Talk:Gender dysphoria in children

Undue weight to conversion therapy in the lede and in the history section

Conversion therapy, or the "theraputic approach", as it was called, is not a safe or effective treatment for gender dysphoria. Including in the lede gives it undue weight, so I recommend we remove it per WP:NPOV.

Also, while there might be value in having a section on the history of gender dysphoria in children, if the entire section is going to be on conversion therapy, we should just call the section that. I saw that there was some unresolved prior discussion on this, so to avoid an edit war-by-proxy, I'm bringing it up here again instead of boldly editing.

And also I'm including this here too because it's about this topic so any edits should be coordinated, there seems to be a page structure issue in the Society and culture section -it seems that this was either supposed to be a heading 3 under History, or for some reason the entire section is dedicated to what one person seems to think on the issue, which again raises undue weight concerns. I recommend restructuring or removing that section. Egefeyzi (talk) 01:46, 3 March 2023 (UTC)

Seeing no objections for a while, I'm boldly editing the page Egefeyzi (talk) 19:29, 21 March 2023 (UTC)

Hrm. The previous version probably gave it undue weight (and especially had too much WP:PROFRINGE stuff defending it) but I do think it might be worth at least a brief mention in the lead, at least to note that it is broadly rejected. --Aquillion (talk) 06:13, 22 March 2023 (UTC)

Are all therapeutic approaches tantamount to conversion therapy? 81.79.156.133 (talk) 13:05, 14 April 2023 (UTC)

References

Internal Inconsistencies / Dishonest Framing in "Persistence"

Apologies for any missteps, infrequent editor and first-time commenter.

I've seen the "Persistence" body used in full or part on another page before, and while I can't recall it precisely, prolific editor @Crossroads raised multiple valid objections and then the page was still changed to match this topic body after seeming consensus against it. Seeing it here again, I felt compelled to leave a comment, but I recognized @TheTranarchist from their exchanges with Crossroads, and I'm not looking to start any fights. I understand the policy of assumption of good faith, but I hope that given the issue I am raising, it is acceptable to politely share my impression of the edit wars and relevant actors. Although I suppose from reading her about me, she is happily combative, which I know is necessary at times. I leave the above "their" in place as a show of good faith: I went to read your page after I decided to tag you and Crossroads, I learned your pronouns in the process, and - as anyone should - I instantly began to use them.

To preface everything, I think it is important to acknowledge the implicit validity in transitioning and trans people in general. And, unrelated, it is relevant to this topic that sensitivity around the evidenced reality that many youth (group in question) have for years demonstrated the possibility (and, as cited in text, propensity) to desist in their feelings of gender incongruence / dysphoria / etc.

The "Persistence" body proceeds as follows:

1. An out of context (with the rest of the body) quote suggesting gender is "stable" by age four.

2. A paragraph-opening sentence, quoted verbatim: "If gender dysphoria persists during puberty, it is very likely permanent." - note this already calls into question the first paragraph; clearly, if one's gender and feelings around and from it continues to change even around puberty, trying to set up a belief in a "stable sense of...gender" "by age four" is unreasonable.

3. Following 2. (same paragraph), the verbiage changes from "during puberty" to "through puberty", continuing the trend of revolving goalposts. Otherwise, the content here is of good quality, and I recognize and affirm the "intensity" and "are" versus "wish" points.

4. The next massive (separate problem) paragraph is most obvious through proportions, aside from the overt "(since debunked)" at the very start. Ignoring the disparate quality of the lower citations and single-author opinion pieces, this paragraph is 460 characters (including 8 citations) speaking to a few of the studies showing a high desistence rate followed by 1926 characters (including 4 citations, ~10% of the above) of unquoted apparent original research with only end-of-paragraph citations.

5. The next (final) paragraph is insultingly poor. Not only is it a bland rehash of the prior paragraph with original claims of "biased research" "disproving the results of the prior studies", the two citations are single-author borderline opinion pieces, and the one that is closest to credible is a "literature review", stylized at the start of the paragraph as a "systematic review of research."

