Given how relentlessly left-wing the Washington Post is (and always has been) it's always a surprise when the editorial board publishes something reasonable and moderate. On Sunday, the board published a piece about the Supreme Court's review of a Tennessee ban on gender affirming care and basically agreed that the state is right to be skeptical at this point.

Multiple European health authorities have reviewed the available evidence and concluded that it was “very low certainty,” “lacking” and “limited by methodological weaknesses.” Last week, Britain banned the use of puberty blockers indefinitely due to safety concerns.

“Children’s healthcare must always be evidence-led,” British Health and Social Care Secretary Wes Streeting said in a press release. “The independent expert Commission on Human Medicines found that the current prescribing and care pathway for gender dysphoria and incongruence presents an unacceptable safety risk for children and young people.”

In short, health authorities outside the US are walking back their commitment to gender affirming care for minors because the evidence supporting this approach is lacking. And this brings us to the Dutch protocol which was really the foundation backing up gender affirming care. It was a very small study with no control group.

Early studies from a Dutch clinic seemed to show promising results, but the research started with only 70 patients (dropping to 55 in a follow-up study) and no control group. Treatment results that look impressive in small groups often vanish when larger groups are studied.

A British study attempting to replicate the Dutch researchers’ success with puberty blockers “identified no changes in psychological function” among those treated.

Best of all, the Post doesn't shy away from the elephant in the room, i.e. the ideologically motivated doctors who seem to be hiding research that contradicts their views.

The British lackluster results were published nine years after the study began, after Britain’s High Court ruled that children younger than 16 were unlikely to be able to form informed consent to such treatments. Internal communications from the World Professional Association for Transgender Health suggest that the group tried to interfere with a review commissioned from a team of researchers at Johns Hopkins University.

Johanna Olson-Kennedy, medical director of the Center for Transyouth Health and Development at Children’s Hospital of Los Angeles, told the New York Times that a government-funded study of puberty blockers she helped conduct, which started in 2015, had not found mental health improvements, and those results hadn’t been published because more time was needed to ensure the research wouldn’t be “weaponized.” Medical progress is impossible unless null or negative results are published as promptly as positive ones.

I wrote about Johanna Olson-Kennedy here and here. She admits to sitting on the results of her own study because they didn't show what she wanted them to show. She is also being sued by a detransitioner who claims (with evidence) that Olson-Kennedy pushed her toward medicalization after a single meeting. By age 13 she was on testosterone and by age 14 she had a double mastectomy.

The story about WPATH's meddling in Johns Hopkins research is also revealing. 

From early on in the contract negotiations, WPATH expressed a desire to control the results of the Hopkins team’s work. In December 2017, for example, Donna Kelly, an executive director at WPATH, told Karen Robinson, the EPC’s director, that the WPATH board felt the EPC researchers “cannot publish their findings independently”. A couple of weeks later, Ms Kelly emphasised that, “the [WPATH] board wants it to be clear that the data cannot be used without WPATH approval”...

in May 2018 Ms Robinson signed a contract granting WPATH power to review and offer feedback on her team’s work, but not to meddle in any substantive way. After wpath leaders saw two manuscripts submitted for review in July 2020, however, the parties’ disagreements flared up again. In August the WPATH executive committee wrote to Ms Robinson that WPATH had “many concerns” about these papers, and that it was implementing a new policy in which WPATH would have authority to influence the EPC team’s output—including the power to nip papers in the bud on the basis of their conclusions.

The Hopkins team published only one paper after WPATH implemented its new policy: a 2021 meta-analysis on the effects of hormone therapy on transgender people. Among the recently released court documents is a WPATH checklist confirming that an individual from WPATH was involved “in the design, drafting of the article and final approval of [that] article”. (The article itself explicitly claims the opposite.) Now, more than six years after signing the agreement, the EPC team does not appear to have published anything else, despite having provided WPATH with the material for six systematic reviews, according to the documents.

Simply put, this is not how science works. You don't cancel studies that don't show what you hoped they would. WPATH is acting as an advocacy group and shouldn't be trusted. The Post editorial board concludes there is no substitute for quality medical research in deciding how to approach these issues and clearly until we have that research there is room for states to act to protect minors.

Also today, the Post has introduced an entirely new commenting system which looks a lot like the much superior one used by the NY Times. Already, the results are improved. Here's the top (most upvoted) comment.

Far too often, usually in comments sections, people attribute using caution regarding treating trans youths as being just a "Republican/Christo" plot.

Completely ignoring the fact that caution is the view of many scientists, most of whom are liberals.

I have a Ph.D. in Clinical Psychology from Vanderbilt. Until I retired I was a professor of psychology and had an active therapy and consulting practice. I have read the research, a lot of it.

I retired 20 years ago. If, before I retired, a parent brought their child to me for help with this issue this is the approach I would have taken: If the child had been displaying signs of gender confusion since he was a toddler then that suggests a quite different approach from the current situation of girls identifying as trans when they reach adolescence. We have known about this small group of trans children (usually boys) for decades. The latter is a new phenomenon.

I would NOT recommend to parents a clinic where trans surgeries are done. Those folks have a financial interest in operating contrary to the research. And are not unbiased.

I would recommend this: That the parents and perhaps the child spend several months with me reading the Cass Report, which is the most complete and thorough and sensitive approach to the issue that exists. But it is long, and would be difficult for someone not trained in research to follow. In other words, my job would be to provide all parties the BEST information science has to offer, so their decisions would be ones they had the best chance of living with in the long run.

When you read criticisms of the Cass Report, ask those criticizing it whether they have a financial stake in providing treatment in any way. Or whether they belong to or adhere to any trans advocacy groups It is the epitome of good science.

This is a big improvement on the usual garbage that infests the Post's comment section.