a sign-off from a professional, but this can be pushed off to their medical provider or someone else if you're uncomfortable. Again, just know who to refer to if you don't feel competent. Support letters basically attest to a person's ability to make informed decisions and meeting criteria for gender dysphoria. You'll also be asked to briefly summarize mental health history and if they're stable. If you've done any transplant/bari evals, this isn't much different.

Gender confirming surgery: Almost always adults! One, it's expensive. Two, there is a long waitlist at most places who are open to doing them. It is rare for someone to have access to surgery and many people don't want to do surgeries at all. Psychology gets asked to do assessments, support letters, psychotherapy, etc. I work with the LGBTQ+ community regularly and rarely get asked to do this. I'm more than happy to, but it doesn't come up a ton.

ETA: clarifying for the types of surgery. You would run into chest-related surgeries more often because more folks will do them. Surgery on genitals is a more complicated procedure and that is where the waitlists come in.

There are people who are comfortable doing none, some, or all of these categories. Just like every psychologist will not do a bariatric assessment for their client, psychologists don't have to do all parts of gender affirming care. Know what you're comfortable with and find compassionate ways to get clients what they need when you're uncomfortable.
 
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Shiori said:
I think it may be important to present broad categories of gender affirming care. These are purely my thoughts:

Social: Many folks who identify as trans or non-binary stay in this category their whole life. No hormone therapy. No surgery. They use other signifiers of gender like their pronouns, clothing, makeup, etc. Professionals can create a welcoming environment by not making assumptions about pronouns/using appropriate pronouns, having bathroom policies that aren't antagonizing, training staff to be knowledgeable about health disparities, etc. You may also be asked to help with getting some legal documents changed, but some of these have to be signed off by medical doctors. If you're unwilling to do that, know who does, so they're not left having to start the process of finding a provider from scratch.

Hormone therapy: This can look a few different ways, but basically folks can block certain hormones or increase hormones. We do this across all kinds of folks, trans and cis. If a kiddo starts puberty super early, they can be prescribed puberty blockers. If a kid is small, they can be given growth hormones. Psychology is rarely involved here. We get called in more often when there is a discussion around gender dysphoria and identity struggles. We assess for gender dysphoria, evaluate other mental health difficulties, etc. Typical assessment/psychotherapy stuff. Psychology probably isn't going to be asked to do much beyond this. In younger folks, you're mostly going to run into puberty blockers and social transitioning. You might get asked to sign a support letter for an insurance company who doesn't want to pay for it without a sign-off from a professional, but this can be pushed off to their medical provider or someone else if you're uncomfortable. Again, just know who to refer to if you don't feel competent. Support letters basically attest to a person's ability to make informed decisions and meeting criteria for gender dysphoria. You'll also be asked to briefly summarize mental health history and if they're stable. If you've done any transplant/bari evals, this isn't much different.

Gender confirming surgery: Almost always adults! One, it's expensive. Two, there is a long waitlist at most places who are open to doing them. It is rare for someone to have access to surgery and many people don't want to do surgeries at all. Psychology gets asked to do assessments, support letters, psychotherapy, etc. I work with the LGBTQ+ community regularly and rarely get asked to do this. I'm more than happy to, but it doesn't come up a ton.

ETA: clarifying for the types of surgery. You would run into chest-related surgeries more often because more folks will do them. Surgery on genitals is a more complicated procedure and that is where the waitlists come in.

There are people who are comfortable doing none, some, or all of these categories. Just like every psychologist will not do a bariatric assessment for their client, psychologists don't have to do all parts of gender affirming care. Know what you're comfortable with and find compassionate ways to get clients what they need when you're uncomfortable.
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What years are you referring to where people remain trans their whole life?
The numbers have increased exponentially in the last few years so we don't have data on that yet
 
Shiori said:
I think it may be important to present broad categories of gender affirming care. These are purely my thoughts:

Social: Many folks who identify as trans or non-binary stay in this category their whole life. No hormone therapy. No surgery. They use other signifiers of gender like their pronouns, clothing, makeup, etc. Professionals can create a welcoming environment by not making assumptions about pronouns/using appropriate pronouns, having bathroom policies that aren't antagonizing, training staff to be knowledgeable about health disparities, etc. You may also be asked to help with getting some legal documents changed, but some of these have to be signed off by medical doctors. If you're unwilling to do that, know who does, so they're not left having to start the process of finding a provider from scratch.

