Talk:Transgender health care misinformation

Did you know nomination

The following is an archived discussion of the DYK nomination of the article below. Please do not modify this page. Subsequent comments should be made on the appropriate discussion page (such as this nomination's talk page, the article's talk page or Wikipedia talk:Did you know), unless there is consensus to re-open the discussion at this page. No further edits should be made to this page.

The result was: rejected by reviewer, closed by SL93 talk 02:26, 9 March 2025 (UTC)

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• ... that transgender health care misinformation has been used to justify legislative restrictions on minor's transgender health care in the United States and United Kingdom?

• Source: https://www.kff.org/health-misinformation-monitor/falsehoods-about-transgender-people-and-gender-affirming-care/

• Reviewed:

Improved to Good Article status by Your Friendly Neighborhood Sociologist (talk). Number of QPQs required: 0. Nominator has fewer than 5 past nominations.

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 00:03, 14 January 2025 (UTC).

• Comment - a careful reading of the source shows that the main hook is not explicitly verified. The source says that misinformation has led to policy restrictions on health care for transgender people in the U.S. (instead of minors' transgender health care in the United States and United Kingdom). The source does go on to discuss bans on gender-affirming care for minors and misinformation continues to impact support for these bans, but then misinformation has been used to justify legislative restrictions is not verified, and the support is not clarified as legislative support or public support. What would be verified is that transgender health care misinformation has been used to justify legislative restrictions on transgender health care in the United States. In any case, a peer reviewed source would be better than the non-profit Kaiser Family Foundation. Also, there is a questionable sentence in the lede to clear up and stuff about Australia too. starship.paint (talk / cont) 13:40, 16 January 2025 (UTC)

Hows ALT1 ...that transgender health care misinformation, such as the claim most pre-pubertal transgender children "desist", has been used to justify legislative restrictions on minor's transgender health care? [1] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:56, 17 January 2025 (UTC)

• Quick comment: this is a much better source (accessible by WP:TWL, but I think more elaboration is needed for the above (i.e. desist from what? gender dysphoria / wanting to transition) but the hook has no space for it. I'd propose the below based on this source, but the below hook content will need to be added to the Wikipedia article. starship.paint (talk / cont) 14:42, 19 January 2025 (UTC)
  • Perhaps ...that legislative bans on minor's transgender health care have been justified with transgender health care misinformation such as the "desistance myth"?[2] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 01:06, 28 January 2025 (UTC)
    • The term "desistance myth" does not appear in the McNamara source (the only mention of myth is in the references) cited above. The term "desistance myth" appears in the Natacha Kennedy source, which at a quick glance doesn't seem to discuss legislative bans. Hence, the above hook would be WP:SYNTH. starship.paint (talk / cont) 14:53, 29 January 2025 (UTC)

ALT2 ... that transgender health care misinformation has been used by authorities in the American states of Alabama, Florida and Texas to justify legislative restrictions on minors' transgender health care? [3] starship.paint (talk / cont) 14:42, 19 January 2025 (UTC)

• I've got two issues with this ALT. 1) I think it's important to include some specific piece of misinfo 2) The scope seems way too narrow relative to the article - We have the endocrine society saying 18 states banned GAC based on misinfo in 2023[4] and the APA et al saying misinformation about ROGD was involved in many of over 100 proposed anti-trans bills in 2021 [5] - seems weird to pick out 3 states when 26 now ban care. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 01:06, 28 January 2025 (UTC)
  • Well, I only picked out 3 states because that's what kind of what that particular source did (picked out 4 states in particular, but the character count only could fit 3). starship.paint (talk / cont) 08:24, 29 January 2025 (UTC)

Alternatively, ALT3 ... that due to transgender health care misinformation, over 18 states in the United States banned gender-affirming care for minors in 2023, encompassing over 30% of trans children in the country?[6] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 01:06, 28 January 2025 (UTC)

• I'd like to workshop ALT1 with you because I do think having a specific example would be educational and a good hook, however, this hook is really engaging as well, better covers the scope of the issue, and with a top tier source that's also more accessible! Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 01:06, 28 January 2025 (UTC)
  • @Your Friendly Neighborhood Sociologist: - ALT3 has a bunch of information not from the source, you really should be more careful not to go beyond what the source says. (a) Source says 18, not "over 18". (b) Source says "gender-affirming care ... even restricting transgender and gender-diverse adults’ access to care", not "gender-affirming care for minors". (c) Source is from 2023, but it doesn't say "in 2023", so maybe the bans could be in 2022 or earlier. (d) Source says "30 percent of the nation’s transgender and gender-diverse youth", not "30% of trans children". (e) Source attributes 30% figure to Human Rights Campaign, so it's not the source's own voice, but you used Wikivoice. (f) Source doesn't explicitly say that the 30% come from the 18 states, logically there could be more states that banned, maybe not from misinformation, but your "encompassing over 30%" directly links the 18 states to the 30%. Having six issues in only one sentence really does not spark confidence (is the rest of the article of the same quality?!) - and should really spark reflection on why this happened. Even more concerning that this came about after I pointed out inaccuracies in the original hook compared to the source! starship.paint (talk / cont) 08:18, 29 January 2025 (UTC)
  • If I were to write ALT3, I would avoid the part attributed to Human Rights Campaign ALT3A ... that due to transgender health care misinformation, 18 states in the United States had banned gender-affirming care by 2023? [7] starship.paint (talk / cont) 08:18, 29 January 2025 (UTC)
    • I support this one, with the addition of "for minors". Saying 18 states banned it without clarifying they mostly only affected kids is unintentionally misleading. There's also a newer statement from them that says misinformation about gender-affirming care is being politicized. In the United States, 24 states have enacted laws or policies barring adolescents’ access to gender-affirming care, according to the Kaiser Family Foundation. In seven states, the policies also include provisions that would prevent at least some adults over age 18 from accessing gender-affirming care.[8] - While the 24 is attributed to the KFF, they are a major healthcare provider and generally reliable for healthcare laws by state I'd say. If we want, we could also use the note that 7 restricted it for adults as well. Responding to point F as it's still relevant, the position of every major medical org in America is that gender-affirming care bans are unscientific and based on misinfo - hypothesizing that some aren't goes into fringe territory. I think we could probably use 2-3 sources to make a composite hook, one from the Endocrine society saying such bans are based on misinformation, perhaps the APA one saying the same, and then a news source for the end of 2024 count of state bans (since medical societies don't update their statements's ban count each time a new one is introduced). Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:23, 1 February 2025 (UTC)
      • @Your Friendly Neighborhood Sociologist: - I don't think your Endocrine source has made it explicit enough to support what you want it to say. We should never need to assume anything. What you are claiming to be a composite hook is simply WP:SYNTHESIS. What you want is a reliable source that explicitly says '24 states banned gender-affirming care for transgender minors based on misinformation'. Well, then go find that source. We shouldn't be doing extrapolation in our hooks or our Wikipedia articles. starship.paint (talk / cont) 13:45, 4 February 2025 (UTC)
        • I think we could both do with a second opinion on: What you want is a reliable source that explicitly says '24 states banned gender-affirming care for transgender minors based on misinformation'. To me, per WP:MEDRS and WP:FRINGE when top tier medical orgs have the position that "policy X is based on misinformation", we don't need them to update their count of states with policy X every time a new state does it, but I could be wrong. The hook that transgender health care misinformation has caused states in the USA to ban gender-affirming care for minors[9][10][11] and in 2024 26 states had implemented such bans?[12] is an example of how that would look. If a second opinion considers that SYNTH, then I've no issues with that due to transgender health care misinformation, 18 states in the United States had banned gender-affirming care for minors and some restricted adult's access by 2023?[13]
  • Passing comment about ALT3: The "due to misinformation" language makes it sound like that's the sole cause, e.g., that plain old bigotry played no part. WhatamIdoing (talk) 06:12, 5 February 2025 (UTC)

@Your Friendly Neighborhood Sociologist and WhatamIdoing: some rewording: How about 26 states in the United States have restricted gender-affirming care for transgender minors, with transgender health care misinformation being one factor behind such bans? starship.paint (talk / cont) 15:28, 5 February 2025 (UTC)

@Starship.paint: perfect! Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:49, 5 February 2025 (UTC)

• I'm opposed to this article running as a DYK per WP:DYKNOT (promotion of political causes). It fails WP:NPOV and frequently cites US activist opinion as though that was internationally accepted fact The lead claims "Misinformation has affected the decision of the United Kingdom to reduce use of puberty blockers for transgender individuals" something I'm sure the clinical experts at NHS England and NHS Scotland would rolls their eyes at. They might in fact have been more swayed by half a dozen systematic reviews published in a top tier medical journal.. Scotland's response to the Cass Review gives no hint at either Florida style conservative bigotry nor giving the time of day to activist bloggers or US legal drama. Readers of this sorry wiki article would be forgiven for thinking it was written by a really enthusiastic teenager who nobody had told NPOV was a core pillar, nor explained the difference between opinion and fact.

This is a field where both activist sides have indulged in misinformation. I'd expect a Wikipedia article to state that clearly and give examples of both. Actual experts admit a lack of knowledge or research or even gathering longterm data on things like outcomes and desistance and so on. Yet both activist sides claim confidently the other side is wrong and they alone have solid facts. This is an article clearly written by a US activist viewpoint. Ironically, it itself is an example of transgender misinformation.

In reality there are grownups, professionals, who run clinics and hospitals and healthcare providers, who aren't influenced by politican bigots nor by their twitter feed or bedroom bloggers. An example of their work is represented by the link I gave earlier. This is a million miles away from the kind of legal battles where facts are irrelevant being played out in US courts right now. Wikipedia should not be abused as a player in such battles. -- Colin°^Talk 16:27, 5 February 2025 (UTC)

• This is a field where both activist sides have indulged in misinformation. I'd expect a Wikipedia article to state that clearly and give examples of both. - do you have any RS to support that opinion? Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:49, 5 February 2025 (UTC)

• YFNS why are you writing these words as if the voluminous comments by User:Void if removed on the talk pages of trans topics, especially Cass Review, haven't put forward numerous reliable sources countering the many examples of misinformation that editors have attempted to push here. Don't act here like you've never seen a reliable source countering misinformation from US trans activists. Or that you aren't aware of any and are challenging me to find even one. Or do you think all sources that disagree with your POV are inherently unreliable. The Cass Review needed its own FAQ to counter the misinformation written about it. An MP had to apologise to the House for repeating misinformation about it.

As an example of misinformation present itself in Transgender health care misinformation is the statement "The Cass Review—a non-peer-reviewed independent evaluation of trans healthcare within NHS England". This contains the activist-trope about the Cass Review not being peer-reviewed. This is a red flag sure to make any healthcare professional roll their eyes at the silly games youngsters play online these days. I guess this sort of tripe works on gullible twitter/blog-reading people already minded to hate, but it is Trump-level argumentation that does not impress at any intellectual level. The Cass Review contains not only the two systematic reviews published by NICE but also six more systematic reviews by the York team, a two-part review of existing clinical guidelines and an international survey. These were peer reviewed and published in the most reputable journal. The issues that activists such as those involved in the Yale PDF have are with those reviews and being upset that yet again systematic reviews found a lack of evidence. Claiming the Cass Review wasn't peer reviewed is a bit like claiming a car has no engine, because it is hidden underneath the bonnet. The final report was not subject to peer review, but no other report like that ever is. So that's like complaining the manual for my computer motherboard wasn't peer reviewed. And for those who understand the strengths and limiations of peer reivew, wouldn't have changed it in any significant way if it was. This is simply hoax put about by activists to attempt to discredit the finest and most comprehensive review of youth trans healthcare yet published. And meanwhile, outside of your the activist silo, it is being accepted and implemented by professionals who are not bigots. This, on Wikipedia should be another red flag. When the serious folk get on with the job without even bothering to address activist noise, it is like when airports get on with flying people on holiday, without checking your 737 isn't dumping chemtrails across the sky. When you read either the Cass Review or NHS Scotland response we don't see Florida-conservative-politician-style anti-gender-ideology nuttery and bigotry. We don't see those professionals making claims that young people can't be trans or that gender ideology is a myth. Scotland didn't implement its plans with a bill called "Protect Our Women From Trans Idiocy and Gender Lunacy" like Trump or DeSantis would.

As I said, this article reads like a teenager wrote it as an activist pamphlet to address problems they only see from a US perspective, fighting a certain kind of US bigot and thinking the rest of the world is like that too. It doesn't belong in an international encyclopaedia that claims to use professional sources. It certainly doesn't belong on the main page. This sort of subject needs to be written by editors with a commitment to NPOV, not a commitment to The Cause. -- Colin°^Talk 09:22, 6 February 2025 (UTC)

There aren't RS in that statement of yours. VIR's volumnious comments tend to go against consensus and promote misinformation in my experience. The one piece of misinfo about the Cass Review was "it dismissed over 100 studies" (which is not misinfo about trans healthcare). The Cass Review article says The Cass Review was a non-peer-reviewed, independent service review which made policy recommendations for services offered to transgender and gender-expansive youth for gender dysphoria in the NHS - it also has Cass Review#Criticisms. Comments like Readers of this sorry wiki article would be forgiven for thinking it was written by a really enthusiastic teenager who nobody had told NPOV was a core pillar, nor explained the difference between opinion and fact. and And meanwhile, outside of your activist silo, (among others) are the kind of inflammatory language you've been warned about.[14] I would appreciate an apology / striking of comments / toning down of rhetoric and for you to save discussion of the article for its talk page. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:21, 6 February 2025 (UTC)

YFNS, I call out this article for the one-sided activist screed it is. And you are an activist single-purpose account. Throwing stones at me doesn't change that. The article demonstrates an inability to write beyond a limited world view where the righteous US activist is fighting a battle against evil US bigots. It is clear the author(s) cannot accept how healthcare decisions and clinical research could possibly come to findings that disappoint and frustrate them without being apparently stupid professionals gullibly believing misinformation. That's the premise of the article and DYK proposal: misinformation credulously believed by stupid and/or bigoted people in healthcare. It is also clear that the author(s) have no comprehension or willingness to admit that activists on their side (and editors including and like them) spread misinformation in return (including on Wikipedia). I'm more used to seeing this sort of belief that healthcare professionals are ignorant of the Big Truth coming from those who peddle herbal cancer cures or think vaccines contain microchips. Note that I don't deny that most of the misinformation described in this article is indeed misinformation. That any or all of it has actually had the influence claimed, is quite another matter. You see, YFNS, the sort of, let's call a spade a spade, shit, thrown by both sides is only actually appreciated by one's own base. Flinging that "non-peer reviewed Cass Review" line about gets nods and likes on Twitter and gets repeated by blogs and is lapped up just as readily by one tribe as some transphobic blogger misgendering some actor gets lapped up by another tribe. But doesn't impress or influence anyone else. Indeed, all it does is mark one out as clearly not engaging in a grown up intellectual discussion. A billionaire doofus claiming USAID is full of Marxists doesn't actually make any Democrat go "Oh, I didn't know it was full of Marxists". Nobody in the UK is sitting here thinking "My oh my, I didn't know the USAID was overrun with Marxists". The UK government isn't cancelling aid collaboration with the US because it is overrun by Marxists. So while that line is very much "misinformation", it hasn't got that effect. It's just a line his followers will like and which signifies which tribe he's in. It's the same with much of this misinformation. If one claims 100 studies were dismissed from the Cass Review, or if one claims there are no trans children, or if one claims the Cass Review contains evidence that desistence is extremely rare, or if one claims in ROGD, or if one claims the Cass Review was ghost written by Genspect, then one is indicating ones tribe: an activist in one camp happy to fling misinformation about for The Cause.

Cass themselves noted, the poor quality of evidence has been exploited by activists on both sides to make claims and counter claims that are unsupported. It takes a braver and more considerate writer to admit "we don't know, and we really should".

In UK and other European countries, healthcare professionals are basing their decisions on evidence based medicine, which includes systematic reviews like those published as part of the Cass Review and many others. They commission serious reports by their top health professionals. One could argue the Cass Review (for NHS England) was "peer reviewed" by the health professionals in NHS Scotland. I value their opinion far far far higher than some bedroom blogger in California. YFNS can you not spot the massive difference in tone and intellectual quality in such a report (written by a team of experts over months) vs the legal-battle PDF's and blog pieces that are your usual go-to for argument. It's like the difference between a speech by Obama and one by Trump.

The assumption of this article is that these professionals, at all levels of healthcare provision, are completely stupid or bigoted or both. If only they read a few US blogs or magazines, or perhaps this Wikipedia article, they might wake up and realise how they were duped. It is an extraordinary claim. And frankly makes one roll ones eyes. -- Colin°^Talk 19:20, 8 February 2025 (UTC)

I suggest posting at WT:DYK (or even WT:GAN, since that is one cursory review!), where any valid claims about violations of WP:NPOV or WP:CIVIL will be readily confirmed.--Launchballer 07:34, 22 February 2025 (UTC)

I took this to WP:GAR and am placing this on hold.--Launchballer 11:59, 1 March 2025 (UTC)

Although WP:DYKTIMEOUT does not apply for another five days, with the article now at GAR and it looking likely that this won't be resolved anytime soon, the nomination no longer appears to have a path forward. If GA status is confirmed and any issues have been addressed, then perhaps no opposition against a renomination if the GAR results in its GA status being retained (perhaps under IAR given the circumstances since GA status retainment doesn't exactly count as promotion to GA status). Narutolovehinata5 (talk · contributions) 03:21, 7 March 2025 (UTC)

I think we forgot to renominate past the 7-day window lol Aaron Liu (talk) 23:17, 24 March 2025 (UTC)

GA Reassessment

Transgender health care misinformation

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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Article (edit | visual edit | history) · Article talk (edit | history) · Watch • Watch article reassessment page • Most recent review

Result: A 180kb review has passed the article. Hopefully this can end here. ~~ AirshipJungleman29 (talk) 18:01, 15 March 2025 (UTC)

Claims of massive WP:NPOV violations were made at Template:Did you know nominations/Transgender health care misinformation. Courtesy pings to @Your Friendly Neighborhood Sociologist, Starship.paint, WhatamIdoing, Colin, and Void if removed:. Launchballer 11:57, 1 March 2025 (UTC)

1) Wrt the peer-reviewed claim: Colin removed it from the Cass Review article, was reverted, then went to @Snokalok's page who pointed him towards the p[ast talk page consensus at Cass Review to include the note it wasn't peer reviewed[15] It's been noted at the Cass Review article for months now.

2) Void if Removed claimed the article had NPOV violations, nobody on talk agreed (he was not part of the DYK conversation btw, Colin just cited him)

3) This article was also reviewed by @LoomCreek and @Dan Leonard, and partially by @IntentionallyDense who should also be pinged

4) WP:GAR says Consider raising issues at the talk page of the article or requesting assistance from major contributors. This has not been done. Colin did not raise specific NPOV issues apart from the peer-reviewed claim (which is silly per point 1), he just repeatedly insulted me at DYK (and had other editors warn him for that behavior - Snokalok, @LokiTheLiar, and @Generalrelative)[16][17]

I'm a little unsure how GAR works, if a user goes onto DYK and posts some walls of text insulting another, and brings up only one issue that nobody agrees with and has been talk page consensus for a while, and never goes to talk to improve things (even after being asked to), does that really justify a GAR? Are they normally opened with claims of massive WP:NPOV violations were made without identifying them? Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:05, 1 March 2025 (UTC)

Most GARs are not opened with claims of massive NPOV violations. However, having a genuine concern that there seem to be such violations is a valid reason for GAR. Any non-trivial level of non-compliance with any one (or more) of the Wikipedia:Good article criteria is a valid reason for GAR. WhatamIdoing (talk) 21:33, 1 March 2025 (UTC)

I may be old fashioned, but I was under the impression that if somebody claimed an article (with a few dozen contributors and talk page discussions agreeing it's neutral) was full of NPOV violations, they were expected to provide at least some evidence that's true. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:42, 1 March 2025 (UTC)

In my experience, and specifically considering the behavior around trans-related articles during the last ~15 years, I have found that editors frequently do not operate according to the usual principle that "whatever the game, whatever the rules, the rules are the same for both sides". I find that people who already agree with an article insist upon unimpeachable proof of error, and that people who already disagree with it do not require any at all. There is, in my experience, no comfortable middle ground.

If the article is going to be tagged with {{POV}}, then someone has to start a discussion "identifying specific issues that are actionable within Wikipedia's content policies", or the tag can be removed. This is probably lower than your goal of "some evidence that's true", and it only applies for the specific and exclusive purpose of slapping a POV banner across the article. There are no such requirements for accusations made in any other venue or through any other form. WhatamIdoing (talk) 22:38, 1 March 2025 (UTC)

"Genuine" isn't really the issue here. I fully believe that Colin's concern is *genuine*, but also his role in discussions about the Cass Review for a while has been to, and I'm trying to be as polite as possible about this, make very strong accusations about other editors ignoring science or being "conspiracy theorists" because they doubt the reliability of the Cass Review. He's already been warned about this at AE once and seems intent on continuing.

I call attention to this dynamic to point out that Colin's opinion is not the consensus even if he is in general a well-respected editor who generally knows what he's talking about. Loki (talk) 22:33, 1 March 2025 (UTC)

"Genuine" is the issue here, in the sense that GARs don't get closed just because other editors think the concern is misplaced. We have deleted GARs, e.g., for being outright vandalism, but if there's a genuine concern, the path forward is to address is. That could mean explaining why the article is correct as it is, in which case the GAR will close as affirming the GA status. It could mean editors reaching a consensus that it does not meet the GA critieria, in which case the GAR will close with delisting the article. It could also mean improving the article. For example, this:

The KID-team at Sweden's Karolinska University Hospital in Stockholm, the second-largest hospital system in the country, announced that from May 2021 it would discontinue providing puberty blockers or cross-sex hormones to children under 16. Additionally, Karolinska changed its policy to cease providing puberty blockers or cross-sex hormones to teenagers 16–18, outside of approved clinical trials.

is rather more news style than is really appropriate (focusing on what was "announced" is news style). That could be re-written this way:

In May 2021, Sweden's Karolinska University Hospital discontinued puberty blockers and cross-sex hormones for everyone under 16. Teenagers age 16 to 18 could obtain them through clinical trials.

Frankly, the three-sentence-long review at Talk:Transgender health care misinformation/GA2 does not do a good job of convincing me that the review was adequate. WhatamIdoing (talk) 22:53, 1 March 2025 (UTC)

Void if Removed claimed the article had NPOV violations, nobody on talk agreed

Anyone can read the talk and see this is not true. Multiple editors were raising POV issues starting last December, long before I commented in mid/late January. Void if removed (talk) 22:55, 1 March 2025 (UTC)

The Cass Review—a non-peer-reviewed independent evaluation of trans healthcare within NHS England - the non-peer-reviewed claim fails verification with the provided source. On the Cass Review article, the non-peer-reviewed claim is sourced to this pdf, where it can be found on page 10, TABLE 2.1, after which this fact is never mentioned again. Indeed, I cannot find this mentioned again in any other reliable source, only Reddit communities and suchlike. So, if nobody else seems to care about this, why should we?  Tewdar  18:17, 1 March 2025 (UTC)

At the DYK, the "ALT1" proposal says that it's a myth that trans kids tend to desist. This is 100% verifiable in reliable sources. However, I've been wondering whether that's entirely true – not that we're after Wikipedia:The Truth exactly, but that a simple "it's misinformation" might be misleading.

So let me tell a different story, with a claim that is equally verifiable as misinformation, but perhaps you'll find it's a bit more complicated than that.

Once upon a time, 300 18-year-old females went to college. In their first year, 200 of them got pregnant. Half of the pregnant ones had abortions or miscarriages during the first trimester. The other half gave birth.

• The ones who didn't get pregnant until after university have a lifetime risk of breast cancer of 8.1%.
• The ones whose pregnancies ended in births have a lifetime risk of breast cancer of 5.3%.
• The ones whose pregnancies ended in abortions or miscarriages have a lifetime risk of breast cancer of 8.1%.

(These are real lifetime risk numbers for US residents, assuming ordinary risk factors.)

Now we could say that if you get pregnant at the age of 18, then having an abortion will cause your lifetime risk of breast cancer increases by 50%, compared to the alternative of giving birth. We could also say that if you get pregnant at the age of 18, then having an abortion will cause your lifetime risk of breast cancer to be exactly the same as if you hadn't gotten pregnant in the first place. Whether the risk is higher depends on the baseline you're choosing.

It is misinformation to say that abortions and miscarriages cause breast cancer. But it is also misinformation to tell pregnant 18 year olds that the decision about whether to get an abortion will make no difference to their lifetime cancer risks.

The reason I have told this long story is because I was reminded of it when I read the ALT1 proposal, which aligns with the sentence in the lead "Common false claims include...that most pre-pubertal transgender children "desist" and cease desiring transition after puberty" and the section Transgender health care misinformation#Desistance myth.

Some of this section seems more overtly POV push-y but still interesting to me personally, like the sentences talking about the etymology of the word desistance and the connection to criminal recidivism. "He took the word from this other psychiatric condition, and that other psychiatric condition took the word from criminology" isn't relevant to misinformation (so it shouldn't be in this article), and it feels like a way to smear the concept. I am fascinated by this factoid, but this is probably a violation of 3b: "it stays focused on the topic without going into unnecessary detail (see summary style)".

Of more importance, and also harder to fix, I wonder whether we've done a good job of explaining reality here. There's ~375 words in this section, and – if I've understood it correctly, which I'm not sure about – it may be failing 1a: "the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct".

If I'm correct, reality looks something like this:

• In the 1980s, gender clinics saw mostly young AMABs, of which a very large fraction were gender non-conforming (e.g., little boys who liked wearing princess dresses but who didn't verbally express a "consistent, persistent, and insistent" desire to be girls) and who mostly grew up to be fabulous gay men, plus a small fraction of "actually trans" kids, who grew up to be trans women.
• Almost every bit of research on the subject (ever) uses a different definition and therefore gets a different result.
• When we look back at those studies, we say "Eh, those kids weren't really trans. The real trans kids want to transition."

So it seems to be true that:

• "Actually trans" kids always grow up to be trans, but
• Most of the time, if the parents think their kid might be trans as a result of their gender non-conforming behavior, the parents are wrong, and the kid is going to grow up to be gay but cisgender.

If that's correct, then the article isn't IMO communicating it in an understandable fashion. WhatamIdoing (talk) 22:31, 1 March 2025 (UTC)

Your summary isn't *very* wrong, but I feel like the emphasis is wrong, because you're using the actual definition of "actually trans" in one place but in other places you're phrasing it as though the way we know kids are actually trans is whether they end up transitioning. That's not true. How this actually works is that generally gender non-conforming behavior is not a good indication that a kid will be trans as an adult, but the same sort of questions that would detect transness in an adult, such as directly asking a kid if they want to be a girl, do work, and kids who consistently say "yes I want to be a girl" end up growing up to be trans women.

I agree this could be clearer in the article, which probably should explain the full situation. But I don't think that it's a failure to be clear, because the statement as phrased really is true. You wouldn't need to say "scientists used to think small amounts of alcohol are good for you" to be able to say "scientists currently think no amount of alcohol is better for you than not drinking". Loki (talk) 22:45, 1 March 2025 (UTC)

And the statement is true "as phrased" that if you're 18 and pregnant and obtain an abortion, your lifetime risk of breast cancer just went up 50%. But it's not clear.

I agree that you don't have to explain past beliefs. If you agree with me, then perhaps you'd like to blank the ~third of Transgender health care misinformation#Desistance myth that is all about past beliefs, and perhaps add a clear statement that "generally gender non-conforming behavior is not a good indication that a kid" is actually trans. WhatamIdoing (talk) 22:58, 1 March 2025 (UTC)

This is all stuff that can/should be in Gender dysphoria in children. It doesn't belong on a page about "misinformation" without strong independent sources that it actually is "misinformation" and not just hyperbolically expressed differences of opinion. Void if removed (talk) 23:20, 1 March 2025 (UTC)

The answer to "will most kids today desist" is "we don't know".

It used to be the case that they did, but clinics in the 80s then were as much about stopping prepubescent boys from growing up gay as growing up trans, so unpicking the more coercive/homophobic methods used in the past is difficult.

However, once blockers and came onto the scene, GIDS found 99.5% persisted.

This also coincided with an exponential increase in the number of teenage girls presenting at GIDS in gender distress, to the point they now outnumber boys 2 or 3 to 1.

So the open question is: do blockers (and to a lesser extent social transition) cause a persistence of gender incongruence that would otherwise have resolved during/after adolescence? Are the factors that affected pre-teen boys in the 80s the same as those affecting adolescent girls in the 2010s?

We have multiple unknowns, and I think it is RGW to present any of this as misinformation. The only MEDRS in the "desistance myth" section is a systematic review that says best quantitative estimates are that 83% desist - which means it isn't a myth. Void if removed (talk) 23:16, 1 March 2025 (UTC)

VIR is misquoting the source. As was discussed on the talk page (here) the MEDRS explicitly describes the sources of the 83% desistance as poor quality. Relm (talk) 03:44, 2 March 2025 (UTC)

Misquoting? The abstract says "Quantitative studies were all poor quality, with 83% of 251 participants reported as desisting". Or are you saying that since the studies are "poor quality", they can't also be the "best quantitative estimates" actually available? Sometimes "the best" is also pretty bad (and not just for trans-related research. For example, our best treatments for chronic low back pain are mostly ineffective, and the research on Back labor, which affects about 100 million women each year, is worse than than the research on trans people). WhatamIdoing (talk) 04:52, 2 March 2025 (UTC)

I am saying that VIR is quoting the MEDRS as if the MEDRS shows 83% desistance as its own claim:

We have multiple unknowns, and I think it is RGW to present any of this as misinformation. The only MEDRS in the "desistance myth" section is a systematic review that says best quantitative estimates are that 83% desist - which means it isn't a myth.

