Commentary: The Signal and the Noise—questioning the benefits of puberty blockers for youth with gender dysphoria—a commentary on Rew et al. (2021)

Abstract

This commentary is a critique of a recent systematic review of the evidence for the use of puberty blockers for youth with gender dysphoria (GD) by Rew et al. (2021). In our view, the review suffers from several methodological oversights including the omission of relevant studies and suboptimal analysis of the quality of the included studies. This has resulted in an incomplete and incorrect assessment of the evidence base for the use of puberty blockers. We find that Rew et al.’s conclusions and clinician recommendations are problematic, especially when discussing suicidality. A key message of the review’s abstract appears to be that puberty blockers administered in childhood reduce adult suicidality. However, the study used for the basis of this conclusion (Turban et al., 2020) did not make a causal claim between puberty blockers and decreased adult suicidality. Rather, it reported a negative association between using puberty blockers and lifetime suicidal ideation. The study design did not allow for determination of causation. Our commentary concludes by demonstrating how the GD medical literature, as it moves from one publication to the next, can overstate the evidence underpinning clinical practice recommendations for youth with GD.

Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice

“…A recent editorial in The Lancet stated puberty blockers reduce suicidality and to remove access to them was to “deny” life (The Lancet, 2021 ). However, there is no robust empirical evidence that puberty blockers reduce suicidality or suicide rates (Biggs, 2020 ; Clayton et al, 2021 ). The authors of the paper, that was the basis for The Lancet’s claim, subsequently clarified that they were not making any causal claims that puberty blockers decreased suicidality (Rew et al, 2021 ).…”

Response: “The Signal and the Noise”—a response to Clayton et al. (2021)

“…The commentators wrote that “The Costa et al. study found no significant difference in psychosocial functioning between a group of adolescents receiving puberty blockers plus psychosocial support, and a group receiving only psychosocial support, at eighteen months (the study end period)” (Clayton, Malone, Clarke, Mason, & D’Angelo, 2021, p. 3). This selected quotation misses other important statements written by Costa et al.…”