The open letter, published in the Wall Street Journal on July 13, responded to a June letter in the Journal by Endocrine Society President Stephen Hammes.
The letter reads:
As experienced professionals involved in direct care for the rapidly growing numbers of gender-diverse youth, the evaluation of medical evidence or both, we were surprised by the Endocrine Society’s claims about the state of evidence for gender-affirming care for youth (Letters, July 5). Stephen Hammes, president of the Endocrine Society, writes, “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.” This claim is not supported by the best available evidence.
Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret. For this reason, more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.
Dr. Hammes’s claim that gender transition reduces suicides is contradicted by every systematic review, including the review published by the Endocrine Society, which states, “We could not draw any conclusions about death by suicide.” There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.
The politicization of transgender healthcare in the U.S. is unfortunate. The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks.
This letter is signed by 21 clinicians and researchers from nine countries.
FINLAND
Prof. Riittakerttu Kaltiala, M.D., Ph.D.
Tampere University
Laura Takala, M.D., Ph.D.
Chief Psychiatrist, Alkupsykiatria Clinic
UNITED KINGDOM
Prof. Richard Byng, M.B.B.Ch., Ph.D.
University of Plymouth
Anna Hutchinson, D.Clin.Psych.
Clinical psychologist, The Integrated Psychology Clinic
Anastassis Spiliadis, Ph.D.(c)
Director, ICF Consultations
SWEDEN
Angela Sämfjord, M.D.
Senior consultant, Sahlgrenska University Hospital
Sven Román, M.D.
Child and Adolescent Psychiatrist
NORWAY
Anne Wæhre, M.D., Ph.D.
Senior consultant, Oslo University Hospital
BELGIUM
Em. Prof. Patrik Vankrunkelsven, M.D. Ph.D.
Katholieke Universiteit Leuven
Honorary senator
Sophie Dechêne, M.R.C.Psych.
Child and adolescent psychiatrist
Beryl Koener, M.D., Ph.D.
Child and adolescent psychiatrist
FRANCE
Prof. Celine Masson, Ph.D.
Picardy Jules Verne University
Psychologist, Oeuvre de Secours aux Enfants
Co-director, Observatory La Petite Sirène
Caroline Eliacheff, M.D.
Child and adolescent psychiatrist
Co-director, Observatory La Petite Sirène
Em. Prof. Maurice Berger, M.D. Ph.D.
Child psychiatrist
SWITZERLAND
Daniel Halpérin, M.D.
Pediatrician
SOUTH AFRICA
Prof. Reitze Rodseth, Ph.D.
University of Kwazulu-Natal
Janet Giddy, M.B.Ch.B., M.P.H.
Family physician and public-health expert
Allan Donkin, M.B.Ch.B.
Family physician
UNITED STATES
Clin. Prof. Stephen B. Levine, M.D.
Case Western Reserve University
Clin. Prof. William Malone, M.D.
Idaho College of Osteopathic Medicine
Director, Society for Evidence Based Gender Medicine
Prof. Patrick K. Hunter, M.D.
Florida State University
Pediatrician and bioethicist
Transgenderism has been highly politicized—on both sides. There are those who will justify any hormonal-replacement intervention for any young person who may have been identified as possibly having gender dysphoria. This is dangerous, as probably only a minority of those so identified truly qualify for this diagnosis. On the other hand, there are those who wouldn’t accept any hormonal intervention, regardless of the specifics of the individual patients.
Endocrinologists aren’t psychiatrists. We aren’t the ones who can identify gender-dysphoric individuals. The point isn’t to open the floodgates and offer an often-irreversible treatment to all people who may have issues with their sexuality, but to determine who would truly benefit from it.
Jesus L. Penabad, M.D.
Tarpon Springs, Fla.