This is not a truthful depiction of the MEDRS's view of this source who's conclusion is quoted by YFNS below. It is WP:CHERRYPICKING at best. Relm (talk) 19:44, 2 March 2025 (UTC)

It looks to me like the review calculated that 83% itself, and does not disavow it.

What they present in their conclusions is a (non-scientific/human-values) recommendation that nobody actually care whether desistance happens. They recommend a short-term focus: Fix today's distress today, and iff today's fix results in distress tomorrow, then fix tomorrow's distress tomorrow. Do not worry about tomorrow, for sufficient unto the day is the evil thereof – poetic advice, but not science. WhatamIdoing (talk) 22:06, 2 March 2025 (UTC)

That is not what the review is stating, and the way that the 83% number is being employed without the context from the MEDRS which is critical of the definitions used to get to that number and other specifics of the study involved is cherry-picking and tendentious. The characterization of it being stated here seems poetic, but is far from scientific. Relm (talk) 02:14, 4 March 2025 (UTC)

Do you think this is a fair description?

"Five quantitative studies that cumulatively found 83% of 251 people desisting, but the review described these quantitative studies as 'all poor quality'." WhatamIdoing (talk) 02:43, 4 March 2025 (UTC)

No, a better one would be "A statistic that ~80% desist after puberty emerged from five studies of a total of 251 children from the late 2000s that used DSM-3, DSM-4, and DSM-4-TR diagnoses of gender identity disorder of childhood and included participants who lacked even those diagnoses. None of these studies explicitly defined desistance and even when definitions could be inferred, they used different ones. The studies had poor methodological quality, relied on outdated understandings of gender and outdated diagnoses, likely misclassified non-binary individuals, and some employed gender identity change efforts".

Summarizing an article whose point is that this 80% number people keep throwing around is ridiculously flawed - these studies don't even talk about the same thing they just use the same word for different phenomenon as saying the best quantitative estimates are that 83% desist is silly. What definition of desistance is that 83% figure using? None, because the review explains where the 80% figure comes from (From all of these collections of studies emerged the commonly used statistic stating that ∼80% of TGE youth will desist after puberty) but it does not claim this number is accurate or meaningful. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 04:03, 4 March 2025 (UTC)

Note that I didn't ask about anything involving the word "best". Is this reply just more of your disagreement with Void?

What I asked about is a sentence along the lines of "Five quantitative studies that cumulatively found 83% of 251 people desisting, but the review described these quantitative studies as 'all poor quality'."

I was actually asking Relm, but feel free to answer. Let me be more specific about the question: Do you think that if such a sentence were in the article, that it would be a {{POV}} problem? WhatamIdoing (talk) 22:20, 4 March 2025 (UTC)

My response was primarily to you as that sentence would be a POV problem. As the review pointed out: these studies all used different definitions of desistance. If a review says "Studies 1-5 used different definitions of X. Collectively, they are used to say that the rate of X is Y. This is problematic due to issues ABC, including the different definitions of X. We recommend people don't even use X anymore." - then translating that into wikivoice as "a review found on average the rate of X is Y" leaves out the most important part, what actually is "X" in this situation?

From the review: From all of these collections of studies emerged the commonly used statistic stating that ∼80% of TGE youth will desist after puberty, a statistic that has been critiqued by other works based on poor methodologic quality, the evolving understanding of gender and probable misclassification of nonbinary individuals, and the practice of attempting to dissuade youth from identifying as transgender in some of these studies ... None of the quantitative studies explicitly defined desistance.31,33,51–53 Three of the quantitative studies had similar inferred definitions based on the disappearance of GD.51,52,53 The other two studies had inferred definitions relating to distress concerning gender identity and desire for medical intervention. ... all the articles conflated these two ideas, implying that the disappearance of GD also meant that the TGE child identified as cisgender after puberty.

Taking your suggested sentence, Five quantitative studies that cumulatively found 83% of 251 people desisting, but the review described these quantitative studies as 'all poor quality and modifying it to Five quantitative studies that cumulatively found 83% of 251 people <definition of desistance>, ..., what <definition of desistance> would be there?

To stick to the review, it would have to be something like Five quantitative studies that didn't explicitly define desistance cumulatively found 83% of 251 people desisted, inferrably defined as either the disappearance of "gender identity disorder in children" or "relating to distress concerning gender identity and desire for medical intervention.". The review described these all as "poor quality" and noted critiques of their methodologic quality, outdated understandings of gender, misclassifications of nonbinary individuals, and usage of gender identity change efforts. It also noted they erroneously conflated disappearance of GD with cessation of transgender identity. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:48, 4 March 2025 (UTC)

I'm getting "desistance reviews based on poor quality studies are extremely X, but puberty blocker reviews based on poor quality studies are extremely Y" vibes.  Tewdar  23:02, 4 March 2025 (UTC)

YFNS, that sentence has been in the article for over a month. If you think that sentence is a POV problem, then this GAR is probably justified, and it fails Wikipedia:Did you know/Guidelines#External policy compliance, so you should withdraw the DYK nomination. WhatamIdoing (talk) 23:16, 4 March 2025 (UTC)

YFNS, that sentence has been in the article for over a month

The text in the article has been A systematic review of research relating to the topic in 2022 found it was poorly defined: studies sometimes did not define it or equally defined it as desistance of transgender identity or desistance of gender dysphoria. They also found none of the definitions allowed for dynamic or nonbinary gender identities and the majority of articles published were editorial pieces. In total, thirty definitions for desistance were found from 35 pieces of literature. This included 5 quantitative studies that cumulatively found 83% of 251 people desisting, but the review described these quantitative studies as "all poor quality", with none of them having "explicitly defined desistance".[18] (bolded, is what I said it would be a POV issue to leave out)

That's a decent summary of the article without NPOV problems. Your quotation Five quantitative studies that cumulatively found 83% of 251 people desisting, but the review described these quantitative studies as 'all poor quality' would have POV issues if the surrounding paragraph, particularly the bolded bit, wasn't included. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:34, 4 March 2025 (UTC)

That just means the number and all its flaws need to be placed in context (as it is now) not omitted entirely (as it was when this article received GA).

It also means the only systematic review that actually puts a number on desistance, contradicts the idea it is a "myth", so the existence of this section at all is highly questionable.

Things have changed a lot in the last 30 years. Crudely, the field has shifted from:

• We mostly see male pre-teens who will mostly desist in adolescence, and some think its a good idea to withhold "girls" toys and "girls" clothes to "help that along"

To

• We mostly see female teenagers with a lot of comorbid conditions like depression and eating disorders, and if we give them puberty blockers 99.5% of them don't desist

With no adequate study of the non-intervention case, no explanation of the sex-ratio shift and virtually nonexistant followup.

What we should do here is convey this uncertainty and the limitations to the reader on the relevant article (Gender dysphoria in children), not remove the information from there and present an incomplete and overly-certain picture on an article dedicated to calling it "misinformation". Void if removed (talk) 15:09, 2 March 2025 (UTC)

From the review: Of the hypothesis- driven research articles pertaining to desistance found in this literature review, most were ranked as having significant risk of bias. A significantly disproportionate number of these articles were not driven by an original hypothesis. The definitions of desistance, while diverse, were all used to say that TGE children who desist will identify as cisgender after puberty, a concept based on biased research from the 1960s to 1980s and poor-quality research in the 2000s. Therefore, desistance is suggested to be removed from clinical and research discourse to focus instead on supporting TGE youth rather than attempting to predict their future gender identity.[19]

The answer to "will most kids today desist" is "we don't know". - so therefore the claim we do know they will is a myth

Things have changed a lot in the last 30 years. Crudely, the field has shifted from: We mostly see male pre-teens who will mostly desist in adolescence, and some think its a good idea to withhold "girls" toys and "girls" clothes to "help that along" - As you know, and has been repeatedly pointed out to you, the majority of those kids did not say they were trans, or that they wanted to transition, and so the to claim they "desisted" is nonsensical.

I hope whoever looks over this takes note of the fact this was already discussed at the talk page and consensus was against Void's issues with the section[20] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:17, 2 March 2025 (UTC)

Also, wrt Some of this section seems more overtly POV push-y but still interesting to me personally, like the sentences talking about the etymology of the word desistance and the connection to criminal recidivism. "He took the word from this other psychiatric condition, and that other psychiatric condition took the word from criminology" isn't relevant to misinformation (so it shouldn't be in this article), and it feels like a way to smear the concept.

Our systematic review of desistance makes clear it is necessary context, stating Desistance as a word has its origins in criminal research,28 and Zucker explains that he was the first person to use desistance in relation to the TGE pre-pubertal youth population in 2003 after seeing it being used for oppositional defiant disorder (ODD).29 In either case, desistance is considered a good outcome in criminal research and ODD. Acknowledging this history of the term is important as it reflects the pathologizing of gender identity (in relation to ODD) and the negative perspectives that have been associated with being TGE (in relation to crime).[21] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 04:07, 4 March 2025 (UTC)

That may be appropriate context for an article on desistance, but it says nothing about misinformation. WhatamIdoing (talk) 21:53, 4 March 2025 (UTC)

Thing is, we've made it so desistance myth redirects to this article on misinformation and is thus bolded. So, as of now, this is the "primary article" on desistance. Aaron Liu (talk) 22:47, 4 March 2025 (UTC)

• I appreciate the ping Launchballer, I will say that I am likely not knowledgeable enough about the entire topic to identify WP:NPOV violations that are not also WP:V or WP:SYNTH violations. For that I defer to more knowledgeable editors. If I have the time I may weigh in on whether I found any WP:V or WP:SYNTH violations. starship.paint (talk / cont) 01:34, 2 March 2025 (UTC)
• Okay as someone who got pinged here and has only partially read through everything, I'm wondering if, at this point, it is best that someone, I am volunteering myself here, does a fresh GA review (or at least a partial review of the areas in question), and then invites others to weigh in. I have never done a GA reassessment before so I'm not exactly sure how this works. Since it may be relevant here, I consider myself unbiased in a sense, as I don't usually edit in transgender/sex/sexuality/political/gender-related topics. This may also come as a disadvantage with some of the finer details of WP:NPOV but I'm welcoming feedback here. I've done quite a few GAN reviews and especially like to help with technical wording which I see has been brought up as an issue here. Is this something others are interested in trying as a way to figure this out? relevant pings: @Your Friendly Neighborhood Sociologist, Starship.paint, WhatamIdoing, Colin, Void if removed, and Launchballer: (sorry for any double pings) IntentionallyDense ^(Contribs) 04:49, 2 March 2025 (UTC)

  A GA reassessment is what we're doing right here, in this discussion. It works like everyone telling everyone else what we think. The most helpful thing to do is to read the article and the Wikipedia:Good article criteria and point out any significant problems you see. (Minor problems should be ignored for GAR purposes, or boldly fixed.) Use a ====Level 4==== subsection if you want to separate out discussion of a particular point.

  I would expect one of the GAR coordinators to write the closing summary and make the final decision. Generally, discussions are kept open for 30 days, and if there's no consensus, it typically remains listed as GA. WhatamIdoing (talk) 05:05, 2 March 2025 (UTC)

  I see, I'll take a look at the article and see if anything jumps out at me then. IntentionallyDense ^(Contribs) 17:38, 2 March 2025 (UTC)

  I'd support you doing a GA review - but the chaoticness of this section seems to be the goal. Rather than raising NPOV concerns at talk, we've gone straight into a free-for-all unstructured GA reassessment (where things like the desistance myth, already discussed at talk, are being rehashed) that I think is more liable to give the closer a headache than anything else. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:41, 2 March 2025 (UTC)

A. That PDF is a RAND corp report, which tend to be considered pretty thoroughly reliable.

B. We should care because the Cass Report makes claims and conclusions separate from those of its peer reviewed sources, and thus we need to make clear the distinction between the two with regards to peer review.

C. Does everything need to be plastered across CNN for it to be relevant to a good wikipedia article? Snokalok (talk) 12:43, 2 March 2025 (UTC)

YFNS wrote "I'm a little unsure how GAR works". Well it sure doesn't work by smearing the person who complained about NPOV violations. Personal attacks earn topic bans, not GAs. Further, they just make everyone else here think: "is that the best you've got?" Same goes for citing our article on the Cass review for backup on the "non peer-reviewed" claim. Wikipedia is not a reliable source. What editors have pushed elsewhere on Wikipedia does not influence whether this article is a GA. Is that the best you've got? Tewdar mentions that the best source said editors have found is a table where a column heading identifies it as non peer reviewed, and elsewhere the internet shows only activist social media and blogs repeat that claim. If that source had instead listed the half a dozen systematic reviews that are very much "the Cass Review" the column heading would be different. Is that the best you've got?

The Oxford English dictionary isn't peer reviewed. They don't send their word definitions over to Collins to be double-checked. The NHS health website isn't peer reviewed. They don't ask Kaiser Permanente to offer their opinions. It suits an activist agenda to conflate the Cass Review as a whole with the Final Report as a document, and claim it isn't peer reviewed, because people who don't know much about academic publishing or healthcare reviews think that if you tell someone this feature is missing, they might believe it was typically present and important and clearly not done this time because bigotry. But anyone who actually knows about the Cass Review knows it contains many peer reviewed publications supporting the evidence base. Saying it, as a whole, isn't peer reviewed, is a whopper. No neutral or reliable source says that. Saying the Final Report isn't peer reviewed is as dumb ass as saying a menu isn't peer reviewed. That isn't how an Independent Review chaired by an esteemed paediatrician and former president of the Royal College of Paediatrics and Child Health, works. It is an activist trope and itself an example of misinformation.

Let me give an example from recent current affairs. Zelenskyy was described as a "dictator" by someone I'm sure we all regard as an unreliable source, but more than half the US voting population personally and specifically voted for to be their president. If you or I read a paragraph that said something like "After being expelled by the US president, the dictator Volodymyr Zelenskyy flew to the UK to meet their prime minister and king...." what would your reaction be? Would you think this was a neutral source reporting on world current affairs. Or would you think you'd accidentally clicked on some link to a right wing MAGA blog? Would you think the authors of that sentence had fact checking and accuracy as values, or were more of the say anything that pushes The Truth, facts are inconvenient, approach? It is a MAGA activist trope. This article is full of this kind of writing. The NPOV alarm isn't just flashing read. It is going "honk" "honk" "honk".

The approach from the get-go on this article is that misinformation in the trans debate is entirely one-sided and that it is influential, vs a neutral approach and exploring the far far the more obvious explanations for healthcare decisions that don't require an assumption that all those healthcare or legal professionals are clearly stupid and gullible. The opinion of activist authors is cited in Wiki voice throughout. For example, the claim "Misinformation has affected the decision of the United Kingdom to reduce use of puberty blockers for transgender individuals" is an extraordinary claim. We cite an opinion piece (it is clearly labelled "Perspective" in the journal). The same opinion piece is used for "Misinformation and disinformation have led to proposed and successful legislative restrictions on gender-affirming care across the United States". There's no room in the mindset of this article, that puberty blocker restrictions in the UK were a decision made after a four year independent review of the most thorough degree ever attempted, based on multiple systematic reviews, including those commissioned by the review but also every single systematic review published previously or since. The mindset of this article is that NHS Scotland are fools when their experts spent four months considering the implications of the Cass Review and carefully worked out which recommendations to adopt, including also restrictions on puberty blockers. That these professionals should have just read some American blogs and their eyes would have been opened to the "misinformation". It is an extraordinary claim. Or the more obvious explanation for why Florida went the way it did: good old fashioned conservative bigotry.

As Void and others have noted, the desistence debate is framed one-sidedly in this article. There's an equal myth that desistence doesn't exist or is vanishingly rare. The truth is we don't know and in fact when Cass' research team tried to find out, they were actively blocked from accessing adult care information that might have shed some light. There are activists who even cite the Cass Review final report as evidence that desistence is vanishingly rare, despite the report explicitly saying the evidence and the audit they discuss does not support that (or any other conclusion). The level of statistical incompetence shown by those citing the Cass Review for this purpose is frankly mind boggling. There is misuse of statistics and applying low-quality data for population group X to population group Y going on by both sides. Perhaps in 20 years time, universities will teach statistical misinformation courses citing the arguments coming from both sides in this debate.

I'm sceptical a NPOV article on trans healthcare misinformation can be written right now, what with US politics and all that. There's been a concerted effort at FRINGE and RS/N boards to ban any source that is negative of US trans activist positions or supportive of the Cass Review. Largely done by smearing the authors, rather than addressing whether they have a point. When the debate is at the level of claiming Dr Cass is a puppet of transphobic organisations, and all of NHS England and NHS Scotland have been "captured" by an anti-trans ideologically driven government of Putin levels of evil manipulation, one has to wonder where we're at. -- Colin°^Talk 11:52, 2 March 2025 (UTC)

The only NPOV violation you identified is whether we say the Cass Review wasn't peer-reviewed - we have an RS saying it wasn't, consensus at the Cass Review article to note that, and consensus at this article to note that.

The medical establishment in the UK has, at best, been skeptical of the government's ban on puberty blockers.[22]

As Void and others have noted, the desistence debate is framed one-sidedly in this article. There's an equal myth that desistence doesn't exist or is vanishingly rare. - Can you find sources backing that up? There are sources saying "most desist" is a myth going back years, I've seen none claiming there's an equal myth that desistence doesn't exist or is vanishingly rare

I'm sceptical a NPOV article on trans healthcare misinformation can be written right now, what with US politics and all that. - this is classic WP:RGW, we can write a NPOV article on any topic, it just depends on setting aside our own convictions and following the sources. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:34, 2 March 2025 (UTC)

The medical establishment in the UK has, at best, been skeptical of the government's ban on puberty blockers. I'm looking at Table 2 in the source you linked. It says that most pharmacists (e.g., General Pharmaceutical Council) support the ban and clinicians ("doctors"; e.g., General Medical Council) are split 50–50. The main opposition comes from a group called "Charities and voluntary and community organisations" (e.g., Mermaids (charity)), which is not "the medical establishment". WhatamIdoing (talk) 21:56, 2 March 2025 (UTC)

It is also not a question of whether they support the ban, but To what extent do you agree or disagree with making the arrangements in the emergency order permanent. An important difference. Void if removed (talk) 09:51, 3 March 2025 (UTC)

That sounds like a distinction without difference to me. ¯\_(ツ)_/¯ WhatamIdoing (talk) 01:49, 4 March 2025 (UTC)

The context is interpretation of a permanent ban, vs banning pending the outcome of clinical trials. The CHM ultimately recommended the latter, ie a ban with periodic review, until the evidence base improves. Void if removed (talk) 08:47, 4 March 2025 (UTC)

The context is a legislative action, which can be undone at any time in the future, for any reason or no reason. "Permanent" isn't permanent in this context. WhatamIdoing (talk) 22:24, 4 March 2025 (UTC)

Also, wrt Well it sure doesn't work by smearing the person who complained about NPOV violations. Personal attacks earn topic bans, not GAs. - I have not done a single personal attack here, merely pointed out, as others have, your DYK comments were full of personal attacks. Your first comment there included Readers of this sorry wiki article would be forgiven for thinking it was written by a really enthusiastic teenager who nobody had told NPOV was a core pillar, nor explained the difference between opinion and fact. ... this is an article clearly written by a US activist viewpoint. Ironically, it itself is an example of transgender misinformation., while your second was As I said, this article reads like a teenager wrote it as an activist pamphlet to address problems they only see from a US perspective, fighting a certain kind of US bigot and thinking the rest of the world is like that too ... This sort of subject needs to be written by editors with a commitment to NPOV, not a commitment to The Cause., and your third, after I asked you to strike your personal attacks, was YFNS, I call out this article for the one-sided activist screed it is. And you are an activist single-purpose account.[23] - you have yet to strike any of the multiple personal attacks you left there. You have also yet to raise NPOV issues on the talk page for the article itself. I quote your comments for the closer to consider in deciding who has made personal attacks. I do agree, and think you should consider, that Personal attacks earn topic bans Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:25, 2 March 2025 (UTC)

The NHS health website isn't peer reviewed.

Their clinical guidelines and position statements very much are. It is MedRS policy that we should not use non–peer-reviewed sources for biomedical information. The Cass Review is supposed to be an academic source on biomedical information; it needs to be peer-reviewed to be cited. Aaron Liu (talk) 23:03, 4 March 2025 (UTC)

Um, technically, MEDRS says no such thing (because textbooks aren't peer-reviewed either, and they're one of MEDRS's favorite sources). WhatamIdoing (talk) 23:19, 4 March 2025 (UTC)

My textbook's long list of reviewers misled me into thinking it was peer-reviewed...
In any case, books with academic editorial policies are the only acceptable MedRSes that aren't peer-reviewed, and the Cass Review doesn't appear to fall under these categories. Aaron Liu (talk) 23:30, 4 March 2025 (UTC)

It's a little more complicated than that. WP:MEDRS wants "high-quality textbooks" and reference works with "good editorial oversight". This is a little different from "academic editorial policies", as anybody can write an editorial policy. (MEDRS itself is an example of an editorial policy.)

MEDRS also accepts "Guidelines and position statements provided by major medical and scientific organizations", which may (or might not) be peer reviewed if they are "formal scientific reports" but can also be "public guides and service announcements", which are not.

MEDRS also accepts, for uncontroversial claims, non-peer-reviewed websites such as WebMD.

"The Cass Review" seems to mean different things to different people. If you see it as "a 388-page-long pdf called 'the final report' ", then it did not undergo a pre-publication, external peer review. OTOH, neither did most of the sources published by the World Health Organization. Or that RAND Corporation pdf that keeps being recommended (which discloses that they used "internal peer review", meaning that it was written by Employee A, reviewed by Employee B, and published by their joint employer).

If "the Cass Review" instead means to you the whole thing – the people, the interviews, the multiple publications, the whole process, perhaps like the United States House Select Committee on the January 6 Attack isn't just its 845-page final report – then parts of the whole thing were peer reviewed (the commissioned reviews), and other parts (e.g., the people) can't be, and some of the rest theoretically could have been, but wasn't (or was only internally peer reviewed). WhatamIdoing (talk) 00:31, 5 March 2025 (UTC)

I agree with this. The final report was unreliable for MedRS as it's not peer-reviewed, but that doesn't mean nothing from the project is MedRS; the peer-reviewed parts are. Aaron Liu (talk) 01:14, 5 March 2025 (UTC)

I didn't notice that this recently became a GA. Good job! Aaron Liu (talk) 13:51, 3 March 2025 (UTC)

This article is nowhere near GA status and contains misinformation. Its central idea is that gender-affirming care, including placing children on puberty blockers, is the only acceptable treatment for gender dysphoria, while almost any critical perspective is presented as disinformation. One example, the article states: "Proponents of bans on gender-affirming care in the United States have argued that youth should receive psychotherapy, including gender exploratory therapy (GET), a form of conversion therapy, instead of medical treatments." The lead has a similar statement. However, psychotherapy and particularly exploratory therapy, is recommended as the first-line treatment by health authorities and medical organizations in several developed countries, such as the UK [24], Finland [25] and Sweden [26] Swedish guidelines recommend "offering psychosocial support for the unconditional exploration of gender identity during the diagnostic assessment." Additionally, major MEDORGs have clearly stated that exploratory therapy is not the same as conversion therapy. For example, the United Kingdom Council for Psychotherapy (UKCP) states: "Exploratory therapy should not in any circumstances be confused with conversion therapy, which seeks to change or deny a person’s sexual orientation and/or gender identity." [27] The Royal Australian and New Zealand College of Psychiatrists (RANZCP) recommends "offering psychosocial support to explore gender identity during the diagnostic assessment." [28] The article presents only one point of view, that supports medical transition, as the correct one, while dismissing gender exploratory therapy as conversion therapy, despite its endorsement by numerous medical organizations. The article lacks balance, disregarding the growing global shift toward banning or limiting puberty blockers and prioritizing psychotherapy.JonJ937 (talk) 17:28, 3 March 2025 (UTC)

Jonj has been repeating this claim at the Fringe Theories Noticeboard where multiple editors have pointed out his sources don't support his claims (among many other claims, such that the Society for Evidence-Based Gender Medicine isn't FRINGE, or that we can't say it's FRINGE to say being trans is frequently a symptom of mental illness). Our article on Conversion therapy discusses gender exploratory therapy (and has for over a year).

WPATH itself supports exploration [Health Care Providers] working with adolescents should promote supportive environments that simultaneously respect an adolescent’s affirmed gender identity and also allows the adolescent to openly explore gender needs - none of these sources are claiming, as proponents of gender exploratory therapy do, that identifying as trans is usually a symptom of a mental illness. All lay out in what situations gender-affirming care will be provided. Almost none even use the term "exploratory therapy" or "gender exploratory therapy".

The only one to use the term "exploratory therapy/"gender exploratory therapy" is the UKCP - the only organization to withdraw from the Memorandum of Understanding on Conversion Therapy signed by all other MEDORGs in the UK, who promptly criticized them for that decision (as did a sizeable chunk of their own membership).

The article presents only one point of view, that supports medical transition, as the correct one, while dismissing gender exploratory therapy as conversion therapy, despite its endorsement by numerous medical organizations - in short, JonJ has cited a bunch of MEDORGs that support medical transition, and don't mention "gender exploratory therapy", as evidence they support gender exploratory therapy over medical transition - this is silly at best and tendentious at worst. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:50, 3 March 2025 (UTC)

The sources I cited mention gender exploratory therapy. While there is no universally agreed definition of this practice, it is recommended by MEDORGs and health authorities worldwide, albeit under slightly different terms. For example, the RANZCP recommends "psychosocial support to explore gender identity", while the Swedish National Board of Health and Welfare advises for "psychosocial support for the unconditional exploration of gender identity". In the UK, the UKCP, a major MEDORG, holds a position aligned with general UK health policies, which prioritize psychological support over medical interventions. Only a small proportion of UKCP members have opposed their stance on gender exploratory therapy. Can we seriously claim that all these countries and MEDORGs support conversion therapy? It is not true that proponents of gender exploratory therapy claim that "identifying as trans is usually a symptom of a mental illness". None of the sources I quoted state this and I am not aware of SEGM or any MEDORG supporting exploratory therapy making such a claim. Our Wikipedia article on conversion therapy has the same NPOV issues, falsely equating gender exploratory therapy with conversion therapy and presenting the views of partisan sources as the only valid perspective, while failing to acknowledge alternative perspectives. The article under discussion here has significant neutrality problems that should not be present in a GA article. JonJ937 (talk) 11:35, 4 March 2025 (UTC)

We should not confuse "psychosocial support to explore gender identity" or "psychosocial support for the unconditional exploration of gender identity" (generic terms) with gender exploratory therapy (a specific term for a specific kind of therapy). The reason they use "slightly different terms" is that they're not recommending GET. If they wanted to recommend it, they would use its name. Lewisguile (talk) 13:34, 4 March 2025 (UTC)

I wonder if we could source a paragraph about misinformation, along the lines of "therapy to explore gender is not necessarily gender exploratory therapy". WhatamIdoing (talk) 22:27, 4 March 2025 (UTC)

I suspect so. On the flip side, there are definitely papers that say exploration doesn't necessarily exclude GAC or that exploration is not always GET. E.g., Florence Ashley says "gender-affirmative approaches [...] often hold space for gender exploration and encourage individuals to explore what gender means to them", and: "Gender-exploratory therapy does not include every clinical approach that facilitates gender exploration." I'm fairly sure this is an issue that has come up in other places in the literature, so there are likely other sources, and I think addressing that particular piece of misinformation would be very sensible. Lewisguile (talk) 15:20, 5 March 2025 (UTC)

Indeed, how is "psychosocial support to explore gender identity" different from gender exploratory therapy? There are different terms to refer to the same practice, but there is no common definition. It is also called psychodynamic psychotherapy and according to sources, they all refer to the same practice:

Other countries are realizing this and making psychosocial treatments and/or exploratory psychotherapy a first line of treatment for gender related distress in young patients. Psychodynamic (exploratory) psychotherapy has established efficacy for a range of conditions, and has been used in youth and adults with gender dysphoria. -- Systematic reviews have consistently found that the evidence that hormonal treatment for GD leads to improved mental health is low quality. Based on these reviews, national health agencies in Sweden and Finland have adopted treatment guidelines which make psychosocial interventions such as psychodynamic psychotherapy (PP) the first line of treatment for GD. [29]

The RANZCP also states that "Psychotherapy is not conversion therapy," referring to all forms of psychotherapy they recommend. If UK's leading MEDORG such as Council for Psychotherapy does not agree that gender exploratory therapy is conversion therapy, and such therapy is recommended by heath policies in some European countries, then there is clearly no global consensus on this issue. It is not acceptable to equate GET to conversion therapy in a wiki voice while ignoring alternative viewpoints.--JonJ937 (talk) 11:25, 6 March 2025 (UTC)

That still doesn't say "gender exploratory therapy", though. Aaron Liu (talk) 12:49, 6 March 2025 (UTC)

Is there a reliable source which states that "exploratory psychotherapy for gender related distress" is not the same as "gender exploratory therapy"? This question was asked above by another user and no such source has been presented. JonJ937 (talk) 16:50, 6 March 2025 (UTC)

You are the one trying to say they are the same thing, you are the one who has to present a source agreeing that is not an editorial from quacks (here is Joanna Sinai, the author with no experience in trans healthcare, providing a webinar with Therapy First[30])

I and others have repeatedly quoted to you sources that note that GAC supports exploration. From gender exploratory therapy the gender-affirming model of care already promotes gender identity exploration without favoring any particular identity, and individualized care. GET proponents deny this. From WPATH: [Health Care Providers] working with adolescents should promote supportive environments that simultaneously respect an adolescent’s affirmed gender identity and also allows the adolescent to openly explore gender needs Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:54, 6 March 2025 (UTC)

Exactly. Unless there are RSes that say "GET = all these other things which aren't called GET", it's WP:OR. Lewisguile (talk) 18:30, 6 March 2025 (UTC)

I think it's more complicated than that.

