Protecting Transgender Health and Challenging Science Denialism in Policy

McNamara, Meredithe; Lepore, Christina; Alstott, Anne

doi:10.1056/nejmp2213085

Cited by 15 publications

(8 citation statements)

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“…These changes began to manifest around 2006 but became pronounced around 2014-2015 [13]. Nonetheless, many clinicians and policymakers promulgate that science long ago established the benefits of gender transition for these adolescents [14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Current Concerns About Gender-Affirming Therapy in Adolescents

Levine

Abbruzzese

2023

Curr Sex Health Rep

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Purpose of Review Results of long-term studies of adult transgender populations failed to demonstrate convincing improvements in mental health, and some studies suggest that there are treatment-associated harms. The purpose of this review is to clarify concerns about the rapid proliferation of hormonal and surgical care for the record numbers of youth declaring transgender identities and seeking gender reassignment procedures. Recent Findings Systematic reviews of evidence conducted by public health authorities in Finland, Sweden, and England concluded that the risk/benefit ratio of youth gender transition ranges from unknown to unfavorable. As a result, there has been a shift from “gender-affirmative care,” which prioritizes access to medical interventions, to a more conservative approach that addresses psychiatric comorbidities and psychotherapeutically explores the developmental etiology of the trans identity. Debate about the safety and efficacy of “gender-affirming care” in the USA is only recently emerging. Summary The question, “Do the benefits of youth gender transitions outweigh the risks of harm?” remains unanswered because of a paucity of follow-up data. The conclusions of the systematic reviews of evidence for adolescents are consistent with long-term adult studies, which failed to show credible improvements in mental health and suggested a pattern of treatment-associated harms. Three recent papers examined the studies that underpin the practice of youth gender transition and found the research to be deeply flawed. Evidence does not support the notion that “affirmative care” of today’s adolescents is net beneficial. Questions about how to best care for the rapidly growing numbers of gender-dysphoric youth generated an intensity of divisiveness within and outside of medicine rarely seen with other clinical uncertainties. Because the future well-being of young patients and their families is at stake, the field must stop relying on social justice arguments and return to the time-honored principles of evidence-based medicine.

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Section: Introductionmentioning

confidence: 99%

Current Concerns About Gender-Affirming Therapy in Adolescents

Levine

Abbruzzese

2023

Curr Sex Health Rep

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“…Many may be hesitant to do so in settings with limited institutional support for gender-affirming care and political climates that emphasize the risk of detransition and regret as a basis of criticism and restriction of GAMC. [30][31][32][33][34][35][36] Adopting a strong ethical framework rooted in patient autonomy may increase the likelihood of adopting such an approach.…”

mentioning

confidence: 99%

“…Pediatricians, including pediatric endocrinologists and adolescent medicine practitioners who deliver GAMC, are often capable of assessing their patients for receipt of GAMC without additional consultation from an MHP. Many may be hesitant to do so in settings with limited institutional support for gender-affirming care and political climates that emphasize the risk of detransition and regret as a basis of criticism and restriction of GAMC 30–36 . Adopting a strong ethical framework rooted in patient autonomy may increase the likelihood of adopting such an approach.…”

mentioning

confidence: 99%

Removing Barriers and Honoring Autonomy: Rethinking Mental Health Professional Assessments in Adolescent Gender-Affirming Medical Care

Mosier-Mills,

Kim,

Keuroghlian

2024

Harv Rev Psychiatry

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Adolescents seeking gender-affirming medical care (GAMC) face numerous barriers that may delay or inhibit their access to these services. Such obstacles include mental health professional (MHP) assessment requirements prior to initiating GAMC. MHP letters ultimately carry little benefit for patients. Their formulaic nature discourages nuance, reduces likelihood of capturing gender embodiment goals (beyond a narrow definition of gender dysphoria), and may cause clinicians to overlook presenting mental health concerns. MHP assessment requirements also reinforce the conception of gender dysphoria as a mental health disorder. Moreover, studies have not shown that requiring MHP assessment letters effectively reduces regret among patients. Fortunately, primary clinicians who provide GAMC are most often capable of assessing patients without additional input from an MHP. In this article, we provide an ethical framework for clinicians that prioritizes patient autonomy through an informed assent approach. We discuss Appelbaum’s criteria and its application, and contexts in which MHP consultation is appropriate. We also address common questions about informed assent among clinicians, patients, and families. Finally, we advocate for bolstering multidisciplinary support teams involved in GAMC to facilitate the informed assent process. This approach upholds patient autonomy, expands access to GAMC, and utilizes the mental health workforce more effectively.

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“…In its November 2022 issue it launched in that section the opinion article by McNamara et al entitled Protecting Transgender Health and Challenging Science Denialism in Policy, a paper that describes the dangers looming on public health in the United States of America (USA) as a result of the interest of certain groups in denying or manipulating scientific results in order to offer misleading information or support the creation of discriminating policies. As an example, they propose denial of public coverage of treatments required by transgender individuals, including gender affirmation in adolescents 2 . The document shows the importance of academic participation in these discussions in order to submit all the available evidence, based on verifiable facts, and not only the evidence in favor of an opinion designed to create skewed public policies.…”

mentioning

confidence: 99%

“…En el número de noviembre de 2022 lanzó en dicha sección el artículo de opinión Protecting Transgender Health and Challenging Science Denialism in Policy, de McNamara et al En este documento se describen los peligros que se ciernen en la salud pública de los United States of America (USA), dado que ciertos grupos están interesados en negar los resultados de la ciencia o manipularlos con el fin de desinformar y soportar la creación de políticas discriminatorias. Proponen como ejemplo la negación de la cobertura con recursos públicos para los tratamientos que requieren las personas transgénero, que incluye la afirmación del género en los adolescentes 2 . El documento muestra la importancia de la participación de los académicos en estas discusiones para que se presente toda evidencia disponible basada en hechos verificables, y no solo la evidencia que favorece una opinión para definir políticas públicas sesgadas.…”

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Nueva sección de opinión en la Revista Colombiana de Obstetricia y Ginecología

Gaitán-Duarte

2022

Rev. Colomb. Obstet. Ginecol.

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E n el presente número se publica un artículo de opinión acerca del manejo dado a la pandemia generada por el SARS-CoV-2; así como también a la salud sexual y reproductiva, y a la salud pública en general desde la dirección del Ministerio de Salud y Seguridad Social en ese momento.Los artículos de opinión son publicados desde hace tiempo en algunas de las revistas científicas médicas más importantes a nivel internacional. El Journal of American Medical Association -JAMA en las indicaciones a los autores menciona que los artículos de opinión incluyen puntos de vista que pueden abordar prácticamente cualquier tema importante

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Protecting Transgender Health and Challenging Science Denialism in Policy

Cited by 15 publications

References 1 publication

Current Concerns About Gender-Affirming Therapy in Adolescents

Current Concerns About Gender-Affirming Therapy in Adolescents

Removing Barriers and Honoring Autonomy: Rethinking Mental Health Professional Assessments in Adolescent Gender-Affirming Medical Care

Nueva sección de opinión en la Revista Colombiana de Obstetricia y Ginecología

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