Talk:Transgender health care misinformation/GA3

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.

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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[1], and included it in the article![2] 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.[3] 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: [4][5][6][7][8] 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 [9] 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: [10][11][12][13][14][15][16][17] 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 [18] 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![19] 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[20] 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[21] is the WPATH SOC 8, which are the world's leading guidelines. Kimberly et al[22] is a review of the ethical issues raised about GAC for youth. Mahfouda et al[23] 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.[24] 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 [25] 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.[26] 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: [27][28][29][30][31][32][33][34][35] IntentionallyDense ^(Contribs) 16:25, 8 March 2025 (UTC)
• Since SPLC was a non academic source that came up quite freqauntly, I did some digging [36][37] 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.[38]

  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![39] 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.[40] 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[41]: 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[42] (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.[43] 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.[44]
• 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).[45] - 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[46]: 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[47]. 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.[48]

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.[49] 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 [50]

The Association of the Scientific Medical Societies in Germany this week released clinical practice guidelines[51] 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.[52] 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[53]. 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".[54]

Gender incongruence is a 1) a diagnosis created to apply to trans people[55] 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.[56]
• 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[57]

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[58] 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).[59] 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.[60] 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[61]
• 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) ... [62] 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. [63]
• 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:[64][65][66][67][68] The RAND report also groups GET with conversion therapy[69] (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[70] (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]]. [71] 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. [72] 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." [73] 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". [74] 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: [75] [76] 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". [77]

  Regarding exploration therapy, the position of two Australian MEDORGs, the Australian National Association of Practising Psychiatrists (NAPP) [78] and the Royal Australian and New Zealand College of Psychiatrists (RANZCP) [79] 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 [80], 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[81]: "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.[82] 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![83] 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![84][85] 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![86]

   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) [87]

   From the SOC 8 p 171[88]: 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"[89]

   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.[90] With the exception of this one paper by a group of people with no experience in trans healthcare, including the founder of SEGM, [91] which was discussed on the Cass Review article[92] as well as at RSN[93] 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 [94]. 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.