- Researchers promoted the medical transition of children through biased research after receiving funding from pharmaceutical companies that produce hormone therapy medications.
- Activists at an organization with the stated goal of helping young people obtain medical transitions published research claiming to find an association between medical transitions and improved mental health.
- Media outlets are promoting this research uncritically while failing to mention problems with methodology and conflicts of interest.
Researchers are churning out biased studies promoting medical gender transitions for children, often supported by pharmaceutical companies and activist organizations, and the media frequently promotes the conclusions uncritically.
A March 2021 National Institute for Health and Care Excellence comprehensive review of nine studies failed to find evidence that hormonal therapy and puberty blockers were helpful. The review pointed out common flaws in transgender treatment research, such as confounding variables and bias resulting from observational studies that lack control groups.
Yet the media has widely publicized studies funded by pharmaceutical corporations and activist groups which claim to find that “gender-affirming” medical care, such as hormones that block children from going through puberty, is good for kids’ mental health.
Stanford University published a Jan. 12 study on childhood hormone therapy funded by the American Academy of Child & Adolescent Psychiatry (AACAP), which, according to a Stanford press release, is supported financially by pharmaceutical giants Arbor and Pfizer. Both companies produce hormonal medications used in gender transitions.
AACAP is an outspoken advocate against laws regulating or restricting puberty blockers, hormone therapy and sex change surgeries for children. It awarded its Pilot Research Award, which supports child and adolescent psychiatry research, to Dr. Jack Turban, the lead author on the Stanford study, in May 2019.
Research suggests that accepting a child's affirmed gender identity and expression can decrease the risk of future psychiatric problems. Read AACAP's Facts for Families on Transgender and Gender Diverse Youth https://t.co/2qECLgMEWi #trans
— American Academy of Child & Adolescent Psychiatry (@AACAP) November 20, 2017
“If Pfizer is producing hormone therapies then of course there’s incentives to promote studies that push those,” Dr. Diana Blum, a California neurologist, told DCNF. “Even though things get published in academic journals, a lot of the funding comes from the pharmaceutical industry.”
Pfizer did not respond to the DCNF’s requests for comment.
There was no communication between Arbor, Pfizer and Turban regarding the Pilot Research Award supporting the Stanford study, according to documents Turban shared with DCNF. Arbor and Pfizer did not know who the funds would go to or the nature of the project prior to funding it, but Turban knew the funds for the research were from a pharmaceutical company when he was notified of the award, and he knew Pfizer was funding it in by June 2019, years before the Stanford study would be published.
Researchers presumably would have been aware of AACAP’s well-established bias towards what it calls “gender-affirming care;” AACAP’s research committee makes the final decision on which projects and researchers are funded through the money pharmaceuticals companies give them.
The Stanford study claimed to find better mental health outcomes for transgender adults who started hormones in adolescence compared to those who waited until adulthood, and it was touted as evidence of the benefits of hormone therapy for children.
Turban said in the press release that the study was “particularly relevant now because many state legislatures are introducing bills that would outlaw this kind of care for transgender youth.”
Dr. Blum spoke with the DCNF about problems with the study’s methodology. “This was not a double-blind placebo-controlled trial where you can actually say they tested a hypothesis and here’s the conclusion and here’s why you know it’s valid,” she explained.
“The Stanford study used surveys. Right off the bat there are confounding variables never taken into account and thus inappropriate conclusions and generalizations are made that may not apply to the patient population studied,” Blum said.
The study acknowledged that a randomized controlled trial, as opposed to the survey method, would have helped to determine causality, but “many have noted that such a trial design is unethical in this context.”
The claim that childhood hormone treatment is associated with improved mental health outcomes did not apply across the board in the Stanford study. Transgender patients who received hormone therapy between ages 16 and 17 were three times as likely to have attempted suicide in the previous year compared to those who had never undergone hormone therapy, and five times as likely than those who took hormones as adults, according to the study. Sample sizes for groups who took hormones under 18 were smaller than the group who took hormones at 18 or older.
Turban also worked on a 2019 study funded by the AACAP award which concluded that exposure to therapy aimed at helping a transgender person accept their biological gender was linked to adverse mental health outcomes. “Our results support the policy positions of the American Academy of Child and Adolescent Psychiatry … that gender identity conversion therapy should not be conducted for transgender patients at any age,” the study concluded.
Media outlets touted the Stanford study as evidence that puberty-blocking hormones and other hormonal medications given to trans-identifying children are beneficial for mental health. NBC News, the Today Show, USA TODAY and Psychology Today published articles repeating the researchers’ conclusions uncritically and did not note the potential conflicts of interest arising from the AACAP funding or the suicide discrepancy for ages 16 to 17.
The New York Times cited the study to support its claim that “preliminary studies have suggested that adolescents who receive drug treatments to affirm their gender identity have improved mental health and well-being.”
“Once it’s in the headlines it gets people’s attention and no one actually digs deeper into it,” Blum said.
