To the Editor:
Re “On Youth Gender Care, Medical Groups Hurt Their Credibility,” by Jesse Singal (Opinion guest essay, Feb. 28):
Mr. Singal does not believe that current scientific research justifies access to gender-affirming care for transgender youth, or the support of these treatments by major medical associations.
What Mr. Singal leaves out is that most health treatments are supported by low- to medium-quality evidence. In response to efforts like Mr. Singal’s to challenge the evidence base of gender-affirming care, one of the founders of the field of evidence-based medicine, Gordon Guyatt, recently stated that low-certainty evidence is not “bad science.” He added that denying care based on low-certainty evidence is “unconscionable.”
The ability of patients, parents and caregivers to choose treatments based on the best available evidence is even more important when uncertainty exists. The data are clear that transgender adults and youth repeatedly and consistently show high rates of satisfaction with gender-affirming treatments.
Academic researchers like us rely on the best available data. Such data support the safety and effectiveness of gender-affirming care, as concluded by a recent independent review conducted in Utah. Medical associations continue to support it for this reason.
Researchers and clinicians in the field are always seeking higher-certainty data on the benefits or risks of gender-affirming care. Yet U.S. state-level bans, federal proposals to defund hospitals, threats to providers, deletion of decades of federal data and the termination of millions of dollars of research funding — which Mr. Singal gives little consideration to — prevent the very research he calls for.
Without providing and studying gender-affirming care, we will never have stronger evidence, and through that, better policy.
Elana Redfield Ayden Scheim Los Angeles The writers are, respectively, the federal policy director and a senior scholar of public policy at the Williams Institute at U.C.L.A. School of Law.
To the Editor:
While I agree with Jesse Singal that more research is needed on the outcomes of medical treatment for minors suffering from gender dysphoria, his essay is of little use to children and parents who have to make decisions based on what we know now.
There are risks and benefits with any type of medical procedure, and we know that many people have benefited from gender-affirming care based on decades of clinical experience. Properly administered, hormones, puberty blockers and, in rare circumstances, surgeries, are provided only after extensive evaluation, consideration of and treatment for confounding conditions, and informed consent by both child and parent.
To help all minors who question the gender they were assigned at birth, both now and in the future, we need to fund robust research and empower rather than restrict the hospitals and clinics that apply these professionally recommended standards of care. We must trust families and doctors to decide what is in the best interests of each individual child.
Christopher Jones New York
To the Editor:
This essay by Jesse Singal focuses on “uncertainty” in health care for transgender youth. So let’s look at what is certain: Transgender adults exist — and they were once children. Some transgender people benefit from appropriate medical care. The question clinicians face is not if any care should be provided at all, but exactly what care is best for each specific patient.
As in any area of medicine, doctors use the best available evidence to navigate careful, individualized decision making with transgender patients and their families. The opposite of this cautious, tailored approach is the enforcement of numerous outright bans on medical care for all transgender youth across the United States.
No evidence review on youth gender care concludes that categorical prohibitions of this care are appropriate, and no medical or mental health association condones them either. Leaders in evidence-based medicine call bans an “egregious and unconscionable” mistake in handling evidentiary uncertainty in medical care.
Careful, considered standards for the provision of medical care to youth who need it aren’t out of step with what the evidence supports — but bans that substitute politicians for parents and doctors certainly are.
Kellan Baker Baltimore The writer is a health services researcher and a senior adviser for health policy at the Movement Advancement Project, an independent nonprofit think tank.
The post The Harm of Banning Care for Trans Youth appeared first on New York Times.
