Quick Review: Gender-affirming Care Saves Lives, Matouk & Wald

This was being shared by Billboard Chris online today and I thought I’d take a quick look at the evidence that the cited study provides to back up the “FACTS” quoted on the leaflet:

It’s available online here, if you would like to read it for yourself, and you’ll note it’s not a peer-reviewed piece, just an online article.

Let’s start with FACT #1 - that gender affirming care reduces the risk of suicide, where they particularly highlight puberty blockers.

The referenced article does not directly quote any evidence that backs this up. They mention the 2020 Trevor Project National Survey in the context of demonstrating the LGBT youth in general have high levels of suicidality, which I don’t think most people would dispute. The reasons for suicidality, however, are very rarely as simple as “it was a result of X” and there is no information on causation here.

Although they don’t actually quote the relevant data in the article, I’ll invoke the principle of charity and assume they meant to point to the part of that the same survey does offer one indication that might support FACT #1 - that access to binders may improve suicidality:

However, this should be taken with a large pinch of salt, as the whole of this survey has significant problems with the way data was collected, with participants self-selecting online. It does not account for co-existing mental health conditions, or other factors additional psychological support and therefore cannot establish any causality.

It says absolutely nothing at all about puberty blockers - which the leaflet specifically highlighted - or other interventions such as hormones and surgery.

As far as FACT #2 goes - that transition is mostly social and reversible - again, there is no evidence at all provided to demonstrate this. In fact, to the best of my knowledge, there have been precisely zero studies into the reversibility of puberty blockers in adolescents.

They use the deliberately weak statement that they are “considered fully reversible” which amounts to ‘someone else said it and I’m repeating it but there is no evidence to back it up’.

They also make the claim that “delaying puberty to promote physical development that is consistent with a child’s gender identity is associated with better mental health outcomes, improved functioning, and life satisfaction” but again, no evidence is provided to back this up.

If I was being charitable and I had to guess I would say they are alluding to the Dutch Studies, which I looked at here and have significant limitations.

They then quote an unusual choice of study relating to the support of transgender children who are supported in their identities:

If we look at this in detail, we can see it looked at a group of 3 to 12 year-old pre-pubescent children, which seems far from relevant to the university students this leaflet was being handed out to.

Even then, the paper states that the group given support “did not differ from the control groups on depression symptoms” and actually notes that they had “marginally higher anxiety symptoms”. The latter seems to actively contradict the article authors’ claims that “social interventions have been found to lower the rates of depression and anxiety in TGNB children”.

I assume this study was supposed to support FACT #3 but I don’t see how it really provides evidence for anything the leaflet says.

The article then makes another bold claim:

Gender-affirming hormone therapy, which involves the use of feminizing or masculinizing hormones to allow the body to develop physical changes that align with a person’s gender identity, also significantly decreases gender dysphoria

And cites this study:

This study does not examine gender dysphoria at all. It writes about the regret rate, which it cites as being low, although a retrospective review without specific long term follow up is unlikely to catch later regrets after patients have left the care of the clinic.

They finish up by quoting this study:

This looks at the outcomes of mastectomies in children and young adults and assesses dysphoria before and after. It appears to have no relevance at all to the points on the leaflet - it does not demonstrate any reduction in suicidality, and it certainly does not fall under the banner of reversible or social interventions.

Overall, there is essentially nothing in the cited reference to back up the supposed “FACTS” in the leaflet.

(As ever, if you think I’ve missed something, please let me know)