Crumbling Confidence in Pediatric Transgender Healthcare Practices
The American Medical Association (AMA) has found itself at the centre of a heated debate, with its stance on gender-affirming care coming under scrutiny. The organisation's president, Bobby Mukkamala, has been criticised for making questionable claims about pediatric gender medicine and demonstrating a lack of understanding of evidence-based medicine (EBM) principles.
In a controversial move, Mukkamala recommended gender doctor, Jesse Krikorian, to a legislator. This recommendation led to meetings where Krikorian was found to be misinformed about gender medicine research and unfamiliar with the workings of EBM. The legislator had recorded these conversations without their knowledge.
Amazeingly, Mukkamala also asserted that the suicide rate among people who identify as transgender is between "50 and 70 percent," a claim that has been debunked as baseless. This statement runs counter to two foundational principles of EBM.
Krikorian, on the other hand, has been minimising the side-effects of cross-sex hormones, casting them as desirable, and dismissing studies conducted more than a decade ago as less relevant. His statements about the risks of infertility, regret rate, and ease of access to intervention are unsubstantiated and contradict existing research.
In a bid to protect pediatric gender-affirming care procedures, the AMA passed a resolution. However, the organisation's stance has been criticised by some who argue that it is prioritising the interests of its members over the best available evidence. The coalition for evidence-based medicine is weak, attracting too little energy and political entrepreneurship from policymakers.
The AMA has also joined an amicus brief in a lawsuit challenging a state age-restriction law for these procedures. Furthermore, it wrote a letter urging state governors to veto similar legislation. Despite this, Mukkamala refused to discuss why the AMA continues to make claims about "gender-affirming care" that are negated by systematic reviews of evidence.
Interestingly, Krikorian considers systematic reviews to be essentially reading lists, which doctors can consult before using their own subjective judgment to evaluate individual studies. This approach inverts the pyramid of evidence in EBM. Krikorian is also unaware of the concept of umbrella reviews, which are systematic reviews of systematic reviews.
AMA board member Michael Suk, however, publicly called pediatric transition "medically-necessary, evidence-based care." Despite the controversy surrounding Mukkamala's recommendations and statements, it is clear that the debate surrounding gender-affirming care is far from over.
The best available research suggests that co-occurring mental-health conditions, common in youth diagnosed with gender dysphoria, likely explain the elevated risk of suicide. It is crucial for medical professionals to approach this issue with a nuanced understanding of the evidence and the complexities involved.
