McMaster University Falls Short on Bioethical Standards
McMaster University, known for its pioneering role in evidence-based medicine, finds itself at the centre of a heated debate over its research on gender dysphoria and the treatment of children and adolescents with the condition.
The controversy is fueled by a growing schism between the university and the Society for Evidence-Based Gender Medicine (SEGM), which funded several reviews on the subject. The reviews, authored by McMaster researchers Vandenbussche, Turban, and Olson, have been cited in reports about medical care for children and adolescents with gender dysphoria.
The reviews, like other systematic reviews in this area of study, found only "low certainty" evidence for the benefits of gender "affirming care." This has sparked concerns about the potential harms, including fertility and sterility issues, sexual dysfunction, neurodevelopmental challenges, loss of bone density, metabolic and cardiovascular issues, psychiatric problems, and more.
Five McMaster researchers from the Department of Health Research Methods, Evidence and Impact (HEI) have released a statement condemning the "misuse" of these systematic reviews to justify restrictions on sex-rejection procedures for minors. They argue that the principles of evidence-based decision-making require that patient "values and preferences" guide shared decisions, especially when evidence is uncertain.
However, the researchers did not dispute the reviews' methodological integrity or findings, but expressed concern about reputational fallout, particularly from "members and allies of 2SLGBTQIA+ communities." This concern was heightened when the Southern Poverty Law Center attempted to smear SEGM by formally labeling it a pseudoscientific "hate group."
Advocates in this camp have targeted HEI researchers, including through a social media operation, and accused them of collaborating with a hate group to "harm trans youth" and "deny gender-affirming care."
Joseph Figliolia, a policy analyst at the Manhattan Institute, argues that basing support for pediatric gender medicine on a combination of low-certainty evidence and a minor's protean desires is not an act of compassion. He contends that true compassion requires weighing risks and benefits in a way that may limit children's immediate desires but will preserve their capacity to make irreversible medical decisions after they come of age.
David Sackett, one of the McMaster researchers, argues in an interview that some physicians may determine that an adolescent possesses the maturity to make serious medical decisions, but concedes that it may not always be the case. He emphasises the importance of shared decision-making between the patient, their family, and their healthcare providers.
The HHS report notes that our knowledge of the effects and mechanisms of puberty blockers and cross-sex hormones allows us to anticipate multiple risks. However, it makes no explicit policy recommendations, citing the findings of the McMaster reviews is consistent with its aim to provide accurate and current information regarding the evidence base for the treatment of gender dysphoria.
Trans-identification itself is not static but dynamic, and gender dysphoria is not a stable diagnosis. Many youths tend to outgrow it during the normal course of development. The World Professional Association for Transgender Health's SOC-8 guidelines advocate for the removal of patient distress as a diagnostic feature for gender incongruence to reduce stigma associated with the condition.
SEGM was forthcoming with McMaster at all stages of their collaboration and agreed to the university's research agreement and terms for managing conflicts of interest. McMaster's leadership became uncomfortable with the SEGM affiliation and urged the HEI researchers to distance themselves.
The debate surrounding McMaster's research highlights the complexities and nuances of treating gender dysphoria in children and adolescents, and the need for continued dialogue and evidence-based decision-making.
