Florida Department of Health Guidance Against Transgender Youth Healthcare Contains False Statements and Misrepresentations and Should Not Be Used by Anyone (part 2)

FLDOH anti-trans guidance attacks “low-quality evidence” for gender-affirming care, citing low-quality evidence for conversion therapy

Previously: FLDOH guidance against social transition, puberty blockers, or HRT for minors is not supported by cited documents from CMS, Sweden, Finland, England, or France

In their 2022 document “Treatment of Gender Dysphoria for Children and Adolescents”, the Florida Department of Health writes:

Systematic reviews on hormonal treatment for young people show a trend of low-quality evidence, small sample sizes, and medium to high risk of bias.

Hruz (2019) is not a systematic review

The linked “systematic reviews” is actually one four-page article by Paul W. Hruz (2019) in the Catholic Medical Association’s journal The Linacre Quarterly, and it is not a systematic review. It broadly encompasses the spectrum of gender-affirming care across all ages and does not specifically focus on “hormonal treatment for young people”. The journal has published it as a “research article”, and it is an unorganized continuous wall of text:

It does not possess any of the expected features of a systematic review, such as a specific research question or discussion of search criteria for inclusion of studies (Robertson-Malt, 2014). The FLDOH has erred in labeling this a “systematic review”. Continue reading

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Florida Department of Health Guidance Against Transgender Youth Healthcare Contains False Statements and Misrepresentations and Should Not Be Used by Anyone (part 1)

FLDOH guidance against social transition, puberty blockers, or HRT for minors is not supported by cited documents from CMS, Sweden, Finland, England, or France

On April 20, 2022, the Florida Department of Health published three nonbinding documents containing sweeping and inaccurate claims about transgender youth and gender-affirming care: the press release “Florida Department of Health Releases Guidance on Treatment of Gender Dysphoria for Children and Adolescents”; the PDF “Treatment of Gender Dysphoria for Children and Adolescents”; and the PDF “Treatment of Gender Dysphoria for Children and Adolescents – Fact Check”. These documents are sloppily written, typically citing either low-quality opinion sources or selectively quoting from sources that clearly contradict the position FLDOH is attempting to support, and at times referring to documents that are not about even about children and adolescents.

The FLDOH misrepresents brief opinion pieces from individual authors in Catholic and psychoanalytic journals as constituting reliable literature reviews of existing knowledge on transgender healthcare and development. FLDOH makes invalid assumptions about desistance of childhood gender dysphoria at adolescence, misrepresents its clinical relevance, and then offers advice far beyond what this evidence supports. And the FLDOH simply lies about numerous national health authorities in the United States and abroad agreeing with the department’s entirely unsupported anti-trans guidance.

These documents represent another disgraceful failure of the FLDOH under the DeSantis administration to fulfill its basic mission of providing reliable, high-quality health information to all citizens of Florida. The fact is that everyone in the state, cis or trans, whether they care about transgender issues or not at all, is now being subjected to another insulting disservice from a department that is already bleeding credibility in the COVID-19 crisis, particularly under the leadership of state surgeon general Joseph A. Ladapo. What they’ve passed off as guidance here is nothing but an embarrassment, and its fatal flaws will be visible to anyone who bothers to follow its sources. Those sources are examined here. Continue reading

Posted in Gender dysphoria, Health care, News, Outcomes of transition, Politics and law, Replies, Trans youth, Transgender medicine, Transphobia and prejudice | Tagged , , , , , , , | 1 Comment

Abigail Shrier and surgeon Marci Bowers falsely claimed trans girls on puberty blockers lack sexual response after vaginoplasty

Last October, anti-trans activist Abigail Shrier was platformed on Bari Weiss’s Substack to discuss – what else? – being silenced. In “Top Trans Doctors Blow the Whistle on ‘Sloppy’ Care”, Shrier opens:

For nearly a decade, the vanguard of the transgender-rights movement — doctors, activists, celebrities and transgender influencers — has defined the boundaries of the new orthodoxy surrounding transgender medical care: What’s true, what’s false, which questions can and cannot be asked.

As a Littman-certified “transgender influencer”, I decided to spend some time asking exactly those questions raised in her article, particularly this ominous claim:

And they never said anything about the distinct possibility that blocking puberty, coupled with cross-sex hormones, could inhibit a normal sex life.

Shrier’s assertion of sexual dysfunction is a fusion of two claims. One questions the outcomes of alternative vaginoplasty techniques necessary for some trans girls who may have very little genital tissue due to early use of puberty blockers. This known issue was broadly misused as a right-wing talking point that began circulating several years ago – long after equally effective surgeries were already in widespread use. The other is an apparently novel claim by Dr. Marci Bowers, a trans woman and vaginoplasty surgeon, that some experience of sexual stimulation or orgasm is necessary before vaginoplasty in order to access any meaningful sexual arousal after surgery. In her telling, early use of puberty blockers at Tanner stages 2 or 3 of a youth’s natal puberty could leave them sexually “naïve” and never motivated to seek out any sexual stimulation or derive enjoyment from this, an issue she says is not being acknowledged by other transition care providers.

But extensive data does exist on these questions. These and other relevant issues have been studied at length in clinical settings, and major transgender care centers have continued to publish their detailed findings in this patient group. What we know about the outcomes of youth who receive these treatments does not at all reflect the claims of Shrier and Bowers. Let’s directly refute the central point. Continue reading

Posted in Hoaxes, Outcomes of transition, Replies, Safety data, Sexuality, Surgery, Trans youth, Transfeminine, Transphobia and prejudice | Tagged , , , , , | Leave a comment

Just out: Study of trans adolescents confirms puberty blockers and HRT are associated with improved mental health

Zinnia JonesThe use of puberty blockers and cross-sex hormone therapy for trans adolescents is not a new or recent development, and this protocol has been in use since the mid-1990s. Clinical data on outcomes in this population is abundant: numerous studies of trans youth who’ve taken puberty blockers have shown significant reductions in gender dysphoria, depressive and anxious symptoms, self-harm, and suicidality, along with improvements in body satisfaction and overall psychological functioning and quality of life. Despite uninformed depictions in the press as an untested treatment fraught with unknowns, adolescent transition has consistently been found to have strong beneficial effects for gender-dysphoric youth, and major medical and pediatric organizations endorse this as a suitable and necessary treatment for appropriately evaluated youth.

This is hardly so new that nobody knows what it does. So the latest study of this treatment by Tordoff et al. (2022) simply adds further confirmation to a large existing body of evidence that clearly points in one direction: adolescent transition helps trans youth. Continue reading

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Beckman Coulter Access Sensitive Estradiol test, subject of FDA adverse event reports, may give falsely low readings for trans women on oral HRT

Zinnia JonesHRT for trans women and transfeminine people is intended to lower testosterone levels and raise estrogen levels to those typically seen in cis women, which is confirmed through observed clinical effects and laboratory measurement of hormone levels. Guidelines such as those offered by the Endocrine Society recommend monitoring hormone levels at least annually, maintaining estradiol levels between 100-200 pg/mL and testosterone below 50 ng/dL (Hembree et al., 2017).

Estradiol, taken via different routes such as oral or sublingual tablets, transdermal patches, gel, or intramuscular injections, can differ in how it is metabolized and how effectively it raises estradiol levels. This is reflected in studies of estrogen levels in trans women taking various types of estradiol: transdermal patches may produce lower levels than tablets or injections, while tablets taken either orally or sublingually produce far higher levels of the metabolite estrone than patches or injections. Continue reading

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