Talk:Society for Evidence-Based Gender Medicine

Reference to Finnish Guidelines

I have edited the article to add a reference to the recommendations of the Finnish Council on Health Care Choices on gender dysphoria in minors, which SEGM translated into English. The edit was deleted on the basis that it linked back only to the SEGM website. I have restored the edit and added a link to the original FInnish version of the guidelines at the Council for Health Care choices website. Justdad78 (talk) 22:08, 7 October 2022 (UTC)

But the latter establishes no substantial connection to the topic of this article, so I'm have removed it until consensus for inclusion develops here on Talk. Newimpartial (talk) 22:10, 7 October 2022 (UTC)

Perhaps I should add that if the implication is that the SEBGM influenced the Finnish recommendations, we need an independent source asserting that. Otherwise we run the risk of WP:POV and/or WP:SYNTH. Newimpartial (talk) 22:16, 7 October 2022 (UTC)

I am quite sure what @TheTranarchist meant was that there was no reliable, secondary source for the addition. While the document itself as a primary source can be used to prove its own existence, if no secondary sources have detailed it, questions may arise regarding the relevance and due weight of mentioning it. Madeline (part of me) 22:13, 7 October 2022 (UTC)

The unofficial translation of the Finnish guidelines is one of the activities that the SEGM has undertaken and a reference to it is relevant to an article which purports to describe the activities of SEGM. The guidelines themselves represent an example of the evidence based approach which SEGM advocates/ Justdad78 (talk) 22:16, 7 October 2022 (UTC)

We don't usually make reference to the translations individuals or groups have made unless the translation itself has been the object of secondary commentary. We don't use primary sources for that. Newimpartial (talk) 22:19, 7 October 2022 (UTC)

Just reviewed the edits now. The question that needs to be asked is why is this WP:DUE? What makes the SEGM translation of those recommendations noteworthy, and such that it deserves a paragraph in an article that is not about those recommendations? Out of the many publications SEGM have produced, why is this one important?

In order to answer those questions, you need to demonstrate via reliable, secondary sources that the translation has importance. The original Finnish document, and the translation by SEGM are both primary sources, and while they verify that the translation exists, they do nothing to help us contextualise their importance and demonstrate why we should have any content covering it. It is important to remember that not every publication by an organisation is noteworthy for inclusion in an encyclopaedia. One thing to note, as you are a new user, you may be unfamiliar with what we consider reliable sources on Wikipedia. While we have a helpful list of sources that have been discussed multiple times, often you are required to check the Reliable Sources Noticeboard archives for past discussions on sources that haven't been frequently discussed, which can be difficult and overwhelming for new editors. So I would recommend that if you're unsure about whether a source is reliable, that you post it here so that we can assess it together. Sideswipe9th (talk) 22:23, 7 October 2022 (UTC)

The translation of the Finnish guidelines is important because the guidelines themselves provide one of the first examples of a national health authority adopting an evidence based approach to gender dysphoria in children. The guidelines provide an illustration of the kind of approach to treatment that SEGM promotes.

https://www.economist.com/science-and-technology/2021/05/13/doubts-are-growing-about-therapy-for-gender-dysphoric-children Justdad78 (talk) 23:53, 7 October 2022 (UTC)

Again, analogies between the approach promoted by SEBGM and the approaches taken by other organizations and various jurisdictions are WP:OR unless secondary sources make that connection themselves. I don't see that in the link from The Economist just provided. Newimpartial (talk) 00:01, 8 October 2022 (UTC)

Unfortunately this is not an article on the Finnish guidelines. The Economist source, while reliable, cannot be used for the content that was proposed because it does not mention or link to SEGM in any way. To include it would therefore be WP:SYNTH and it would fall afoul of the no original research policy.

If you want to include a paragraph on the translation of the Finnish guidelines, then you need to provide a reliable source that asserts why SEGM's translation is important, and ideally what impact that translation has had (if any). The source must mention SEGM in some way for it to comply with the relevant policies and guidelines that cover articles such as this. Sideswipe9th (talk) 00:18, 8 October 2022 (UTC)

Questioning "opposes standard medical care for gender dysphoria."

There doesn't seem to be standard medical care for gender dysphoria, as there is disagreement between experts. The UK and Swedish and Finnish and WPATH appear to differ. And the French National Academy of Medicine. See, e.g., https://www.bmj.com/content/378/bmj.o2303 . It is not clear that SEGM disagrees with all of these, if one wanted to say they are, all together, "standard." Also there is e.g., https://pubmed.ncbi.nlm.nih.gov/26119518/ which is earlier and talks with reference to WPATH guidelines: "However, in actual practice, no consensus exists whether to use these early medical interventions." So this sentence about SEGM opposing standard medical care at the beginning of the page does not appear accurate.