Hormone therapy: This can look a few different ways, but basically folks can block certain hormones or increase hormones. We do this across all kinds of folks, trans and cis. If a kiddo starts puberty super early, they can be prescribed puberty blockers. If a kid is small, they can be given growth hormones. Psychology is rarely involved here. We get called in more often when there is a discussion around gender dysphoria and identity struggles. We assess for gender dysphoria, evaluate other mental health difficulties, etc. Typical assessment/psychotherapy stuff. Psychology probably isn't going to be asked to do much beyond this. In younger folks, you're mostly going to run into puberty blockers and social transitioning. You might get asked to sign a support letter for an insurance company who doesn't want to pay for it without a sign-off from a professional, but this can be pushed off to their medical provider or someone else if you're uncomfortable. Again, just know who to refer to if you don't feel competent. Support letters basically attest to a person's ability to make informed decisions and meeting criteria for gender dysphoria. You'll also be asked to briefly summarize mental health history and if they're stable. If you've done any transplant/bari evals, this isn't much different.

Gender confirming surgery: Almost always adults! One, it's expensive. Two, there is a long waitlist at most places who are open to doing them. It is rare for someone to have access to surgery and many people don't want to do surgeries at all. Psychology gets asked to do assessments, support letters, psychotherapy, etc. I work with the LGBTQ+ community regularly and rarely get asked to do this. I'm more than happy to, but it doesn't come up a ton.

ETA: clarifying for the types of surgery. You would run into chest-related surgeries more often because more folks will do them. Surgery on genitals is a more complicated procedure and that is where the waitlists come in.

There are people who are comfortable doing none, some, or all of these categories. Just like every psychologist will not do a bariatric assessment for their client, psychologists don't have to do all parts of gender affirming care. Know what you're comfortable with and find compassionate ways to get clients what they need when you're uncomfortable.
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Great post! Also, bottom surgeries have a lot more risks (of course, no surgeries are risk-free) and more variable outcomes than top surgeries, so a fair number of trans people skip or wait on them, because the cost-benefit ratio isn't right for them.
 
ClinicalABA said:
If you think this is "long" think that medical professionals and psychologists have a different view of what "long" means in reference to journal articles. I cut and pasted it into WORD, and it's 2 pages, double-spaced. 701 word count. I think my reply to it on the other post may have been longer!

Regardless of where it's published, it's journalism- not research. That doesn't mean it's bad or good, but it is what it is.

ETA- I also don't see an author listed or a byline, other that "BMJ Newsroom." The article cites "Jennifer Block, investigations reporter" but it doesn't make it clear where who is actually writing what we are reading.
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Rare off topic reply from me: someone remind me to stop reviewing articles for psychology journals. The manuscripts are so long. Nope.
 
PsychPhDone said:
Rare off topic reply from me: someone remind me to stop reviewing articles for psychology journals. The manuscripts are so long. Nope.
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I was once asked to review a manuscript where the author appeared to have literally just submitted their unedited dissertation--the introduction alone was about 30 pages. I noped out of that.
 
Watched a documentary on David Bowie the other day. He made challenging gender norms cool. Those were the good old days. All this political stuff is just so non-entertaining. If gender affirming care just means supporting an individual in the process, then I’ve been doing that for years. I think some people are concerned that it will mean a mandate to begin medical transition when an adolescent expresses that desire. The ability to appraise risks and benefits on the long term as shiori was discussing is something I have seen in my adult patients and not so much in the younger ones who are usually pushing hard to get it done and upset that there are any obstacles.
 
I really recommend sitting down with the WPATH recommendations if the process is concerning. It is very thorough about caveats, necessary competencies for providers, etc. If a child or teen (or adult) expresses that they are trans, the first step is not medical transition.

The recommendations start on page 45/S43 for adolescents.
https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

I found another article! I like it because it's from a referral center for sex hormone therapy and they give concrete numbers showing the increase of patients since they started in the 90s.
Changing Demographics in Transgender Individuals Seeking Hormonal Therapy: Are Trans Women More Common Than Trans Men?
 
smalltownpsych said:
Watched a documentary on David Bowie the other day. He made challenging gender norms cool. Those were the good old days. All this political stuff is just so non-entertaining. If gender affirming care just means supporting an individual in the process, then I’ve been doing that for years. I think some people are concerned that it will mean a mandate to begin medical transition when an adolescent expresses that desire. The ability to appraise risks and benefits on the long term as shiori was discussing is something I have seen in my adult patients and not so much in the younger ones who are usually pushing hard to get it done and upset that there are any obstacles.
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The same people who now have qualms about gender-affirming care were (for the most part) the same people who ridiculed cis people for challenging gender norms. Make it make sense.
 
futureapppsy2 said:
I was once asked to review a manuscript where the author appeared to have literally just submitted their unedited dissertation--the introduction alone was about 30 pages. I noped out of that.
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For real? Your editor must've been too busy with their golf game to bother with desk rejection.
 
borne_before said:
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More research is always better but the fact that there are no RCTs isn't that surprising considering you have to take into account equipoise and the ethics of clinical research. It would be unethical to have a group of control participants be refused hormone therapy considering the risk it would present to their mental well-being. I'm not even talking about suicidality. Simply having gender dysphoria is painful and allowing a child to go through that unnecessarily sans intervention is unethical.
 
borne_before said:
Here's an interesting comparison of Sweden's model vs WPATH 8 (which, to their credit, is always updating):

Personally, from a policy perspective, I think Sweden's is probably a better move.
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Do you mind sharing where this screenshot is from?