If someone turns up tomorrow talking about how their new Exploratoryyay EnderGay ErapyThay (EEGET®) was totally different from Gender Exploratory Therapy (GET), even though it had all the key features (whatever reliable sources claim those features to be), then we'd still correctly call it a type of GET. We don't need an exact word-for-word match when words are synonyms.

More generally, I feel like every time this question is asked, we get a different answer. For example, editors have claimed that the Cass Review is directly promoting conversion therapy in the form of GET, even though the Cass Review does not use the name of gender exploratory therapy (or conversion therapy) to describe what they want to see happen. Then it was okay to have gender exploratory therapy (i.e., 'a therapy in which gender is explored', not GET™ itself) as long as it was client-led and non-judgmental. Now we're told that if you don't have the exact words 'gender exploratory therapy' in the source, then it's not gender exploratory therapy and the claim would be WP:OR. I don't think that our editors are being dishonest. So: Are we seeing a transition in the real world (e.g., greater differentiation between ethical and unethical approaches to talk therapy)? Are editors getting better informed about the details as time goes on? What's causing the story to change over time? WhatamIdoing (talk) 03:13, 7 March 2025 (UTC)

There are some major differences between the two cases. Firstly, subject experts and international medical organisations have said the requirement for exploratory psychosocial approaches is tantamount to GET, and we have quoted them with attribution. Secondly, many of these RSes say that it's the requirement to undergo explorative psychotherapy as the main treatment while also denying GAC that is the problem.

E.g., this is from the section on GET at the Cass Review: the denial of gender-affirming treatment under the guise of 'exploratory therapy' has caused enormous harm to the transgender and gender diverse community and is tantamount to 'conversion' or 'reparative' therapy under another name. We attribute this and it's clear what distinguishing features they're talking about here. If RSes say similar things about these treatments, then we can certainly say so, as we have here (with attribution). There's also a difference between psychosocial support provided while exploring gender (this could include "soft" interventions like having someone to talk to, letting a child experiment with gender without judgment, as well as more involved "therapies") and mandatory psychosocial therapy as an approach to exploration (which is a treatment in itself). Both "psychosocial support to explore gender identity" and "psychosocial support for the unconditional exploration of gender identity" are subtly different uses of language. In both cases, it's psychosocial support (i.e., adjunct therapies, as well as softer forms of social support) while a person is exploring their gender and potentially receiving other treatments, as needed. Without seeing a protocol or statements otherwise, I couldn't confidently say GAC is forbidden with this approach or that these interventions are mandatory; it could be an agnostic approach that allows for all of the above. In GET, it's a primary treatment that replaces other interventions—it's not agnostic because it assumes psychosocial therapy is the first-line treatment, which makes inherent assumptions in spite of the patient's own wishes or their individual needs. Lewisguile (talk) 09:15, 7 March 2025 (UTC)

Who claims that GET replaces other forms of treatment? Supporters of therapy, whether they call it "gender exploratory therapy," "exploratory therapy," or "psychosocial support for the unconditional exploration of gender identity", suggest it be the first-line treatment, not a complete replacement for other methods. For example, Therapy First states that "Psychological approaches should be the first-line treatment for gender dysphoria", and that they oppose any form of conversion therapy. [31] First line is not the same as a compete replacement of any other treatment. The UKCP, a leading MEDORG in the UK in its field of activity, explicitly states that exploratory therapy is not conversion therapy. How can we claim the opposite in a wiki voice when there is clearly no international consensus on such a claim? JonJ937 (talk) 11:15, 7 March 2025 (UTC)

Lewisguile, in the statement "while also denying GAC", is "GAC" (gender-affirming care) effectively synonymous with "prescribing medications"? As in, there are no forms of caring for someone and affirming their identity that don't involve prescribing drugs? WhatamIdoing (talk) 04:10, 8 March 2025 (UTC)

@WhatamIdoing, I'm not sure why you made that assumption from "while also denying GAC". GAC, as I understand it, does not mandate medication either as a first-line treatment or as the end result. You can always consult the RSes if you're personally unsure. Lewisguile (talk) 13:41, 8 March 2025 (UTC)

GAC does not mandate medical interventions, but what it does mandate is no significant barrier to those interventions. Likewise exploratory approaches do not mandate no medical interventions, but they do mandate some level of exploratory psychotherapy as a first line treatment. Hyperbole about "denying" care is a misrepresentation, and it is one borne of different clinical perspectives on the same patient group.

When you say undergo explorative psychotherapy as the main treatment while also denying GAC this is essentially describing the level of psychotherapeutic assessment as undertaken in the Dutch Protocol. The whole point was to restrict access to puberty blockers to those that the clinicians were most sure would benefit, until they reached an age where CSH were permitted - because historically most desisted and clinicians were never able to predict which.

When adopted in the US at Boston, this was dropped, and dropping this "gatekeeping" at GIDS once the puberty blockers trial was underway was one of the reasons they were subjected to criticism - they deviated from the protocol they were attempting to reproduce.

The affirmative model which emerged at this time is an "informed consent" model, without the gatekeeping of the Dutch Protocol. That's the chief distinction. As described by its originator, Diane Ehrensaft:

Prior treatment models have included a “wait and see if these behaviors desist” approach; prohibition of starting adolescents on cross-sex hormones until age 16 (Netherlands model)[...]. Central to the GAM is the evidence-based idea that attempting to change or contort a person’s gender does harm. Instead, the GAM defines gender health as follows: the opportunity for a child to live in the gender that feels most real and/or comfortable for the child and the ability for children to express gender without experiencing restriction, criticism, or ostracism. In the model, the role of the mental health professional is a facilitator in helping a child discover and live in their authentic gender with adequate social supports.

Proponents view stringent assessment and age barriers as attempts to "contort" or "change" an authentic expression of gender identity, but this is not a universally accepted position.

It is messy and contentious and spans lots of different clinical positions with weak and contested evidence, and introducing accusations that anything other than the affirmative approach is "conversion" is inflammatory and unhelpful. Void if removed (talk) 16:59, 8 March 2025 (UTC)

@Lewisguile, I asked because of what you wrote: it's the requirement to undergo explorative psychotherapy as the main treatment while also denying GAC that is the problem.

As a simple matter of logic, if it is possible to "undergo explorative psychotherapy...while also denying GAC", then that psychotherapy can't be GAC, right? Because if that psychotherapy were GAC, then it would be impossible to undergo that therapy while denying GAC.

So: Is it possible for that therapy to be GAC, and your statement was just a little confusing? Or did you mean that GAC requires prescription drugs? WhatamIdoing (talk) 18:02, 8 March 2025 (UTC)

@Void if removed, firstly, you're still conflating vaguely defined "exploratory approaches" with GET, as the majority of RSes describe it. Secondly, your reading of what's above seems rather bad faith to me—"without restriction" doesn't mean "no assessment or exploration". The language about "facilitation" is pretty standard for modern psychological treatments, as is the stuff about avoiding "criticism or ostracism". Crucially, it says it's about "helping the child discover...their gender". How do you suppose the discovery occurs without any exploration? It doesn't say that exploration is forbidden, only that attempts to "change or contort" are.

@WhatamIdoing, you're still missing the therapy distinction of what I wrote. If someone gets CBT while being treated for MS, the CBT isn't a curative treatment for MS—it's a treatment that can be offered alongside treatment for MS and can augment that treatment. But it doesn't replace the immune therapies the person is taking. Moreover, the person with MS isn't required to undergo CBT before they get immune modifying treatments.

As part of GAC, psychological support can be offered and therapies can be offered to treat any psychological issues that need addressing. But there isn't an assumption that the treatment is curative, or the only option. It's also not a hoop you have to jump through—even if you don't need it—before exploring other options. Psychological assessment is not the same thing as psychological treatment, so not requiring psychotherapy doesn't mean not giving psychosocial support or not assessing someone. And clinicians are more than experienced enough at investigating differential diagnoses and comorbidities. It's a key part of their job. That isn't superceded by not forcing people to undergo therapies they don't need. And receiving treatments that aren't needed can be a form of iatrogenic harm—that applies equally to psychological as well as medical treatments. This will probably be my last reply on this topic, because it seems we're just not understanding each other, and it comes down to a fundemantal difference on how we're viewing even the basics of this issue, so I don't think anyone can convince the other and it's just wasting all our time.Lewisguile (talk) 22:02, 8 March 2025 (UTC)

you're still conflating vaguely defined "exploratory approaches" with GET, as the majority of RSes describe it.

No, you are repeatedly ignoring that this is not true. As I said here WPATH refer to "exploratory therapy" with reference to the Cass Review, which says "exploratory approaches" referencing Spiliadis 2019, which says "gender exploratory model", which was critiqued by Florence Ashley in 2023 as "gender exploratory therapy".

These are all the same thing. There is no such thing as "gender exploratory therapy" that is not the "exploratory approaches" described in the Cass Review. There is no source that makes this distinction, and if there was, it would not carry the weight of WPATH, which explicitly considers them the same. Void if removed (talk) 22:29, 8 March 2025 (UTC)

Therapy First is the conversion therapy advocacy group that lobbies in favor of conversion therapy, and that's things explicitly called "conversion therapy". They're also established by the SEGM can of worms, currently the topic of an unclosed FTN RfC debating whether or not they're a hate group.

This view of UKCP is fringe. The page you linked says Case law has confirmed that gender-critical beliefs are protected under the Equality Act 2010., and hopefully we can agree here that gender-critical views are fringe:

The Council of Europe has condemned gender-critical ideology, among other ideologies, and linked it to "virulent attacks on the rights of LGBTQ people" in Hungary, Poland, Russia, Turkey, the United Kingdom, and other countries.[24] UN Women has described the gender-critical movement, among other movements, as extreme anti-rights movements that employ hate propaganda and disinformation.[25][26]

As mentioned above, UKCP followed this guidance by withdrawing from the Memorandum of Understanding (MoU) on Conversion Therapy just because it also applied to children, and was promptly criticized for both actions by every major MedOrg in the UK and the MoU's organization. The MoU is signed by 29 associations of psychiatrists including the entire NHS. I don't see how that can't be fringe. You have no other source that claims GET is not conversion therapy, and I do not see what basis you have to put one British MedOrg's opinion over that of so many plus the World Professional Association for Transgender Health and universal agreement in systematic reviews to conclude that there is no international consensus, Aaron Liu (talk) 18:02, 7 March 2025 (UTC)

Therapy First is not a conversion group, no matter what the activists say. TF oppose conversion therapy, and simply support the therapy as the first line treatment, like it is done in many developed countries. It is a mainstream view, shared by the health authorizes of Finland, Sweden and the UK which also advise for therapy as the first line of treatment. US's HHS has recently stated that: The United Kingdom, Sweden, and Finland have recently issued restrictions on the medical interventions for children, including the use of puberty blockers and hormone treatments, and now recommend exploratory psychotherapy as a first line of treatment and reserve hormonal interventions only for exceptional cases. [32] HHS is hardly a fringe opinion. I have not seen a single reliable source stating that Sweden and Finland do not advise exploratory therapy, but something else. UKCP withdrew from the MoU due to concerns that its overly restrictive definition of conversion therapy would complicate providing appropriate therapy for children, not because they support conversion therapy. The opposition within the organization was too weak to change its position. UKCP is not alone in in their stance that exploratory psychotherapy is not conversion therapy. RANZCP also says that psychotherapy is not conversion therapy. The Australian National Association of Practising Psychiatrists (NAPP) states the same. [33] Together with health authorities in Scandinavia recommending exploration therapy as first line treatment, this shows that there is no consensus to consider exploratory therapy a conversion therapy. Otherwise, that would mean claiming health authorities in Sweden and Finland, along with other major MEDORGs, support conversion therapy, which is too far-fetched. JonJ937 (talk) 11:04, 8 March 2025 (UTC)

You're yet again dismissing sources that overwhelmingly say TF is a conversion group, skipping past the largest human rights organizations and various straight-news sources. TF says that transitioning should be avoided whenever possible, which is way beyond simply recommending therapy first. (And AFAIK the idea that hormone treatments for children should be reserved for exceptional cases is quite widespread and accepted.) You can't claim that the article has major sourcing issues if you provide no reason to dismiss the sources. Aaron Liu (talk) 23:36, 8 March 2025 (UTC)

Exploratory therapy is recommended by health authorities and MEDORGs worldwide. The MEDORGs I quoted above explicitly state that exploratory therapy is not conversion therapy. Therefore, this Wikipedia article is inappropriately equating exploratory therapy with conversion therapy, despite the lack of scholarly consensus to support such a statement in a wiki voice. This is against WP:NPOV. When the sources diverge on a topic, we must present all existing views on the subject, not just one JonJ937 (talk) 12:23, 9 March 2025 (UTC)

I'll concede that the difference—between the "exploration" that Therapy First pushes and recommended normal exploration that respects clients' wishes—is not very clear, and the articles mentioning GET should find a good source that talks about the differences. (Currently the only source cited for this is Mother Jones which is, well, WP:MOTHERJONES.) As for what sources mention how the GET that TF and affiliates push think this should replace other interventions, "Demons and Imps" cites various sources about this, as does our article on Therapy First. (You're also exaggerating HHS's claims. Our article already addresses this from Transgender health care misinformation#Children are transitioned too quickly until the start of the "Impact" section.) As for the rest, I'll refer back to #c-Your_Friendly_Neighborhood_Sociologist-20250303175000-JonJ937-20250303172800. Aaron Liu (talk) 22:45, 9 March 2025 (UTC)

TF is a topic for separate discussion, but I have yet to see any statement from TF itself supporting conversion therapy. TF explicitly states that they view therapy as a first-line treatment, meaning that there can be second- and third-line treatments too. They oppose conversion therapy and use the term "exploration of gender identity" rather than GET, but it refers to the same practice. [34] Setting TF aside, as they are just one organisation among many, the key issue here is the broader claim that any form of GET constitutes conversion therapy. If there are no reliable sources showing that gender exploratory therapy means different things in different countries, then how can you unequivocally claim that GET is a form of conversion therapy? If prominent MEDORGs such as the UKCP, RANZCP, and NAPP explicitly state that GET is not conversion therapy, how can a Wikipedia article claim otherwise in a wiki voice? That would imply accusing health authorities in Sweden and Finland of endorsing conversion therapy for dysphoric individuals, which is not supported by any reliable source whatsoever. I have already addressed YFNS above and do not wish to repeat myself. The article about Conversion therapy has the same NPOV issues, as it cherry picks sources that support a particular point of view, while completely disregarding other perspectives. My concern about the inappropriate equating of GET with conversion therapy remains. We cannot make such strong claims when there is no clear scientific consensus and opinions differ significantly. JonJ937 (talk) 10:27, 10 March 2025 (UTC)

The only thing you've said that hasn't been addressed already is addressed by the following:

while gender-affirming model of care already promotes gender identity exploration without favoring any particular identity, and individualized care.[66] GET proponents deny this.[69]

Again, the only MedOrg you've listed that supports "exploratory therapy" is the UKCP (and TF even if you consider that a MedOrg), whose position on this has been extensively marginalized. Aaron Liu (talk) 14:09, 10 March 2025 (UTC)

UKCP, RANZCP and NAPP all state that exploratory therapy is not conversion therapy. Finland and Sweden recommend exploratory therapy as a first-line treatment (see HHS reference above). No one has explained why these Scandinavian countries would promote conversion therapy. My point still stands. There is no scientific consensus that exploratory therapy is conversion therapy. It is just an opinion of some sources not shared by others. JonJ937 (talk) 10:10, 11 March 2025 (UTC)

No, we cannot. The very first source on the Gender exploratory therapy section is WPATH describing the NHS' interim service specification which uses language like careful therapeutic exploration and psychosocial (including psychoeducation) and psychological support and intervention as "exploratory therapy" which is tantamount to “conversion” or “reparative” therapy under another name. There is essentially no coherent thing as "gender exploratory therapy" which is not also referred to synonymously as "exploratory approaches" or "psychotherapy".Void if removed (talk) 16:13, 5 March 2025 (UTC)

References

General sourcing issues

A significant amount of the article depends on a handful of non-independent non-MEDRS, but these are ultimately making MEDRS claims, or at least claims about the validity of MEDRS.

These sources are:

• "A thematic analysis of disinformation in gender-affirming healthcare bans in the United States" (McNamara, Meredithe; McLamore, Quinnehtukqut; Meade, Nicolas; Olgun, Melisa; Robinson, Henry; Alstott, Anne) - 16 citations, a social science paper, lead author engaged as expert witness in litigating against gender-affirming healthcare bans, so is not an independent source.
• Southern Poverty Law Centre's CAPTAIN report (Cravens, R. G.; McLamore, Quinnehtukqut; Leveille, Lee; Hodges, Emerson; Wunderlich, Sophie; Bates, Lydia) - 11 citations. This is a partisan lobby group who is plaintiff in the cases mentioned above, with no noted reliability in this area and who is supposed to be used with attribution per WP:SPLC. So, again, not independent.
• ""Demons and Imps": Misinformation and Religious Pseudoscience in State Anti-Transgender Laws" (Alstott, Anne; Olgun, Melisa; Robinson, Henry; McNamara, Meredithe) - 9 citations, a law & feminism paper, same authors as first source.

So a total of 34 citations on this article - many of which are key to the themes of misinformation and disinformation regarding medical matters - are derived from the same non-MEDRS sources, which are all non-independent.

An example of claims:

• It relied on studies that had serious methodological flaws such as low sample sizes, outdated diagnostic frameworks that conflated gender non-conformity with transgender identity, usage of conversion therapy on the sample population, and poor definitions of desistance - these are strong claims about desistance and prior studies which require MEDRS, and the citations are all three of the above.
• Most youth sampled in them never identified as transgender nor desired to transition, but were counted as desisting. - the sole citation for this is SPLC, unattributed, and I can't find what it refers to in the text.
• Though every major medical organization endorses gender-affirming care, proponents of gender-affirming care bans in the United States argue the mainstream medical community is untrustworthy, ignores the evidence, and that doctors are pushing transgender youth into transition due to political ideology and disregard for their well-being. This extends to claims that standards of care and guidelines from reputable medical organizations do not reflect clinical consensus - this cites the two McNamara papers. Given that a systematic review of guidelines found eg. WPATH's SOC8 to be of low quality, and obvious differences of clinical opinion across the world, presenting criticism of alleged "clinical consensus" as "misinformation" is a strong claim indeed, and requires much better sourcing than this.
• This has included arguments transgender youth are incapable of providing informed consent to medical transition though scientific literature demonstrates that transgender youth, including those with mental health conditions, can competently participate in decision-making - again, cites the two McNamara papers, again these are medical claims, and obviously competence is complicated, varies greatly by age and other factors, and cannot be presented in this blanket manner.
• Though transgender people have higher rates of mental illness, there is no evidence these cause gender dysphoria and evidence suggests this is due to minority stress and discrimination experienced by transgender people. - again, cites the two McNamara papers, and this is a strong MEDRS claim, at odds with entirely valid concerns about diagnostic overshadowing. If we read the first source, it gives as an example of "misinformation" the statement: Many of the children who undergo these procedures have other psychological problems, like attention deficit hyperactivity disorder and autism. This is as true a statement as is possible to make in this area, backed up by systematic review. It isn't even controversial. The high rates of ADHD and autism in this cohort is by now well-established.

I think this article is better understood as "the strong opinions of those fighting trans healthcare bans in court in the US", and to have those presented as definitive - and globally applicable - while other opinions are "misinformation" is not really indicative of a GA. This is all based on WP:PRIMARY, non-independent sources, often expressing opinions at odds with MEDRS, and producing their own definitions of "misinformation", which this article renders into wikivoice, making strong claims with no caveats and no balancing perspectives. Void if removed (talk) 11:44, 3 March 2025 (UTC)

For the detransition and desistence sections, I was extremely surprised to find that Care pathways of children and adolescents referred to specialist gender services: a systematic review was not used as a source.  Tewdar  12:13, 3 March 2025 (UTC)

Seven citations, if you're interested in the numbers...  Tewdar  12:20, 3 March 2025 (UTC)

It's more interesting that it isn't cited in Detransition (we do have 3 other reviews cited there though). In this article it could be construed as coatracking or OR to include it as it doesn't mention misinformation whatsoever (unless a source discussing misinformation used it). LunaHasArrived (talk) 12:42, 3 March 2025 (UTC)

Well, one of the other companion articles is cited in the 'European nations are banning gender-affirming care' section, despite also not mentioning misinformation whatsoever. Is that OR/coatracking, then?  Tewdar  18:48, 3 March 2025 (UTC)

In this case it's a miscitation. That source says nothing whatsoever about the 2023 Norwegian health investigation board and therefore shouldn't be used there. Thank you for pointing this out. LunaHasArrived (talk) 19:02, 3 March 2025 (UTC)

1) It seems doubtful we need to cite that article so no issues with it being removed, it does indeed seem extraneous

2.1) That systematic review was discussed on talk - it did not actually report on desistance or even define it so it seemed useless for the desistance section

2.2) If we were going to cite it for detransition statistics, we have better sources at Detransition, but this source itself points to detransition being very rare Discontinuation of medical treatments was similar across reviewed studies. In the seven studies reporting data for puberty suppression, discontinuation ranged from no patients to 8%. ... For masculinising/feminising hormones, six studies reported discontinuation, with very low rates (0–2 individuals) reported.

So the article cited for Norway's treatment can be removed without issue, and it's unclear how/why we would cite the review as the statement Data suggests that regret and detransitioning are rare is so accepted among MEDRS (nobody's even argued it's an incorrect summary of the field) it seems superflous - though, I think there's a case for citing that review and the others at detransition to note the detransition rate is rare in this article just to avoid argument over how accepted that is Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:17, 3 March 2025 (UTC)

And how about The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Urological Association, the American Society for Reproductive Medicine, the American College of Physicians, the American Association of Clinical Endocrinology, GLMA: Health Professionals Advancing LGBTQ+ Equality, the American Medical Association (AMA), AMA's Medical Student Section cosponsored an Endocrine Society resolution "opposing any criminal and legal penalties against patients seeking gender-affirming care, family members or guardians who support them in seeking medical care, and health care facilities and clinicians who provide gender-affirming care."? What does this add to an article about Transgender health care misinformation, exactly?  Tewdar  19:31, 3 March 2025 (UTC)

Because it's cited to an Endocrine Society statement that includes Due to widespread misinformation about medical care for transgender and gender-diverse teens, 18 states have passed laws or instituted policies banning gender-affirming care. More than 30 percent of the nation’s transgender and gender-diverse youth now live in states with gender-affirming care bans, according to the Human Rights Campaign. Some policies are even restricting transgender and gender-diverse adults’ access to care. These policies do not reflect the research landscape. and lists the major medical organizations opposing these bans (which are stated to be based on misinformation) [35] A statement on "widespread misinformation about medical care for transgender and gender-diverse teens" and the contrasting positions of MEDORGs seems fairly obviously relevant for an article about "Transgender health care misinformation" Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:37, 3 March 2025 (UTC)

I think Tewdar is correct about the laundry list paragraph being off topic. (For avoidance of doubt, I think the one before it seems more related to the article's subject.) WhatamIdoing (talk) 01:57, 4 March 2025 (UTC)

"Thematic" is a review paper submitted to the highly prominent Social Science & Medicine journal, published by Elsevier. (Note the "& Medicine". This is, in fact, a MedRS journal.) If I recall correctly, such review articles published in highly prominent journals are usually pretty much commissioned/invited by the journal. Regardless of that, I don't find McNamara's credentials a problem, while the journal and its peer review did not find it a problem,

Opinions (e.g. labeling, non-surveyed evaluation of importance) that were only cited to SPLC were attributed. The only time SPLC was cited alone and not attributed was for the factual information Most youth sampled in them never identified as transgender nor desired to transition, but were counted as desisting.; factual information does not fall under RSOpinion as mentioned at RSP, and thus does not need attribution (and especially not in the example I mentioned, which directly follows a sentence cited to academic consensus on certain studies having serious methodological issues).

"Demons" is indeed a problem, but it's never cited alone in the article. It can be removed if needed. Aaron Liu (talk) 14:07, 3 March 2025 (UTC)

The about page says it is social science research on health, which means it is not a biomedical source, it is social sciences. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines and and material relevant to the social sciences from any of the professions concerned with physical and mental health. It is peer-reviewed in a high quality journal for sure, but I don't believe it meets WP:MEDRS. I could be wrong, but that's my reading of it anyway. And my concern is not McNamara's credentials, it is non-independence. Relying so heavily on 3 interrelated primary sources with a vested legal interest in the subject is a problem for a GA because we should be favouring independent secondary sources.

factual information

If this is factual information, then find a better source. As it is, I can't even find where this even is in the SPLC source given. SPLC are a biased and opinionated source with no track record for reliability on biomedical subjects. You cannot use a report from the SPLC to make factual claims aimed at critiquing or "debunking" biomedical research, as is the case here.

The section on the "desistance myth" consists of:

• A paragraph almost entirely based on these three primary sources
• A paragraph which makes BLP claims of spreading misinformation, based on these three sources
• A paragraph on the systematic review which found most actually desisted

Meanwhile other relevant sources which do not support this framing are omitted. Void if removed (talk) 15:47, 3 March 2025 (UTC)

Just for note I've just added sources which confirm the comment about children being included that never identified as transgender. This and here both talk about the problem. LunaHasArrived (talk) 16:25, 3 March 2025 (UTC)

The first source is an editorial, from a special issue of clinical perspectives, so is WP:RSOPINION.

The second is a critical commentary, so it is also WP:RSOPINION. It also appears in the same issue as two critical responses to the commentary which question its position:

https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1468292

https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1468293

So - again - you can't establish this as "fact" in wikivoice, but actually have to explain (with attribution) the different perspectives, at which point presenting this as a definitive "myth" is no longer appropriate.

I think this is the danger of assembling a particular overly-certain POV from primary sources like this. Void if removed (talk) 17:54, 3 March 2025 (UTC)

That first response notes Although we do not believe that many of our non-responders are in fact persisters, we do agree with the authors that the persistence rates may increase in studies with different inclusion criteria. The classification of GD in the Wallien and Cohen-Kettenis (Citation2008) study was indeed based on diagnostic criteria prior to DSM-5, with the possibility that some children were only gender variant in behavior. We have clearly described the characteristics of the included children (clinically referred and fulfilling childhood DSM criteria) and did not draw conclusions beyond this group, as has wrongly been done by others. The broadness of the earlier DSM criteria was also acknowledged by the American Psychiatric Association and World Health Organization. This was, among other things, a reason to tighten the diagnostic childhood criteria for DSM-5 and the proposed criteria for ICD-11. As we have stated elsewhere (Hembree et al., Citation2017; Steensma, Citation2013), we expect that future follow-up studies using the new diagnostic criteria may find higher persistence rates and hopefully shed more light on developmental routes of gender variant and transgender children. and Unlike what is suggested, we have not studied the gender identities of the children. Instead we have studied the persistence and desistence of children's distress caused by the gender incongruence they experience to the point that they seek clinical assistance.

• So the authors of the study would in fact agree that not everyone they tracked identified as transgender

The second response linked is by conversion therapist Kenneth Zucker

The desistance review notes in Table 4 that none of the studies tracked DSM-5 diagnoses, many of the youth didn't even meet the DSM-4 threshold for diagnosis[36] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:14, 3 March 2025 (UTC)

It's an interdisciplinary journal that does social science research on health. Unless they have had some scandal, I would say that they are MedRS. And regardless of that, the journal already has enough confidence in this review article's indepndence.

Relying so heavily on 3 interrelated primary sources

This is a review, a secondary source. I also don't see the relation to SPLC.

As it is, I can't even find where this even is in the SPLC source given.

it is notable that many participants in these studies were never actually diagnosed as such in the first place, being as they were “sub-threshold” (and desistance was higher among subthreshold participants)

with no track record for reliability on biomedical subjects

Fair enough.

A paragraph on the systematic review which found most actually desisted

That's an extremely poor summary of it by omission...

Meanwhile other relevant sources which do not support this framing are omitted.