I cannot be invested enough to fight this battle myself, and I think it would be ethically dubious to directly place text into the wiki as someone active in the field, but I implore the understandably-dedicated, understandably-polarized (subject of polarization, by the many opponents of trans rights) editors to reevaluate your own biases. Gender dysphoria is variable and multifactorial, to say the least. Acknowledging that neither invalidates nor undermines trans people or trans identities, and intellectual dishonesty not only hurts the greater cause and dissemination of knowledge, it is causing youth to bypass that critical self-understanding of "are" versus "wish" (referencing point 3, above). "If you, a youth, experience dysphoria, you are trans" - unqualified - is not true, and you must not lead people to that belief. "If you, a youth, experience a desire to be the opposite sex/gender, you are best served by transitioning" - unqualified - is not true, and you must not lead people to that belief. Sacrificing integrity to put on a stronger front for the public eye will backfire, and it is not a good way to be. Sadly, that is the state of a number of the ideological topics of this decade. It has become propaganda on both sides. 49.186.63.35 (talk) 09:35, 26 April 2023 (UTC)

You could start by chopping about 90% of that wall of text per WP:TLDR. Dronebogus (talk) 12:22, 26 April 2023 (UTC)

Much of it seems to be analyzing the content in the article, which obviously takes some length. What, if any, changes are merited I'll have to come back to. Crossroads ^-talk- 23:23, 28 April 2023 (UTC)

Yeah I'll have to agree the massive edit was not my best work, the article still has ways to go. The version before this one had major NPOV issues, but after stepping away from the article for a while and reading what you wrote, I agree it's still not great. I'll respond to your concerns piece by piece:

All the credible sources I've found seem to indicate that there is no propensity of youth to have their gender dysphoria resolve on its own without transitioning. To the contrary, it seems to get much worse very quickly. (See the sources in the article.) Can you cite credible and recent secondary/tertiary sources that disagree with that? I couldn't find any.

The persistence section was a mess of severely outdated information and that and a few other sections were focusing on a single researcher and their studies, which obviously raise major WP:NPOV and WP:PROFRINGE concerns. There was a paragraph or so at the very bottom talking about how the research was discredited. This, however, buries the ending in the details and makes it look like the studies are credible to a reader skimming the article. I tried to not blank the whole section but instead point out that the studies in question were not credible. In hindsight, bringing up a study just to debunk it is not good practice so I probably should have deleted that whole bit to avoid WP:FALSEBALANCE.

Regarding inconsistent use of language, feel free to fix copy editing mistakes without bringing them up here.

With regards to the final paragraph, I'm just going to ask you to read up on the current medical consensus regarding gender dysphoria and remind you that Wikipedia is not a forum, nor is it a platform for advocacy. No matter what your opinions on what we should be pushing children to do, our job here is to provide unbiased information from a neutral point of view. With all due respect, giving undue weight to a fringe point of view just because you want to achieve a certain social effect is not appropriate on Wikipedia.

So overall, I think we should edit the persistence section to remove the very long description of debunked studies (which is now an obvious conclusion but oh well lol) and instead focus on the up to date information from the APA/CPA/etc. Egefeyzi (talk) 06:13, 10 May 2023 (UTC)

Yeah, I don't think we should be bringing WP:FRINGE theories into these pages unless there is some strong reason that readers need to be aware of them. Since these are medical topics, we should generally follow the best mainstream sources, ideally from systematic reviews, etc., rather than trying to throw in every idea that has ever come up, and creating a sense of WP:FALSEBALANCE. Especially when the sources represent old theories that never gained mainstream acceptance. Hist9600 (talk) 16:30, 10 May 2023 (UTC)

Seems like there's a consensus to remove that part of the section, edited the article. Also cleaned up some direct quotes to improve flow. Egefeyzi (talk) 22:51, 3 June 2023 (UTC)

Without having looked at the article recently, and only having skimmed your comment for now, I think there are some good points and this section is likely in need of improvement. Hopefully I'll have time to take a look into it once I get home this evening. Equivamp - talk 10:34, 10 May 2023 (UTC)

Dubious sources on long term effects of puberty blockers

Of the three sources listed for the claim "Research on the long-term effects on brain development, cognitive function, fertility, and sexual function is limited." one is a newspaper article, another disagrees with that claim, and the third one from "Annals of Pediatric Endocrinology & Metabolism" is misquoted. It explains that research is limited specifically for the use of puberty blockers on trans youth and that controlled studies aren't common because they are considered unpractical and unethical.

What the author is explaining here is that it's very difficult to see the effects of puberty blockers on trans youth by using the usual double blind placebo controlled studies, because they're already the standard of care. Giving a group of patients placebo instead of the actual standard of care would be unethical, so these studies aren't contucted in the usual manner, and not frequently. When they are, longitudinal studies are conducted instead. The limited data we have seems to indicate the somewhat obvious conclusion of puberty blockers being helpful at preventing trans children from having their gender dysphoria worsened.

Also it's important to know that puberty blockers have been used for a very long time to treat precocious puberty.

