President Trump has made his hostility toward transgender people abundantly clear.
On the first day of his second term, he issued a sweeping executive order against “gender ideology” that led federal employees to erase public health data from websites and remove pronouns from email signatures, among other actions. A week later he banned trans people from the military in an executive order laced with animus, suggesting, ridiculously, that being trans “conflicts with a soldier’s commitment to an honorable, truthful and disciplined lifestyle.” (A federal judge issued a preliminary injunction halting the order last week.)
It’s unsurprising, then, that the administration’s early funding cuts to health research have included millions of dollars worth of grants focused on trans people and gender identity. So far, the canceled grants mostly seem to involve adults. But Mr. Trump also wants to hobble scientific studies on what puberty blockers, hormones and surgical procedures such as mastectomies do to young people who are undergoing treatment for gender dysphoria. One of his early executive orders threatened to withhold federal funding from medical institutions providing these treatments. In combination with the “gender ideology” order, this effectively defunds research studying them.
I’ve long been a critic of American youth gender medicine. Researchers in this field have often produced slipshod work and drawn premature conclusions about the benefits of blockers, hormones and surgery. There are serious unanswered questions about the safety and efficacy of these treatments, which have been banned or restricted in about half of American states and a number of European countries in the wake of several damning government-sponsored reports.
But cutting back on research about these treatments would be a tragic error. What this field needs — and what gender-questioning youth deserve — is reform, oversight and higher methodological standards. To cripple this field in its infancy would be to leave countless families in intolerable limbo.
I regularly hear from parents whose kids express severe distress about their biological sex. These parents desperately want to help their children, but are torn about whether medical interventions are worth the potential risks.
Reliable, evidence-based research on these questions is hard to come by. A parent whose child is considering transition might hope to find insight in a study that followed youth at a Seattle gender clinic between 2017 and 2018. But that team used byzantine statistical techniques to claim that young people who went on blockers and/or hormones enjoyed improved mental health, even though their own data offered no meaningful evidence of improvement. Another team, publishing in JAMA Pediatrics, reported reductions in chest dysphoria in youth as young as 13 who received mastectomies. But to reach that conclusion, researchers primarily relied on a survey that included a number of questions that would naturally shift in the direction of “improvement” after the patient no longer had breasts, like “I sleep with a binder on at night.”
Then there’s the Impact of Early Medical Treatment in Transgender Youth project. This $10 million landmark effort was supposed to provide data that could help parents and providers answer some of the most urgent questions in youth transgender care: Do puberty blockers irreversibly harm bone health? Does medical transition for gender dysphoric youth improve mental health? But I’ve found the project marred by seemingly missing data and the exaggeration of apparently modest results. Moreover, the project’s lead investigator, the youth gender physician Dr. Johanna Olson-Kennedy, admitted to withholding findings demonstrating that there was no evidence that puberty blockers improved the recipients’ mental health.
The families considering puberty blockers, hormones or surgery for their kids need better research, as do youth and young adults who have already physically transitioned.
Of course, this issue matters only if there are providers still willing to offer these treatments to youth. In the wake of Mr. Trump’s executive order threatening medical institutions, some hospitals canceled appointments for transgender youth (though at least some have resumed offering treatments). Nonetheless, these treatments are still legal in half the country and are likely to remain so. As long as they are still offered, people should have access to good data about their effects.
Which brings me to the Trump administration’s other option, given that it is intent on doing something about youth gender medicine research: reform.
Dr. Jay Bhattacharya, the newly confirmed director of the National Institutes of Health, is a health policy expert well equipped to evaluate the methodological problems underlying the youth gender medicine debate. He could steer his boss’s hand away from the chain saw and toward the scalpel.
What would that look like? With Mr. Trump’s cooperation, Dr. Bhattacharya could take advantage of the N.I.H.’s tremendous power of the purse to enact some common-sense reforms. The N.I.H. could more tightly enforce existing data-sharing rules, which would make it easier for research to be evaluated, improved on and, when applicable, debunked. The agency could also set higher bars for N.I.H. grantees, refusing to provide funding to — or even clawing it back from — researchers who, without justification, engage in common acts of methodological tomfoolery.
And researchers should not be allowed to sit on data just because it doesn’t support their hypothesis — “null findings” are useful to the advancement of science, even when the results are inconvenient to the researchers who produce them. (If scientists can’t find a journal willing to publish their null results, a common problem because journals prefer to publish exciting findings, the N.I.H. could require, as a term of its grants, that these findings be posted to the agency’s own website.)
It sounds as if Dr. Bhattacharya is already open to reforms of this kind. When asked about Dr. Olson-Kennedy’s study during his confirmation hearing, he was clear: N.I.H.-funded researchers should not be allowed to withhold negative results, even when they are “politically inconvenient.”
The issues underpinning this debate are bigger than politics. If our government is going to fund science, it should be good science. And what better way to promote government efficiency — supposedly a key imperative of the second Trump administration — than to insist that federal dollars flow toward well-designed and properly executed research?
More important, when research on this subject isn’t conducted, or is conducted poorly, it’s gender-questioning youth who suffer the most. There are kids hurting immensely, right now, because they feel at war with their biological sex. We have a moral imperative to help them — with the best science possible.
The post Trump’s Attack on Trans Youth Research Is a Tragic Error appeared first on New York Times.