What are some post-2013 sources that support your framing? Aaron Liu (talk) 00:29, 4 March 2025 (UTC)

Social Science & Medicine is a quite good journal.[37] WhatamIdoing (talk) 02:03, 4 March 2025 (UTC)

It absolutely is a good journal but, genuine question, is this source MEDRS? This paper is a Reflexive Thematic Analysis of Five legal filings published in a journal for social science research on health. Maybe I'm being too specific and others agree it is MEDRS, but my understanding was that social science papers like this were not. Void if removed (talk) 14:18, 4 March 2025 (UTC)

Instead of asking whether it's MEDRS, I think the first question to ask is whether it's supporting Wikipedia:Biomedical information. For example:

• "Misinformation and disinformation about transgender health care sometimes relies on biased journalism in popular media" – not biomedical information
• "Data suggests that regret and detransitioning are rare, with detransition often caused by factors such as societal or familiar pressure, community stigma or financial difficulties" – probably not biomedical information
• "States in the United States have primarily relied on anecdotes to argue detransition is cause for bans on gender affirming care" – not biomedical information
• "Detransitioner Chloe Cole has supported several such state bans as a member of the advocacy group Do No Harm" – not biomedical information
• "It relied on studies that had serious methodological flaws such as low sample sizes, outdated diagnostic frameworks that conflated gender non-conformity with transgender identity, usage of conversion therapy on the sample population, and poor definitions of desistance" – probably biomedical information
• "The myth was primarily popularized in a commentary by James Cantor in 2020, who argued based on the outdated studies that most children diagnosed with gender dysphoria will grow up to be gay and lesbian adults if denied such care" – not biomedical information

and so forth. WhatamIdoing (talk) 22:32, 4 March 2025 (UTC)

That supplement says causes of conditions are biomedical information. It doesn't say psychological conditions are any different. I think №2 is BioMed and "outdated" in the last one is BioMed.
That said, I see no reason social science papers on health are not MedRS. Aaron Liu (talk) 22:40, 4 March 2025 (UTC)

I agree that classifying some statements is subjective, and that different details might be classified differently. For example, "The myth was primarily popularized" is not biomedical, but "the studies were outdated" might be.

I also would not want to interpret MEDRS as saying that no other field has any relevance or right to speak to health-related subjects at all. A good economics journal may be more capable of reviewing (e.g.,) a question of short-term vs long-term costs and benefits than a biology-focused journal. WhatamIdoing (talk) 23:27, 4 March 2025 (UTC)

I don't think we should be using articles from Social Science & Medicine to support biomedical claims.  Tewdar  08:50, 7 March 2025 (UTC)

As well as a shared co-author between the first two sources, the lead author is expert witness for plaintiffs (SPLC) in eg. Boe vs Marshall. Again this is about independence, and such legal/professional relationships between sources need to be taken into account.

What are some post-2013 sources that support your framing?

I am not the one suggesting a framing that the historic data showing that most desist is now misinformation. I am suggesting it is nuanced and we don't really know, with some legitimate differences of opinion in the literature, and I think the removal of discussion of this from Gender dysphoria in children was a bad precedent that facilitated a stronger framing here than the evidence supports. As WPATH's SOC8 says The research literature on continuity versus discontinuity of gender-affirming medical care needs/requests is complex and somewhat difficult to interpret., and I think trying to fashion definitive statements from a paucity of data has veered into WP:RGW.

The best systematic review in 2024 does not support this (it barely supports anything) and a 2024 German analysis of insurance data found high rates of desistance, heavily biased towards female teenagers. Singh et al. 2021, a retrospective study put desistance at >85% for the group who were threshold for GD, and this 2018 review says it is around 80%, citing Ristori & Steensma's 2016 review. YFNS does not like these sources, and I agree we should not fashion a definitive statement that desistance is high from primary sources, but they are peer-reviewed publications that haven't been retracted or corrected and pointing in good faith to what they say cannot be "misinformation". If the best we can do is show the different perspectives then we should do that.

If we focus only on the Karrington and Taylor et al. systematic reviews, we get:

• Historically the rates were high but the methodology was bad and the numbers were tiny
• Current rates are confounded by poor and inconsistent data, lack of followup, and use of puberty blockers and social transition from a young age
• We should either stop trying to track this (Karrington), or track this better with more consistency (Taylor et al)

This entire section of this article is misplaced. It should not be on a page with this title, and in its current form serves mostly to advance as factual the opinions of SPLC and their expert witness.

On the SPLC citation, what the article says is:

• Most youth sampled in them never identified as transgender nor desired to transition, but were counted as desisting.

And what you pulled from the source is:

• it is notable that many participants in these studies were never actually diagnosed as such in the first place, being as they were “sub-threshold” (and desistance was higher among subthreshold participants)

Which does not support the text. Many is not most, and sub-threshold GD diagnosis is not "never identified as transgender nor desired to transition".

So the article misrepresents the source substantially.

As for the SPLC source, consider the Singh et al study above which is specifically mentioned in the SPLC report. Only a third were subthreshold for GD (so that fits with "many" but not "most"), and the difference between threshold vs subthreshold desistance was 90.2% vs 86.4%. So yes, desistance was technically higher in the threshold group, but the marginal degree of difference here is misleading the reader by omission. SPLC aren't a RS for facts on biomedical topics. Void if removed (talk) 10:09, 4 March 2025 (UTC)

I understand what you were saying about the independence now. That does make a little bit of sense, but 1. out of eleven unique authors, just one author who was also accepted by an impartial judge does not seem like it would affect intellectual independence much 2. the SPLC sources can be removed now anyways (though IMO it's better for them to stay).

The 2016 review cited just aggregates the same qualitative studies—including the Singh study—that Karrington aggregates as "of all poor quality", as they did not consider outside factors (such as if participants were in supportive homes and communities) and followed up too early (instead of following up post-adolescence). These are two of the three essential criteria in the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, which was chosen for its focus on reporting and methodology. The German insurance-data analysis similarly does not account for how much support the desisters received.
The three bullet points you have seem mostly correct. (though I do not see where you got "use of puberty blockers and social transition from a young age") While I would've asked to condense and restructure the paragraph in our WP article if I had reviewed this article for GAN, I fail to see how our WP article's paragraph misrepresents these points. Besides the doubtfully weightful indeed part about nonbinary and dynamic identities, our paragraph just restates the review's conclusion section and adds some details for your first bullet point. I also don't get your SPLC comment, as I found no association between Karrington and SPLC.

w.r.t. WPATH's difficult to interpret continuity of gender-affirming medical care needs requests: this is where the Taylor review is useful, as it talks about continuity:

Six studies reported whether hormones were continued or discontinued, all reporting either no discontinuations or one or two individuals discontinuing. [...]

In the seven studies reporting data for puberty suppression, discontinuation ranged from no patients to 8%. [...] The lack of reporting on reasons for discontinuation makes drawing conclusions problematic. Longer-term follow-up into adulthood is necessary to understand trajectories more comprehensively.

I think this clearly evinces that continuance is high while stating that the rare discontinuance is hard to interpret.
Note that this is not about discontinuance, not desistance. (Taylor strangely avoids discussing "desistance" despite mentioning it in the introduction.) Discontinuance is squarely excluded by the plurality desistance definition of "ceasing to be diagnosed w/ gender dysphoria" as not all diagnoses provide treatment. Therefore I feel like it's erroneous for you to lump Taylor or the WPATH quote under desistance discussion.

I concede that SPLC cannot cite the "most" claim. Aaron Liu (talk) 22:33, 4 March 2025 (UTC)

A discontinuation rate with no time period attached is a strange thing. If the study period is short, that could be essentially meaningless. (Imagine if a new drug claimed 100% adherence, but when you looked into it, it 100% meant "for the first day", and everyone stopped on the second day.) WhatamIdoing (talk) 00:03, 5 March 2025 (UTC)

The summarized studies for discontinuation all had different follow-up durations. (Plus the full text of the paragraph that I ellipsisfied did include the follow-up duration of one of the studies.) Aaron Liu (talk) 01:17, 5 March 2025 (UTC)

No, it doesn't. Taylor says "In one study, a single person stopped treatment after 4 months", but knowing when a single person dropped out is not the same as "The median follow-up time for all patients was ____ years (range: x–y)".

I looked at the underlying studies. They do not provide statements about follow-up times. I didn't see numbers on patients being lost to follow-up, either. "We know for certain that one person stopped treatment after 4 months" is not the same as "We know for certain that the other 37 people continued treatment". That makes sense for the particular source (which is primarily trying to describe incoming referrals, not the patients' outcomes) but it would be important not to misrepresent this as proof that 97% of patients in this study had a lifelong trans identity. 40% of them took some form of puberty blocker, almost all of whom did so too late (i.e., after puberty was nearly or completely over). What happened to the other 57%? Did they stay on puberty blockers forever? Do the authors even know? WhatamIdoing (talk) 01:40, 5 March 2025 (UTC)

I don't see how you got to that conclusion. The relevant sources are No. 56--59; 56: The median duration of follow-up of people starting GnRHa and GAH at the VUmc was 4.6 years (IQR, 2.8-8.5; range, 0.7-18.9) 57 specifies a data collection range with a median start date of 14.1/16.0 AMAB/AFAB and end date of 20.2/19.2 AMAB/AFAB. 58 is the only one without a clear follow-up duration, and the review paragraph mentions that. 59's follow-up duration is quoted in the review paragraph as average 3.2 years for birth-registered females, 6.1 years for birth-registered males. Aaron Liu (talk) 18:53, 5 March 2025 (UTC)

I was looking at the sources in https://adc.bmj.com/content/109/Suppl_2/s57, in the "Six studies reported whether hormones were continued or discontinued" paragraph you quoted above. Now I wish I'd added links/quotations, because I no longer remember which one I spent the most time on. WhatamIdoing (talk) 19:49, 5 March 2025 (UTC)

Welp, I was looking at the second paragraph I quoted: the "In the seven studies..." one. As for the paragraph you were talking about, I don't have time to check all the sources right now, but the first one I checked (№32) says Our follow-up experience for adolescents undergoing hormone treatment for GID is 20.7 person-years (range 0–8.2 years) (however that could make sense...) Aaron Liu (talk) 03:07, 6 March 2025 (UTC)

I do find Karrington's cut-off for "post-adolescence" a bit weird, though. They define the the cutoff as 24 years-old as this age is the maximum age to be considered a young adult by the Federal Interagency Forum on Children and Family Statistics in the United States. Would be nice to have studies with mean follow-up past 24, but in their review, they make this seem as a criterion for discarding IMO, one of the studies having a cutoff of 23.86 years-old. The only remain failed criterion (for Davenport, Drummond et al., and Singh, at least) is the one about outside factors, and I guess there is an argument to be had about whether Karrington's position is a bit fringe since the qualitative studies on continuance weren't discounted based on that. I also feel like we should incorporate what's currently source [19] "A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children" a bit more. Aaron Liu (talk) 19:47, 5 March 2025 (UTC)

Addressing sources

• As Aaron pointed out, that's a review in a MEDRS journal. You keep bringing up the testifying argument but, to be clear, on one side you have every medical organization in the country and their representatives, on another you have Christian fundamentalist organizations. You are trying to impugn a source for opposing bans on trans healthcare, which every medical organization in the country says should be done.
• You have, any time the SPLC has been cited about the anti-trans movement, argued vociferously to remove it. Consensus has always found against you and that WP:PARITY applies. The SPLC is WP:GREL on hate groups, like it or not.
• Demons could be removed, but it is an academic RS by subject matter experts and the field of disinformation studies is sociological as well as medical

Addressing issues:

• The systematic review of desistance says the same - I added the citation to the paragraph
• That systematic review of guidelines found that most agreed with or were based on WPATH. They did not like this fact, but it nevertheless remains a fact. And it is true that every single MEDORG supports gender-affirming care, and opponents claim these organizations are ideologically captured.
• MEDRS are overwhelmingly clear that trans youth can provide informed consent - find a source backing up and obviously competence is complicated, varies greatly by age and other factors, and cannot be presented in this blanket manner.
• That statement is obviously true, there is in fact an RFC on it's way to a snowclose about this[38] That thing you quoted about "diagnostic overshadowing" is about "depressed trans kids are given hormones but no therapy for their depression" not "XYZ causes gender dysphoria" - it is not at all at odds with the claim Though transgender people have higher rates of mental illness, there is no evidence these cause gender dysphoria. That second part is a selective quotation, the text actually says Three documents (the Arkansas, Alabama, and Florida briefs) specifically highlight ADHD and autism as “psychological problems” or “mental health disorders.” The Alabama Brief claims that “many, if not most gender dysphoric children suffer from” these “neurocognitive difficulties” (p. 16). These documents insinuate that autism and ADHD act as “underlying causes” of gender dysphoria. However, higher diagnosis rates among TGE people do not imply that “most” TGE people are neurodivergent or that autism causes gender dysphoria. - You statement that The high rates of ADHD and autism in this cohort is by now well-established. - is not something the paper disagreed with

I think this article is better understood as "the strong opinions of those fighting trans healthcare bans in court in the US", and to have those presented as definitive - and globally applicable - while other opinions are "misinformation" is not really indicative of a GA. - Are there RS saying other things are misinformation / not misinformation?

This is all based on WP:PRIMARY, non-independent sources, often expressing opinions at odds with MEDRS, and producing their own definitions of "misinformation", which this article renders into wikivoice, making strong claims with no caveats and no balancing perspectives. - apart from all the other dubious claims here, this bit specifically: often expressing opinions at odds with MEDRS - is BS. No MEDRS have been presented contradicting any of these. I'm not sure what balancing perspectives you're referring to, if you can find RS saying "this isn't misinfo" present them. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:08, 3 March 2025 (UTC)

The systematic review of desistance says the same - I added the citation to the paragraph

The only mention of "myth" in that systematic review is a citation to Zucker's "The persistence myth".

What you are doing is taking this review's criticism of poor data and applying it to the idea desistance is therefore a "myth", which this source does not say at all. So this is WP:SYNTH. You can't just combine multiple sources like this, and use the MEDRS status of this source to bolster the "myth" claims of another source. Void if removed (talk) 18:08, 3 March 2025 (UTC)

The sentence it's cited to is It relied on studies that had serious methodological flaws such as low sample sizes, outdated diagnostic frameworks that conflated gender non-conformity with transgender identity, usage of conversion therapy on the sample population, and poor definitions of desistance

From the review: From all of these collections of studies emerged the commonly used statistic stating that ∼80% of TGE youth will desist after puberty, a statistic that has been critiqued by other works based on poor methodologic quality, the evolving understanding of gender and probable misclassification of nonbinary individuals, and the practice of attempting to dissuade youth from identifying as transgender in some of these studies. and Disappearance of GD and a change in gender identity are two concepts that, while occasionally connected, remain distinct. GD is associated with significant distress at the differences between gender and body, whereas a TGE gender identity does not require that distress. Therefore, a TGE child could still identify as TGE even if they do not experience GD. Despite having stated difference in these definitions, all the articles conflated these two ideas[39]

You said regarding the quoted article text these are strong claims about desistance and prior studies which require MEDRS and when presented with a MEDRS saying exactly that, you've shifted the goalpost

You can't have it both ways, you repeatedly argue "we don't know if most kids desist" but also that we can't say it's a myth that "we know most kids desist". Unless MEDRS actually agree "we know that most kids desist", the claim that "most kids desist" is in fact FRINGE. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:23, 3 March 2025 (UTC)

I very much dont see the credibility of such NPOV claims. Its well accepted by highly respected medical orgs that trans affirming care has an astounding success rates, with 99% satisfaction rate for gender affirming surgery and HRT. And detransition is rare, according to many credible studies. Most commonly due to social pressures, not due to a changing of identities. Its highly rare phenonom when external pressures, ie discrimination, are excluded. (one such study is Turbin, Jack et al. 2021) Treating this challenge as anything but a fringe and bigotry based challenge i think would be frankly ridiculous. And I wont entertain such false equivalency/credibility when there is no such basis. -LoomCreek (talk) 01:34, 4 March 2025 (UTC)

Puberty blockers were banned or limited to trials in many European countries [40] and the WHO refused to issue a guideline for children because they find that: "the evidence base for children and adolescents is limited and variable regarding the longer-term outcomes of gender affirming care for children and adolescents". That is hardly a success story. JonJ937 (talk) 11:43, 4 March 2025 (UTC)

It is stated in wikivoice that Detransition refers to the cessation of gender-affirming care, sourced to McNamara et al. (2024) and Wuest & Last (2023). While Wuest & Last say detransitioners (i.e., individuals who have halted GAC), and McNamara et al. write Discontinuation of GAC is sometimes called “detransition,”, the McNamara source makes clear that this is not the only definition (e.g. Most studies suggest that however detransition is defined, the percentage of people who report actual regret for GAC is very low and spend some time discussing how different definitions affect the stats. The source used in the Detransition article lede says Detransitioning refers to the process whereby people who have undergone gender transition later identify or present as the gender that was assigned to them at birth.  Tewdar  10:00, 4 March 2025 (UTC)

For the record, I fixed the definition to clarify the more expansive one.[41] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:58, 6 March 2025 (UTC)

Coord comment

I'm going to ask everyone in this discussion to avoid further increasing the temperature, and step away if they cannot. The subject is a hot button political issue, but that doesn't make it ok to throw attacks and insults at other editors. Trainsandotherthings (talk) 23:24, 3 March 2025 (UTC)

I noticed the DYK nom a while back and thought of commenting on it but chose not to. My first thought was the objections to the DYK did not appear to be made in good faith even if they were intended to be. You can't cite policy and say you merely want to see a neutral take on the arguments of both sides, then belittle one side as "teenagers" who have no idea what they're writing about and likewise label the nominator and reviewer as such. The objections only needed to touch on the coverage and sources cited, but instead it devolved into a thinly veiled attack on other editors that nobody else wanted to touch with a six-foot pole. Yue🌙 02:17, 4 March 2025 (UTC)

This has also put me off from really engaging with this thread, too. There's lots I feel I could say, but it just eats up so much time and effort. I'd rather deal with articles in the (much more civil, if no less passionately debated) WP:PIA topic area. Lewisguile (talk) 14:25, 6 March 2025 (UTC)

This discussion is waaay more civil and calm than the GENSEX topic used to be just a couple of years ago.  Tewdar  15:03, 6 March 2025 (UTC)

That's more of a statement of how awful general conduct in GENSEX used to be than a ringing endorsement of how it is now. Trainsandotherthings (talk) 00:07, 7 March 2025 (UTC)

Actionable items

Creating this section for the GAR coordinators to highlight which, if any, issues need to be addressed before this can be closed. Courtesy pings to @Lee Vilenski, @Iazyges, @Chipmunkdavis, @Trainsandotherthings. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:56, 4 March 2025 (UTC)

I'm not going to put my thumb on the scale right now, especially with the new rule that these are required to be open 1 month (which I disagree with strongly but will respect). Please let the discussion develop for now. Trainsandotherthings (talk) 23:18, 4 March 2025 (UTC)

Sounds good to me! 2 quick notes though

1. ) WP:GAR should be updated as it currently says GARs typically remain open for at least one month. (typically -> should/must, the page hasn't been updated in almost a year)
2. ) WP:GAR does say If discussion becomes contentious, participants may request the assistance of GAR coordinators at Wikipedia talk:Good article nominations. The coordinators may attempt to steer the discussion towards resolution or make a decisive close.

Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:42, 4 March 2025 (UTC)

While I am not a coord, the most critical issue here is that the original review was clearly improper by any reading of the reviewing instructions; as far as I am concerned, the article has not passed a proper GA review. The easiest solution would simply be closing this discussion as delist and renominating at GA; I suppose the original place in the GAN queue would be reinstated. ~~ AirshipJungleman29 (talk) 13:20, 6 March 2025 (UTC)

Amen, and I apologise for not stating such in my original nomination statement.--Launchballer 13:25, 6 March 2025 (UTC)

That was not the original review... That was the second GA review, after the original GA review failed due to some long quotes failing copvio and raised some other issues I addressed. As WP:GAN/I#N5 says If your nomination has failed, you can take the reviewer's suggestions into account and renominate the article, which I did. That is not evidence of NPOV violations, which is supposedly the premise of this GA reassessment. If the coordinators think a fresh GA review is necessary, then User:IntentionallyDense has offered to do so above. I do not think that is necessary. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:57, 6 March 2025 (UTC)

@Your Friendly Neighborhood Sociologist I do see what others are saying, the second review shows no evidence of source spot checks or really any review. That doesn't mean the article is or isn't up to GA criteria, it just means the reviewer didn't do their job in reviewing the article. IntentionallyDense ^(Contribs) 16:37, 6 March 2025 (UTC)

@LoomCreek, your review has a green tick next to "source spot check", so I'm assuming you did actually perform one, even if you didn't elucidate on it?

On the basis of WP:AGF, I don't think not giving enough detail is in itself evidence of an invalid review.

A new review may be the fastest route, but LoomCreek should also have a chance to defend their review here for the record, whatever else happens. Lewisguile (talk) 10:08, 7 March 2025 (UTC)

Over the years, we as a community have come to expect that GA reviews are more than just a brief glance and speedy promotion to GA status. There can be no more waving people through with a cursory check in a post-Coldwell enWiki. At minimum there should be some evidence that all the GA criteria were checked. Had I been aware of how poor the GA review was, I wouldn't have stated the creation of this GAR was improper (though the nom has already stated that they should have included that in the nomination). As a nominator, I would ask for a second opinion if someone passed one of my nominations with that little feedback.

As far as I'm concerned, if someone wants to take on a full GA3, we can keep this open until that concludes, assuming a consensus to delist doesn't develop here. I'm deliberately not digging into content discussions in this article because I think someone needs to act independently here when tensions are high. Trainsandotherthings (talk) 00:06, 7 March 2025 (UTC)

I'm guess neither I nor anyone else here can take on the GA3? Aaron Liu (talk) 00:52, 7 March 2025 (UTC)

There's no formal rule against it, but if you think that other people might feel you were WP:INVOLVED, even to a small degree, it would probably be better to let someone else do that. WhatamIdoing (talk) 02:58, 7 March 2025 (UTC)

@Trainsandotherthings Would I be able to just start this on the talkpage? I have purposely not given any input here and have just barely skim read this to stay neutral. IntentionallyDense ^(Contribs) 04:27, 7 March 2025 (UTC)

Support this being put on hold/closed as keep and IntentionallyDense starting a GA3: Frankly, I think it is ridiculous, if not insulting or even farcical, that this was opened claiming NPOV violations without any evidence of them, based off a user leaving multiple insults at a DYK without engaging on talk like requested, and used to try and re-litigate settled content disputes where consensus was clear, and now it must procedurally stay open for 30 days where it'll evidently be a venue for forumshopping content disputes that no coordinator wants to touch with a 39.5 foot pole. The only valid reason this GAR could exist is the procedural issue the GA2 could have been too speedy (if one ignores that it was a follow-up of a thorough GA1), a factor that wasn't mentioned until a week into this GAR. I want to short-circuit this nonsense and support @IntentionallyDense's offer of a thorough and independent GA review to put this to rest. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:00, 7 March 2025 (UTC)

I also think that just doing another, more thorough, GAR is probably the best way to go here if there are concerns that the second GAR wasn't thorough enough. Loki (talk) 21:04, 7 March 2025 (UTC)

Another GA sounds good to me. Aaron Liu (talk) 23:39, 7 March 2025 (UTC)

Surely it would be inappropriate for IntentionallyDense to do a GA review? He has declared himself to be not neutral by offering to do a review on the basis that someone else might fail it – implying that he won’t? [42] Sweet6970 (talk) 00:07, 8 March 2025 (UTC)

This is a stunning misrepresentation of what he said... Frankly you should apologize for it and impugning him like that

I wouldn’t be shocked if someone takes the nomination with the intent of failing it

Nowhere does he say he wouldn't fail it, or that his motivation is somehow, as you put it, offering to do a review on the basis that someone else might fail it.

He has previously offered to do the GA2 and Loomcreek beat him to it, that's why he's offering to do a GA3. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 01:42, 8 March 2025 (UTC)

@Sweet6970 When did I declare myself as not neutral? I think everything considered, it is completely reasonable for me to suggest that someone may go into this review with the intention to fail or pass it. I did not imply anything, do not imply things for me. If I had something to say I would have, I wouldn't have left it for someone else to imply. IntentionallyDense ^(Contribs) 02:21, 8 March 2025 (UTC)

To add: I have purposely stayed out of this conversation to stay neutral. I have no history with GENSEX. I have no skin in this game. I do not take kindly to baseless accusations of bias, especially when I have gone the extra mile to remain unbiased. I showed interest in this article before it was even a GA. I haven't even read it all the way through, I just thought it was well sourced. I also have done quite a few GAN reviews, many of which overlap with medical topics and I have an extensive history of editing medical content which means I am more likely to pick up on sourcing issues that non-medical editors overlook. If you want to dig up some dirt on me, feel free to take a look at some of my past reviews. I am very thorough, sometimes to a fault, with my reviews. IntentionallyDense ^(Contribs) 02:26, 8 March 2025 (UTC)

someone takes the nomination with the intent of failing it means someone else taking the review with a preconceived outcome in mind, which is what Dense is trying to avoid. Aaron Liu (talk) 03:02, 8 March 2025 (UTC)

@Your Friendly Neighborhood Sociologist ⚧ Ⓐ Agreed, the conduct of this so-called GA3 thus far has been increadibly disrespectful of other contributors. If there are issues to be raised, then fair enough, but as you said it certainly appears as though some are seeking to insult rather than improve or propperly engage. I can understand the issues with GA2 that some have mentioend but only to the extent that they seem to not mention, perhaps by accident, GA1. Bejakyo (talk) 01:26, 8 March 2025 (UTC)

Not sure what you meant in your last sentence. A thorough GA1 doesn't mean GA2 has no need to spot-check. Aaron Liu (talk) 03:03, 8 March 2025 (UTC)

That might not have been clear to the GA2 reviewer, who was doing their first-ever GA review. I don't think we should blame them, even if the review is not very similar to what we usually see, and even if it gets delisted (I make no judgment either way about whether that will eventually be deemed necessary). WhatamIdoing (talk) 04:25, 8 March 2025 (UTC)

Yeah this article is a tricky one to review, let alone as someone not familiar with GAN reviews. IntentionallyDense ^(Contribs) 18:04, 8 March 2025 (UTC)

Agreed -- this GAR seems to have been inappropriately raised and conducted. I'd support this proposal. Srey Sros^talk 17:31, 8 March 2025 (UTC)

@IntentionallyDense: You said on YFNS’s Talk page: I wouldn’t be shocked if someone takes the nomination with the intent of failing it. whilst offering to do the review yourself. You have pre-emptively smeared anyone who takes on the review, and fails the article, as not only being biased, but as having deliberately taken on the review with the intent of failing it. This is an extraordinary accusation. Even now, you have provided no explanation for your extraordinary comment. You are assuming that anyone who fails the article in the review must be biased. The inescapable logical conclusion is that you think an ’unbiased’ reviewer must pass the article. I don’t understand how you can think you are unbiased, and a suitable editor to perform the review. Sweet6970 (talk) 13:25, 8 March 2025 (UTC)

Whatever other assumptions we might make here, let's also remember to assume good faith. I don't think ID's edit history supports an assumption that they would treat the article particularly favourably. Lewisguile (talk) 14:09, 8 March 2025 (UTC)

AGF is a rebuttable assumption which is overridden by IntentionallyDense’s extraordinary comment, which, in itself, assumes bad faith in others, and for which he has not provided any explanation. Sweet6970 (talk) 15:23, 8 March 2025 (UTC)

You believing that I did not AGF does not mean that you no longer have to AGF. IntentionallyDense ^(Contribs) 18:05, 8 March 2025 (UTC)

@Sweet6970 Please stop twisting my words and putting words into my mouth. I know what I said and I have given further explanation. The only people I have "smeared" (using your words not mine) are those that would go into the review with the intent of failing it. I am not accusing anyone of anything. I am simply saying that is a possibility. I have provided further explanations but I will explain it again for you: many people have expressed their opinions of this article, I have not, having reestablished strong opinions of an article may effect a review. Your inescapable logical conclusion is both very not logical and easy to escape. Not to mention, not a single person has agreed with it. Both of your comments thus far towards me have been assuming bad faith.

It would have been different if I had named names or made actual accusations about specific users, but I have not, nor did I make that comment thinking of any particular editor. I am going to advise you to drop this as I don't think you are getting anywhere with your accusations. If you have any constructive feedback about my review, feel free to mention it on the review page. 16:12, 8 March 2025 (UTC) IntentionallyDense ^(Contribs) 16:12, 8 March 2025 (UTC)

You've already said the same thing above and you seem to be ignoring the comments that claim a different meaning to the phrase. Aaron Liu (talk) 19:31, 8 March 2025 (UTC)

Conclusion

Ignoring the above kerfuffles, which regrettably seem to be the inevitable result of any discussion in this topic area, we now have a simultaneous GAR and GAN open on the same article. While this is not explicitly forbidden, I think common sense leads to that conclusion; it may possibly also lead to bot malfunctions when one is closed. I would prefer to procedurally delist this article, with no prejudice as to the actual quality of this article, in the strong belief that the current review will produce a secure and justifiable conclusion, whatever the result. Thoughts @IntentionallyDense, Your Friendly Neighborhood Sociologist, and Launchballer: and @GAR coordinators: ?

