The Partial Observer by Dr. William Malone

When Ideology Suppresses Medical Evidence, Patients Pay the Price

Something unusual is happening in medicine. A once-rare diagnosis—gender dysphoria—has become common among American children. An estimated 3 percent of youth now identify as transgender, and another 2 percent are questioning their gender identity. That surge should have prompted urgent, transparent scientific inquiry. Instead, the field of pediatric gender medicine has become one of the most ideologically charged—and least open to critical debate—areas in healthcare.

In nearly every branch of medicine, new interventions undergo rigorous testing and transparent review before being widely administered to patients or incorporated into clinical practice guidelines. When evidence is limited, we acknowledge uncertainty and proceed cautiously. Yet gender medicine has taken a different path. Puberty blockers, cross-sex hormones, and, in some cases, surgeries are being offered to minors despite a striking lack of evidence on long-term safety or efficacy.

Systematic reviews commissioned by health authorities in Sweden, Finland, and the UK—as well as recent North American reviews—have concluded that the benefits are uncertain. This prompted a growing number of European health authorities to state that psychological support and psychotherapy, rather than hormones and surgeries, should be the first-line approach. But in the United States, questioning the evidence can bring reputational risk. Researchers and clinicians who raise concerns are often accused of bias or bigotry.