Thanks. Jdbrook talk 23:37, 9 October 2022 (UTC)

They also oppose poor trans people of any age transitioning (see their actions in Arizona), don't forget that part. Do you have any evidence that a blanket ban on public funding for medical transition at any age is supported by medical consensus? I'm not going to bother debating the rights of minors since that part itself is so blatantly against "standard medical care for gender dysphoria" I needn't bother. TheTranarchist ⚧ Ⓐ (talk) 23:52, 9 October 2022 (UTC)

@TheTranarchist@TenBlueEagles I don't see evidence of medical consensus, so I don't expect to find someone who agrees with it or disagrees with it.

Where do you see the opposition for medical interventions for poor trans people "at any age"? The headings in the Arizona brief seem to be about adolescent females with mental health problems, double mastectomies on minors, and the poor quality of the evidence regarding these interventions for young people. A lot of evidence reviews have been regarding minors, and it seems this case is about minors.

Thanks. Jdbrook talk 00:10, 10 October 2022 (UTC)

Re: The headings in the Arizona brief seem to be about adolescent females with mental health problems, double mastectomies on minors, and the poor quality of the evidence regarding these interventions for young people - if you are going to insist on taking these WP:FRINGE, transphobic political interventions at face value and defending their POV verbatim - well, I can't see that as being on topic for WP Talk pages, at all. Repetition of bigoted talking points isn't really a way to improve Wikipedia articles IMO. Newimpartial (talk) 00:42, 10 October 2022 (UTC)

To clarify, two transgender minors (who still deserve rights fringe views aside) filed a class-action lawsuit on behalf of people under 21 because the state has had a flat out ban on providing medicaid coverage for transition related surgeries since 1982 (for reference, 18-21 means adult). SEGM, being their wonderful selves, filed a brief misgendering them and congratulating the state for refusing to extend that coverage. Their brief states SEGM recognizes the right of mature adults to undergo gender-affirming interventions despite the low quality of evidence on which the interventions are based but is very concerned about applying experimental procedures to vulnerable youth, whose gender identity is still developing and whose ability to meaningfully consent to interventions with unknown long-term outcomes is highly uncertain. They sneak into the footnotes that This Brief refers to “pediatrics” as the practice of medicine for patients under age 18; “children” as pre-pubescent; “adolescents” as pubescent individuals; and “young people” and “youth” as those 25 and under. There is a lot of high quality evidence that adults are benefited by transition (same for youth, but it's easier for anti-trans groups to cry "save the children"), which this explicitly contradicts. It also makes clear they oppose the right of those under 25 to transition while nominally just protecting the children. TheTranarchist ⚧ Ⓐ (talk) 01:07, 10 October 2022 (UTC)

@Newimpartial I said what it looked to me like the brief covered, rather than what was said about the brief earlier in the discussion (" oppose poor trans people of any age transitioning"). I don't see that you've addressed what I said?

@TheTranarchist as you just quoted above, SEGM explicitly says it recognizes the rights of mature adults, so I don't see where you are getting the "trans people of any age transitioning" being opposed.

Also, why did you highlight the low quality of evidence statement? This is a technical term and refers to, e.g., the recommendations of the Endocrine Society regarding double mastectomies and surgeries (https://academic.oup.com/jcem/article/102/11/3869/4157558#99603239 ) which it appears to me gave the evidence behind their recommendations (section 5) low quality GRADE, very low quality GRADE or didn't grade it ("Direct evidence for these statements was either unavailable or not systematically appraised and considered out of the scope of this guideline.")

Note that some countries view 18 as adult for some things but not others (e.g., smoking and drinking in the US), given the reality of how brains develop regarding decision making, hence the age of around 25 for Finland for these interventions, too, and WPATH SOC8's mention of people just above 18 as well as being different (transitional-age adults, p S44). Again, there isn't consensus.

Most recent reviews I've seen (Sweden, Finland, UK) concentrate on young people. What evidence reviews are high quality?

And again, it doesn't seem there is a "standard medical care" for gender dysphoria, given the expert disagreements.

Thanks.

Jdbrook talk 02:14, 10 October 2022 (UTC)

Are you disputing that the "standard medical care" for gender dysphoria is to make gender-affirming surgeries and treatments available to adults? If you are, what authorities support your contention that there is a dispute about this? No red herring, please. Newimpartial (talk) 02:28, 10 October 2022 (UTC)

Also, Jdbrook, if you are going to talk about adolescent females with mental health problems, I'm just not going to talk about that, because it is irrelevant to the reality SEBGM's "brief" was supposed to be addressing. That was, in fact, a red herring. Newimpartial (talk) 02:31, 10 October 2022 (UTC)

@NewImpartial the brief is focusing on minors. I was giving you the headers of the section. Here is more on the case:https://law.justia.com/cases/federal/appellate-courts/ca9/21-15668/21-15668-2022-03-10.html

The Amicus Brief gives evidence that "THERE IS NO MEDICAL CONSENSUS SUPPORTING BENEFICIAL EFFECTS OF MASCULINIZING MASTECTOMIES FOR ADOLESCENT FEMALES."

