Leor Sapir (@LeorSapir) · Jul 26, 2023 · 5:56 PM UTC
I'm reposting my review of a new paper in
@TheLancet by @Dr_ArjeeRestar, which makes the case that "gender-affirming care" is preventative medicine. I claimed in the previous post that the paper was peer-reviewed (it isn't). Here is the original commentary, amended.
Highlights [of Restar's paper] include:
1. "Other forms of GAC services ranges from affirmative counselling to hormones for youths, while surgeries is [sic] limited to adults."
We already know this is provably false. In fact, WPATH SOC-8 has no age minimums surgeries (except phalloplasty). What source does Restar cite for "surgeries is limited to adults"? You guessed it: WPATH SOC-8. (You can't make this up.)
2. "Notably, in a large match control study, use of hormones was associated with less depression, and trans people not on hormones had 4-fold increased risk of depressive disorder."
The citation Restar provides says this: "Due to the cross-sectional design, longitudinal research is required to fully confirm the finding that CHT use reduces depression." Cross-sectional means no causal inferences. One reason the hormone cohort might have done better is that only people with better mental health were allowed to get hormones.
3. "To date, no studies have reported findings that suggest GAC increases negative mental health outcomes."
Some studies found no improvement (e.g., GIDS failed attempt to replicate Dutch study), and some found deterioration in treatment subsets. Even if using drugs with known/anticipated harms results merely in no MH benefit, it's (potentially) a net harm.
4. "Results from a prospective cohort study of U.S. trans youths showed increases in positive psychological outcomes, including positive affect and life satisfaction, and decreases in depression and anxiety symptoms after receiving 2 years of hormones—addressing the lack of longitudinal data in this area."
Restar cites Chen et al., but forgets to mention the HARKing [hypothesising after the results are known] in this study, the unimpressive extent of MH improvement, and the fact that... 2 of the 315 kids who got medicalized committed suicide, which is 20+ times the gen pop rate.
And the list goes on and on. Restar's basic point? No gatekeeping! GAC is settled science, most "relevant" (read: GAC-approving) medical associations agree, and one shouldn't have to have a GD Dx to get GAC. But also, we should totally depathologize trans identity. (Note: this is not a contradiction, but enhanced dialectical awareness.)
Good grief. It's like they're not even trying anymore.
Restar's paper:
https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(23)00118-7/fulltext