The Weak Evidence Behind ‘Gender-Affirming Care’ for Children

Stephen Hammes’s response (Letters, July 5) to our op-ed (“The Endocrine Society’s Dangerous Transgender Politicization,” June 29) proves our point: The Endocrine Society is ignoring the dangers that sex-change treatments pose to children.

Dr. Hammes, president of the Endocrine Society, leaves out that the society’s pro-sex-change guidelines are based on “low” or “very low” quality evidence. He says nothing about the growing number of progressive European countries that are abandoning America’s model of gender-affirming care following systematic reviews of the evidence.

Dr. Hammes says that “2,000 studies published since 1975” support gender-affirming care. Yet many of these studies show negative results or nonresults, while all suffer from methodological problems like selection bias or a lack of proper control groups. These failings make it impossible to say whether drugs and surgeries were superior to less invasive alternatives like psychotherapy or even placebos. All but two dozen studies involved adults who transitioned as adults, not children, meaning more than 1,900 of the studies Dr. Hammes cites have no bearing on this issue. The layman may be impressed by the large number, but evidence-based medicine is concerned with the quality and reliability of research, not its quantity.

If Dr. Hammes is so confident in the Endocrine Society’s guidelines, he should have no problem launching a systematic review of all risks and benefits of hormonal interventions. It is more than warranted, six years after the guidelines were released. Until then, states have no choice but to pass laws to protect children from well-intended but harmful practices.

Roy Eappen, M.D., and Ian Kingsbury, Ph.D.

Do No Harm

Montreal and Marblehead, Mass.