You are currently browsing the daily archive for February 29, 2020.

It is going to be very disheartening for people who bought into the puberty blockers as a solution to their ‘gender dysphoria’ realize that they were the first test subjects in a long term trial.  What they were told, and what will happen are likely to be two very different occurrences.


“When ECRI was contacted by this author and asked why WPATH guidelines were not included, and why the Endocrine Society guidelines did not have a scorecard rating, they responded in an email, saying that the reason the Endocrine Society guidelines did not meet inclusion criteria to be rated was because “Only a few of their recommendations were supported by the systematic review; the majority were not.” The reason WPATH was not included, ECRI stated, was because the guidelines were over five years old, and “did not use a systematic review to process”.

They did not use a systematic review to process.


A search of the Canadian database yielded no results for transgender treatment. When contacted, Joule’s response was “In order to be included in our database, all guidelines have to be either developed or endorsed by an authoritative medical/healthcare organization.  Neither the WPATH nor the Endocrine Society guidelines on transgender care have been endorsed by any Canadian organization(s) and therefore are not included in our database”. A search of the GIN library also yielded no results for transgender care.

Neither the WPATH nor the Endocrine Society guidelines on transgender care have been endorsed by any Canadian organization(s) and therefore are not included in our database.


Guidelines over five years old are at high risk of becoming clinically irrelevant due to new research findings, or changes in patient populations.  Given the rapidly changing epidemiology and treatments in transgender care, seven-year-old guidelines are severely outdated in this field. One case in point is that when the WPATH guidelines were published in 2011, natal males were the primary group presenting to gender clinics in adolescence, but now males have been eclipsed by natal females 3 to 1

Research on male adolescent clients cannot be generalized to females, an age-old fallacy in medicine.  This makes the entire recommendation section for adolescent transgender care in the WPATH SOC dubious at best, irrelevant at worst. Investigation must be undertaken to determine why a new cohort has developed, and whether this group can be included in guidelines that were developed for a group with different histories and possibly different etiologies.”


To their credit, WPATH does not say anywhere in the SOC that treatment is proven safe and effective. Instead, the overall message in the guidelines is to urge physicians to follow the patient’s wishes only, putting aside scientific evidence and ethical delivery of care.

The concept of an innate gender identity is unproven, unverifiable, and does not even have a clear definition. In the same spirit of historical psychiatric misadventures, somatic treatments are being prescribed for a psychologically based identity disorder. How many vulnerable children, adolescents and young adults will be harmed before we realize that history is repeating itself.

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