The Dutch Studies and The Myth of Reliable Research in Pediatric Gender MedicineA new study identifying flaws in gender medicine research demands urgent attention from the medical community
January 11, 2023
A new open-access publication, “The Myth of Reliable Research in Pediatric Gender Medicine,” focuses on the two Dutch studies that gave rise to “gender-affirmative” care for youth worldwide. The authors convincingly demonstrate that rather than "solid prospective research" or even the “gold standard” in research, as these studies are frequently described by the proponents of "gender-affirmative care," the Dutch research suffers from profound, previously unrecognized problems. These problems range from erroneously concluding that gender dysphoria disappeared as a result of “gender-affirmative treatment,” to reporting only the best-case scenario outcomes and failing to properly examine the risks, despite the fact that a significant proportion of the treated sample experienced adverse effects.
The authors note that the Dutch studies, while of unacceptably low quality by today’s standards, were commensurate with the clinical and research practices during the era of expert opinion-led medicine widely practiced before the 1990s. The term “evidence-based medicine” and its focus on quality comparative clinical research to determine optimal treatment only emerged in the 1990s. The Dutch researchers began to medically transition gender dysphoric adolescents in the late 1980s and early 1990s—just as medicine was starting to undergo this major paradigm shift.
The authors assert that had the Dutch studies been published today for the first time, the "innovative practice" of using hormones and surgery to gender-transition children and young adults would never have been permitted to enter general medical settings due to the very low quality of the research, and problematic outcomes experienced by several of the young people. Unfortunately, since the publication of the final Dutch study in 2014, the practice of youth gender transitions underwent what's known as “runaway diffusion”— a problematic but not uncommon phenomenon whereby the medical community mistakes a small innovative experiment as a proven practice, and a potentially nonbeneficial or harmful practice “escapes the lab,” rapidly spreading to general practice settings.
The authors note that the only way to curb the damage of ongoing “runaway diffusion” is to conduct systematic reviews of evidence, update treatment guidelines to reflect the lack of evidence, and then “de-implement” unproven or harmful practices—a process known as “practice reversal.” They observe that such practice reversals of “gender-affirming” interventions for youth are already underway in Finland, Sweden, England, and most recently the state of Florida.
The authors also address the plethora of new studies since the Dutch research. They note that these newer studies, which purport to have definitively proven that puberty blockers and cross sex hormones are “as benign as aspirin, as well-studied as penicillin and statins, and as essential to survival as insulin for childhood diabetes” are even more flawed than the original Dutch research. To demonstrate the lack of rigor in more recent research, the authors focus on three recent studies, including the most recent study by Tordoff et al. That study made headlines for purportedly demonstrating that following 12 months of “treatment” with puberty blockers and cross-sex hormones, depression in gender-dysphoric youth all but disappeared. The authors demonstrate that this finding is both implausible and indefensible. They conclude that far from having perfected previously flawed research methods, these newer studies continue to suffer from serious problems but that researchers have indeed perfected the art of spin—misrepresenting weak, uncertain, or even negative findings as strong and positive.
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Source:
https://segm.org/Dutch-studies-critically-flawed