To YFNS, who replied above (I don't care to figure out the indenting): the logic that the first review was thorough enough that the second review could be a tick-box exercise is flawed, as GACR violations could have been introduced between the first and second reviews, and regardless, the first review could have missed things. All GA reviews should be thorough, but happily I am certain that ID is setting a really good example. ~~ AirshipJungleman29 (talk) 10:37, 11 March 2025 (UTC)

Excellent idea.--Launchballer 10:52, 11 March 2025 (UTC)

Sure. Aaron Liu (talk) 14:33, 11 March 2025 (UTC)

Mostly agree, but I think it should procedural keep (with no prejudice as to the actual quality of the article) instead of a procedural delist. Either way, the GA3 will decide its eventual fate, but I'd prefer it not be delisted. My tune may be different if the GAR was started with saying the GA2 was too brief, but I don't want a drive-by GAR saying "Claims of massive WP:NPOV violations were made..." (and not noting any specific issues) to have the article delisted after a week on another issue.

I'd be reluctantly ok with a procedural delist as long as the close is really clear that the NPOV allegations were not the impetus for delisting and this was handled poorly. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 14:56, 11 March 2025 (UTC)

It's just really weird for a GAN to delist an article. Aaron Liu (talk) 15:37, 11 March 2025 (UTC)

I would be okay with this since yes the whole GAR and GAN open at the same time is odd however my only thing is, this GAR has to be open for 30 days and I'm pretty sure I'll be done my GAN by then. Also there is the issue that some may disagree with whatever conclusion I come to. IntentionallyDense ^(Contribs) 18:31, 11 March 2025 (UTC)

I'd prefer to leave this open while the GA review takes place, but I'm not going to raise a huge stink if consensus is otherwise. Trainsandotherthings (talk) 17:44, 13 March 2025 (UTC)

@GAR coordinators: I have finished my review which can be found here: Talk:Transgender health care misinformation/GA3. I apologize for how messy everything got. IntentionallyDense ^(Contribs) 16:17, 15 March 2025 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Every major medical organization

Transgender health care misinformation#Untrustworthiness of medical organizations begins with this line: Though every major medical organization endorses gender-affirming care…

One of the cited sources says this almost word-for-word: "Every relevant major medical organization endorses gender-affirming care. This slight change in the wording suggests there are some "irrelevant" major medical organizations that do not publicly endorse gender-affirming care. It's ultimately not important whether the American Society of Nephrology or the National Neonatology Forum of India have gotten around to voting on a resolution endorsing gender-affirming care, because its outside their practice area, but our wording does not convey that.

The source identifies about 25 "relevant major medical organizations" that specifically endorse "when medically appropriate, puberty suppression and cross-sex hormones" "after the onset of adolescence". None of the organizations are government agencies, and the list specifies that they are "medical societies". They are also all US organizations (which makes sense, since the list is taken from a US lawsuit).

I suggest re-wording this to more completely describe the facts as presented in this source. Perhaps No major US medical association opposes gender-affirming care? Or even No major US medical association opposes the use of puberty blockers and cross-sex hormones as part of gender-affirming care? WhatamIdoing (talk) 00:22, 3 March 2025 (UTC)

Maybe, but why "US"? Is that not true of any other country? Sumanuil. _{(talk to me)} 02:19, 3 March 2025 (UTC)

I support the reword as well- but you raise a good point. Stickymatch 02:55, 3 March 2025 (UTC)

The cited source only names and cites US-based organizations for this statement. It draws its list from an amicus brief for a US court case, and it makes sense for a US legal process to be engaged in by US-based organizations, but it would be wrong to assume this statement applied to, say, the Russian Academy of Medical Sciences, and such a claim is not supported by the cited source. WhatamIdoing (talk) 02:58, 3 March 2025 (UTC)

GA review

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

This review is transcluded from Talk:Transgender health care misinformation/GA3. The edit link for this section can be used to add comments to the review.

Nominator: Your Friendly Neighborhood Sociologist (talk · contribs) 21:09, 7 March 2025 (UTC)

Reviewer: IntentionallyDense (talk · contribs) 02:27, 8 March 2025 (UTC)

• I will be reviewing this shortly. I use the GA Table and make most of my comments below the table so it is easier for nominators to respond to my feedback. I usually start with assessing images, stability, and sources then move on from there. I am fine with nominators responding to my feedback as it is given or all at the end. If you have any questions feel free to either ask me here or leave a message on my talk page! IntentionallyDense ^(Contribs) 02:27, 8 March 2025 (UTC)
• I am going to stay out of the reassessment page that is going on and otherwise treat this like any other review that I would do. IntentionallyDense ^(Contribs) 02:27, 8 March 2025 (UTC)

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.	Prose is clear, concise and not overly technical. All spelling and grammar are correct. IntentionallyDense (Contribs) 02:53, 15 March 2025 (UTC)
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.	Article complies with relevant sections of the MOS. IntentionallyDense (Contribs) 02:53, 15 March 2025 (UTC)
2. Verifiable with no original research, as shown by a source spot-check:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.	Article contains a reflist. IntentionallyDense (Contribs) 02:37, 8 March 2025 (UTC)
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).	Article is appropriately sourced, including MEDRS sources for any biomedical claims. IntentionallyDense (Contribs) 02:53, 15 March 2025 (UTC)
	2c. it contains no original research.	No OR. IntentionallyDense (Contribs) 02:53, 15 March 2025 (UTC)
	2d. it contains no copyright violations or plagiarism.	Author has put everything into their own words. I have no doubts about plagiarism here. IntentionallyDense (Contribs) 16:34, 8 March 2025 (UTC)
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.	Addresses all the main aspects. IntentionallyDense (Contribs) 19:22, 10 March 2025 (UTC)
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).	No unnecessary detail. IntentionallyDense (Contribs) 19:22, 10 March 2025 (UTC)
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.	Article is neutral. IntentionallyDense (Contribs) 02:53, 15 March 2025 (UTC)
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.	While this article has attracted some attention lately, I would still consider it stable right now. There is some content dispute however it is unclear from my POV where that dispute lays. No edit wars. IntentionallyDense (Contribs) 02:37, 8 March 2025 (UTC)
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.	All images tagged.IntentionallyDense (Contribs) 02:53, 15 March 2025 (UTC)
	6b. media are relevant to the topic, and have suitable captions.	Photos have relevant captions. IntentionallyDense (Contribs) 16:34, 8 March 2025 (UTC)
	7. Overall assessment.	As outlined above and below, this article meets GA criteria. IntentionallyDense (Contribs) 02:53, 15 March 2025 (UTC)

• Misinformation - Legislation Pipeline for Trans Healthcare image should be upscaled a bit as it's hard to read. This is also an image which I would consider requiring a source since it has so much text.IntentionallyDense ^(Contribs) 02:37, 8 March 2025 (UTC)
• Transhealthcarebans, has the needs update tag. I would recommend either reaching out to the creator or making a footnote explaining the recent changes in law. I also think this image would benefit from a source. IntentionallyDense ^(Contribs) 02:37, 8 March 2025 (UTC)

  I created an up to date map, uploaded it to Wikimedia Commons[43], and included it in the article![44] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 12:15, 8 March 2025 (UTC)

  Thanks! Kuddos for just creating the map yourself! Would you be able to add a source for the map just because it does include content that could be reasonably challenged? IntentionallyDense ^(Contribs) 16:29, 8 March 2025 (UTC)

  Updated and added the source! Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:23, 8 March 2025 (UTC)

Sources

• There is a cite error for the MacKinnon source.
• Upon first glance, the sources look appropriately reliable for the context however I will have to see based on the context they are used in. IntentionallyDense ^(Contribs) 02:37, 8 March 2025 (UTC)

  Fixed the MacKinnon source error.[45] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 06:10, 8 March 2025 (UTC)

• To start off my source spot check, I'm checking the most commonly used sources. I checked the following sources and found no issues: [46][47][48][49][50] IntentionallyDense ^(Contribs) 04:15, 8 March 2025 (UTC)
• Seeing as the rest of the lead is sources, the last sentence Medical organizations such as the Endocrine Society and American Psychological Association, among others, have released statements opposing such bans and the misinformation behind them. should be as well. IntentionallyDense ^(Contribs) 04:15, 8 March 2025 (UTC)
• I'm having a hard time verifying which was closely related to Genspect and Therapy First in this [51] source. Could you maybe copy and paste the bit where you found that so I can verify it? IntentionallyDense ^(Contribs) 04:15, 8 March 2025 (UTC)

  The part is under the section title The SEGM-Genspect-GETA Triad and stated The relationship between three groups, SEGM, Genspect and GETA, represents the strongest triad (relationship between three nodes or groups) within the R&P subnetwork. Along with Marchiano, the groups share two dozen personnel connections, suggesting deep integration and mutual support. R&P Subnetwork in this case refers to Research and Practice Groups (R&P) are ... are groups and platforms for so-called experts on LGBTQ+ health care. The groups are largely populated by academics and health care workers and help produce anti-LGBTQ+ pseudoscience. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 05:11, 8 March 2025 (UTC)

  Thank you. Them using the acronyms made it harder for me to verify oops. IntentionallyDense ^(Contribs) 16:26, 8 March 2025 (UTC)

• For the rest of my source checks, I am going to check any sources for claims that seem particularly strong or that could be potentially damaging if false. For this I checked the following sources and found no issues: [52][53][54][55][56][57][58][59] IntentionallyDense ^(Contribs) 04:45, 8 March 2025 (UTC)
• I'm having a hard time verifying The global anti-gender movement has also relied on these inflated statistics. in the source [60] could you copy and paste a bit to help me find it? IntentionallyDense ^(Contribs) 04:45, 8 March 2025 (UTC)

  The relevant section is Anti-gender actors also often point to the existence of people who have “detransitioned” to push their anti-TGNCNB rhetoric and policies.213 The phrase “detransition” denotes when a person who has already either medically or socially transitioned to a gender identity that differs from their sex assigned at birth, decides at a point after this initial transition, to return to living in a gender aligning with their sex assigned at birth.214 Anti-gender actors argue that the existence of these individuals proves that transgender identities are a hoax.215 They argue that if these individuals were protected from gender-affirming therapies, they would not have to face the mental or physical effects of transitioning and detransitioning.216 These arguments once again focus on the extreme end of a spectrum and create fear to push for a solution that completely disregards the root causes of the problem at hand. Statistical evidence shows the majority of individuals who transition medically, socially, or both are happy with their decision.217 For the 3% of individuals who noted experiencing some form of regret around their transition, the reasoning behind such feelings is complex. 218 Research shows that around 90% of those who detransition may do so because of societal pressure and a lack of support. 219 Other reasons include exploring different gender identities, unrelated health issues, and financial complications.220 Further, research shows that around 0.04% of those who detransitioned did so because they felt that the initial transition was not the right choice for them. 221 Therefore, the issues related to detransitioning include a lack of acceptance, proper information, care, and support for individuals who are exploring their gender. Thus, the anti-gender movement’s attempt to focus on promoting anti-TGNCNB policies distort these findings and disregard research to detract from the valuable lessons for better TGNCNB care. Unfortunately, the detransition issue is ripe for using disinformation to bolster anti-gender arguments. Anti-gender actors discussing issues related to transitioning reference a study that claimed over 80% of children who transition ended up de-transitioning.222

  That could probably be worded better, particularly as the last bit of the relevant section refers to the desistance myth - perhaps The global anti-gender movement has justified anti-trans rhetoric and policies by pointing to detransitioners, and arguing they prove transitioning is a hoax or necessitate protecting transgender people from medical transition, distorting the findings that detransition is rare and often caused by social pressure. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 05:20, 8 March 2025 (UTC)

  Thank you! It's a lengthy source so I was having a hard time verifying it. maybe using the word "manipulating" statistics may be better since that seems to be what the source is implying? Your wording is also good tho so it's up to you! IntentionallyDense ^(Contribs) 16:31, 8 March 2025 (UTC)

  Updated![61] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:21, 8 March 2025 (UTC)

• However, few providers offer such care and it requires parental consent, health insurance approval, social transition, and psychiatric assessment. this seems like a bit of a generalization. I'm not sure if the study provides what area they are talking about but is their evidence to say that this is true for the entire world? I know it is true for North America but I'm not sure if there is sources to definitively say it is true for the whole world. IntentionallyDense ^(Contribs) 04:45, 8 March 2025 (UTC)

  I'm not sure about the whole world (eg Russia), but I'd say fairly close from the sources given. But the source[62] cites the relevant definition, 2. misinformation about the accessibility of trans care - such as claims that youth who express inconsistencies in gender presentation are pressured by medical providers to undergo medical transition, when actually there are a limited number of providers from whom youth can receive gender-affirming care, which they generally must do with dual parental consent, after psychiatric assessment and a period of social transition, and with approval from health insurance providers (e.g., Coleman et al., 2022; Kimberly et al., 2018; Mahfouda et al., 2019); Coleman et al[63] is the WPATH SOC 8, which are the world's leading guidelines. Kimberly et al[64] is a review of the ethical issues raised about GAC for youth. Mahfouda et al[65] is a review of data around the world on hormones and puberty blockers and guidelines including the Endocrine Society's and WPATH's.

  The insurance is a missumary, it should be health care providers not insurance agencies I admit, it is slightly depressing that I saw "healthcare provider" and thought that meant insurance, the US is ridiculous. Fixed it up in this edit to better represent the source.[66] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 05:54, 8 March 2025 (UTC)

  Your edit looks good and clarifies things nicely. I have no doubt that this is most likely true for the whole world however I just needed to make sure that the sources matched the claims. US healthcare is very depressing, most of North America's healthcare is actually IntentionallyDense ^(Contribs) 16:33, 8 March 2025 (UTC)

• I'm having a hard time verifying that the Cass review wasn't peer reviewed based on the source [67] IntentionallyDense ^(Contribs) 04:45, 8 March 2025 (UTC)

  The source should've been this RAND report, described as a non-peer reviewed narrative review on table 2.1 on page 10 and discussed on pages 31-35 of the report, per Cass Review#Methodology.[68] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 06:06, 8 March 2025 (UTC)

  Thank you for adding that source! IntentionallyDense ^(Contribs) 16:33, 8 March 2025 (UTC)

  Cass Review (2022) is the Interim Report, not the Cass Review, or the Cass Review's 2024 final report. Void if removed (talk) 16:37, 8 March 2025 (UTC)

  @Void if removed I honestly am not super educated on the Cass Review so I was wondering if you could help break some stuff down for me. What is the difference between the interim report, the Cass Review, and the final report? Which of them is peer reviewed vs not peer reviewed? and what is the relationship between the three? (as in, is the final report based on the interim report etc) Thanks! IntentionallyDense ^(Contribs) 16:44, 8 March 2025 (UTC)

  Since VIR hasn't replied I'll chime in to clarify: the "Cass Review" refers to an indendent service review commissioned by the NHS, named for Hilary Cass, who was chosen to lead the review (explicitly chosen for her inexperience with trans healthcare) - it was more a process than specific publication; the review's goal was to provide recommendations on improving/restructuring trans healthcare in the UK; the cass review commissioned some peer-reviewed systematic reviews and surveyed clinicians, trans groups, etc; halfway through (2022) it produced the "interim report", a non-peer reviewed update on what they'd found so far and their thoughts; in 2024 it produced the "final report", a 400 page non-peer-reviewed document which summarized the findings of the reviews and surveys and made recommendations on how to reshape trans care in the UK. The final and interim reports also made a number of statements that have been extensively criticized (see Cass Review#Criticisms for a non-exhaustive list, more criticisms are peppered throughout the rest of the article and reception section) Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:40, 8 March 2025 (UTC)

• For the last bit of my source review, I will be checking some random refs. I checked the following sources and found no issues: [69][70][71][72][73][74][75][76][77] IntentionallyDense ^(Contribs) 16:25, 8 March 2025 (UTC)
• Since SPLC was a non academic source that came up quite freqauntly, I did some digging [78][79] and it seems that the overwhelming consensus is that it is a reliable and valuable source. IntentionallyDense ^(Contribs) 16:39, 8 March 2025 (UTC)
• For criteria 1, 3, and 4 I usually read through the article carefully and provide feedback as I read. This often looks like me suggesting things be reworded, asking for further explanation etc. Oftentimes I will ask questions about the article that come from a place of not being educated on the topic. Sometimes these questions don't have answers or don't result in any changes needing to be made. I ask these questions so I can better understand the topic and thus better provide feedback. Throughout this process, I often make small changes to grammar or punctuation. I try to make these changes by section and if you disagree with any changes I make feel free to revert them! IntentionallyDense ^(Contribs) 16:47, 8 March 2025 (UTC)

While copyediting the article, I tried and failed to verify the following written by @Usr Trj (after getting confused about the meaning of "other providers", guessing it meant private healthcare but wanted to make sure):

Additionally, other providers in Sweden continue to provide puberty blockers, and a clinician's professional judgment determines what treatments are recommended or not recommended. Youth are able to access gender-affirming care when doctors deem it medically necessary. Sweden has not banned gender-affirming care for minors and it is offered as part of its national healthcare service.

References

Aaron Liu (talk) 00:50, 14 March 2025 (UTC)

The first Linander supports that treatment is available nationally. That source also says:

• To access the evaluating teams the care-seeker needs a referral, in some regions from general practitioners, in some from general psychiatry and for some teams, it is possible to write a "self-referral". Specific multidisciplinary teams are responsible for the evaluation and for referrals to medical procedures. (p. 2–3) This supports "professional judgment".
• The National Board of Health and Welfare (2015, 2021) has published separate recommendations for the care for gender dysphoria for adults and for children and youth. People below 18 can access voice therapy, hair removal, puberty blockers and, in some cases, hormones. Access to breast surgery before 18 years old is generally restricted but can be deemed as therapeutically necessary in some cases. (p. 3) This supports "as necessary" and per "professional judgment".
• In March 2021, the hospital leadership at Karolinska (the hospital with the largest number of transgender youth care seekers per year) decided to stop all hormonal treatments for people below 18. Two other university hospitals have followed suit. (p. 3) I.e., other services haven't (yet) stopped these treatments. This might be what's intended by the "other services" part? As in, it's not a nationwide ban.
• It is common that the evaluating psychiatrist writes an assessment to the Legal Advisory Board at the National Board of Health and Welfare, which is the agency that assesses applications for legal gender recognition and grants permission for genital surgery, in accordance with the Gender Recognition Act (p. 3) This feeds into the "as necessary" part and the "professional judgment" part.

Lewisguile (talk) 12:15, 14 March 2025 (UTC)

This supports "professional judgment".

It doesn't support and contradicts the "a clinician" part, though your last point does.

People below 18 can access voice therapy, hair removal, puberty blockers and, in some cases, hormones. Access to breast surgery before 18 years old is generally restricted but can be deemed as therapeutically necessary in some cases. (p. 3) This supports "as necessary" and per "professional judgment".

I saw that. It only says breast surgery is restricted to therapeutically necessary, not gender-affirming care in general. In fact this passage seems to contradict our sentence by saying many components of gender-affirming care are not restricted (though this passage wouldn't be able to source that).

I.e., other services haven't (yet) stopped these treatments That's not something we can source with that quote; that'd be original research. Textual sources have to explicitly state or make immediately obvious (which this does not; saying three stopped doesn't necessarily mean others did not) the claim summarized in the article. Aaron Liu (talk) 12:34, 14 March 2025 (UTC)

How would you reword the text? I don't know who originally added the text or the refs, but since they haven't clarified and the wording is weird, I think it would be better if it reflected the sources we do have. Lewisguile (talk) 10:43, 15 March 2025 (UTC)

It's been reworded: #c-Your_Friendly_Neighborhood_Sociologist-20250314193000-IntentionallyDense-20250314162800 Aaron Liu (talk) 13:17, 15 March 2025 (UTC)

Perfect! Lewisguile (talk) 15:02, 15 March 2025 (UTC)

Origins

• which was closely related to Genspect and Therapy First. I would mention here the whole rename thing just that readers know moving forward about the rename. IntentionallyDense ^(Contribs) 17:53, 8 March 2025 (UTC)

  I've implimented the latter of these two recommendations, but wasn't sure what the rename thing is. Could someone clarify it for me if possible? Bejakyo (talk) 19:55, 8 March 2025 (UTC)

  GETA renamed itself to therapy first. It clarifies this later in the article. (at work so sorry for the short response) IntentionallyDense ^(Contribs) 21:53, 8 March 2025 (UTC)

• Other notable producers of anti-LGBTQ misinformation and disinformation include the evangelical organizations may sound better as Other notable producers of anti-LGBTQ misinformation and disinformation include evangelical organizations such as... to avoid the whole "the evangelical organizations the" which can be a bit awkward to read. IntentionallyDense ^(Contribs) 17:57, 8 March 2025 (UTC)

Common misinformation

• such as societal or familiar pressure shouldn't this be "familial"? IntentionallyDense ^(Contribs) 18:10, 8 March 2025 (UTC)
• It relied on studies may sound better as the myth relies on... IntentionallyDense ^(Contribs) 18:10, 8 March 2025 (UTC)
• sampled in them -> sampled in these studies IntentionallyDense ^(Contribs) 18:10, 8 March 2025 (UTC)
• The claim has often been used to -> The desistance myth has often been used to. IntentionallyDense ^(Contribs) 18:10, 8 March 2025 (UTC)
• reflected the pathologization of transgender identities. would it make more sense to say "reflecting" instead of "reflected". Either that or change to "which reflected". IntentionallyDense ^(Contribs) 18:10, 8 March 2025 (UTC)

  I've implimented all five of these wording recommendations Bejakyo (talk) 19:54, 8 March 2025 (UTC)

• Though every major medical organization endorses gender-affirming care I missed this on my initial source check, but I was wondering if you could point out where exactly you got this. The reason I doubt this is because NICE guidelines for example recently stopped supporting some gender-affirming care. I also think logistically it may be hard to say that a) what is considered a major medical org and b) that they all have the same definition of gender affirming care. IntentionallyDense ^(Contribs) 19:21, 10 March 2025 (UTC)

  The first source says every US org, the second says "every relevant" but is an analysis of the US. That could be changed to "in the US". But we could possibly make a more global statement - as this source from the "European nations are banning gender-affirming care" section notes But a POLITICO review of the state of care for transgender people in Europe found more nuance than Republicans critics like Hunt and Bailey often portray. While Europeans are debating who should get care and when, only Russia has banned the practice. The reassessment of standards in some European countries has aimed to tighten eligibility for gender-affirming care, but also sought to expand research studies including minors.[80]

  I'd say it's less the definition that's debated, medical orgs overwhelmingly globally agree that GAC / medical transition should be available when needed, there's just debate over in what situations it's needed. I'll try and find some better sources and think on better wording! Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:12, 10 March 2025 (UTC)

• In 2024, former United States president Donald Trump he is currently the president. However if you want to convey that he wasn't at the time I suggest tweaking the wording. IntentionallyDense ^(Contribs) 19:21, 10 March 2025 (UTC)
• and the Directorate, which is, has not implemented the recommendations, though they have said they are considering them. I think this needs some rewording to properly convey what you are trying to say. The "which is, has not" does not make sense to me. IntentionallyDense ^(Contribs) 19:21, 10 March 2025 (UTC)

  Fixed the wording for the above 2 sentences![81] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:27, 10 March 2025 (UTC)

Impact

• I'd recommend either adding a quick explanation or wikilink for "astroturfed". IntentionallyDense ^(Contribs) 19:21, 10 March 2025 (UTC)

  Wikilinked! Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:32, 10 March 2025 (UTC)

• I wonder what (if anything) should be done with the overlap the "European nations are banning gender-affirming care" section above has with "Europe" and "Norway" sections, especially with the latter entirely duplicating material from the former. Aaron Liu (talk) 00:55, 14 March 2025 (UTC)

Responses from medical organizations

• In the same statement, the APA urged that the spread of disinformation be curbed via greater and more easily accessible scientific research, describing it as essential for protecting access to gender-affirming healthcare. is in violation of WP:MOSLAYOUT due to it being a single sentence paragraph. I'd recommend either finding a way to merge it or adding to it. IntentionallyDense ^(Contribs) 19:35, 10 March 2025 (UTC)

  Moved it to above the blockquote in this edit.[82] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:33, 10 March 2025 (UTC)

NPOV

• For this I have decided to reading through WP:NPOV and assess it as I go.IntentionallyDense ^(Contribs) 19:35, 10 March 2025 (UTC)
• Avoid stating opinions as facts.: throughout this article, the author attributes opinions to sources when needed. For example saying Transfeminist Julia Serano has summarized the debate when stating Julias opinion. IntentionallyDense ^(Contribs) 19:35, 10 March 2025 (UTC)
• Avoid stating seriously contested assertions as facts. The article has many things that most sources agree on but some do not. In the cases where there may be significant debate the author has provided context. For example Yale School of Medicine report described them as spreading "biased and unscientific content" Bias and unscientific claims can be objective, however in this case I'm sure some would argue that this organization isn't biased or unscientific, so the author appropriately attributed this claim to another organization. IntentionallyDense ^(Contribs) 19:35, 10 March 2025 (UTC)
• Avoid stating facts as opinions. there are many examples of this. But when many reliable sources state the same thing, the author has written it as such and not as an opinion. For example instead of saying "it was the opinion of XYZ" the author simply stated the Norwegian Healthcare Investigation Board, an independent non-governmental organization, issued a non-binding report finding "there is insufficient evidence for the use of puberty blockers and cross-sex hormone treatments in young people" IntentionallyDense ^(Contribs) 19:35, 10 March 2025 (UTC)
• Prefer nonjudgmental language the author does this by using more easily defined terms such as pseudoscience instead of more sensationalized terms such as "transphobia" which have been used by the media. IntentionallyDense ^(Contribs) 19:35, 10 March 2025 (UTC)
• Indicate the relative prominence of opposing views. I'm not going to give examples for this one since my other examples overlap with it. But the author makes sure to make it clear what authority is giving an opinion and lists findings from studies from both ends of the spectrum here. IntentionallyDense ^(Contribs) 19:35, 10 March 2025 (UTC)
• In my current opinion, based on WP:NPOV this article has a NPOV. I am now going to allow the nominator to get back to my feedback and also read through some of the other feedback from others to see if there is anything I have overlooked. IntentionallyDense ^(Contribs) 19:35, 10 March 2025 (UTC)

NPOV

Looking at the above approach it seems to be focused so far on existing text and existing sources. Working out what a comprehensive and NPOV article would look like and be worded requires a quite significant investment in time reviewing possible sources and other material about the topic. What do those sources say and equally importantly how do those sources say it. If we only cite partisan non-independent sources written by activists and people authoring documents to support the legal battles they earn money from, then we end up sounding like an activist and cherry picking misinformation advantageous to one side.

Consider the line

The Cass Review—a non-peer-reviewed independent evaluation of trans healthcare within NHS England—said that there was a lack of evidence to support trans healthcare for children.

The very first adjective we present about the Cass Review is that it is "non-peer-reviewed". We've already discussed how describing a four year government review that itself commissions studies (which are peer reviewed) and contains meetings with groups and individuals and access to audits and healthcare data and produces at least two publications (the interim report from 2022 and the final report from 2024) as "non-peer-reviewed" is nonsensical. And those who have read about the controversies know this is an activist trope that causes eyes to roll, in much the same way as any experienced MEDRS editor rolls their eyes when asked whether "the Cass Review" is a MEDRS. (it depends what document you are citing and what you are using from it and then caring whether it is MEDRS or not depends on whether your text is a biomedical claim or not and so on).

The source cited has "Cass Review (2022)" in a table and the word "No" under the "Peer reviewed" column. The author's state that their work was "in preparation" as the Cass Review was finally being published (2024). So they only mentioned this Interim Report. Their research looked for reviews (systematic or narrative) to cite and includes an explicit filter:Publication date: from 2014/1/1 to 2023/12/31 . Therefore they were unable to cite the following:

• Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Characteristics of children and adolescents referred to specialist gender services: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s3 – s11. doi:10.1136/archdischild-2023-326681. ISSN 0003-9888. PMID 38594046. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
• Hall, Ruth; Mitchell, Alex; Taylor, Jo; Heathcote, Claire; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Impact of social transition in relation to gender for children and adolescents: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s12 – s18. doi:10.1136/archdischild-2023-326112. PMID 38594055. Archived from the original on 22 April 2024. Retrieved 22 April 2024.
• Heathcote, Claire; Mitchell, Alex; Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth; Jarvis, Stuart William (9 April 2024). "Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s19 – s32. doi:10.1136/archdischild-2023-326347. PMID 38594045. Archived from the original on 23 April 2024. Retrieved 23 April 2024.
• Taylor, Jo; Mitchell, Alex; Hall, Ruth; Heathcote, Claire; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s33 – s47. doi:10.1136/archdischild-2023-326669. ISSN 0003-9888. PMID 38594047. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
• Taylor, Jo; Mitchell, Alex; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s48 – s56. doi:10.1136/archdischild-2023-326670. ISSN 0003-9888. PMID 38594053. Archived from the original on 10 April 2024. Retrieved 11 April 2024.
• Taylor, Jo; Hall, Ruth; Langton, Trilby; Fraser, Lorna; Hewitt, Catherine Elizabeth (9 April 2024). "Care pathways of children and adolescents referred to specialist gender services: a systematic review". Archives of Disease in Childhood (Review). 109 (Suppl 2): s57 – s64. doi:10.1136/archdischild-2023-326760. PMID 38594052. Archived from the original on 28 April 2024. Retrieved 28 April 2024.
• Taylor, J; Hall, R; Heathcote, C; Hewitt, CE; Langton, T; Fraser, L (9 April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)". Archives of Disease in Childhood (Review). 109 (Suppl 2): s65 – s72. doi:10.1136/archdischild-2023-326499. PMID 38594049. Archived from the original on 2 August 2024. Retrieved 13 April 2024.
• Taylor, J; Hall, R; Heathcote, C; Hewitt, CE; Langton, T; Fraser, L (9 April 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)". Archives of Disease in Childhood (Review). 109 (Suppl 2): s73 – s82. doi:10.1136/archdischild-2023-326500. PMID 38594048. Archived from the original on 29 June 2024. Retrieved 13 April 2024.

