Research at odds with gender affirming groupthink is having an international impact
The influence of American public health researcher Dr Lisa Littman, best known for coining the term “rapid-onset gender dysphoria” (ROGD), appears to have been unaffected by activist attacks on her work.
In its February 25 statement, the French National Academy of Medicine cites Dr Littman’s ROGD paper in the context of “a sharp increase in demand for medical interventions” to treat youth gender dysphoria.
“Whatever the mechanisms involved in adolescents — excessive engagement with social media, greater social acceptability, or influence by those in one’s social circle —this epidemic-like phenomenon manifests itself in the emergence of cases or even clusters of cases in the adolescents’ immediate surroundings,” the academy’s statement says.
Also last month, Sweden’s National Board of Health and Welfare referenced Dr Littman’s 2021 detransitioners study and declared that the low regret rate (often lower than 1 per cent) claimed by youth gender clinics “no longer stands unchallenged”.
In the Littman detransitioner study, only 24 per cent of the 100-strong sample said they went back to their gender clinic to report their regret.
Dr Littman has welcomed the developments in Sweden and France as “steps in the right direction for protecting the long-term health and well-being of gender dysphoric youth”.
“These [developments] are consistent with the findings of all quality systematic reviews of evidence, which show that the evidence of benefit from the medicalization of minors is highly uncertain and must be carefully weighed against the risks,” she told GCN.
Thursday’s interim report from the United Kingdom’s official review of the Tavistock youth gender clinic also cites Dr Littman’s detransitioners paper.
“Therapists who work with detransitioners and people with regret have highlighted a lack of services and pathways and a need for services to support this population,” the report says.The Cass Review, tasked with evaluating England's pediatric gender identity services, has issued its interim report. The Review expresses the concern that puberty blockers and hormones may not be the best approach for all desiring these interventions. /1
The independent review of youth gender dysphoria care within the National Health Service is led by Dr Hilary Cass, who is a former president of the Royal College of Paediatrics and Child Health, with a track record of concern about patient safety.
“The issues faced by detransitioners highlight the need for better services and pathways for this group, many of whom are living with irreversible effects of transition but for whom there is no clear access to services as they fall outside the responsibility of NHS gender identity services,” the report says.
“Internationally as well as nationally, longer-term follow-up data on children and young people who have been seen by gender identity services is limited, including for those who have received physical interventions; who were transferred to adult services and/or accessed private services; or who desisted, experienced regret or detransitioned.”
Tomorrow the international parents’ group Genspect is hosting a #DetransAwarenessDay forum featuring well-known detransitioners including Sinéad Watson, Helena Kerschner, Grace Lidinsky-Smith, and Keira Bell, whose litigation against the Tavistock clinic has been big news around the world.
Dr Littman’s ROGD paper described the now internationally recognised trend for teenagers, disproportionately female, to declare a trans identity out of the blue against a background of social media immersion, clusters of friends coming out together as trans and winning the approval of peer groups.
Her exploratory study proposed ROGD not as a formal diagnosis but as a hypothesis warranting further research. She was open about her reliance on a targeted sample of parents, many of them sceptical of medicalisation and reporting the lack of any history of gender questioning by their children.
The suggestion of social contagion driving some trans identity is awkward for the more militant form of the “gender affirming” treatment model in which young people are regarded as experts in their identity unswayed by peer or online influence.
Activists misrepresented the Littman study and judged it according to a methodological benchmark not applied to heavily promoted studies that declare gender affirming care to be “lifesaving”.
Under trans activist pressure, Dr Littman’s paper was subjected to a highly unusual post-publication review, which added “hedging” language about the study to soothe activist sensitivities but left intact its findings. The “correction” issued by the journal PLOS One was “Orwellian”, according to psychologist Dr Lee Jussim.
“In my experience, a ‘correction’ that is not a correction is unprecedented in psychology and most scientific publishing,” Dr Jussim wrote.
The new advice from Sweden’s NBHW says the risks of puberty blockers and cross-sex hormones for young people appear to outweigh the benefits, and the agency gives special emphasis to possible under-reporting of treatment regret.
Key studies reporting low regret predate the post-2010 flip in patient profile from mostly early-onset male dysphoria to mostly adolescent-onset female dysphoria, and typically failed to track down large numbers of former patients, who might be more likely to regard treatment as a harmful mistake.
“For those who regret or discontinue treatment, there may be a risk that the treatment has led to poorer health or quality of life,” Dr Thomas Lindén, head of department at the NBHW, told the journal of the Swedish Medical Association.
Dr Lindén has given new details about Sweden’s stricter regime for gender medicine.
“The care for gender dysphoria is currently being restructured and concentrated into three national specialised medical care services,” he told GCN.
There are six specialised youth gender clinics in Sweden, with the largest at Stockholm’s Astrid Lindgren Children’s Hospital, which is part of the famous Karolinska Institute.
Dr Lindén says the application process is in train and it is hoped that the three permits — which come with conditions and are to be followed up annually by the NBHW — will be decided in May.
Only those three licensed clinics will be permitted to give puberty blockers and cross-sex hormones to patients under 18.
To qualify for treatment outside research studies young patients will have to be judged “exceptional cases”.
The new NBHW advice seeks to limit these “Dutch protocol” treatments to the classic, pre-2010 patient profile of marked gender dysphoria that has persisted since early childhood. The evidence base for that patient group is considered to be stronger.
Dr Lindén says the new NBHW recommendations do not have the force of law, but may be invoked by a former patient taking a gender clinic to court and seeking damages. It would be up to the court to decide what evidentiary weight to give to the recommendations.
Note: Next week I plan to post more detailed reporting on developments in France and the UK.