Overall, I don't like the sources cited for that claim, they don't support it. We should either find better sources or remove the claim entirely. Egefeyzi (talk) 23:30, 3 June 2023 (UTC)

I agree better sources should be found, but the claim is not completely unsupported. Specifically, I think reliable sources positively affirming the contrary should be provided if the research of long-term effects is not 'limited'. The Reuters article contains "Puberty blockers and sex hormones do not have U.S. Food and Drug Administration (FDA) approval for children’s gender care. No clinical trials have established their safety for such off-label use," which is clear enough in itself. --TadejM ^{my talk} 19:04, 27 June 2023 (UTC)-

If a source such as a newspaper article does not meet the criteria for WP:MEDRS, it probably is not reliable for establishing anything important for this subject. See in particular: WP:MEDPOP. Hist9600 (talk) 19:22, 27 June 2023 (UTC)

In my opinion, this goes along with "As the quality of press coverage of medicine ranges from excellent to irresponsible, use common sense, and see how well the source fits the verifiability policy and general reliable sources guidelines." Specifically, there are two crucial claims that are easy to verify. --TadejM ^{my talk} 19:34, 27 June 2023 (UTC)

I believe the interpretation of the Reuters article regarding the lack of FDA approval is a classic example of a statement that is (presumably) true but does provide any information about the question at hand, in this case, whether puberty blockers are safe for trans youth. Lack of FDA approval due to lack of clinical trials itself is clearly not the same as "it is unsafe" or "nothing is known about its safety".

I agree with Hist9600 and Egefeyzi that we clearly need sources that meet WP:MEDRS. For example, doi:10.1111/camh.12437 is a recent review already cited in the article and concludes that "[a]lthough large long-term studies with diverse and multicultural populations have not been done, the evidence to date supports the finding of few serious adverse outcomes and several potential positive outcomes."--TempusTacet (talk) 19:55, 27 June 2023 (UTC)

If it was a matter of citing well-known easily-verifiable facts, then it might not be an issue. But since this is a controversial topic, and people should be able to verify any and all details, I don't find one or two sentences in a news article to be sufficient. Better sources should be used that summarize the latest findings. From WP:MEDRS: Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies. Hist9600 (talk) 19:57, 27 June 2023 (UTC)

Ok, but the question at hand is not whether they are safe but whether the research is limited as this is what the statement in the article claims. The provided source corroborates the opinion of Reuters in this regard: "long-term studies with diverse and multicultural populations have not been done". --TadejM ^{my talk} 20:01, 27 June 2023 (UTC)

Yes. There is not necessarily a contradiction but WP:MEDRS-compatible sources should take precedence & the phrasing in the article should not imply that a lack of studies means that there is a lack of safety or a significant level of uncertainty regarding safety.--TempusTacet (talk) 20:11, 27 June 2023 (UTC)

Exactly, pharma companies don't reapply for FDA approval for a new area their medications can be used in is discovered. It's an extremely expensive process that they have no reason to repeat when they're already allowed to sell the medication in the US.

We do already know GnRH agonists safely and effectively block puberty, since they've been used for precocious puberty for ages now (see article for details/sources.) Any studies in their use for GD would focus on effectiveness in psychiatric concerns, not safety. Egefeyzi (talk) 23:12, 28 June 2023 (UTC)

As long-term research is lacking, the question of the long-term safety of puberty blockers, particularly regarding bone health and psychosocial health, remains open.[1] There may also be unknown long-term adverse effects. As stated: "Lack of information about long-term effects of GnRHa use was not considered an important problem by interviewed adolescents with gender dysphoria in the study by Vrouenraets, Fredriks, Hannema, Cohen-Kettenis, and de Vries (2016), but is seen as a major problem by many professionals (Vrouenraets et al., 2015)." [2] --TadejM ^{my talk} 17:38, 30 June 2023 (UTC)

I would argue that psychosocial health is not a safety concern but rather a question of treatment effectiveness. I still think that the review by Rew et al. doi:10.1111/camh.12437 (published in 2021) is a good, recent source that comes to more concrete conclusions than doi:10.1111/apa.1679 who are mostly concerned with methodological problems. I didn't have the time yet to compare the two in detail but I'd assume a significant overlap in the studies considered in the two analyses. I also came across doi:10.1111/camh.12533, which is a commentary on the 2021 Rew et al. paper sponsored by the "Society for Evidence-Based Gender Medicine" that one could consider the anti-PB voice in the debate. Puberty_blocker#Medical_uses contains a relatively comprehensive review of the recent literature that one could draw from and/or link to.

In general I believe that the discussion around long-term safety is a bit of a red herring. Considering the poor mental health outcomes in children with GD concerns over effects on bone density are surely valid but small in comparison to eg Combined_oral_contraceptive_pill#Side_effects.--TempusTacet (talk) 21:11, 30 June 2023 (UTC)

I would disagree with you and recent research confirms my earlier stance.[3][4][5] --TadejM ^{my talk} 14:51, 6 March 2024 (UTC)

References