If these systematic reviews had been published within their search window, or this document had been written a few months later, they would have cited all or most of these seven systematic reviews, which are part of the Cass Review. Sources (and editors) claiming "Cass Review (2022)" is "The Cass Review" are being unhelpful, to put it mildly. That's the "Interim Report". Even if the table in the document was written late enough that "Cass Review (2024)" was an entry, that's also just the "Final Report". Claiming, as our article does, that the entire Cass Review is non-peer-reviewed is being unhelpful. Or, em, an activist trope. You only read that kind of claim in activist works and on social media and forums.

So if use of this adjective, to describe "The Cass Review" is not supported by the source, why are we stating it? The purpose of "non-peer-reviewed" in a sentence making a biomedical claim about the evidence base for trans healthcare is to disparage the review. Which is what US activists have spent nearly a year doing. Before someone complains about AGF lets be clear that disparaging things isn't necessarily bad. We freely use the word "fraudulent" in our lead on Wakefield. But the question, if we want to make that our primary adjective about the review isn't just whether one can find a source to support it, but whether that's the sort of thing reliable independent sources say when describing the Cass Review. And, well, they don't. It isn't just don't often. It is just don't. Full stop. It is something only activists say. That should ring alarm bells.

The article goes on to very briefly mention the support the review got and then a long list of criticisms and negative claims. Those negative claims are presented as though it is accepted that the Cass Review "endors[es] gender exploratory therapy" or "impl[ies] poor mental health causes children to be transgender" and most shocking of all "claims that a majority of transgender youth desist". The idea that the Cass Review "claims that a majority of transgender youth desist" is a whopper of "transgender healthcare misinformation". The actual comment in the review refers to pre-pubertal children, not in any way to the teenagers that had come to represent the vast majority of the cohort, for who we simply have no idea. The report later goes on to look at the evidence in detail, for which then one finds out there are lots of caveats about the data. This is a nuanced analysis that activists have de-nuanced and then totally twisted into a .. well a lie. This game, where data restricted to one set of patients, is expanded or altered to seem to apply to a wider group, is misinformation. Both sides are guilty of that game. Frankly, seeing the words that the Cass Review "claims that a majority of transgender youth desist" in a Wikipedia article purporting to be describing how all these other bad people are spreading misinformation, should be enough to make any GA reviewer pause. What is going on here where Wikipedia itself, where this article itself, is filled with transgender misinformation. -- Colin°^Talk 16:12, 10 March 2025 (UTC)

I'm purposely not going to read this until I complete the rest of my review as I want to remain unbiased with my review. After completing my review, but before making any final pass or fail decisions I will give your comment a read through. I will note that I have not gotten to the NPOV part of the assessment yet so I would ask that you please remain patient with me as I wrap up the rest of my review. You are of course still welcome to chime in whenever just note that I will not be reading much aside from the current article and sources until I have finished the majority of the review. This does not mean that I don't plan to take yours, and others opinions into account when making my final decision, it is just that I'm not ready to make that final decision yet. Thank you for your understanding. IntentionallyDense ^(Contribs) 19:04, 10 March 2025 (UTC)

At this point I'd be fine removing "non-peer-reviewed" since it doesn't add much (though it's true and consensus was to include it on talk and at Cass Review#Methodology.)

Regarding The idea that the Cass Review "claims that a majority of transgender youth desist" is a whopper of "transgender healthcare misinformation".

Here is our Cass Review article's section on Desistance. Here is a quote from p 41 of the final report[83]: The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist. Sidenote, Gender incongruence of childhood is a formal diagnosis, that none of the studies she referenced tracked, which requires the marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. It includes a strong desire to be a different gender than the assigned sex; a strong dislike on the child’s part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender ... Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis. - it was a diagnosis explicitly created to refer to trans people

• 1) p 162 of the report notes the 2022 study finding 93% who transitioned prior to puberty continued to identify as trans 6 years later Sidenote here: only 2.5% identified as cisgender, while 3.5% id-ed as nonbinary and 1.3% re-transitioned twice, so this number is closer to 97.5% This result is ignored in her claim the majority desist.
• 2) page 67 cites some studies by conversion therapists from the 1980s, notes one of the dozens of critiques of their methodology, then cites a 2016 narrative review by Steensma looking at early 2000s data. Nowhere in the report does it mention the 2022 systematic review[84] (a much higher quality MEDRS), or its critiques of the studies reviewed by Steensma - such as the fact many included those who didn't meet DSM-4 diagnostic criteria for gender identity disorder of childhood, which itself no longer exists because everyone agreed it was too broad a diagnosis
• 3) Steensma 2018 noted We have clearly described the characteristics of the included children (clinically referred fulfilling childhood DSM criteria) and did not draw con- clusions beyond this group, as has wrongly been done by others. The broadness of the earlier DSM criteria was also acknowledged by the American Psychiatric Association and World Health Organization. This was, among other things, a reason to tighten the diagnostic childhood criteria for DSM-5 and the proposed criteria for ICD-11. As we have stated elsewhere (Hembree et al., 2017; Steensma, 2013), we expect that future follow-up studies using the new diagnostic criteria may find higher persistence rates and hopefully shed more light on developmental routes of gender variant and transgender children.[85] So the author she cited for her claim has explicitly noted diagnoses shouldn't be conflated, and the updated diagnoses will give new data. Cass conflated diagnoses, and didn't comment on the updated diagnosis.
• 4) The endocrine society noted in 2017 In adolescence, a significant number of these desisters identify as homosexual or bisexual. It may be that children who only showed some gender nonconforming characteristics have been included in the follow-up studies, because the DSM-IV text revision criteria for a diagnosis were rather broad. However, the persistence of GD/gender incongruence into adolescence is more likely if it had been extreme in childhood (41, 42). With the newer, stricter criteria of the DSM-5 (Table 2), persistence rates may well be different in future studies.[86]
• 5) As WPATH noted in response to the interim report: The document makes assumptions about transgender children and adolescents which are outdated and untrue, which then form the basis of harmful interventions. Amongst these is the supposition that gender incongruence is transient in pre-pubertal children. This document quotes selectively and ignores newer evidence about the persistence of gender incongruence in children (Olson et al., 2022). Many older studies regarding the stability of gender identity enlisted children who did not have gender incongruence or gender dysphoria, but rather, had culturally non-conforming gender expression. The findings of these older studies should only carefully be applied to children and young people who are presenting to gender identity clinics seeking gender-affirming treatment: it may be a different population (Temple Newhook et al., 2018).[87] - so Cass knew about the issues with these claims in her Interim report for 2 years before repeating them in the final one.

TLDR, Cass claimed gender incongruence usually desists, based on outdated studies that didn't track gender incongruence or even gender dysphoria, and didn't mention that issue with the data despite it being well-known and acknowledged for almost a decade including by the authors she cited and WPATH calling her on it in the Interim Report. Funny enough, this is the kind of issue a peer-review would have spotted almost immediately. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:21, 10 March 2025 (UTC)

The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist

This is an accurate statement and also absolutely in line with what Colin said here: The actual comment in the review refers to pre-pubertal children, not in any way to the teenagers that had come to represent the vast majority of the cohort, for who we simply have no idea.

That is what the current evidence base suggests. The current evidence base is pretty bad, but it is still that evidence base that the Karrington systematic review uses to put desistance at > 80% (before then suggesting everyone stop trying to measure it). The evidence base for the existing set of adolescent presentations is practically non-existent, and it is inconsistent to complain about not meeting DSM-V criteria while using WPATH's reference to Olson et al 2022 because that is a cohort where an unknown number have never been diagnosed. In any case WPATH's attack on the interim review has no bearing on the final review, which does discuss Olson et al 2022, as you know because you say This result is ignored in her claim the majority desist.. The whole problem is it is confounded by social transition and lack of diagnosis of participants, and so it is discussed on pp163, in the chapter on social transition, saying It is not possible to attribute causality in either direction from the findings in these studies. This means it is not known whether the children who persisted were those with the most intense incongruence and hence more likely to socially transition, or whether social transition solidified the gender incongruence.

You keep saying the studies are outdated, but they are still the current evidence base. There is no better evidence. There isn't some massive body of robust evidence saying desistance is a myth. All you've got there are a couple of aspirational statements that persistence rates "may well be different" with stricter diagnostic criteria, but that's not evidence, and it is completely incompatible with studies like Olson 2022 which don't even use the diagnostic criteria!

If you're sticking to systematic reviews, then all you have is Taylor et al and Karrington, which are not a basis for calling it a myth. The York team attempted to systematically review this and came up with nothing useful, and the UK Adult clinics refused to share their data with the Cass Review. If you're widening it to other studies, then you really need to include things like Bachmann et al 2024 or Singh et al 2021 which again are not a basis for calling it a myth. This is a subject that requires far more nuance than this, not one where anyone can say definitively that saying what the Cass Review says is "misinformation". When RS disagree we should simply neutrally recount all the significant viewpoints, and that is what we had on gender identity disorder of childhood till you removed it. Void if removed (talk) 23:11, 10 March 2025 (UTC)

IntentionallyDense, I just want to note that VIR's take on the Karrington review was heavily discussed on multiple talk pages and the GAR.

This comment: Karrington systematic review uses to put desistance at > 80% is false. The review says From all of these collections of studies emerged the commonly used statistic stating that ∼80% of TGE youth will desist after puberty, a statistic that has been critiqued by other works based on poor methodologic quality, the evolving understanding of gender and probable misclassification of nonbinary individuals, and the practice of attempting to dissuade youth from identifying as transgender in some of these studies. It reviews these quantitative studies, notes the statistic, and notes they were methodologically poor quality, used differing definitions of desistance and repeatedly conflated things that shouldn't be. A review saying study A tracked "X" defined as Y, study B tracked "X" defined as Z, these definitions are not compatible but they have been used to say "X" happens at rate Q which we find ridiculous is not saying X happens at rate Q.

Void, regarding that is what we had on gender identity disorder of childhood till you removed it - we don't actually have that article, it's gender dysphoria in children - GIDC is the diagnosis that was scrapped for being overly broad.

Regarding You keep saying the studies are outdated, but they are still the current evidence base. There is no better evidence. There isn't some massive body of robust evidence saying desistance is a myth. We do seem to know that identifying as trans pre-puberty means you'll probably do so after. - They are not evidence of anything. Saying "Diagnosis A has dissapears after puberty X% of the time" does not mean "Diagnosis B dissapears after puberty X% of the time", especially when we have multiple sources pointing out "Data from Diagnosis A is innaplicable to Diagnosis B since they have very different criteria".

More importantly - we are not saying desistance is a myth. We are saying in essence the claim that we definitively know the majority of youth diagnosed with GD or GI, or who identify as transgender, will 'desist' is unsupported by the evidence. The studies used to support this claim didn't track GD & GI, much less trans identity. They tracked GIDC, which had broad criteria that included trans kids and gender-nonconforming cis kids, which was supplanted by stricter criteria in GD & GI. From the data we have, the majority of kids identifying as trans pre-puberty do so after. Do you agree with that broadly speaking?

And Olson tracked the consistency of gender identity, as Karrington noted, desistance is often defined as a change in gender identity from TGE to cisgender. I believe Olson 2022 is one of the only, if not the only, study longitudinally tracking gender identity. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 00:10, 11 March 2025 (UTC)

we don't actually have that article

I am well aware - I simply used the same article title you did, for consistency so my reply made sense, this is a strange complaint to make.

Olson tracked the consistency of gender identity

Olson explicitly did not track DSM-V diagnosis, making your argument inconsistent here. Touting it as definitive while criticising other studies for not explicitly tracking DSM-V criteria makes no sense.

And the point is none of these assessments are for editors to make. The best we can do is say some say X, others say Y. And that's not a clear enough picture to stick on a page about misinformation in the way you have. Void if removed (talk) 10:56, 11 March 2025 (UTC)

I didn't refer to the article by that title, I hyperlinked the name of the diagnosis in a comment noting it no longer existed pointing to the article noting it no longer exists.

Olson explicitly did not track DSM-V diagnosis, making your argument inconsistent here. Touting it as definitive while criticising other studies for not explicitly tracking DSM-V criteria makes no sense.

From Karrington 2022[88]: some definitions of desistance focus on GD, while others focus on gender identity. An almost equal number of articles referred to desistance as the disappearance of GD as did articles that referred to desistance as the change of a transgender identity to a cisgender identity.

If we are asking "how often do people desist from identifying as trans", you need to track identity, not DSM-5 diagnoses. If you're asking "how often do people diagnosed with GD desist from experiencing GD", then you need studies tracking the DSM-5 diagnosis GD, not identity. My argument is consistent - studies of "gender identity disorder in childhood" (ie not GD) which don't track identity don't answer either question. It only makes no sense if you don't understand that GIDC is a separate diagnosis from GD with separate criteria.

And the point is none of these assessments are for editors to make. Which is why it's a good thing we have sources going back years that point out that these outdated studies are inapplicable to GD rates, and doubly inapplicable to questions of trans identity. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:17, 11 March 2025 (UTC)

Please stop citing the "over 80%" number. You have been informed repeatedly in multiple places at many different times - including on this very page only a week ago - that this figure in the context of the source it is from explicitly can not be used in the way you employ it by disregarding the overwhelming criticism contained within the context of the source for why it is not applicable to transgender people broadly. Relm (talk) 03:17, 11 March 2025 (UTC)

@Colin Okay, I have finished the bulk of my review and I'm now carefully reading through everyone feedback. I will do my own research on some of the claims in the article to see if they hold up. But in regards to the cass review, I want to make sure I have something correct: The Cass review as a whole is made up of many different studies, some peer reviewed and some not. The interm report was not peer reviewed. However what I am confused about, was the 2024 final report peer reviewed? And were policy changes made based on the interm report, the final report, or the cass review as a whole? IntentionallyDense ^(Contribs) 19:52, 10 March 2025 (UTC)

What YFNS wrote at 23:40 8 March 2025 above isn't entirely wrong (though the language "inexperience" is not neutral). I wouldn't describe it as "made up of many different studies, some peer reviewed and some not". It commissioned two systematic reviews from NICE. Those were insufficient to make recommendations from so a further seven systematic reviews were commissioned from a world class team in York university. But there are other documents and other kinds of inputs into the review, such as an audit of GIDs, a QCQ inspection of GIDs, a high court case, an earlier review by a Multi-Professional Review Group. Meetings with "an extensive range of stakeholders, including professionals, their respective governing organisations and those with lived experience, both directly and through support and advocacy groups" -- apparently over 1000. I could go on. They were mainly concerned with what went wrong with GIDs and what should replace it and be done differently. This wasn't an academic exercise, but a dialog with the professionals involved in the current UK trans health provision as well as trans people who had been through it. Indeed that reminds me of another activist trope: "exclusion of transgender expertise" which this article repeats. This is just 100% a lie. It is covered by the FAQ. (some activists appear to have misunderstood the role of a small team who's role was checking protocol was followed, not in any shape or form, influencing the findings or recommendations).

You can get a feel for what the review was for by reading England: Children and Young People’s Gender Services: Implementing the Cass Review recommendations and Cass Review – implications for Scotland: findings report both of which spend a lot of time making recommendations about setting up clinics and ensuring experts see patients in a timely manner and so on. To even ask whether the final report was "peer reviewed" in the way a paper submitted by some random researcher to an academic publication is, is getting things upside down. Dr Cass was appointed for their neutrality and paediatric healthcare expertise. Academic journals do not commission medical studies or systematic reviews: they get sent them. It would be deeply deeply weird if after finishing the review, NHS England said, oh thank you very much Dr Cass. We're going to send this to former heads of paediatric professional bodies in six other countries, to ask them if what you wrote is ok. It's just, we've absolutely no idea who you are or why you've given us this 400 page document. But if you expect us to publish it, we're going to need to get some help from your peers. I mean, it certainly got reviewed. Both during the process of writing it and subsequently by NHS England and NHS Scotland. But peer review is mainly used for user-submitted works in academic journals. It isn't the only possible form of review and it is most appropriate for work one didn't commission. As I said on the other page, the entire NHS Health website is not peer reviewed. We consider it a reliable source of medical information, albeit not an ideal one because it is rather dumbed down. The people who write the page on angina for the UK public to read were asked to do that. It's their job. We kinda assume whoever employed them did so because they are qualified and experienced. And we hope the NHS web team have some kind of internal review process. But nobody thinks they need to do "peer review". No random academic or doctor or submits "Angina - what are the symptoms" ad hoc to the NHS and asks them if they would like to publish it.

Wrt policy changes, IIRC the GIDS clinic was closed towards the end of the review process, just before final publication. Both NHS England (who the review was commissioned by and for) and NHS Scotland already knew their services were not functioning and were already starting to make changes. Examples of policy change might be to have several regional centres with multi-disciplinary teams, not just one big overloaded centre within a psychiatric clinic. That's also not the sort of thing that gets peer reviewed. Or particularly controversial. Most of the Cass Review findings and recommendations are not controversial at all, though you wouldn't get that impression from US activist sources or this article. Colin°^Talk 22:00, 10 March 2025 (UTC)

Colin, I believe this is the umpteenth time you've attributed criticisms of the Cass Review to "US activist sources". It has been criticized by academics, clinicians, and MEDORGS in the UK and around the world. The first peer reviewed critique of the review was by a British sociologist who specializes in researching trans youth in the UK[89]. Serious question, is there a single critique of the review you would not attribute to "US activists"?

Regarding the recommendations, I believe the UK's Association of LGBTQ+ Doctors and Dentists (GLADD) put it best It is notable that there is a significant disconnect between the narrative text of the Cass Review and the recommendations. GLADD is broadly supportive of a number of recommendations, but we are concerned with what we believe to be an ingrained bias against the autonomy of trans people throughout the narrative text. We note that similar concerns have been raised by other recent appraisals of the report.[90]

Regarding Indeed that reminds me of another activist trope: "exclusion of transgender expertise" which this article repeats. This is just 100% a lie - I refer to Cass Review#Transparency and exclusion of transgender expertise: The Assurance group explicitly excluded trans people and trans healthcare providers. You defined it as a small team who's role was checking protocol was followed, not in any shape or form, influencing the findings or recommendations - it's remit included Advise on the types of evidence that should be sought by the Review team, the methods for gathering that evidence and the interpretation, significance and relevance of the evidence.[91] So what evidence to gather, how to gather it, how to interpret it and what relevance to assign to it, had absolutely no input from 1) trans people or 2) trans healthcare providers.

As a recent polish clinical guideline (top tier MEDRS) noted One of the overt criteria that the NHS followed in choosing Hilary Cass was her complete lack of experience in working with people with gender incongruence and dysphoria, which was to ensure her independence and impartiality. However, in practice it resulted in an unprecedented situation in healthcare when a non-expert in the field was invited to develop expert recommendations. The common thread of many objections to the Cass report is the multifaceted downplaying of the importance of the voices of adolescents and their families, clinical practice, the scientific knowledge base, and national and global recommendations, while misleading the public that a complete lack of clinical experience in a given field is a guarantee of reliability. As a multidisciplinary team of experts and patients, we consider such a trend to be harmful and completely contrary to the interests of adolescents in need of help [92]

The Association of the Scientific Medical Societies in Germany this week released clinical practice guidelines[93] which gave a scathing summary of the Cass Review (p 405 - 409) - said the strength of consensus in the Cass Review was nonexistent due to being a single author, which did not provide grading of evidence or recommendations, and was not transparent about multiple things. It used unclear terms about the population, underwent no discernible review before publication, had different standards of evidence for psychosocial v medical recommendations, surveyed trans people but there was no transparency in what weight if any that was given or how it effected anything, contained no studies of how the recommendations would effect the population, recommends psychotherapy for reducing GD despite there being no evidence it reduces GD, gives no data on alternative treatments and comparisons when reviewing PBs / hormones, etc etc etc. Also see page 169-70 for more criticisms.

WP:MEDASSESS - clinical practice guidelines and systematic reviews sit at the top of the MEDRS pyramid. I do not know where exactly the Cass Review's final report (which underwent no discernible review prior to publication and has been criticized by MEDORGS and CPGs worldwide) sits on that, but it's certainly below them. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:11, 10 March 2025 (UTC)

Sorry I may have mislead you a bit, I was wondering more of the statement “The Cass Review isn’t peer reviewed” was true or not before I could start assessing if it’s relevant or not as I do know that not all reliable sources are peer reviewed. IntentionallyDense ^(Contribs) 00:10, 11 March 2025 (UTC)

The Cass Review was a process so can't undergo peer review per se (thought, the German CPG did find it stunningly lacking in transparency at various levels though). The interim and final reports underwent no peer review, the text should've made clearer the reports the thing lacking peer review. I just updated the text to put this to rest.[94] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 00:35, 11 March 2025 (UTC)

@Your Friendly Neighborhood Sociologist I'm kind of leaning on the side of excluding it all together because it is hard to say (from what I understand) if the policy changes were directly effected by the final or intern report or if they were affected by the review process as a whole. That's to say that I'm sure some of the policy changes were affected by peer reviewed studies under the Cass Review so to call the whole review not peer reviewed doesn't seem as relevant here if you get what I mean. I'm curious to hear your thoughts on this and if you're following my train of thought here. Either way I think your edit looks good, I just wanted to put my reasoning out there. IntentionallyDense ^(Contribs) 05:23, 11 March 2025 (UTC)

I'm following! it is hard to say (from what I understand) if the policy changes were directly effected by the final or intern report or if they were affected by the review process as a whole. - I'd say this is a bit of a false dichotomy because the Cass Review was commissioned to review the evidence and propose policy changes and the final report was the venue through which they did (with the interim being a progress update / preliminary thoughts). By analogy, it's a bit like differentiating between "a person was moved to do X by their friend's text saying they should" and "a person was moved to do X by their friend putting in the effort to text them they should do X" as in either case it's the text that was the impetus to do X. That's to say that I'm sure some of the policy changes were affected by peer reviewed studies under the Cass Review - indirectly yes, but directly less so - Cass Review#Implementation covers the timeline decently as does this NHS statement on how they're implementing the recommendations from the final and interim reports[95]. so to call the whole review not peer reviewed doesn't seem as relevant here if you get what I mean. - agreed on that point, I already took out mentions of peer review entirely in that previous edit though as opposed to clarifying which part wasn't reviewed. If you think it prudent, I could put change it to say The review's non-peer-reviewed final report was published April 2024 but I don't feel strongly either way. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 06:16, 11 March 2025 (UTC)

I appreciate the perspective. I think your current wording is good! IntentionallyDense ^(Contribs) 18:44, 11 March 2025 (UTC)

Working out what a comprehensive and NPOV article would look like and be worded requires a quite significant investment in time reviewing possible sources and other material about the topic

I think this is the crux of the issue. Virtually everything strongly described as misinformation in this article has viable balancing sources. When additional sources are used I think it is entirely possible to paint a markedly different picture of some of these issues, so there isn't really an NPOV way of presenting it that doesn't defeat the whole thrust of the page, namely: to make definitive claims that those other viewpoints are "misinformation". Once you start watering claims down with attribution, then it is just duelling opinions, and not "misinformation". That is why I said even the presence of some of these subjects on this page has veered into WP:RGW. It is not our job to pick winners and call the losers "misinformation", it is our job to reflect what sources say. Void if removed (talk) 09:21, 12 March 2025 (UTC)

I am trying to amend this by carefully looking at the wording to properly represent what is an opinion and what has been proven untrue. IntentionallyDense ^(Contribs) 17:57, 12 March 2025 (UTC)

Final comments

• As this review is being wrapped up, I have finally read through all of the feedback given on the reassessment page. While doing so, I took notes on what issues others seemed to have. I have made a list of the following issues:

1. 3b violations

• The term 'desistance' was first used for trans children by Kenneth Zucker in 2003, who borrowed the term from its usage in Oppositional defiance disorder which stemmed from its usage in criminology, where in both cases it is regarded as a positive outcome, reflecting the pathologization of transgender identities. If I understand correctly, the point of this sentence is to give some brief background on the term and to emphasize the pathologization of transgender identities. I'm wondering if this sentence could be shortened to The term 'desistance' was first used for trans children by Kenneth Zucker in 2003, who borrowed the term from its usage in Oppositional defiance disorder; in both cases it is regarded as a positive outcome, reflecting the pathologization of transgender identities. The criminology aspect of this sentence is in my opinion, not needed. IntentionallyDense ^(Contribs) 03:53, 12 March 2025 (UTC)

  That's sensible. Will change now. Lewisguile (talk) 13:09, 12 March 2025 (UTC)

1. Cass review peer reviewed claim. - Has been addressed and no longer an issue.
2. Cass reviews views on how many children desist

• claims that a majority of transgender youth desist I'm not really seeing wording in the sources that directly reflects this statement. I invite you to pull quotes that do directly back this up. However I wonder if it would be more accurate to say that the Cass review misrepresented desistance in transgender children or something along those lines. I think based on the sources, we definetly have enough evidence to say that they misrepresented it (as in using older, flawed studies to make comments on desistance in transgender children). Because I know this is a hot topic, just because a source is deemed "the most reliable" of available sources on a topic, does not make it inherantly reliable. Sometimes we have no reliable sources on a topic, and that's okay. At that point we have to relfect on what good including less than ideal figures and studies would have on building the encyclopedia. (not directed at the nominator but I saw this mentioned on the reassesemnt page) IntentionallyDense ^(Contribs) 03:53, 12 March 2025 (UTC)

we definetly have enough evidence to say that they misrepresented it

Very strongly disagree there. For a start, the Cass Review was not about "transgender children" - it was about "children and young people who are questioning their gender identity or experiencing gender incongruence". What the Cass review says is:

The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist.

Nothing about "transgender children", and this was all in line with how it used to be presented on the relevant article, till it was removed.

The Cass Review expands on this, with relevant citations, and noting the criticism:

Several studies from that period (Green et al., 1987; Zucker, 1985) suggested that in a minority (approximately 15%) of pre-pubertal children presenting with gender incongruence, this persisted into adulthood. The majority of these children became same-sex attracted, cisgender adults. These early studies were criticised on the basis that not all the children. had a formal diagnosis of gender incongruence or gender dysphoria, but a review of the literature (Ristori & Steensma, 2016) noted that later studies (Drummond et al., 2008; Steensma & Cohen-Kettenis, 2015; Wallien et al., 2008) also found persistence rates of 10-33% in cohorts who had met formal diagnostic criteria at initial assessment, and had longer follow-up periods. It was thought at that time that if gender dysphoria continued or intensified after puberty, it was likely that the young person would go on to have a transgender identity into adulthood (Steensma et al., 2011).

The idea that the majority of those with some sort of gender incongruence desisted before puberty is not a "myth" - it was a foundational principle of the Dutch Protocol. This has to be seen in the context that:

The rationale for use of puberty blockers at Tanner Stage 2 of development was based on data that demonstrated that children, particularly birth-registered boys who had early gender incongruence, were unlikely to desist once they reached early puberty

Under the Dutch Protocol, the inclusion criteria were:

that the patients had to be minimum age 12, have suffered from life-long gender dysphoria that had increased around puberty, be psychologically stable without serious comorbid psychiatric disorders that might interfere with the diagnostic process, and have family support.

And > 99% of those placed on blockers persist. Under the Dutch Protocol, this high persistence on blockers was anticipated because the diagnostic gatekeeping was intended to weed out the majority who would desist during adolescence.

The problem now is that since the mid-2010s we have a rapidly increasing new cohort of mid-adolescent mostly-female presentation where we simply don't know whether they would or would not have persisted without intervention. As van der Loos et al 2023 concedes:

Still, one cannot exclude the possibility that starting GnRHa in itself makes adolescents more likely to continue medical transition

Complicated by the fact that GIDS tried to reproduce their results but didn't apply the same diagnostic criteria as the Dutch, but still found the same high persistence, which is what raised the (still open) question as to whether the blockers were causing the persistence. This is why the hypothetical rate of desistance is such a charged subject - it is bound up in the safety and efficacy of early medical interventions. The UK has banned blockers until proper clinical trials can take place, while in the US this polarised issue is making its way through the courts.

