Decades of research on transgender procedures for kids riddled with errors: critical review

When the American tide started turning against social and medical affirmation of gender confusion in children, some observers blamed the backlash on U.S. providers’ failure to follow clinical standards developed in the Netherlands in the 1990s, which discouraged any form of transition before puberty or in adolescents without long-term confusion.

The divergence between the so-called Dutch protocol and its American knockoff, which affirmed confusion early and often regardless of concurrent mental health problems and social dynamics, was the throughline of the New York Times podcast The Protocol and cited by critics of social transitioning, which may bias children to persist in otherwise fleeting confusion.

The scientific underpinnings of the Dutch protocol are now facing serious academic scrutiny, with political ramifications in the Netherlands, while stateside the Biden administration’s politicization of gender-identity research has been exposed again.

“Three decades of ‘Dutch Protocol’ research has not produced reliable evidence,” says the May 30 paper in the Taylor & Francis publication European Journal of Developmental Psychology, rebutting a Feb. 23 review in the same journal that claimed research has supplied “far more confidence” in medicalized transitions for minors than when the protocol started.

It was written by Baylor Medicine psychiatrist Kathleen McDeavitt, an author of the Department of Health and Human Services-commissioned systematic review of so-called gender affirming care for minors, and Jay Cohn, of the Society for Evidence-Based Gender Medicine, whose research was cited in the review, several of whose authors are associated with SEGM.

The paper “chronicles failure of Dutch clinicians to respond scientifically and appropriately to problems of evidence from their own clinic” and “documents how the Dutch (and others) responded by shifting the rationales for treatment,” Manhattan Institute senior fellow Leor Sapir summarized. He’s another author of the HHS review.

Dutch Member of Parliament Diederik van Dijk submitted 17 written questions to Health, Welfare and Sport Minister Sophie Hermans, in response to the journal paper.

As translated by Google, van Dijk asked whether Hermans agrees that the “methodological basis” for giving children puberty blockers and cross-sex hormones is “highly questionable,” why the country hasn’t followed Finland, Sweden and the U.K. in pulling back on such care for kids and whether the paper will be included in the Health Council’s related study.

“Is it true that in the scientific study underlying the Dutch Protocol, a male patient died as a direct result of complications following colovaginoplasty [making an artificial vagina from a segment of colon], which had to be performed because of underdevelopment of the penis and scrotum due to the administered puberty blockers?” van Dijk asked.

He posed several questions related to informed consent for children seeking care and their parents, including “uncertainty surrounding the expected mental health benefits,” known risks such as infertility and the lack of evidence that “puberty blockers and hormone treatments reduce suicidality or depression,” which a U.S. researcher buried for years.

Selection bias, confounding variables, measurement scales switched

McDeavitt and Cohn’s European Journal of Developmental Psychology paper says Amsterdam University Medical Center’s Center of Expertise on Gender Dysphoria, which developed the Dutch protocol, judged the blocker, hormone and surgery regimen for youth a success based on three decades of studies that lacked “methodologically robust” designs.

Most of the studies the center authors reviewed for their February “narrative review,” which “comprise a large part of the evidence in this field,” have been “formally assessed by one or more high-quality” systematic reviews, the rebuttal says.

Those reviews identified multiple methodological problems: “lack of long-term follow-up” to appraise outcomes such as cardiovascular disease risk and “treatment regret,” no suitable comparison groups, “use of surrogate outcome measures,” low follow-up rates and “lack of analytic methods that adequately adjusted for confounding variables.”

No studies used randomized controlled trials, the gold standard for research, the paper says. Two of them on mental health outcomes, “considered to be the evidentiary foundation of the field,” reported data on the first 70 patients given blockers, approved for hormones after psychological assessment, then assessed again after surgeries.

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