Weak evidence for transgender interventions

MARY REICHARD, HOST: It’s Tuesday the 20th of May.

This is WORLD Radio and we are so glad you’ve joined us today. Good morning, I’m Mary Reichard.

NICK EICHER, HOST: And I’m Nick Eicher.

First up on The World and Everything in It: a warning about risky medicine for vulnerable kids.

A quick heads-up for parents: the next two stories deal with pretty sensitive topics. They may not be appropriate for your younger children. So there’s still a moment before we get underway.

REICHARD: This first piece has to do with a big report by the Department of Health and Human Services. It’s a 400-page review of medical interventions for children with gender dysphoria. The findings? In short, what many people expected.

Weak evidence to support it and serious risks from it.

WORLD’s Mary Muncy talked to one detransitioner who says what’s being offered should not be called treatment.

MARY MUNCY: Prisha Mosely knows exactly what started her gender dysphoria.

PRISHA MOSELY: When I was 14, I was sexually assaulted, and I became pregnant as a result of that, and miscarried.

She developed anorexia and joined an online group that encouraged her not to eat.

MOSELY: A bunch of trans identifying adults came in and explained to us that our distress was actually based on the fact that we were born in the wrong body.

Before this, her doctors had been telling her the truth about her body. She wasn’t fat. She should eat, and they refused to give her liposuction.

MOSELY: And when I went to my doctors, and the narrative had changed, and I was no longer saying that my life was bad because I was fat. It was bad because I was born in the whole wrong body. All of a sudden they were agreeing with me.

At 17, she started testosterone… and she felt better...for the first few months.

MOSELY: I got validation and affirmation from feeling stronger. I really did gain some muscle, and that made me feel safer.

But those feelings started to wear off.

MOSELY: And that's why I thought it was time to have my breasts removed.

So, shortly after her 18th birthday, she got a double mastectomy.

MOSELY: I thought that I was having a life-saving procedure that was going to prevent my suicide. And I was so suicidal, I mean, that I would have cut off my breast to live, and I did.

Mosely is not alone. Advocacy organization Stop the Harm found that between 2019 and 2023, almost 14,000 minors had interventions to change their sex characteristics… and almost 6,000 underwent reassignment surgery.

KURT MICELI: We know that the harms are significant just by having knowledge of what takes place

Kurt Miceli is the medical director for Do No Harm.

MICELI: We know that they're significant downsides in terms of bone mineral density. We also understand that there is infertility that results when one is taking puberty blockers and then adding cross sex hormones to that. There's sexual dysfunction that folks experience. There the cardiovascular effects that come with the hormones.

But he says that perspective isn’t published in the literature.

MICELI: The literature has tended to focus on on the notion of what benefits might exist.

But this month, the Health and Human Services Department, or HHS, published a literature review… saying the evidence is weak that gender-affirming interventions for minors are beneficial. It follows several other countries reversing their policies.

The HHS report is an “umbrella review”—meaning the authors compiled other reviews of the evidence and reviewed those.

MICELI: Systematic reviews are really a gold standard. And so I think in medicine, that's what we look for.

The HHS report found that many published studies promoting gender-affirming care are poorly done. Some featured small sample sizes, others lacked long-term analysis, and still others didn’t have a control group.

For example, the HHS reviewed one study published in the New England Journal of Medicine that claimed to prove gender affirming health care is safe and effective.

In that study, researchers asked 315 adolescents about their physical and mental health before starting treatment for gender dysphoria… then they followed up two years later.

Physically, the follow-up included biomarker tests but did not include information about growth or fertility.

On the mental health side, when they started the study, they were testing for 19 outcomes… but at the end of the two years, they only reported four—excluding the outcome of patients’ gender dysphoria, suicidality, and self-harm, among other things. Critically, two people committed suicide within a year of starting hormones.

The HHS found that due to these shortcomings, and others… the study didn’t have enough information to know whether medical intervention helped their subjects’ gender dysphoria… despite the study’s claims.

MICELI: I know oftentimes we defer to autonomy and to how people want to be self directed and such. But I think what has happened here is we've fallen very much into a almost consumeristic, child driven process.

Instead of life-altering procedures, the HHS report encourages doctors and parents to focus on psychotherapy if their child is struggling with gender dysphoria.

Prisha Mosely was 24 and starting to detransition before she truly realized what the interventions had done to her body.

MOSELY: I had given up on the idea of pregnancy.

As she started detransitioning, a doctor helped her even out her hormones. She also began dating a man in Michigan.

MOSELY: I started birth control because my doctor wanted me on estrogen and progesterone while we were waiting for bioidentical hormones, and within, like, I mean, weeks of starting the birth control, I got pregnant. It was shocking to me.

She was terrified. She would have to quit all of her psychiatric medications… and because she had transitioned so young, her hips were too small for her baby’s head. She would have to have a C-section.

MOSELY: I had to keep telling myself, like, okay, I there's for sure. Like, actually a baby inside of me. I actually do need this surgery for something real.

When her due date came, she yelled at the doctors not to touch her and couldn’t stop throwing up… even during surgery.

MOSELY: But when he was out and on me, you know. Everything changed, and it was only us in the room, and everything was perfect again.

Mosely was not able to breastfeed her son. Now, she’s suing the doctors involved in her transition. Her case is the first to proceed to court.

She says the people who were supposed to help her when she was most vulnerable failed her… and now she and her son are living with that.

MOSELY: For a very, I mean, about a decade or more of my life, I was just looking for a savior, someone to save me. I really thought that I needed saving, and I was bad and I was broken, and I, yeah, I was looking for a savior.

Mosely says some painful experiences in the church were part of the trauma of her transition… but she says she has a personal relationship with God… and now, a nearly one-year-old son to share it with.

MOSELY: Detransition has brought so much healing and so much peace that I have such an abundance of love that another person was born out of my infertility.

Reporting for WORLD, I’m Mary Muncy.

WORLD Radio transcripts are created on a rush deadline. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of WORLD Radio programming is the audio record.