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.”

McCarthy Invites Biden To Deliver State Of The Union Address

President Joe Biden is set to deliver his State of the Union address next month following an invitation by House Speaker Kevin McCarthy (R-CA).

McCarthy, who was voted speaker by his peers less than a week ago, issued a letter to Biden on Friday that set February 7 as the date for the president to deliver his speech before a joint session of Congress.

“It is my solemn obligation to invite the president to speak before a Joint Session of Congress on February 7th so that he may fulfill his duty under the Constitution to report on the state of the union,” McCarthy said in a tweet.

It is my solemn obligation to invite the president to speak before a Joint Session of Congress on February 7th so that he may fulfill his duty under the Constitution to report on the state of the union. pic.twitter.com/YBmzLxs3Iz

— Kevin McCarthy (@SpeakerMcCarthy) January 13, 2023

White House Press Secretary Karine Jean-Pierre said Biden accepted the invitation.

“We have received Speaker McCarthy’s kind invitation and the president has accepted it and looks forward to delivering the State of the Union address,” she told reporters at the White House. The press secretary added: “We truly appreciate the kind invitation by Speaker McCarthy.”

White House Press Sec. Karine Jean-Pierre says President Biden has accepted House Speaker Kevin McCarthy’s invitation to deliver the State of the Union address on February 7th. pic.twitter.com/tYfdotpl4P

— The Recount (@therecount) January 13, 2023

The speech will be Biden’s first State of the Union address before a divided Congress, as Republicans won control of the House in the 2022 midterm elections and Democrats kept the Senate. In his letter, McCarthy alluded to actions the GOP-led House is gearing up for over the next two years.

“The new year brings a new Congress, and with it, a responsibility to work towards an economy that is strong, a nation that is safe, a future that is built on freedom, and a government that is accountable,” McCarthy wrote.

Biden may soon announce a 2024 re-election bid, which could set him up for a rematch against former President Donald Trump in the general election.

A recent report from The Hill cited insiders who emphasized February as a month to watch, around the time of the State of the Union.

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