Chen 2023 Paper Raises Serious Concerns About Pediatric Gender Medicine Outcomes

Here are two paragraphs where the author draws conclusions.

'The short-term effect of GAH is no longer an unanswered question. Its theoretical basis was strong in the absence of data, but like many strong theories it has failed in the face of data. Now that two studies have failed to report meaningful benefit we can no longer say, as we could as recently as 2021, that the short-term benefits are so strong that they outweigh the potential long-term risks inherent in permanent body modification. Some non-trivial number of patients come to regret these body modifications, and we can no longer claim in good faith that there are enormous short term benefits that outweigh this risk. The gender affirming clinicians had two bites at the apple to find the benefit that they claimed would justify these dramatic interventions, and their failure to find it is much greater than I could have imagined two years ago.

I am not unaware of how fraught and politicized this topic has become, but the time has come to admit that we, even the moderates like me, were wrong. When a teenager is distressed by their gender or gendered traits, altering their body with hormones does not help their distress. I suspect, but cannot yet prove, that the gender affirming model is actively harmful, and this is why these gender studies do not have the same methodological problem of large placebo effect size that plagues so much research in psychiatry. When I do in depth chart reviews of suicidal twenty-something trans adults on my inpatient unit, I often see a pattern of a teenager who was uncomfortable with their body, "affirmed" in the belief that they were born in the wrong body (which is an idea that, whether right or wrong, is much harder to cope with than merely accepting that you are a masculine woman, or that you must learn to cope with disliking a specific aspect of your body), and their mental health gets worse and worse the more gender affirming treatments they receive. First, they are uncomfortable being traditionally feminine, then they feel "fake" after a social transition and masculine haircut, then they take testosterone and feel extremely depressed about "being a man with breasts," then they have their breasts removed and feel suicidal about not having a penis. The belief that "there is something wrong with my body" is a cognitive distortion that has been affirmed instead of Socratically questioned with CBT, and the iatrogenic harm can be extreme.'

This is an unusually well argued position on a contentious topic, worthy of a read whatever your prior position on this issue. It takes issue with the prevailing medical consensus on methodological and statistical grounds, without impugning the dignity of its subjects or the sincerity of other professionals in the field.

Most damning in that lengthy post is that the paper omits some of the key data collected by the study, including suicidality:

acute suicidality was an exclusion criterion for this study (see section 4.6.4). There were two deaths by suicide in this study, and 11 reports of suicidal ideation, out of 315 participants, and these patients showed no evidence of being suicidal when the study began. This raises the possibility of iatrogenic harm. It would be beneficial to have more data on the suicidality of this cohort, but the next problem is that the authors did not report this data, despite collecting it according to their protocol document.

The 5 reported outcome measures in Chen 2023 are only a small fraction of the original data collected. The authors also assessed suicidality, Gender Dysphoria per se (not merely appearance congruence), body esteem and body image (two separate scales), service utilization, resiliency and other measures. This data is missing from the paper.