Transphobes Thought This Evidence-Based Medicine Guy Was Their Pal. As Usual, They Were Wrong.

It’s a bitter irony that so many of those who will sneer at “expertise” when the experts are saying something different from what their gut is telling 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 the vaccines were bad, that they didn’t need to wear masks, that they could just take Ivermectin or something to that effect, was instantly elevated to celebrity (and a whole lot of money).

We’ve seen more or less the same thing 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 so 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 systemic 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 and included them in the US Department of Health and Human Services report on gender dysphoria.

That was not what Guyatt intended. In August, he and other researchers who participated 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 saying that it doesn’t help people, because it does.

This occurred after a campaign by McMaster students and trans activists protesting the fact that these reviews were being used to harm them, and that they were requested and funded by the Society for Evidence-Based Gender Medicine (SEGM), whose mission it is to promote and fund studies that show that gender-affirming care is harmful. SEGM claims that they are not out to get transgender people, but that they just want them to have the best care possible. This does not appear to be true, given their opposition to conversion therapy bans and support of the pseudoscientific concept of “Rapid Onset Gender Dysphoria.”

It seems the primary issue is a misunderstanding — deliberate or otherwise — of what it means when such a review categorizes something as having low-quality (or low-certainty) evidence. They, as laymen, interpret this as meaning that the research conducted is bad or that it shows that they are right about the supposed “harms” of gender-affirming care. But that is not, Guyatt explained to Mother Jones, what it means to a scientist.

Low-quality, in Guyatt’s GRADE methodology, 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 very 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 only supported by smaller studies without the same kinds of control groups: “low-quality” evidence. (GRADE also includes other levels of evidence.)

Guyatt has also explained that a very large percentage of standard treatments are regarded as having “low-quality” evidence, for these reasons, but that it does not mean they are not helpful or not effective. It would not even be humanly possible to do a double-blind study on this kind of medical intervention. 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 as care driven by ideology, and low-certainty evidence as bad science. Many of the interventions we offer are based on low certainty evidence, and enlightened individuals often legitimately and wisely choose such interventions,” Guyatt and others asserted in the August statement.

Guyatt also explained that, in cases where there is “low-quality evidence,” 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, weirdly, chosen to devote the entire last decade of his life to attacking trans kids and their families, doubled down on this in an interview with Guyatt.

After Guyatt explained to him that two-thirds of medical therapies have ratings of “low-certainty” for a variety of reasons, and that this does not mean they aren’t beneficial or that they shouldn’t be used, Singal still seemed to think that 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 then explained, patiently, 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 he was about bitterly trying to make a case for how the 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 that they do not like. We all want the medications and devices we use to be as safe as humanly possible, but there’s no such thing as a 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 out perfectly for everyone is an absurd standard that 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 are out here accusing him of “bending the knee” and being “naïve” or having somehow been bullied by all the mean transgender people into betraying the evidence-based science he is supposed to stand for.

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 poly-cystic 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.

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