Times asked did ACLU, trans left, push too for failure at Supreme Court

Nicholas Confessore, a Times investigative reporter, relays a more balanced review of recent trans rights history to ask whether the recent landmark Supreme Court case allowing state bans on trans healthcare was an unforced error.

Confessore reviews the conflicted state of the medical research. The so-called “Dutch protocol” is a response to researches there who “theorized that the stigma and depression they observed in their older patients might have been avoided if they began to transition much earlier, before puberty shaped their bodies.” This is because

Boys who take estrogen can begin to grow breasts; girls taking testosterone can develop deeper voices and coarser, darker facial and body hair. In the early 2010s, the researchers published studies demonstrating, for the first time, that medical intervention could improve the well-being of some adolescents with dysphoria. Drugs that blocked puberty, they argued, could give dysphoric young people time to think while exploring the possibility of what was then called “sex reassignment” with cross-sex hormones and, eventually, surgery.

Then, in 2012, “the World Professional Association for Transgender Health (WPATH) incorporated the Dutch protocol into its standards of care, best-practice guidelines meant to serve as a reference for physicians, insurers and others.”

We have likely heard of these studies and guidance cited as evidence to support puberty blockers and other medical (that is, nonsurgical) treatments for trans youth seeking such care in most cases. However, a two systematic literature reviews by the British National Institute for Health and Care Excellence “provided only ‘very low certainty’ evidence that puberty blockers or hormone treatments actually improved patients’ dysphoria.”

The consensus repeatedly cited by L.G.B.T.Q. advocacy groups in the United States relied heavily on small-scale observational studies, patient surveys and the professional experience of gender clinicians themselves — a category that evidence-based medicine ranks as least reliable. Many studies were designed in ways that made it difficult to tease out confounding effects, the reviews found, like whether a patient’s mental health had improved because of taking blockers and hormones or because of some other factor. Even the landmark Dutch studies suffered from “high risk of bias.”

Meanwhile gender theory jumped from academia into everyone’s signature lines, and the activist left called out the khaki caution of their opponents. And now, here we are, with potential for both minors and adults to face state bans on gender affirming care. Not a great outcome, but a good read.