This is a contentious issue that cannot be given its due on a page titled "misinformation". Void if removed (talk) 10:13, 12 March 2025 (UTC)

I've changed "transgender" to "with gender dysphoria". Aaron Liu (talk) 12:38, 12 March 2025 (UTC)

For a start, the Cass Review was not about "transgender children" - it was about "children and young people who are questioning their gender identity or experiencing gender incongruence"

• From the Cass Review's final report p 160 Clinicians have said that most children have already socially transitioned before reaching the specialist gender service.
• The Cass Review has been criticized for being a review of trans healthcare and doing everything in its power to avoid the term "trans kids", including repeatedly innacurately referring to trans kids sure of their gender as "gender questioning".[96]

Gender incongruence is a 1) a diagnosis created to apply to trans people[97] 2) was not tracked by any of the studies Cass referenced - which predated it.

The dutch protocol was created while "gender identity disorder of childhood" was still a diagnosis.

@IntentionallyDense @Aaron Liu here are two sources on desistance in the Cass Review that explicitly note she's making claims about trans kids

• Here the Cass Review dismisses trans children’s identities by presenting the theory of “desistance.” This concept, a term drawn from criminology, has been extensively critiqued in peer reviewed literature, and is not considered a useful concept in modern healthcare (Ashley, Citation2022; Temple Newhook et al., Citation2018). The concept has also been contradicted by a body of modern research (De Castro et al., Citation2024; Olson et al., Citation2022). Nevertheless, the Cass Review is content with reference to a highly disputed theory, referring to it in several sections ... In this first sentence the Cass Review distorts the actual literature, inserting reference to a modern cohort and diagnosis of “gender incongruence” on studies that focused instead on gender identity disorder. The distinction is an important one, as the diagnosis of gender incongruence is intended to focus on trans children, whilst the broader category of gender identity disorder pathologized a wider range of children including those who were non-conforming cis children. Next, the Cass Review acknowledges a sub-set of the criticisms of desistance literature, avoiding reference to peer reviewed literature that has critiqued the application of desistance literature to trans children.[98]
• WPATH et al stated in response to the review The document makes assumptions about transgender children and adolescents which are outdated and untrue, which then form the basis of harmful interventions. Amongst these is the supposition that gender incongruence is transient in pre-pubertal children. This document quotes selectively and ignores newer evidence about the persistence of gender incongruence in children (Olson et al., 2022). Many older studies regarding the stability of gender identity enlisted children who did not have gender incongruence or gender dysphoria, but rather, had culturally non-conforming gender expression[99]

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:22, 12 March 2025 (UTC)

I don't see much harm in this change. IMO changing "transgender" to "with gender dysphoria" here is an easy way to avoid bickering. These quotations still make a careful effort to only connect this to transgender children instead of directly stating that it's resistance of trans identification.

(Also, let's not engage and get derailed by improperly synthesized arguments over things like the Dutch protocol that aren't even mentioned in the article reviewed.) Aaron Liu (talk) 15:37, 12 March 2025 (UTC)

@Aaron Liu I want to note that "gender dysphoria" is not supported by any of the sources and significantly obscures the dispute. The Cass Review says "gender incongruence" usually desists, not "gender dysphoria" - these are 2 separate diagnoses. The 2 sources I quote above also specifically call out Cass's use of "gender incongruence", noting the fact it's a diagnosis created to apply to trans children which the studies she cites didn't track, and this means she's making statements about trans kids. From Horton the Cass Review dismisses trans children’s identities by presenting the theory of “desistance.” ... The distinction is an important one, as the diagnosis of gender incongruence is intended to focus on trans children and from WPATH The document makes assumptions about transgender children and adolescents which are outdated and untrue... Amongst these is the supposition that gender incongruence is transient in pre-pubertal children. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:09, 12 March 2025 (UTC)

Horton says that to distinguish it against the broader category of gender identity disorder pathologized a wider range of children including those who were non-conforming cis children; I don't think it was supposed to emphasize the "children" part as opposed to the "trans" vs "non–gender-conforming" part. In fact I find the notion that gender incongruence was created for trans children quite ridiculous, as gender incongruence is the ICD's direct analogue to the DSM's gender dysphoria. As our article says: Gender dysphoria of transgender people is called Gender incongruence in the ICD-11. [...] [64] Aaron Liu (talk) 16:45, 12 March 2025 (UTC)

I don't think it was supposed to emphasize the "children" part as opposed to the "trans" vs "non–gender-conforming" part - I completely agree, to clarify: GD, GI, and GID all had/have linked "in children" diagnoses with separate criteria from adults. So when explicitly discussing children, people often drop the "in children" specifier from the broader diagnosis name as it's implied.

• For example the broader category of gender identity disorder pathologized a wider range of children: GID was never applied to children, it was definitionally GIDC for children and GID for adults, but Horton just said GID as it's clear from context it was GID applied to children.
• Likewise, Cass says The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist. - Cass defines "gender incongruence of childhood" in the glossary but throughout the text just uses the shorthand "gender incongruence" and specifies she's talking about young children

In fact I find the notion that gender incongruence was created for trans children quite ridiculous, - bit of a misunderstanding from not adding the "in children" specifier. It's not that "gender incongruence" refers only to kids and not adults - GI was created for trans people and has 2 subtypes: "Gender incongruence of adolescence or adulthood" (for trans teens and adults) and "Gender incongruence of childhood" (for trans kids)- see the WHO's statement on updated diagnosis[100] and Gender dysphoria in children#International Classification of Diseases (ICD)

Regarding it being a "direct analogue", the cited source doesn't support that at all (so our article should be rewritten) as it has a section contrasting the GD and GI diagnoses and noting key differences in criteria and scope (GD requires distress, GI doesn't which the source notes means trans kids in supportive environments who aren't actively distressed are better covered).[101] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:42, 12 March 2025 (UTC)

I agree with (most of) that. How about just replacing the parenthetical with a (non-parenthetical) "in children", then? DSM's gender dysphoria has the exact same subtype system, and it would feel similarly weird with this parenthetical. Aaron Liu (talk) 18:05, 12 March 2025 (UTC)

Tried to address it with this edit.[102] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:16, 12 March 2025 (UTC)

I still think that sources better support the claim that The Cass Review misrepresented desisting and not that they claimed the majority desist, I say this because while the original sources they cited do (from my understanding) imply that the majority desist, the Cass Review itself does not (again from my understanding) assert this. How would you feel about changing it to "misrepresent"? This whole thread has gotten a bit lengthy, so I apologize if I am asking you to repeat yourself, but again if you have any evidence to say that the Cass Review did assert the majority desist, please show it to me. 17:49, 12 March 2025 (UTC) IntentionallyDense ^(Contribs) 17:49, 12 March 2025 (UTC)

As Void pointed out, it does: (though it only mentions ICD's gender dysphoria analogue and not trans youth)

19.23 The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist.

Aaron Liu (talk) 18:11, 12 March 2025 (UTC)

Thanks for this, I would say that this is appropriate to include then. IntentionallyDense ^(Contribs) 18:15, 12 March 2025 (UTC)

@IntentionallyDense I'm unsure about "misrepresent", it comes down to Cass saying The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist.

So it's a slim distinction (imo) between "Cass said most desist" and "Cass said the evidence says most desist".

The article text is currently claims that a majority of pre-pubertal youth with gender incongruence (a diagnosis created to apply to transgender children) desist, - I'm thinking we fix it to claims that the evidence suggests the majority of pre-pubertal children with gender incongruence desist

• Also partly changed due to Aaron's comment as I was typing[103]
• Ideally, we'd phrase this in a way that mentions "gender incongruence" but also that "gender incongruence" refers to trans people - but I'm unsure how to phrase this nicely. Perhaps a footnote to "children with gender incongruence" explaining it refers to trans kids?
• Sidenote, created Gender incongruence of childhood as a redirect to the right place, kinda weird we didn't have it before

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:16, 12 March 2025 (UTC)

The claims that the evidence suggests the majority of pre-pubertal children with gender incongruence desist looks good. Thanks for clarifying! IntentionallyDense ^(Contribs) 18:18, 12 March 2025 (UTC)

RS do use the word "transgender children" even if the Cass Review didn't (not claiming it didn't as I haven't read enough of it to say that). In that case I think both transgender children and children with gender dysphoria is okay here. As for the rest of your comment, regardless of if there is current evidence to say that trans kids do desist (again not claiming there is or isn't) I still stand by my statement that by using flawed studies, the Cass Review misrepresented the topic. I don't think either of us are going to change our opinions on this. IntentionallyDense ^(Contribs) 17:46, 12 March 2025 (UTC)

@IntentionallyDense just want to note that "gender dysphoria" wouldn't be ok in this instance - Cass, and the sources criticizing Cass, don't say "gender dysphoria", they say "gender incongruence", a separate diagnosis that was explicitly created to refer to trans people. We shouldn't conflate them. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:51, 12 March 2025 (UTC)

Ah thank you. In that case I would like to make the correction that both the terms "transgender children" and "Children with gender incongruence" would be appropriate here. IntentionallyDense ^(Contribs) 17:55, 12 March 2025 (UTC)

1. Desistence myth validity

• There is a lot to look into here but I'll start with "is the desistence theory a myth or not?"

• I am classifying this as not a biomedical claim as the view of wether or not a theory can be classified as a myth or not is kind of a grey area in terms of if it is biomed. With that being said. I found this opinion piece, published in a reputable source (meaning it fits criteria per WP:RS that explicitly calls it a myth.
• The Karrington study, in an oversimplified way, seems to be saying that there is not enough evidence to support that desistence is a widespread issue. If we are saying that the myth here is that the majority of transgender children will desist, then I'd agree that this source backs up the assertion that there is not enough evidence to support that.
• Any further arguments about whether this means it is a myth or not will most likely get overly semantic. Perhaps the wording could be changed to reflect that their is no high quality evidence of its existence, but then again we do have RS saying it is a myth. I'm a little stuck on this one so I'll most likely come back to it but feel free to chime in with any thoughts or opinions. IntentionallyDense ^(Contribs) 06:50, 12 March 2025 (UTC)

That Temple-Newhook piece also has this peer-reviewed response and this peer-reviewed response, and then provided a further peer-reviewed response to both. This paper describes this three-way exchange as disputes in the desisting literature and only goes so far as saying the claim that “most transgender children do not become transgender adults” is far from settled. Meanwhile there is still research published after Karrington's systematic review that accords with high rates (eg. Singh et al 2021.).

This is, at best, a debate among clinicians and should be presented as such. As I said before, it needs an admission we don't know and for all perspectives to be given due weight on the page it used to be on (Gender dysphoria in children), but it cannot be given an NPOV treatment on a page as inherently POV as one devoted to "misinformation". Void if removed (talk) 10:36, 12 March 2025 (UTC)

Void, the Singh et al peice provides no new data and is based on the same poor quality studies, it was also published pre the Karrington review (march 2021, as opposed to Karrington in May 2021). LunaHasArrived (talk) 13:11, 12 March 2025 (UTC)

• Response 1 is by a conversion therapist (Kenneth Zucker) ... [104] I would appreciate it if we could have content dispute where you don't cite famous conversion therapists
• Response 2 (from Steensma) says we do agree with the authors that the persistence rates may increase in studies with different inclusion criteria. The classification of GD in the Wallien and Cohen-Kettenis (Citation2008) study was indeed based on diagnostic criteria prior to DSM-5, with the possibility that some children were only gender variant in behavior. We have clearly described the characteristics of the included children (clinically referred and fulfilling childhood DSM criteria) and did not draw conclusions beyond this group, as has wrongly been done by others. The broadness of the earlier DSM criteria was also acknowledged by the American Psychiatric Association and World Health Organization. This was, among other things, a reason to tighten the diagnostic childhood criteria for DSM-5 and the proposed criteria for ICD-11. As we have stated elsewhere (Hembree et al., Citation2017; Steensma, Citation2013), we expect that future follow-up studies using the new diagnostic criteria may find higher persistence rates and hopefully shed more light on developmental routes of gender variant and transgender children. - ie, the authors quoted to say most trans kids desist and most kids with GD desist explicitly call out misapplying their research since they focused on GIDC
• That's a selective quotation.... My point in bringing up this discussion is to make clear that the commonly heard claim that “most transgender children do not become transgender adults” is far from settled. - is stated after noting all the critiques and inapplicabilities of the literature and noting Steensma agree about the inapplicabilities. [105]
• I'll note Singh was, once again, looking at GIDC.

So the sources you've provided support the claim "the evidence doesn't support the claim most trans kids desist or that most kids diagnosed with GD desist". Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:53, 12 March 2025 (UTC)

If we can both agree that “most transgender children do not become transgender adults” is far from settled then do you understand why I think it is therefore reasonable to say that the assertion that the majority of trans kids desist is unproven? I am not arguing that there is some major evidence to say they do not desist as that is beyond the scope of my review, however I think sources do support that there is not enough evidence to say that they do desist. IntentionallyDense ^(Contribs) 17:52, 12 March 2025 (UTC)

1. GET therapy, what is defined as such and if it is conversion therapy

• I've found this source which is a WP:RS. This is the source I will be using for the following points:

• Its proponents describe it as an “agenda-free, neutral therapy” and “ethical non-affirmative” approach—contrasting it with gender-affirmative approaches... Gender-affirmative approaches follow clients’ lead when it comes to gender, emphasizing the importance of respecting clients’ desires regarding social gender affirmation, which includes gender identity, gender expression, name, and pronouns; supporting clients’ free, self-directed gender exploration; and scaffolding their decision-making surrounding transition-related medical interventions I think this sums up the differences between GET and therapy for transgender individuals. To me it seems that the term.
• Critics consider gender-exploratory therapy a form of conversion practice, and opponents of proposed bans on conversion practices have claimed that the laws would prohibit gender-exploratory therapy establishes that many do hold the opinion that GET is a form of conversion therapy.

• With the second point in mind. I would advise changing gender exploratory therapy (GET), a form of conversion therapy to gender exploratory therapy (GET), viewed by xyz as a form of conversion therapy unless there are other RS saying that it is a form of conversion therapy.
• According to this source from a physician that advocates for GET, the author specifically brings up examples of how gender dysphoria could be caused by homophobia, autism, and sexual abuse. Wether or not that statement itself is valid (ie if gender dysphoria could be caused by those factors) is out of the scope of this review. However based on what I've read, I'm going to recommend that argue that their patient's gender dysphoria is caused by be changed to argue that their patient's gender dysphoria may be caused by since it seems that the author is saying these are possibilities and not every single case. IntentionallyDense ^(Contribs) 06:50, 12 March 2025 (UTC)

@IntentionallyDense: I agree with the second suggestion, but not the first. International expert groups such as WPATH have likened GET to conversion therapy, so this does appear to be a widely held consensus. Over at Conversion therapy#Gender exploratory therapy, there are five sources for this:[106][107][108][109][110] The RAND report also groups GET with conversion therapy[111] (p. 53). I think this justifies a statement in Wikivoice. Most of those saying it isn't conversion therapy are WP:FRINGE and non-independent, and even reading their reasons for why they offer this treatment modality speaks volumes[112] (see pp. 571–3). I have added these to this article for now. Lewisguile (talk) 15:05, 12 March 2025 (UTC)

Lewisguile hit the nail on the head here and I agree with keeping GET is a form of conversion therapy in wikivoice. I'll toss this nearly-exhaustive source table I created into the equation: User:Your Friendly Neighborhood Sociologist/Gender exploratory therapy - the only people arguing GET isn't conversion therapy are conversion therapists (either those with the organizations that created GET and have been caught providing conversion therapy like Genspect or famous conversion therapists like Kenneth Zucker). Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:34, 12 March 2025 (UTC)

Sorry again if I am asking you to repeat yourself, but are there RS that claim GET is a form of conversion therapy? If so could you link those here and in the article? IntentionallyDense ^(Contribs) 17:54, 12 March 2025 (UTC)

Nearly all of the reliable ones in Soc's giant table say so. They've also been bundled into the [a] {{efn}} in the article. Aaron Liu (talk) 18:13, 12 March 2025 (UTC)

The issue is that these are not included in the article itself to my understanding. IntentionallyDense ^(Contribs) 18:16, 12 March 2025 (UTC)

Transgender health care misinformation#cite note-30, footnote [a], attached to the sentence that says it's conversion therapy. Aaron Liu (talk) 18:20, 12 March 2025 (UTC)

Looks good to me. IntentionallyDense ^(Contribs) 01:55, 13 March 2025 (UTC)

1. Non-MEDRS sources being used for biomedical claims

• I am going to use the examples that VIR brought up on the reassessment page but let me know if there is anything I missed.

1. The myth relies on studies that had serious methodological flaws such as low sample sizes, outdated diagnostic frameworks that conflated gender non-conformity with transgender identity, usage of conversion therapy on the sample population, and poor definitions of desistance I'm on the edge about wether or not this is considered [[WP::Biomedical information]]. [113] which is a MEDRS source (systematic review, reliable publisher) does address the poor methodologic quality. This combined with the fact that I'm not convinced this is even a biomedical claim, leads me to conclude that the sourcing here is okay.
2. Most youth sampled in these studies never identified as transgender nor desired to transition, but were counted as desisting, again I am torn as to whether this counts as biomedical information. There are two other RS used alongside SLPC as well
3. Though every major medical organization endorses gender-affirming care, proponents of gender-affirming care bans in the United States argue the mainstream medical community is untrustworthy, ignores the evidence, and that doctors are pushing transgender youth into transition due to political ideology and disregard for their well-being. This extends to claims that standards of care and guidelines from reputable medical organizations do not reflect clinical consensus. I do not believe this is a biomedical claim
4. though scientific literature demonstrates that transgender youth, including those with mental health conditions, can competently participate in decision-making I do think that a MEDRS source should be used for this part of the sentence.
5. Though transgender people have higher rates of mental illness, there is no evidence these cause gender dysphoria and evidence suggests this is due to minority stress and discrimination experienced by transgender people. I do think this would benefit from a MEDRS source, however I'm not sure there is any reliable sources saying that mental illness does cause GD. Correlation vs causation type of thing.

• I think that sums up the majority of what people were concerned about with biomedical claims. IntentionallyDense ^(Contribs) 02:13, 13 March 2025 (UTC)

  I checked out #4. The cited "A thematic" cites a 2021 Clark & Virani study. However, that study was the only one found and excluded from "A systematic review and qualitative research synthesis of the lived experiences and coping of transgender and gender diverse youth 18 years or younger" due to "high concerns":

  Only the age of participants was specified (not gender identities, ethnicity, or other information). No interview guide or examples of questions were included, nor who did the interviews and analysis. Reflexiveness of the analysis process was missing. Nothing on security or anonymization. No positionality of researchers’.

  Combined with a Google Scholar search on the topic yielding quite a bit of debate (some even citing Clark & Virani 2021), I'm not sure we should use that at face value. ("A thematic" only cited it as evidence that contradicts the misinformation, anyways.) However, that review also cites another study to say Communication between clinic staff and parents to inform about medical issues and to ensure optimal support was valued by youth. I think that can be combined with the existing synthesis from "A thematic" that says Supportive parents or legal guardians are heavily involved in decision-making, but all five sources insinuate otherwise. So here's my suggestion:

  This has included arguments that medical transition of transgender youth is decided upon their incapable informed consent, though scientific literature demonstrates that clinical decisions heavily value communications with parents.

  Aaron Liu (talk) 11:52, 13 March 2025 (UTC)

  Lewis has implemented this. Aaron Liu (talk) 14:53, 13 March 2025 (UTC)

  Ninja'd! Lewisguile (talk) 15:00, 13 March 2025 (UTC)

  Aaron, I've made your suggested change re: informed consent. Sounds good to me. Lewisguile (talk) 14:56, 13 March 2025 (UTC)

• Please give me some time to assess each of these issues. Just because something was listed here doesn't mean it is inherently an issue. If you think something is an issue but hasn't been mentioned, feel free to mention it on this page, but I think I have covered most of what people had to say. IntentionallyDense ^(Contribs) 02:26, 12 March 2025 (UTC)

  The SPLC is listed as a reliable but biased source at WP:RSP. I think this article should avoid citing biased political sources for medical information. As a political advocacy group with its own agenda, the SPLC lacks the medical expertise to assess misinformation in a specialized medical field. Regarding exploratory therapy and conversion therapy, equating the two in a wikivoice contradicts NPOV, as there is no global consensus. Psychotherapy, particularly exploratory therapy, is recommended as a first-line treatment by health authorities and medical organizations in several developed countries, including the UK, Finland, and Sweden. [114] The United Kingdom Council for Psychotherapy (UKCP), a leading UK medical organization in its field, states: "Exploratory therapy should not in any circumstances be confused with conversion therapy, which seeks to change or deny a person’s sexual orientation and/or gender identity." [115] Australian psychological organizations hold a similar position. According to the rules, when there are conflicting views on the subject, we must present all existing views, not just one. JonJ937 (talk) 14:41, 12 March 2025 (UTC)

  @JonJ937 I agree with your statement I think this article should avoid citing biased political sources for medical information.. However, unless i missed something, this article does not use SPLC to cite Wikipedia:Biomedical information. I am currently doing some research on the whole GET thing so I will get back to you on that one. IntentionallyDense ^(Contribs) 17:42, 12 March 2025 (UTC)

  Unlike in Europe, the debate over transgender healthcare in the U.S. is highly politicized. Advocacy groups such as the SPLC have become involved in medical disputes, labeling doctors who question the use of puberty blockers or prioritize psychotherapy as "hate groups." However, the SPLC lacks medical expertise, so how can it determine who is right or wrong in a complex medical debate and based on that slap political labels on supporters of certain views? In fact, the positions of organizations like SEGM and TF are increasingly aligning with the global medical consensus. In recent years, there has been growing recognition that the evidence supporting the benefits of puberty blockers remains weak and requires further research. Many countries have decided to limit their use until better data is available. Even the World Health Organization (WHO), the leading global health authority whose guidelines generally reflect international medical consensus, stated that its guidance on transgender healthcare would exclude children, because the evidence base regarding the long-term outcomes of gender-affirming care for minors is "limited and variable". [116] This Wikipedia article presents treatment with puberty blockers as something decided by the science and opposition to it as fringe/misinformation, etc. The very opening statement in the lead section is non-neutral suggesting that the bans and restrictions in Europe and elsewhere are driven by fringe or conservative groups. In reality, these policies are based on scientific research. Studies in the UK and Scandinavia have shown that the evidence supporting puberty blockers and surgeries for minors is very weak. There are reports in the mainstream media that reflect this global shift: [117] [118] Stating that "Misinformation has affected the decision of the United Kingdom to reduce use of puberty blockers for transgender individuals" based on a single source is not line with WP:BALANCE, because there are many sources stating otherwise. The claim that gender dysphoria can never be caused by mental illness is inaccurate. In some cases, it may be linked to conditions such as dissociative identity disorder (DID) or schizophrenia, as documented in reliable MEDRS. Autism may also play a role in gender dysphoria, but this is a very little researched topic to make definitive statements. For example, this study states: "Although many trans young people display traits of autism, how these traits relate to the nature of their gender diversity is unclear". [119]

  Regarding exploration therapy, the position of two Australian MEDORGs, the Australian National Association of Practising Psychiatrists (NAPP) [120] and the Royal Australian and New Zealand College of Psychiatrists (RANZCP) [121] might be of interest as well. Exploratory therapy is recommended by health authorities in Finland and Sweden. By claiming that exploratory therapy is conversion therapy we imply that those countries support conversion therapy, which is false and even slanderous. When major MEDORGs such as UKCP reject the claim that GET is a form of conversion therapy, we cannot state in a wikivoice that the two are the same thing. I think the whole section on conversion therapy needs to be removed. It is unrelated to misinformation and reflects an ongoing debate whether children should undergo immediate medical transition or receive extensive psychotherapy first. I also believe that WPATH's attempts to manipulate the evidence in support of puberty blockers, as described here [122], constitute misinformation and deserve a mention too in this article. It is the greatest controversy in this medical field, even reaching the Supreme Court. JonJ937 (talk) 15:22, 14 March 2025 (UTC)

  SEGM and TF are not reliable sources according to the reliable sources noticeboard. The opening statement is supported by RS. The claim that gender dysphoria can never be caused by mental illness is inaccurate. from my understanding, this article is claiming that there is not evidence to say that the majority of gender dysphoria is caused by mental illness. Not saying it never can be. I'm going to use a personal example to help get this across. My older brother is schizophrenic. One of his delusions is that he is a drug addict. Despite no evidence of drug use, he is convinced he is one. He still got treatment from a addictions counsellor for his "addiction". Would it be fair for me to then say that anyone who claim they use drugs is schizophrenic? No, that would be ridiculous. However there is a slim chance that someone claiming to be a drug addict is schizophrenic, but that does not mean all drug addicts should be questioned as such. Just as other issues can cause gender dysphoria, it would not be fair to say everyone with gender dysphoria has these conditions or if they do have these conditions, it is caused by such. IntentionallyDense ^(Contribs) 16:06, 14 March 2025 (UTC)

What is misinformation vs disagreement

IntentionallyDense wrote "If we can both agree that “most transgender children do not become transgender adults” is far from settled then do you understand why I think it is therefore reasonable to say that the assertion that the majority of trans kids desist is unproven? I am not arguing that there is some major evidence to say they do not desist as that is beyond the scope of my review, however I think sources do support that there is not enough evidence to say that they do desist."

Now, we have already covered the fact that the Cass Review does not "assert[] that the majority of trans kids desist". Nor does it assert, as our article now reads "majority of pre-pubertal children with gender incongruence desist". It uses a much looser term to describe the cohort, and it doesn't state it as a fact, but rather as something that the current "evidence" says, while fully admitting the current evidence is poor. And we certainly don't have independent or neutral sources even remotely claiming "they misrepresented" this aspect. We have partisan, activist and hostile bodies making claims about "the other side" which should all be treated with caution. Because both sides in this debate have decided that facts no longer matter. Throw mud at the other side and hope some of it sticks.

WPATH SOC8 says "diverse gender expressions in children cannot always be assumed to reflect a transgender identity or gender incongruence" and "This chapter employs the term “gender diverse” given that gender trajectories in prepubescent children cannot be predicted and may evolve over time. At the same time, this chapter recognizes some children will remain stable in a gender identity they articulate early in life that is discrepant from the sex assigned at birth. The term, “gender diverse” includes transgender binary and nonbinary children, as well as gender diverse children who will ultimately not identify as transgender later in life. It goes on to say "Nonetheless, empirical study in this area is limited, and at this time there are no psychometrically sound assessment measures capable of reliably and/or fully ascertaining a prepubescent child’s self-understanding of their own gender and/or gender-related needs and preferences and "Research and clinical experience have indicated gender diversity in prepubescent children may, for some, be fluid; there are no reliable means of predicting an individual child’s gender evolution". So WPATH can only bring themselves to claim "some children" wrt the stability of "gender expressions" in pre-pubertal children. The word "some" is not "most" and it isn't even "many". How have we reached a point where the Cass Review saying effectively the same thing as WPATH is "misinformation".

But do we think someone making a claim for which someone else says there is "not enough evidence" is misinformation? If we do then WPATH claiming that puberty blockers and cross sex hormones for children are "evidence based medicine" is misinformation. This systematic review in a top journal says "Most clinical guidance lacks an evidence-based approach" and The WPATH and Endocrine Society international guidelines, which like other guidance lack developmental rigour and transparency have, until recently, dominated the development of other guidelines.. This systematic review in a top journal say There are no high-quality studies using an appropriate study design that assess outcomes of puberty suppression in adolescents experiencing gender dysphoria/incongruence. No conclusions can be drawn about the effect on gender-related outcomes, psychological and psychosocial health, cognitive development or fertility. Bone health and height may be compromised during treatment. High-quality research and agreement on the core outcomes of puberty suppression are needed.. This systematic review in a top journal says There is a lack of high-quality research assessing the outcomes of hormone interventions in adolescents experiencing gender dysphoria/incongruence, and few studies that undertake long-term follow-up. No conclusions can be drawn about the effect on gender-related outcomes, body satisfaction, psychosocial health, cognitive development or fertility. Uncertainty remains about the outcomes for height/growth, cardiometabolic and bone health. There is suggestive evidence from mainly pre–post studies that hormone treatment may improve psychological health although robust research with long-term follow-up is needed. I have three top MEDRS sources saying WPATH and US Activist claims that aspects of youth gender affirming care lack evidence (which is what Cass concluded too).

Let's compare the sources this article cites about Cass and desistance. The first is Horton, Cal (2024). Horton is employed at a business school and most of their published work consists of interviews with groups of like-minded individuals on social media. They have no medical qualifications or clinical research experience and are a well known activist. The document cited only refers to the interim report. The second is a "WPATH, ASIAPATH, EPATH, PATHA, and USPATH" press release. They claim, falsely, that the Cass Review supposes that "gender incongruence is transient in pre-pubertal children". It does no such thing. But Cass does, like WPATH SOC8, say that transience is a thing for a portion of that cohort. They then go on to argue about what cohort the studies look at. Which brings us back to arguments about what this article says is the cohort. This is important. A woman who goes to the GP with a lump in her breast is not a "cancer patient" and if tests show the lump is benign, they were not "cured". Just the same as a pre-pubescent child referred to a gender clinic for concerns about their gender is not "converted" if after psychological assessment (which, em, WPATH SOC8 requires) they later decide a different gender/sexuality identity. Anyway, that's a press release. And the third source is the infamous Yale PDF. Written by people who earn big money as expert witnesses in US legal battles, and for the purpose of winning those battles. It isn't a reliable source. It is just a document an activist group of academics stuck up on their university web server. It isn't even stable, having changed at least three times. I come back to my complaint from a while back. "Is that the best you've got". An activist at a business school, a press release from the organisation Cass and their systematic reviews heavily criticises for not doing evidence based medicine, and a PDF from some legal activists.

