New Study Finds ‘Methodological Flaws’ And ‘Significant Risk Of Harm’ In ‘Dutch Protocol’ For Pediatric Medical Transition

A new study found that even the “best” evidence for pediatric medical transition is of extremely low quality and should not be relied upon as justification for medically transitioning minors.

A peer-reviewed paper published last week critically analyzed the “gold standard” evidence in support of medically transitioning trans-identified children, known as the “Dutch studies,” and found it has “profound, previously unrecognized problems,” and requires “urgent attention from the medical community,” according to the Society for Evidence-based Gender Medicine (SEGM), an international group of over 100 clinicians and researchers.

“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,” said SEGM. (emphasis theirs).

The paper, titled “The Myth of Reliable Research in Pediatric Gender Medicine,” focuses on the two Dutch studies and the resulting “Dutch protocol” that inspired the “gender-affirming” model of care now used worldwide. The Dutch protocol was often considered the more cautious, conservative approach to the radical “affirming” method, but all justification for even carefully selecting minor candidates to medically transition falls apart upon closer inspection.

According to the authors of the paper, the Dutch protocol — which used hormones and surgeries to give minors the appearance of secondary sex characteristics of the opposite sex — would never have been accepted by today’s standards of evidence-based medicine because of its extremely low-quality research and harm caused to some of its participants.

The three clinicians who began medically transitioning gender dysphoric adolescents in Amsterdam practiced in the 1980s and 1990s, before medicine became an established “evidence-based” practice, and relied heavily on “expert opinion.”

The reason why this protocol became the foundation toward “gender-affirming care,” the authors explain, is through a phenomenon called “runaway diffusion,” where the medical community mistakes a small experiment as proven practice. The damage done by “runaway diffusion” can be mitigated by conducting systematic reviews of the evidence and implementing “practice reversal,” as Finland, Sweden, England, and recently the state of Florida have done, the authors note.

The authors of the paper charge that the results of the Dutch studies relied heavily on cherry-picking the participants who had positive or neutral outcomes, while excluding the participants with negative outcomes, to give the illusion of an overall positive result. Another methodological flaw noted by the authors found that the originally stated intention of the Dutch studies was to investigate whether or not the treatment “improved psychological functioning,” but when their research failed to show benefits, the goalpost was moved to a measure of “satisfaction with treatment.”

“The Dutch studies reported only the best-case scenario outcomes while ignoring the serious risks that emerged; wrongly concluded that gender dysphoria ‘disappeared’ post-treatment; and failed to separate the effects of psychotherapy from those of blockers, hormones and surgery,” SEGM summarized in a tweet.

The authors address the many newer short-term studies that have been published since the Dutch research, all of which “perfected the art of spin — misrepresenting weak, uncertain, or even negative findings as strong and positive,” said SEGM. They also note the unprofessional level of political activism demonstrated by gender-clinicians, many of whom try to quash scientific debate by dismissing it as “science denialism” motivated by “transphobia.”

“The key problem in pediatric gender medicine is not the lack of research rigor in the past—it is the field’s present-day denial of the profound problems in the existing research, and an unwillingness to engage in high quality research requisite in evidence-based medicine,” the authors of the paper said.

Leor Sapir, a Manhattan Institute fellow, shared a summary of the paper to his followers on Twitter, explaining its significance, given that the Dutch studies are often cited as the “best available evidence” in guidelines for treating gender dysphoric youth by the World Professional Association for Transgender Health (WPATH), the Endocrine Society, and the American Academy of Pediatrics.

“The new article is therefore hugely significant, as it goes to the heart of the entire pediatric medical transition enterprise,” said Sapir. “It explains in detail why the Dutch studies are fatally flawed and anyway inapplicable to the current clinical scene.”