Does anyone know if the WPATH SOC8 is available for free (it cost 55 bucks on their website). I'm particularly curious about the WPATH SOC8 summary statement on the document @borne_before posted stating that "patient desire is the ultimate eligibility criterion." This statement is presented parallel to the Swedish Position summary statement regarding eligibility for hormonal treatment, which implies that it is the WPATH SOC8 positions on hormonal treatment. Is that really the WPATH SOC8 on hormonal treatment? That seems unlikely to me.

ETA- found the link (the 55 bucks was for a printed copy). Link is here: https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

I'm curious to check out the source and see if the summary statements in @borne_before screenshot are representative of the actual WPATH standards of care.
 
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Sorry! I didn't mean to make it seem like they are objective. I meant that they present links to different positions. If they make an assertation that someone said something, they will provide a link, etc. They don't attempt to be objective regarding individuals. I should have made that clear. I have followed the blog off and on for years and many of them have been a part of the "skepticism" movement. They run in spaces with people like Michael Shermer, Richard Dawkins, and Penn & Teller. I don't follow the skepticism movement as much, but it introduced me to this blog. Steve Novella has been a regular commentator as well.
 
I encourage you all to, on your own, compare the SEGM characterization of the WPATH SOC8 with the position as actually stated in the WPATH SOC8 document. Regardless of the "rightness" or "wrongness" or empirical support/lack of for either position, I believe that you will find that the SEGM summaries mischaracterize (and in some cases grossly so) the WPATH positions on many/most of the issues. Given my biases and what I know about SEGM, I personally believe they (or he- if it is all coming from William Malone) do so intentionally, hiding an activist group with a political and moral agenda behind a "sciency" sounding name. I may be incorrect on the latter position (i.e., intent), but I think I'm pretty spot on with my former one (i.e., the WPATH position is mischaracterized).

I'll also add that the WPATH SOC8 is a comprehensive document that includes the methodology for arriving at their conclusions, clear definitions of terms- including population labels, and an appendix with more detailed methodology and definitions. It also included a very comprehensive reference section citing 100s (1000s? I lost count) of primary sources. Their methodology includes multiple checks of procedures from independent (i.e., not directly affiliated with WPATH or otherwise involved with the SOC8 project). The linked source from SEGM is a web page which does not include even an authors name and has no references. As such, we are not privy to who is summarizes the WPATH SOC8 positions, or their methods or rationale for developing those summaries. We are also not clear why they have focused exclusively on Sweden, rather that summarize the positions of similar countries boards of health.

I have not reviewed the Swedish NBHW positions in detail, but can say that the SEGM summary statement that " Hormonal interventions should be restricted to research settings" is somewhat misleading, if not an outright mischaracterization. The NBWH position is that, yes, hormonal therapies with "young people" should be "provided within a research context", but they clarify that this does not mean an RCT (randomized clinical trial). Further, they state that "Until a research study is in place, the NBHW deems that treatment with GnRH-analogues and sex hormones may be given in exceptional cases, in accordance with the updated recommendations and criteria described in the guidelines." Those guidelines include criteria of "an early (childhood) onset of gender incongruence, persistence of gender incongruence until puberty and a marked psychological strain in response to pubertal development is among the recommended criteria." That is not quite the same a saying it should be restricted to research settings. If this is how SEGM summarizes/characterizes the NBHW point on this one issue, it brings into question the accuracy of their/his characterization their other positions.
 
Apologies if this is already addressed in one of the articles posted, but is anyone aware of studies of hormonal interventions in patients that are born female and effects on schizophrenia development/severity?

The thought occurs because of the higher rates of GDD in patients on the schizophrenia spectrum, and the protective effect of estrogen from schizophrenia. The potential clinical significance would be assessing for schizophrenia risk and including in discussion of risks/benefits with born-female patients before starting hormonal interventions, and whether increased monitoring for signs/symptoms of developing schizophrenia are warranted after starting intervention.
 
aim-agm said:
Apologies if this is already addressed in one of the articles posted, but is anyone aware of studies of hormonal interventions in patients that are born female and effects on schizophrenia development/severity?

The thought occurs because of the higher rates of GDD in patients on the schizophrenia spectrum, and the protective effect of estrogen from schizophrenia. The potential clinical significance would be assessing for schizophrenia risk and including in discussion of risks/benefits with born-female patients before starting hormonal interventions, and whether increased monitoring for signs/symptoms of developing schizophrenia are warranted after starting intervention.
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EDIT: re-reading I see I was not answering your question, sorry.
 
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