Coauthor of gender-affirming care reviews says they've been misused to justify bans

A scientist who’s coauthored several reviews of gender-affirming care says his work has been misused to justify bans on the care.

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Gordon Guyatt, an epidemiologist and a professor of health research methods, evidence, and impact at McMaster University in Canada, joined in three reviews of this care for children and young adults — one of puberty blockers, one of hormone therapy, and one of top surgery. A Ph.D. student led the reviews, and Guyatt’s task was to assure they were “as objective as possible,” Stat10 reports.

The reviews found the evidence for these treatments had “either low or very low certainty,” the site notes. But Guyatt said that’s not a reason to ban them.

“Low-quality evidence doesn’t mean it doesn’t work. It means we don’t know. And so we try,” he told Stat10. “There is, I would say, quite good evidence from the accounts of the individuals who’ve undergone the therapy that they were really benefited by the therapy.” There is actually low-quality evidence for most medical care, he said, such as the exercises he was advised to do after hurting his neck in a mountain biking accident.

Related: What is gender-affirming care, who uses it, and do they regret it?

The reviews were funded by the Society for Evidence-Based Gender Medicine, which “doesn’t explicitly advocate for restrictive policies” but “consistently emphasizes the weakness of the evidence base for gender-affirming care, emboldening those who do call for bans,” Stat10 reports. It submitted a friend-of-the-court-brief in the U.S. Supreme Court case on Tennessee’s law banning this care for transgender youth, and it “was in support of neither party, but called gender-affirming care ‘experimental,’ highlighting its ‘remarkably weak scientific foundation,’” the outlet explains. The court upheld the law and said other states can enact or enforce similar laws.

The Southern Poverty Law Center has designated SEGM a hate group.

When LGBTQ+ activists questioned the worth of the McMaster reviews because of the funding source, university officials said they would no longer accept money from SEGM.

Guyatt believes he and other researchers do a good job of keeping the funding source from influencing them, he said, such as in drug trials funded by pharmaceutical companies, which he’s often involved in. “If anything, that’s easier in systematic reviews to keep it clean than in the randomized trials,” he noted. He knew that SEGM had supported the reviews but didn’t know it had a formal contract with the university, he said.

Related: U.K. to begin major study on health of transgender youth

When he realized the reviews were being used to justify bans, he decided to speak out. “It just became extremely evident to me that our work was being used in what I thought was egregious and unconscionable ways,” he said. He wrote a letter to the editor about this to a right-wing Canadian newspaper, which didn’t publish it, but he’s glad now that McMaster has issued its statement.

He said gender-affirming care should be done with caution and allowed that there’s some appeal for using certain interventions, such as hormone therapy, only in research, but “if you say ‘in research only’ and the potential for being involved in the research can accommodate 1 percent of the individuals seeking care, then that’s not acceptable.” The care should be available to all those “who pass the hurdles,” he said.

“If we put minimal or zero value on patient autonomy, and a very high value on avoiding harm to the — what seems clear — minority of individuals who, had they gone forward, would be harmed, then banning [gender-affirming care] would be a reasonable position,” he added. “Those values and preferences that I’ve just described are extremely problematic from my point of view. I would say the values and preferences of those who are banning it, I think, come from a broader anti-trans perspective.”