It’s a bitter irony that so many of those who sneer at expertise—when experts say something different from what their gut tells them—also have a tendency to make full-on icons out of those who they feel do agree with them.
As we saw during COVID, any doctor, regardless of their actual field of expertise, who was willing to tell people that vaccines were bad, that they didn’t need to wear masks, or that they could just take Ivermectin or something similar, was instantly elevated to celebrity status (and a whole lot of money).
We’ve seen more or less the same phenomenon with practically every other politicized scientific controversy: evolution, climate change, vaccines causing autism, and, perhaps most fervently, gender-affirming care and even the existence of trans people.
This is why so many arbiters of transphobic ideology (two can play at this game!) were thrilled to count Gordon Guyatt—the scientist who created the very concept of evidence-based medicine—as one of them. Or, at the very least, to believe he was.
Earlier this year, Guyatt was part of a group of researchers from McMaster University in Hamilton, Ontario, who conducted three systematic reviews on different gender-affirming-care interventions for adults and children: one each on puberty blockers, hormone therapy, and top surgery. Their finding was that the evidence for these treatments had either low or very low certainty of effectiveness.
Transphobic activists and legislators were so thrilled that they immediately used these reports to successfully push for bans on gender-affirming care, including incorporating them into the U.S. Department of Health and Human Services report on gender dysphoria.
That, however, was not what Guyatt intended.
In August, he and other researchers involved in the reviews issued an official statement decrying the use of these reviews for the purposes of banning or otherwise denying gender-affirming care or claiming that it doesn’t help people—because it does.
This statement came after a campaign by McMaster students and trans activists protesting the harmful use of these reviews, which were requested and funded by the Society for Evidence-Based Gender Medicine (SEGM). SEGM’s mission is to promote and fund studies that portray gender-affirming care as harmful.
SEGM claims they’re not out to get transgender people but simply want them to have the best care possible. This claim, however, seems dubious given their opposition to conversion therapy bans and support of the pseudoscientific concept of Rapid Onset Gender Dysphoria.
The primary issue appears to be a misunderstanding—deliberate or otherwise—of what it means when such a review categorizes something as having low-quality (or low-certainty) evidence.
As laypeople, many interpret this label as meaning that the research conducted is bad or that it supports the idea that gender-affirming care is harmful. But, as Guyatt explained to *Mother Jones*, this is not what it means to a scientist.
In Guyatt’s GRADE methodology, “low-quality” means there may be a lot more individual variability than is captured in the data, leaving physicians to rely on observational evidence and clinical experience. The gold standard for evidence-based medicine is randomized controlled trials; high-quality evidence generally comes from studies with large numbers of participants who are blinded—meaning they don’t know whether they’re receiving the treatment—a setup that isn’t always possible or ethical.
Many medical practices, as a result, are supported only by smaller studies without the same kinds of control groups, which leads to low-quality evidence. (GRADE also includes other levels of evidence.)
Guyatt has explained that a very large percentage of standard treatments have low-quality evidence for these reasons, but that does not mean those treatments are not helpful or effective. In many cases, it wouldn’t even be humanly possible to do a double-blind study on certain medical interventions. After all, “I mean, I think the kids would probably notice if they were on puberty blockers or not.”
It is profoundly misguided to cast health care based on low-certainty evidence as bad care or care driven by ideology, and low-certainty evidence as bad science. Many interventions we offer are based on low-certainty evidence, and enlightened individuals often legitimately and wisely choose such interventions, Guyatt and others asserted in their August statement.
Guyatt also emphasized that, in cases where evidence quality is low, it is very important to consider the autonomy of the patient and what they want for themselves.
Of course, those who previously cherished his reviews are determined to continue using their own interpretations of these findings regardless of what he says.
Jesse Singal, who has, oddly, devoted much of the last decade to attacking trans kids and their families, doubled down on this in an interview with Guyatt. After Guyatt explained that two-thirds of medical therapies have ratings of low-certainty for various reasons—and that this does not mean they aren’t beneficial or shouldn’t be used—Singal still seemed to think they shouldn’t be.
“But if they’re disseminating the use of a surgical procedure or a medical device before the evidence is in, that can cause problems,” Singal insisted.
Guyatt patiently explained that of course there can be problems with anything like that, but that doesn’t mean you should deny people care that could be beneficial to them.
Unfortunately, Singal was less interested in understanding this than in bitterly trying to make a case for how “bad transgender people” are ruining anyone who has questions about gender-affirming care and insinuating that this is what happened to Guyatt.
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It’s unfortunate that the concept of gold standard science is being used by ideological extremists as a cudgel to attack medical interventions they dislike. We all want the medications and devices we use to be as safe as humanly possible, but there’s no such thing as 100 percent safe or effective anything.
The idea that people should only be allowed to have life-saving gender-affirming care (or vaccines) if there are double-blind studies (somehow) done on it and it works perfectly for everyone is an absurd standard we do not require for literally anything else in this world.
It’s also unfortunate that, instead of listening to what Guyatt has to say about how his review is being misused, transphobes accuse him of bending the knee, being naive, or somehow being bullied by “all the mean transgender people” into betraying evidence-based science.
But that’s because it’s not about safety.
It’s not about the imaginary legions of 13-year-old girls getting top surgery (which, by the way, would be absurd to begin with, if only because their breasts would still be growing and you can’t even get a regular reduction until you’re fully developed).
It’s not about pretending puberty blockers—which have been used for decades to treat early puberty—are going to harm those children taking them.
It’s not about pretending hormones—which have also been taken by teenagers to manage conditions like polycystic ovary syndrome or growth disorders—are inherently dangerous.
The fact is, they just really, really, really don’t want trans people to exist.
They don’t want trans children to exist.
They don’t want their children to turn out to be trans and reject them and their nonsense.
That’s it. And science can’t change minds when it’s the heart that is the problem.
https://www.wonkette.com/p/transphobes-thought-this-evidence