They specifically address "Neither the WPATH nor the Endocrine Society guidelines establish a valid standard of care for masculinizing mastectomies." Page 24.

There is the definition of youth in footnote 20 as mentioned by @TheTranarchist but this brief seems to be talking about laws for minors. They say therapy can help youth, but as far as what is accepted practice they talk about minors:

ETHICAL EXPLORATORY PSYCHOLOGICAL INTERVENTIONS ARE A COMMONLY ACCEPTED PRACTICE FOR TREATING MINORS’ DISTRESS page 28.

Going back to the question: is the argument that this Arizona case shows that SEGM opposes standard medical care for gender dysphoria?

They state why there is no standard of care for this intervention, explicitly, and more generally there are, as I said above, different criteria espoused by different experts, and a lack of consensus, more generally.

Thanks.

Jdbrook talk 04:27, 10 October 2022 (UTC)

The law applies to adults too, dance around it as much as you want, and they stated they oppose adults transitioning. Also, The Endocrine Society and WPATH opposed the ban, and I trust them more than an organization which has been critiqued and compared to NARTH for not offering any real alternatives to care apart from insisting that respecting transgender people is bad and publishing opinion pieces since they can't get in peer-reviewed journals.

This Arizona case shows that SEGM opposes standard medical care for gender dysphoria yes it does, as evidenced by actual medical organizations speaking against it. More than that, most sources referring to them contrast their positions with the actual medical organizations. See, for example, Every major medical association in the United States — including the American Medical Association, the Endocrine Society, the Pediatric Endocrine Society, the American Academy of Pediatrics, the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry — has issued statements supporting gender-affirming care for youth. Unless SEGM is on board with that, it is opposed to medical consensus. TheTranarchist ⚧ Ⓐ (talk) 04:45, 10 October 2022 (UTC)

First of all, referring to young trans men as adolescent females is offensive, POV language, and the fact that a FRINGE group used this language when lobbying state lawmakers does not make it either DUE for article space or appropriate for you to parrot in Talk space. That isn't how mainstream scholarship refers to young trans people, and so if you want to convince anyone of anything, you need to avoid using POV language.

Also, one of the issues at stake was the age limit of 21 set for gender-affirming surgery in Arizona to be covered by Medicaid. Are you denying that the SEBGM brief was filed in opposition to lowering that limit from 21? If it was, that flies in the face of standard practice for treatment of gender dysphoria, in which there is no significant debate within the relevant professional communities about the appropriateness of those 18 and over to be able to access surgery and other treatment. Newimpartial (talk) 05:45, 10 October 2022 (UTC)

initial description of SEGM

@Newimpartial why did you remove my change to the initial description of SEGM? I took it from an Associated Press article.

I had put in:

The '''Society For Evidence-Based Gender Medicine (SEGM)''' is an [[Nonprofit organization|non-profit organisation]] of health professionals who are "concerned about medical transition risks for minors."<ref>{{Cite web |date=2022-05-04 |title=Early transgender identity tends to endure, study suggests |url=https://apnews.com/article/science-health-gender-identity-79a844a84cbc3fc1ff178476cc16cf2e |access-date=2022-10-10 |website=AP NEWS |language=en}}</ref> It has been called a group that opposes standard medical care for gender dysphoria.

Do you have some citations to show that the AP description is incorrect?

The AP description did not call them an activist organization so I took that part out. And I don't see that we editors have converged on whether they oppose standard medical care for gender dysphoria because we haven't agreed there is a standard medical care for gender dysphoria, given all the disagreements between guidelines out there.

Thanks.

Jdbrook talk 03:58, 10 October 2022 (UTC)

Despite your protestations to the contrary, the only recognized treatment for gender dysphoria is transition. Conversion therapy used to be tried, until it was proved not to work and denounced by every medical organization. Unless you can point to sources that state that there is a standard care for transgender people apart from transition, opposing people's right to transition is opposing standard medical care.

The AP article mentions them briefly, the other sources go in depth and actually list what medical organizations actually believe, and how SEGM's positions are contrary to that. For example, from BuzzFeed News: Every major medical association in the United States — including the American Medical Association, the Endocrine Society, the Pediatric Endocrine Society, the American Academy of Pediatrics, the American Psychiatric Association, and the American Academy of Child and Adolescent Psychiatry — has issued statements supporting gender-affirming care for youth.

