Explanation
There are no unicorns.
More precisely, there is no evidence that they exist, but they are not exactly the same. As astronomer Carl Sagan famously said, “the lack of evidence is not evidence of absence.”
But Sagan also popularizes the idea that “extraordinary claims require extraordinary evidence.” This is also true, and a reenactment of a similar axiom, clarified by French mathematician and scientist Pierre Simon Laplace in the early 19th century: “The weight of the evidence of an extraordinary claim must be proportional to its oddity.”
And you can freely claim that the unicorn is authentic, but unless you find exceptional evidence to back it up, that claim deserves to be dismissed.
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The two papers are a rigorous systematic review and meta-analysis, with the first examining practices of administering adolescent blockers to young people with “gender violations” and, secondly, the practices of managing “gender-affirming” hormone therapy in gender dysphoric patients under the age of 26.
It is a modern claim that gender and gender are not essentially binary, but rather that they exist in the spectrum and are possible to be males trapped in a female body, and finally, it is certainly an unusual claim that it is possible to translate from sex or gender to another gender. They are so for a sudden introduction to medical discussion and for a quick acceptance of being self-evident truth. Therefore, we would expect extraordinary evidence to support the practice of “affirming” adolescent blocker management and “gender-affirming” hormone practices to gender-compensated individuals.
However, this is the conclusion of Dr. Gaiat et al. Regarding adolescent blockers:
“There remains a considerable amount of uncertainty regarding the effects of adolescent blockers in individuals experiencing GD (gender violations). A methodologically rigorous prospective study is required to understand the effects of this intervention.”
And the conclusion of the gender crosshormonal study:
“There is considerable uncertainty about the effects of GAHT (gender-maintaining hormone therapy) and it cannot rule out any benefits or potential harm. A methodologically rigorous prospective study is required to produce evidence of higher certainty.”
This is Guyatt et al. Adolescent Blocker Paper Discussion Section:
“Since the best current evidence, including systematic reviews and meta-analyses, is primarily very low certainty, clinicians must clearly communicate this evidence to patients and caregivers. Treatment decisions should take into account the lack of moderate and high quality evidence, uncertainty regarding the impact of adolescent blockers, and patient values and preferences. Given the individualistic nature of values and preferences, guideline developers and policymakers must be transparent about which values they prioritize when making recommendations and policy decisions.”
Their “gender-affirming” hormone therapy papers employ a similar language.
“Evidence regarding the impact of GAHT in individuals under the age of 26 who used GD is primarily very low certainty, and there is no evidence of moderate and high certainty regarding the impact of this intervention. This information is very important for patients, caregivers, clinicians, guideline developers and policy makers involved in treatment decisions. Beyond the certainty of the evidence, decision-making should take into account other factors, such as the potential benefits and magnitude and outcomes of patients and caregivers, value and preferences of resources, feasibility, acceptability, and equity. Guideline developers and policy makers must transparently state which values and their values prioritize when developing treatment recommendations and policies.”
All of these should act as a massive flashing light that is cautious for Canadian gender clinicians. But what we have is the opposite: the complete steam is ahead.
It’s extraordinary. And strange. And I am very upset by clinicians like me and many others like me who are deeply interested in the well-being of our youth.
The views expressed in this article are the views of the authors and do not necessarily reflect those of the epoch era.