So, if the standard of "misinformation" is simply stuff the other guys say that I disagree with, then I'm looking forward to the lead of this article saying WPATH are peddling misinformation about the evidence of the clinical treatments they offer in youth gender medicine, citing three high quality sources in the Archives of Disease in Childhood. Not an "inductive and deductive reflexive thematic analysis" by an activist at a business school, not a press release by a hostile organisation and not a random PDF on a web server by legal activists.

But I'm being ridiculous. That isn't what "misinformation" should be. And yet the idea that misinformation is basically "anything the other guys say, that I disagree with" is the bedrock of this article as it stands. There is zero, zero attempt at NPOV here. In a contentious topic like this, we have to open our eyes to the fact that both sides will label the other side's claims and opinions as invalid, outdated, wrong, and activists will call the other guy's claims "misinformation". In reality, a claim of "misinformation", when made against something as weighty as the Cass Review (or WPATH SOC for that matter) is an extraordinary claim. We shouldn't just take partisan activists or people fighting legal batttles word for it. And we can't just accept sources that say "We strongly disagree with what the other people wrote" as a claim of "misinformation". Rational people disagree and can come to different conclusions when looking at the same evidence and ratinoal people can make different decicisions about what to do when there's a lack of evidence, and rational people can disagree about how much evidence is convincing.

For me, as a fan of MEDRS, the two systematic reviews (NICE and York) on the puberty blocker evidence merely joined the many existing systematic reviews (and one subsequent) that say the same thing: there isn't good evidence here. Anyone persistent in claiming they do have good evidence, at this point, is imo spreading misinformation. They need to commission something equally weighty, a better systematic review, say, that concludes the evidence is strong enough. But I also recognise that's my opinion, and I'm not proposing a Wiki article saying that. This article has confused disagreement with misinformation, and has spectacularly written the least NPOV article I have ever read on Wikipedia. - Colin°^Talk 11:19, 13 March 2025 (UTC)

Colin, YFNS covered this in detail here. The most pertinent part is this:

Here is a quote from p 41 of the final report[123]: "The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist." If gender incongruence (GI) only persists for a small number, then it doesn't persist for the rest (all but a "small number"). Which is another way of saying most desist. But what does GI itself mean? Here's what YFNS points out above:

Sidenote, Gender incongruence of childhood is a formal diagnosis, that none of the studies she referenced tracked, which requires the "marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. It includes a strong desire to be a different gender than the assigned sex; a strong dislike on the child’s part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender ... Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis." - it was a diagnosis explicitly created to refer to trans people.

YFNS' summary here is absolutely spot on. Gender incongruence (GI) does not include people who are merely gender non-conforming (GNC). Cass is making a specific claim, despite using evidence from a broader cohort. She is using both language and evidence in a way that is inaccurate and imprecise at best (perhaps understandable – she is a non-expert, after all), and intentionally misleading at worst. When Cass states that most GI (=trans) kids don't persist (=they desist), she's not only wrong, she's perpetuating a myth.

Lewisguile (talk) 14:34, 13 March 2025 (UTC)

Forgive me if I do not get back to all of your feedback here as there is a lot to unpack.

First off, if we just narrow in on the concept of desisting, my comment applies. Ignoring all of the Cass Review stuff for just a second, we have reliable sources saying it is a myth and that there is not enough evidence to support the claim that the majority of transgender children desist. I think the issue that YFNS was trying to get across here is that some studies have tried to claim the majority of children desist.

Now moving on to the Cass Review claims around desisting. Per page 41 of the Cass review "The current evidence base suggests that children who present with gender incongruence at a young age are most likely to desist before puberty, although for a small number the incongruence will persist." As you can see above, me and others are working on finding a way to carefully word this. As for the misrepresentation part, that was my own wording that I suggested that has since been shot down. Apart of the review process is for me to make suggestions and they will not always be the most accurate.

So WPATH can only bring themselves to claim "some children" wrt the stability of "gender expressions" in pre-pubertal children. The word "some" is not "most" and it isn't even "many". How have we reached a point where the Cass Review saying effectively the same thing as WPATH is "misinformation". you pointed out clear differences is wording and scope and then claimed they are effectively saying the same thing. I do not understand this.

I will have to get back to you on whether not WPATH claiming that puberty blockers and cross sex hormones for children are "evidence based medicine" is misinformation as this will require me to do some research into the WPATH claims, alternative views, and what is truly considered EBM.

I would not consider claims that the evidence suggests the majority of pre-pubertal children with gender incongruence desist biomedical information as it is something the Cass Review explicitly states. Therefore, sources for it are a little less strict. But Cass does, like WPATH SOC8, say that transience is a thing for a portion of that cohort based on your description of the differences between the two studies, this is not what both studies are claiming. Just the same as a pre-pubescent child referred to a gender clinic for concerns about their gender is not "converted" if after psychological assessment (which, em, WPATH SOC8 requires) they later decide a different gender/sexuality identity. I do not believe that anyone stated that psychological assessment is a form a conversion therapy. The only remotely connected topic I can think of here is that GET is a form of conversion therapy. However defining GET and just a form of "psychological assessment" would be inaccurate so I doubt that is what you are trying to say here. Per Wikipedia:Independent sources Press releases cannot be used to support claims of notability and should be used cautiously for other assertions. I would say that in this case, using the press release alongside two other sources, is cautious. As for the yale source, I will have to do some more research on the topic.

So, if the standard of "misinformation" is simply stuff the other guys say that I disagree with That's not what this article is about from my understanding and I'm sure others can chime in here as well. You have zeroed in on a couple parts of this article that are hot topics right now, largely disregarding the rest of the article in this statement. The piece that, to me, seems like misinformation here, is the presentation of unfounded claims as facts.

In reality, a claim of "misinformation", when made against something as weighty as the Cass Review correct me if I am wrong, but I do not believe that this article directly claims the Cass Review is misinformation. The article highlights contested parts of the review and shares other organizations opinions on it but does not outright state such. IntentionallyDense ^(Contribs) 02:28, 14 March 2025 (UTC)

it doesn't state it as a fact, but rather as something that the current "evidence" says, while fully admitting the current evidence is poor

Pretty much the same thing, and the secondary sources agree with us. I find that the longest comments here often try to defeat information already explained in secondary sources with original research instead of more secondary sources. What reason do you have to explain why the numerous high-quality sources we cite say that Cass's treatment of the desistance studies was uncritical?

Don't see the problem with the WPATH quote. Which Cass quote are you referring to?

The three reviews you cited share the exact same authors and are from the same journal. Only the first one make conclusions about WPATH and/or clinical guidelines, and all it says is that they lack transparency and thus lack evidence. It even says Although it is not uncommon to adopt an expert consensus-based approach when evidence is limited, it is less common for guideline developers to draw so heavily on other guidelines.

if the standard of "misinformation" is simply stuff the other guys say that I disagree with

When a very strong proportion of academia thinks something is wrong, that something would be misinformation indeed. Aaron Liu (talk) 11:37, 14 March 2025 (UTC)

Unresolved issues

• @Your Friendly Neighborhood Sociologist, Aaron Liu, Bejakyo, and Lewisguile: (pinging those that have been making changes) there are still some unresolved issues here that should be addressed. This page has gotten so lengthy that it is hard for me to parse what has been done and what is left. I am making this section to bring up what is left to be done. If you resolve something on this list of have comments on it, please reply here so we can try to keep things all in one place. Thank you for your time and patience. IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

1. Seeing as the rest of the lead is sources, the last sentence "Medical organizations such as the Endocrine Society and American Psychological Association, among others, have released statements opposing such bans and the misinformation behind them." should be as well. IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   I've now done this here. Lewisguile (talk) 18:43, 14 March 2025 (UTC)

2. Verification of Additionally, other providers in Sweden continue to provide puberty blockers, and a clinician's professional judgment determines what treatments are recommended or not recommended. Youth are able to access gender-affirming care when doctors deem it medically necessary. Sweden has not banned gender-affirming care for minors and it is offered as part of its national healthcare service. IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   I rewrote the section and cut that sentence out, replacing it with a shorter summary from other sources in the section.[124] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:30, 14 March 2025 (UTC)

3. Though every major medical organization endorses gender-affirming care YFNS did mention they were going to find better sources and/or adjust wording for this but I'm not sure where we are at with this. IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   Fixed the wording![125] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:46, 14 March 2025 (UTC)

4. Aaron pointed out I wonder what (if anything) should be done with the overlap the "European nations are banning gender-affirming care" section above has with "Europe" and "Norway" sections, especially with the latter entirely duplicating material from the former. which I think is a good point and should be addressed. IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   Fixed in these 2 edits![126][127] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:31, 14 March 2025 (UTC)

5. Jon has brought up that several respected MEDORGS do not consider GET a form of conversion therapy and recommend it. I'm not sure if there is more to this but it does feel odd that if GET truly is a form of conversion therapy, that European MEDORGS would recommend it. IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   Lewis, YFNS, and I have pointed out at the GA reassessment that all NAPP, RANZCP (as well as the WPATH standards of care, in fact) recommends is the gender-affirming model of care already promotes individualized care and psychotherapeutic gender identity exploration without favoring any particular identity mentioned in the article. As reflected in YFNS's behemoth source table, the term "exploratory therapy" is overwhelmingly associated with conversion therapy, while the actual concept of unconditional psychotherapeutic gender exploration is not. The only MedOrg that's been pointed out to support exploratory therapy is the UKCP, which was promptly criticized by all the other MedOrgs for this position along with their withdrawal from the Memorandum of Understanding on Conversion Therapy. Aaron Liu (talk) 16:45, 14 March 2025 (UTC)

   Thanks for clearing that up for me. I took a look at the sources themselves and found this: Psychotherapy for gender dysphoria in children and adolescents is a respectful, supportive and exploratory process that does not seek any particular outcome in relation to gender identity or sexual orientation (NAPP), which if we go back to the definition of GET doesn't seem to match with GET. RANZP says Psychiatrists can work with TGD people in a non-judgmental and non-directive therapeutic space to reflect on their gender experience when sought by the individual. In addition, psychosocial support should be available when needed for TGD people, their families, and whānau before, during, and after any gender-affirming treatment, to optimise mental health outcomes. again this does not fit the definition of GET. I'm going to say that this issue is resolved. IntentionallyDense ^(Contribs) 17:48, 14 March 2025 (UTC)

6. Finding a MEDRS source for "Though transgender people have higher rates of mental illness, there is no evidence these cause gender dysphoria and evidence suggests this is due to minority stress and discrimination experienced by transgender people." IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   Found![128]

   There's currently a related RFC about this at FTN btw (Is the view that transgender identities are, in themselves, a mental illness or otherwise frequently caused by mental illness WP:FRINGE) [129]

   From the SOC 8 p 171[130]: Some studies have shown a higher prevalence of depression (Witcomb et al., 2018), anxiety (Bouman et al., 2017), and suicidality (Arcelus et al., 2016; Bränström & Pachankis, 2022; Davey et al., 2016; Dhejne, 2011; Herman et al., 2019) among TGD people (Jones et al., 2019; Thorne, Witcomb et al., 2019) than in the general population, particularly in those requiring medically necessary gender-affirming medical treatment (see medically necessary statement in Chapter 2—Global Applicability, Statement 2.1). However, transgender identity is not a mental illness, and these elevated rates have been linked to complex trauma, societal stigma, violence, and discrimination (Nuttbrock et al., 2014; Peterson et al., 2021). In addition,psychiatric symptoms lessen with appropriategender-affirming medical and surgical care (Aldridgeet al., 2020; Almazan and Keuroghlian; 2021; Baueret al., 2015; Grannis et al., 2021) and with inter-ventions that lessen discrimination and minoritystress (Bauer et al., 2015; Heylens, Verroken et al., 2014; McDowell et al., 2020). Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:50, 14 March 2025 (UTC)

   Thanks! I appreciate the MEDRS source. IntentionallyDense ^(Contribs) 02:41, 15 March 2025 (UTC)

7. Misinformation has affected the decision of the United Kingdom to reduce the use of puberty blockers for transgender individuals. as Jon pointed out above, this is a pretty heavy claim. I'm wondering if we could find some other sources to back this up or maybe change the wording? So that I can better understand this, could someone give me a brief rundown of why this is? IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   The full sentence from the source is Anti-transgender legislation has thrived in a media environment of misinformation and disinformation. False and misleading claims about gender diversity, gender dysphoria, and GAC have been central to proposed legislative restrictions on GAC,13 in both the USA and globally, as with the UK’s Cass Review and the National Health Service’s decision to limit use of pubertal blockers in context of GAC.14 Restrictions on GAC have been justified by depicting GAC as experimental or unsafe, ignoring studies that show positive outcomes in youth with use of puberty blockers and exogenous hormones, and overstating risks such as thromboembolism The source for the UK sentence is the Yale Report mentioned elsewhere in this article, which notes The Review’s implication that puberty-pausing medication should lead to a reduction in current gender dysphoria or improve one’s current body satisfaction indicates ignorance or misunderstanding at best, and intentional deception about the basic function of these medications at worst. In an era of abundant misinformation, it is important remember the exact function of these medications. The Review, as a document of such influence and importance in the field of transgender health, should not operate from any position of ignorance about this care. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:54, 14 March 2025 (UTC)

   I think the first source also supports this in the second sentence, though "United Kingdom" could be replaced with "UK's National Health Service (NHS)". Aaron Liu (talk) 23:02, 14 March 2025 (UTC)

   You could put "decisions of the UK and UK NHS" and cite both sources so that this claim is a little more backed up. IntentionallyDense ^(Contribs) 02:40, 15 March 2025 (UTC)

   The Yale source is a bit less-than-stellar IMO since it's not intellectually independent from the "A thematic" group and it does not directly mention the UK; it mentions the review (whose recommendations were implemented) but does not connect that part with the UK's actions. Aaron Liu (talk) 02:50, 15 March 2025 (UTC)

8. Is WPATH claiming that puberty blockers and cross sex hormones for children are "evidence based medicine" is misinformation as Colin suggested? IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   Also, something has to be called misinfo by reliable sources to be included in the article. Aaron Liu (talk) 23:04, 14 March 2025 (UTC)

   No source says this - we have MEDORGs and CPGs around the world recommending PBs and CSHs because that is the only way to resolve gender dysphoria that's ever been discovered - the alternative was conversion therapy and it never worked. They all say it's evidence based. From the latest CPG of dozens of MEDORGS in Germany and other states they said there's "no proven effective treatment alternative without body-modifying medical measures for a [person with] permanently persistent gender incongruence"[131]

   Colin's argument is that because the evidence is not perfect and there are known unknowns and unknown unknowns, it's not evidenced based. But we have perfect evidence bases on no field of healthcare so CPGs and MEDORGS base their recommendations on the best evidence they have - not the best evidence hypothetically possible.

   From the lead of evidence-based medicine, it's the "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research

   According to the best evidence we have, there's evidence that withholding care causes harm (including irreversible unwanted pubertal changes), there's no evidence any alternative treatment works and evidence they cause harm (ie, conversion therapy to match mind to body and not vice versa), and decades of evidence that trans people live much happier lives when provided GAC, and evidence that it's reasonably safe (with extra provisions built in for safety, like those blood tests for hormone levels I have to take every 3 months). Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:17, 14 March 2025 (UTC)

   This all seems reasonable. IntentionallyDense ^(Contribs) 02:39, 15 March 2025 (UTC)

9. The reliability of the Yale source. IntentionallyDense ^(Contribs) 16:28, 14 March 2025 (UTC)

   It's reliable for the fact the review was criticized for those 2 reasons cited. The Yale Report was a white paper critique of the Cass Review written by a group of experts in trans healthcare. It is heavily referenced in most other critiques (including the new German CPG). In this case, reliable is perhaps less the question that WP:due/WP:V.

   Other peer reviewed research generally finds it reliable.[132] With the exception of this one paper by a group of people with no experience in trans healthcare, including the founder of SEGM, [133] which was discussed on the Cass Review article[134] as well as at RSN[135] and found to be a questionable source at best. People who find that critique of the Yale report convincing include Stephen B. Levine, famous for the view that being trans is generally a symptom of psychopathology [136]. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:14, 14 March 2025 (UTC)

   That all makes sense. I consider this as resolved. IntentionallyDense ^(Contribs) 02:35, 15 March 2025 (UTC)

Final decision

• I did not reach this decision lightly. As shown, I did my absolute best to understand everyone's concerns and make changes where appropriate. I feel that I have done my job as a reviewer, and can say that this article passes GA criteria. I knew from the start that no matter what decision I made people would disagree. I would recommend (with no authority to make such recommendations) that if people disagree with my decisions, alternative routes be taken for such discussion. Perhaps this article needs another look by a larger group of uninvolved people, that is not an area I am familiar with. If there are questions directly regarding my review or how it was conducted, please tag me or let me know. Before I officially submit this as a pass I am going to sleep on it and see if anyone has any final comments. IntentionallyDense ^(Contribs) 02:53, 15 March 2025 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Yale School of Medicine

It is not the Yale School of Medicine report, but the opinion of individual faculty members for which Yale takes no responsibility. The source that was cited miss-attributed the claim to the Yale school, which shows poor research quality by Wuest et al. The original report could be found here: [137] and there is a disclaimer stating: This report reflects the academic work of individual Yale faculty and does not represent the views of Yale University, Yale Law School, or Yale School of Medicine. --JonJ937 (talk) 11:14, 11 March 2025 (UTC)

I've amended this to say "A report by researchers at..." That ought to cover it. Lewisguile (talk) 12:51, 12 March 2025 (UTC)

"A report by a group of faculty from Yale School of Medicine", might be more appropriate to clarify that the report is not endorsed by Yale. JonJ937 (talk) 14:44, 12 March 2025 (UTC)

Are they not also researchers? "Faculty" alone implies they're just teaching staff. Lewisguile (talk) 14:51, 12 March 2025 (UTC)

I think it should be made absolutely clear that this is the work of individual faculty not endorsed by Yale. JonJ937 (talk) 15:25, 14 March 2025 (UTC)

Universities normally don't endorse (nor disavow) the work of researchers.
Oppose "faculty" as it's a lot more obtuse. When I was young I thought the words meant janitors and people for a time long enough to surprise you. Aaron Liu (talk) 16:28, 14 March 2025 (UTC)

That looks good to me. I do not think that labelling them researchers is more accurate than faculty. IntentionallyDense ^(Contribs) 17:50, 14 March 2025 (UTC)

Summary of problems with the article

• The article claims that it is misinformation to say that children are being transitioned too quickly. This is contradicted by significant evidence such as this Reuters investigation: "Doctors and other staff at 18 gender clinics across the country described their processes for evaluating patients. None described anything like the months-long assessments de Vries and her colleagues adopted in their research. At most of the clinics, a team of professionals – typically a social worker, a psychologist and a doctor specializing in adolescent medicine or endocrinology – initially meets with the parents and child for two hours or more to get to know the family, their medical history and their goals for treatment. They also discuss the benefits and risks of treatment options. Seven of the clinics said that if they don’t see any red flags and the child and parents are in agreement, they are comfortable prescribing puberty blockers or hormones based on the first visit".
• The article claims that ROGD is misinformation because it is not a formal diagnosis. The latter part of that statement is true, but it is certainly a stretch to therefore conclude that the concept is misinformation, since there is significant evidence in favor of the hypothesis. Aside from Lisa Littman's original paper, the Cass Review stated that ROGD might exist and that the rise in gender clinic referrals could not be entirely explained by increased social acceptance.

Partofthemachine (talk) 01:32, 24 March 2025 (UTC)

I'm honestly not super comfortable with these two topics, but the issue I'm mainly seeing with the Reuters source is that they give no source for this claim. They said they talked to some doctors but do not give information as to where those clinics operated, how they operated, and what their process looked like. This does not lead me to believe that this Reuters source outweighs the other sources. As for your second point, I would recommend you read the GAN review I did above where many people gave their opinions on what constitutes as misinformation. IntentionallyDense ^(Contribs) 01:40, 24 March 2025 (UTC)

@IntentionallyDense: Reuters does give sources for their claim: they talked to employees of several different transgender clinics in multiple regions. I think that should be given more weight than primarily activist sources saying they disagree without explaining why. Partofthemachine (talk) 03:54, 9 April 2025 (UTC)

ROGD is explicitly rejected by experts, as this very page shows. The Littman paper, quite apart from all the criticism it has faced, explicitly doesn’t establish ROGD exists. The Reuters article you link to isn’t a report of a formal study looking into the issue of whether treatment is rushed, but more like a report of rumour mongering. Reuters in any case is not WP:MEDRS, which is what we need for this topic. The contents of this page may surprise you given what you may have read in the media. But when you think about it, the prevalence of misinformation in popular media is part of what has made this topic notable. OsFish (talk) 02:44, 24 March 2025 (UTC)

@Partofthemachine, WP:DROPTHESTICK - you complained about ROGD's inclusion in article, and claimed it was a POVFORK of ROGD, when I first wrote it and seemed to get the message when I reminded you that 1) dozens of medical organizations had explicitly said misinformation about ROGD was widespread and 2) you've previously tried to remove scientifically unsupported from the lead of the ROGD article and had almost a dozen editors point out there's no evidence it exists (with many noting that Littman's paper had to issue a correction noting it wasn't evidence ROGD existed).[138] I am unsure why you're restarting the discussion now and it feels WP:TENDENTIOUS. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 14:56, 24 March 2025 (UTC)

If they’re familiar with the topic AND know directly from personal experience that consensus is against them AND they don’t acknowledge that they’ve had this discussion before then yes, this is tendentious. They wasted my time in me giving a reply they’ve been given before. OsFish (talk) 15:53, 24 March 2025 (UTC)

Did you know nomination 2

(

• Comment or view
• Article history

)

Map of US state laws regarding trans healthcare access for youth as of March 8, 2025 based on data from Movement Advancement Project

• ... that over 20 states in the United States have restricted gender-affirming care for transgender minors, with transgender health care misinformation being one factor behind such bans?

• Source: https://www.endocrine.org/news-and-advocacy/news-room/2024/statement-in-support-of-gender-affirming-care

• Reviewed:
• Comment: The DYK timed out as the article underwent a GAR - a GA3 and the GAR found keep so relisting with the alt discussed at Template:Did you know nominations/Transgender health care misinformation.
  I also second Launchballer's idea that it be used for Transgender Day Of Visibility (March 31). Courtesy pings to @Starship.paint, Narutolovehinata5, SL93, and Launchballer:

Improved to Good Article status by Your Friendly Neighborhood Sociologist (talk). Number of QPQs required: 0. Nominator has fewer than 5 past nominations.

Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:52, 16 March 2025 (UTC).

• Comment: @Your Friendly Neighborhood Sociologist: This is a great hook, and I find it interesting. A few initial concerns:

1. The hook fact is sourced to a press release from the Endocrine Society, which means it is a self-published expert primary source.
2. A close reading of the press release indicates that the exact wording is slightly different from the hook. It says: "Although the scientific landscape has not changed significantly, misinformation about gender-affirming care is being politicized. In the United States, 24 states have enacted laws or policies barring adolescents’ access to gender-affirming care, according to the Kaiser Family Foundation. In seven states, the policies also include provisions that would prevent at least some adults over age 18 from accessing gender-affirming care."
3. The hook fact should adhere as close as possible to the source. I wonder if you can find other secondary sources to support the current wording of the hook or if you can rewrite it for parity. Attribution might also be needed.
4. I like the hook image, but the caption is too long, and the legend (key) is too small. I wonder if there is a way to convey this info in a brief caption

More later. Viriditas (talk) 23:50, 17 March 2025 (UTC)

@Viriditas: Thank you! My apologies for missing your reply, unsure why I never got the notification. Responding to your points

1) which means it is a self-published expert primary source - I think this characterization is innacurate. Self-published refers to things like Twitter and Medium, not statements from international medical organizations. Per WP:MEDORG/WP:MEDASSESS it's a good source and per WP:MEDDEF A primary source is one in which the authors directly participated in the research and documented their personal experiences while A secondary source summarizes one or more primary or secondary sources to provide an overview of current understanding of the topic, to make recommendations, or to combine results of several studies. Examples include ... medical guidelines or position statements published by major health organizations so this is secondary.

2) The wording was based on discussions with Starship.paint for the last DYK nom - I'm open to changing it but unsure how. The source later says Transgender and gender-diverse teenagers, their parents, and physicians should be able to determine the appropriate course of treatment. Banning evidence-based medical care based on misinformation takes away the ability of parents and patients to make informed decisions. The Endocrine Society's been consistent with saying these bans are based on misinfo, in 2023 saying Due to widespread misinformation about medical care for transgender and gender-diverse teens, 18 states have passed laws or instituted policies banning gender-affirming care. ... Some policies are even restricting transgender and gender-diverse adults’ access to care. These policies do not reflect the research landscape.[139] The reason the hook says trans healthcare misinfo is "one factor" is SP argued they were not taking the position these bans are always based on misinfo (I argued they were). I suggested citing the ES to say such bans are based on misinfo and another source to say how many bans exist currently, but SP said this would be SYNTH. Your call how to best reword this!

3) Per 2 I'm down to change the wording and per 1 I don't think attribution is needed. Perhaps something like U.S. states have banned gender-affirming care for minors based on transgender health care misinformation and over 20 states have implemented such bans?

4) Thanks, made it myself! Could the caption be US state laws on trans healthcare access for youth with bans marked in shades of red and shield laws marked in blue or US state laws on trans healthcare access for youth - most restrictive (dark red) to most protected (dark blue)?

Best, Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:09, 20 March 2025 (UTC)

Thank you for the thoughtful reply. The Endocrine Society has their clinical practice guidelines posted here and their position statements listed here. The source we are discussing is neither a clinical practice guideline nor a position statement, it is a press release. A press release is "considered a primary source, meaning they are original informants for information". WP:V, footnote 1: "Self-published material is characterized by the lack of independent reviewers (those without a conflict of interest) validating the reliability of the content. Further examples of self-published sources include press releases..." I should note that many position statements are often posted in a journal.[140][141][142][143] To be clear, I agree with the statement in the press release that says "misinformation about gender-affirming care is being politicized", and I acknowledge that a position statement or clinical practice guideline isn't likely to deal with it, however, this topic did come up during the COVID-19 pandemic and resulted in many peer-reviewed articles about misinformation and politicization. Likewise, Meredithe McNamara has studied this closely.[144][145] I'm guessing that ES is referring to the work of McNamara et al. but in the form of a press release, this is all a bit opaque. I should note that most of the MED source guidelines say to avoid press releases, so I'm a bit confused by this. I will pass this on to someone else as I generally avoid press releases for hooks, even if I agree with them, and I think the sourcing should be tightened up a bit. Given that McNamara et al. is so prolific, this seems like it should be easy to do. Viriditas (talk) 20:16, 20 March 2025 (UTC)

@Viriditas: No problem! I don't think the ES was directly referring to McNamara et al but more so the wave of anti-trans laws. However, I did find a better source / hook if you want to consider that instead of dealing with the question of using a press release! that due to transgender health care misinformation, over 20 states in the United States have banned gender-affirming care for transgender minors since 2021? [146] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 23:57, 24 March 2025 (UTC)

New reviewer requested. Viriditas (talk) 20:16, 20 March 2025 (UTC)

• Seeing as I have a more in depth knowledge on this article, I will give it a DYK review.

General: Article is new enough and long enough
New enough: Long enough:

Policy: Article is sourced, neutral, and free of copyright problems
Adequate sourcing: Neutral: Free of copyright violations, plagiarism, and close paraphrasing:

Hook: Hook has been verified by provided inline citation
Cited: Interesting:

Image eligibility:

• Freely licensed:
• Used in article:
• Clear at 100px: - n

QPQ: None required.

Overall: I do see the issues that the other reviewer mentioned. I can see where they are coming from but because this hook is not biomedical info it doesn't require as strict of sources. If I remember correctly, press releases can be used as RS If used cautiously. I think using a press release from a reliable society and the fact that is stating things that can be easily verified (as in the policy changes and that misinformation has played a role) makes it appropriate here. I do not think that the image is clear at 100px due to the legend. I would support this hook without the image. IntentionallyDense ^(Contribs) 23:42, 24 March 2025 (UTC)

@IntentionallyDense: I appreciate all the time you've devoted to this, but please read WP:DYKRR: "You're not allowed to approve your own hook or article, nor may you review an article if it's a recently listed good article that you either nominated or reviewed for GA (though you can still nominate it for DYK)." Since you passed Talk:Transgender health care misinformation/GA3, we need a new reviewer. Viriditas (talk) 00:05, 25 March 2025 (UTC)

Oops I didn't know this and had reviewed DYK hooks for article I reviewed in the past. Good to know this moving forward, thank you! IntentionallyDense ^(Contribs) 00:41, 25 March 2025 (UTC)

New reviewer needed. Viriditas (talk) 00:05, 25 March 2025 (UTC)

About the image, could we proclaim "skill issue" and just crop the image to only a map and then make the caption "states with stricter bans are colored more red"? I'd prefer brevity, but we could also add "gender-affirming care" before "bans" and "and stronger shield laws more blue" to the end of that caption if needed. Aaron Liu (talk) 01:59, 25 March 2025 (UTC)