Every day, and especially today on International Transgender Day of Visibility, we support, stand in solidarity with, and celebrate our transgender colleagues, friends, and family. #TDOV #TransdayOfVisibility 🏳️⚧️ pic.twitter.com/j8g3rOnwKx
— Pfizer Inc. (@pfizer) March 31, 2021
In addition to receiving funding from pharmaceutical companies that sell medications used in gender transitions through the Arbor and Pfizer-funded AACAP, the Stanford study noted that Dr. Turban received “expert witness” payments from the ACLU, which promotes “gender-affirming care” for children in its activism.
Turban was also one of four researchers behind a 2020 AACAP-funded study that claimed to find a strong relationship between puberty blocker use in adolescence and reduced risk of suicide in adulthood.
Oxford Sociologist Michael Biggs pointed out problems with Turban’s 2020 study, titled “Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation,” in a lengthy commentary.
Among other issues, according to Biggs, the study relied on a low-quality survey which elicited unreliable answers on puberty blockers; it assumed that puberty blockers were available in the U.S. several years before they actually were; it barely acknowledged the fact that adolescents with severe psychological problems were less eligible for drugs; it excluded those who underwent medical intervention and then subsequently stopped identifying as transgender and, perhaps most importantly, it excluded individuals who had actually commit suicide.
A similar story played out in December 2021 when a study conducted by researchers at the Trevor Project, a transgender activism group, claimed to find a positive relationship between hormone therapy for transgender youth and reduced depression and risk of suicide.
📢 “This study comes at a critical time, as several states have been introducing unscientific legislation that would limit access to gender-affirming medical care for transgender youth, despite opposition from all major medical organizations" 📢https://t.co/TrkQ5FbuMN
— The Trevor Project (@TrevorProject) December 15, 2021
The study was not a randomized trial, but was based on a voluntary online quiz which found trans youth through targeted ads on social media and offered $50 prizes to respondents.
In the Trevor Project study, transgender youth who took hormones were 8-14% less likely to report recent depression or seriously consider or attempt suicide in the last year compared to transgender people who wanted but did not receive hormones. At 15%, transgender individuals who had taken hormones were still about 3,000% more likely to have attempted suicide in the last year compared to the general population. The results excluded data on transgender youth who did not want hormone therapy, who comprised 36% of the transgender and nonbinary respondents.
The Trevor Project study stated that researchers were unable to control for the effect of parental support in improved outcomes, as every respondent who said they took hormones also had at least one supportive parent. It’s unclear whether parental support, rather than hormonal medications, could have driven the slight improvement in mental health since researchers were unable to examine those variables independently.
Researchers also noted that those with histories of suicidal thoughts and depression may have been less able to seek out hormone therapy, which could confound the results.
These issues were not mentioned in the brief conclusion of the Trevor Project study, which claimed the “findings support a relationship between access to [gender-affirming medical treatments] and lower rates of depression and suicidality among transgender and nonbinary youth.”
— NBC News (@NBCNews) January 12, 2022
NBC News uncritically reported Dec. 14 that “gender-affirming hormone therapy is strongly linked to a lower risk of suicide and depression for transgender youths,” citing the Trevor Project research alongside quotes from its employees. The NBC report failed to mention the study’s questionable methods, how small the mental health gains were, or that the study did not and could not find causality.
“Causation cannot be inferred due to the study’s cross-sectional design,” the study stated. “It is possible that those who historically have higher rates of depression and suicidal thoughts and behaviors are also less able to seek or obtain GAHT.”
The Trevor Project’s mission is to help “young people” obtain what it calls “gender affirming” healthcare, meaning hormones and genital surgeries rather than counseling to accept one’s biological sex. The organization’s website, which is targeted towards a young audience, tells new users that they can quickly close out of the site by pressing the escape key three times. It also advertises an online community for “LGBTQ young people ages 13–24” where “you can explore your identity, get advice, find support, and make friends.”
Activists are promoting drastic medical interventions for children suffering from gender dysphoria, often touting the high suicide rate of transgender youth as justification. But researchers and doctors don’t all agree that hormones and surgeries for children are beneficial for mental health, and medical practitioners have voiced concern about the harms of gender transition treatments.
Doctors and scientists pointed to emerging research on puberty blockers’ adverse effects on bone and brain health in an October 2020 letter to the editors of Springer Link, a scientific journal. The letter questioned other researchers’ assumption that puberty blockers are safe and reversible.
“Since almost all of the children treated with puberty blockers proceed to cross-sex hormones … puberty blockers may consolidate gender dysphoria in young people, putting them on a lifelong path of biomedical interventions,” the letter noted.
The world’s largest data set on sex reassignment procedures does not show a clear link between mental health benefits and surgical or hormonal interventions, contrary to the narrative many media outlets appear to be advancing. Published in the American Journal of Psychiatry in 2019, the study of over 9 million individuals including 2,679 transgender patients demonstrated no mental health benefits from sex reassignment surgeries or hormone therapy, and surgeries corresponded with higher likelihood of later treatment for anxiety disorders.
Despite these findings, researchers titled the study “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study,” and claimed patients were less likely to seek out mental health treatment after gender reassignment surgery before issuing a correction nearly a year later amid a deluge of criticism.
“The results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison,” the correction noted, adding that their original claim that the findings lent support to gender transition surgeries was “too strong.”