You have proposed one source, that paints an incredibly incomplete picture, while the current lead is based on 5 and reality. Hope that helps. TheTranarchist ⚧ Ⓐ (talk) 04:17, 10 October 2022 (UTC)

@TheTranarchist Actually, for recommendations which have something besides medical/social intervention:

the French National Academy of Medicine recommends psychotherapy as first line, as does

Finland (which I think someone showed you above, and I think they specifically don't have surgery below perhaps it is 18),

the risks outweigh the benefits in general for medical intervention, so only exceptional cases are treated, others no, not generally, with medical intervention (Sweden for under 18's), and the

UK is also not agreeing that the only recognized treatment for gender dysphoria is transition ( the national review of the UK's child/adolescent gender clinic, the Cass Review mentions several ways gender dysphoria can resolve including: gender dysphoria resolves without transition, settled sexuality resolves gender dysphoria, continued gender fluidity, and then they also have social and medical transition).

Psychotherapy can help resolve certain kinds of gender dysphoria which is likely why it is first line, as there is no clear test to tell when gender dysphoria isn't temporary. There are case studies showing this, composite case studies in a book on gender dysphoria, etc. The claim is not that every case of gender dysphoria will resolve with psychotherapy, but that some will, and the issue is that no one can say for certain who those "some" are. You can also see lack of clarity about how gender dysphoria for anyone will behave stated as expert opinion in the recent Reuters report: https://www.reuters.com/investigates/special-report/usa-transyouth-care/, quotations by de Vries (who is the lead author of seveal keypapers), Anderson (another leading physician in the field).

"Unless you can point to sources that state that there is a standard care for transgender people apart from transition, opposing people's right to transition is opposing standard medical care."

Your claim is that standard medical care is medical transition. The burden of proof is on you. I've given you guidelines above that do not require medical transition. They disagree with each other. I've said that there is no consensus and also given a paper for that.

Thanks.

Jdbrook talk 04:48, 10 October 2022 (UTC)

As I asked above, are you disputing that there is consensus supporting medical transition for adults, when they desire it, as the best practice for standard care for trans people? If you are, please provide some RS that gives some evidence of this dispute - the French and Finnish sources you have provided so far so not do this. Newimpartial (talk) 05:35, 10 October 2022 (UTC)

@TheTranarchist and I have quoted what AP says the organization does. You are saying it is not what it does and choosing to override the AP?

Thanks.

Jdbrook talk 05:00, 10 October 2022 (UTC)

Better sources are already used in the article. The AP is simply quoting what the organization says about itself, and that by itself does not make the self-serving and misleading description WP:DUE for inclusion in the article. Newimpartial (talk) 05:32, 10 October 2022 (UTC)

@Newimpartial I do not see that Buzzfeed's description of a group is better than the Associated Press' description of a group, that appears to be your opinion, is it not?

Thanks.

Jdbrook talk 06:17, 10 October 2022 (UTC)

Yet another revision (reverted, yet again): a description of what someone said was taken out as "opinion"

@NewImpartial You took out the following:

In August 2022, SEGM Adviser J. Mason and a co-author said that the American Academy of Pediatrics has ignored the evidence regarding medical intervention for gender dysphoria. They called the AAP out for "effectively burying" a resolution asking the AAP to do an evidence review which would bring the AAP "into line with better-informed European countries."

This is what Mason says in the article. It's an opinion article by a SEGM adviser and she is making this public statement, this is absolutely correct.

It is fine to say "SEGM member William Malone told The Christian Post in 2019 that "No child is born in the wrong body, but for a variety of reasons some children and adolescents become convinced that they were"." but not to say that a person says something in the Wall Street Journal that they actually say in the Wall Street Journal?

Please explain.

Thanks.

Jdbrook talk 04:58, 10 October 2022 (UTC)

If you think there is a reason to remove the Malone quote, then go ahead with my blessing. But I had understood that the passage in the article cited to The Christian Post was cited to actual reporting, but the bit you tried to add cited an unreliable WSJ WP:RSOPINION piece. Newimpartial (talk) 05:30, 10 October 2022 (UTC)

The WSJ piece is what Mason actually said, in the WSJ opinion piece. The Christian Post is reporting what Malone said. I have no reason to think that The Christian Post is lying about what Malone said, but if it is appropriate to list what Malone says it is appropriate to list what Mason says. And it is difficult to argue Mason is not calling out the AAP, as that is exactly what the article she co-authored is doing.

Thanks.

Jdbrook talk 06:16, 10 October 2022 (UTC)