Do No Harm’s efforts to expose the scandal of sex-trait modification in gender non-conforming minors are getting noticed. In a recent manuscript published in the journal Social Science & Medicine, authors Joanna Wuest and Briana Last identify Do No Harm, where I am director of research, as an “agent of scientific uncertainty” in discussions of the safety and efficacy of so-called gender-affirming care.
They intended the “agent of uncertainty” label as an insult, but we wear it as a badge of honor. Doubt is a bedrock of scientific inquiry, an essential tool to separate opinion from fact. As Wuest and Last see it, however, “medical and mental health associations across the globe have widely accepted gender affirming care for children and adolescents.” They seem to think that doubt—asking basic questions—is antithetical to science.
European countries have conducted systematic reviews of the safety and efficacy of pediatric gender medicine and have pulled back on the practice as a result. They have cited their doubts that the benefits of so-called gender-affirming care outweigh the risks. In the United States, the supposed consensus in favor of the practice is illusory. Physicians at the Endocrine Society’s annual meeting, for example, reported widespread skepticism about the merits of hormone therapy for minors and noted their reluctance to speak out for fear of professional retribution from transgender activists. The specious consensus on gender medicine is forged through activism and maintained through attempts to stifle debate—the very tactic that Wuest and Last use in their piece.
The authors claim that “medical and mental health associations” have “shifted away from the goal of preserving a child’s assigned gender identity and toward affirmation of a child’s sense of self.” This accurately reflects the views of U.S. medical associations (which are fundamentally doctor-advocacy unions), but not those of European health authorities. Recently published draft guidance for schools in the United Kingdom, for example, specifically advises school officials to “allow for watchful waiting” for gender-distressed youth. The draft guidance recognizes even social transition as “an active intervention” with the potential to lock in gender confusion and put a healthy child on a pathway to medical harm. Finnish and Swedish health authorities, meantime, recommend psychotherapy as the main treatment for youth gender dysphoria, with hormonal interventions reserved for the most extreme cases and given only in research settings.
Wuest and Last’s citation of a recently published randomized control trial as evidence in favor of pediatric gender medicine is also misleading. In the cited trial, some Australian participants seeking access to cross-sex hormones received a waiver from the traditional three-month waiting period. After three months, surveys revealed better measures of mental health among the group that received the waiver compared with the group randomly assigned to wait the traditional three months. But cross-sex hormones typically don’t manifest any outward physiological changes in three months, meaning that the mental-health improvement was not the result of more closely resembling the opposite sex but either a placebo effect or the antidepressant effects of testosterone. Indeed, the results should fuel skepticism, not certainty.
That Wuest and Last peddle such misinformation is no cause for surprise, given their backgrounds. Wuest is a trans-rights activist and member of the Democratic Socialists of America. Last is an “inclusion, diversity, equity, and access fellow” at Stony Brook University.
More alarmingly, their agitprop was deemed worthy of publication in a peer-reviewed journal. Policymakers rely on peer-reviewed journals to separate fact from fiction. Many journals fail to maintain rigorous standards, however, and instead serve political agendas under the guise of science. Wuest and Last’s manuscript does not represent Social Science & Medicine’s first foray into activism. A so-called study published last year, for example, laughably tries to draw a link between “exposure to the anti-Black Lives Matter movement” with obesity in the black population. Another, called “MANstruation: a cyberethnography of linguistic strategies of trans and nonbinary menstruators,” frets over language that acknowledges the biological reality that only women menstruate. The journal is a purveyor of progressive ideology, not an arbitrator of scientific truths.
Too many scientific institutions have prioritized the comforting certainties of social justice over the discomfort of living with doubt. More doctors and researchers need to become “agents of uncertainty.”