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This is an old revision of this page, as edited by Jdbrook (talk | contribs) at 01:19, 5 January 2023 (→initial description of SEGM: Reply). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

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)[reply]

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)[reply]
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)[reply]
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)[reply]
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)[reply]
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)[reply]
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)[reply]
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)[reply]
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)[reply]
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)[reply]
@Justdad78 Here is a source that describes the translation, attributes to the Society for Evidence Based Gender Medicine, it's a publication based in Ireland. https://gript.ie/gender-reassignment-of-children-experimental-practice-finnish-health-authority/
Thanks.
Jdbrook talk 22:04, 10 October 2022 (UTC)[reply]
@Jdbrook: Just to note, Justdad78 is currently indefinitely blocked, and has expressed that he will not be returning to Wikipedia editing.
I'll also point out that Gript does not appear to be a reliable source, and seems to publish either only opinion articles, or make it so that it is impossible to distinguish non-opinion articles from the opinion articles. Sideswipe9th (talk) 22:17, 10 October 2022 (UTC)[reply]
That's a source, yes, but I believe Justdad was challenged to find a reliable source. Newimpartial (talk) 22:19, 10 October 2022 (UTC)[reply]
@Sideswipe9th Thank you for the info about justdad78 and Gript, it does indeed seem unreliable, I didn't find that page about Gript earlier or I'd not have suggested it. Thank you both. Jdbrook talk 01:43, 11 October 2022 (UTC)[reply]
No worries. This sort of issue, trying to identify if a source is or is not reliable, is why talk page discussions are always recommended in controversial content areas such as this one. Sideswipe9th (talk) 02:13, 11 October 2022 (UTC)[reply]

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)[reply]

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)[reply]
@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)[reply]
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)[reply]
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)[reply]
@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)[reply]
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)[reply]
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)[reply]
@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)[reply]
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)[reply]
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)[reply]
@TheTranarchist@Newimpartial
You are claiming SEGM goes against the standard of care. They have given evidence and I have given evidence that there is no agreed upon standard of care. They have in fact detailed issues with WPATH and the Endocrine Society guidelines and said there is no consensus and again, I've given you several guidelines.
You can repeat that you prefer some professional societies over the Swedish National Board of Health and Welfare, its counterpart in Finland, the UK review of the gender care services in the largest pediatric gender clinic in the world, and the recommendations of the French National Academy of Medicine, but that doesn't mean there is consensus.
There are several standards. Many prioritize psychotherapy, which does in fact help some kinds of gender dysphoria resolve and helps to try to figure out what kind one is dealing with. There is more than one treatment for gender dysphoria, and similarly, there are ways of being trans identified which are temporary.
Repeating that one prefers WPATH and the Endocrine Society or that 18-21 for WPATH is recommended for a certain treatment doesn't change this.
Thanks.
Jdbrook talk 06:40, 10 October 2022 (UTC)[reply]
Re: Repeating ... that 18-21 for WPATH is recommended for a certain treatment doesn't change this. - actually, if there is general agreement within the community of practice worldwide that surgery and supplementary treatments should be available for those 18-21, then that does indeed change this, because it means that in spite of the WP:FUD you are sowing on their behalf, SEBGM's detailed issues with WPATH do in fact mean that it goes against the standard of care for transgender adults in particular. And this is, in fact, one of the things the WP:RS reliable sources say about SEBGM. Newimpartial (talk) 11:19, 10 October 2022 (UTC)[reply]
"Standard medical care" is vague and seems to have a degree of country-relativeness, which can confuse international readers; we should specify what treatments they oppose and who in turn opposes SEGM's position. Crossroads -talk- 22:04, 10 October 2022 (UTC)[reply]
@Newimpartial @Crossroads I have a suggested sentence:
SEGM objects to the new WPATH SOC8 guidelines (https://www.medscape.com/viewarticle/964604)
This states one guideline that SEGM disagrees with, it is specific and it has a reliable reference (Medscape).
Instead of "a group that opposes standard medical care for gender dysphoria"
Thanks.
Jdbrook talk 03:14, 14 October 2022 (UTC)[reply]
Doesn't that imply that SEGBM's objections are specific to WPATH SOC8? Because that doesn't appear to be the case... Newimpartial (talk) 03:24, 14 October 2022 (UTC)[reply]
@Newimpartial that lists a set of guidelines (to be accurate the draft, but it is a sweeping statement) that SEBGM disagrees with, and has a clear reference. One could say what it is concerned about more generally, e.g.,
"SEGM member Roberto D’Angelo said the group was concerned with the “low quality of evidence” in gender-affirming treatment." https://www.buzzfeednews.com/article/avivastahl/transgender-trans-kids-healthcare-science and the list below.
This says exactly which rules for care it disagrees with, otherwise one is back to arguing about which medical care is "standard". It also disagrees with the American Academy of Pediatrics, it seems, according to the op-ed by a SEBGM Advisor in the WSJ which I am still trying to argue is a good reference for an activity of SEBGM. This is what the WSJ op-ed says:
"The AAP has ignored the evidence that has led Sweden, Finland and most recently the U.K. to place severe restrictions on medical transition for minors. The largest pediatric gender clinic in the world, the U.K.’s Gender Identity Development Service, was ordered to shut down in July after an independent review expressed concerns about clinicians rushing minors to medical transition. Medical societies in France, Belgium and Australia have also sounded the alarm. The U.S. is an outlier on pediatric gender medicine"
Thanks.
Jdbrook talk 04:03, 14 October 2022 (UTC)[reply]
WP:RSOPINION material is not DUE unless discussed in independent sources, as a rule. And as far as Buzzfeed, you have chosen a sentence that is fairly tangential to the source article as a whole, have you not? Why have you done that? Newimpartial (talk) 04:52, 14 October 2022 (UTC)[reply]
I would go with something like "SEGM opposes [X] treatment for gender dysphoria in children, a position that is in turn opposed by [Y]." Crossroads -talk- 16:09, 14 October 2022 (UTC)[reply]
@Crossroads I agree with this.
Jdbrook talk 02:26, 10 November 2022 (UTC)[reply]

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)[reply]

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)[reply]
@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)[reply]
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)[reply]
@Newimpartial The Finnish guidelines are for under 25. Not under 18.
Thanks.
Jdbrook talk 06:18, 10 October 2022 (UTC)[reply]
So are you saying that because the Finnish guidelines take a different position, that therefore there is no consensus in the relevant professional community for the availability of surgery to trans people age 18-25? Newimpartial (talk) 11:26, 10 October 2022 (UTC)[reply]
@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)[reply]
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)[reply]
@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)[reply]
Where AP is parroting the group's misleading self-description, yes. But scholarly sources are better. Newimpartial (talk) 11:24, 10 October 2022 (UTC)[reply]
@Newimpartial your current stance seems to be that if an organization agrees with with the group calls itself, that it is misleading. This will restrict you to sources which disagree with what the group claims it is doing, as well as violating WP:NPOV . The Associated Press is a reliable source and thus should be quoted. Currently it is violating WP:NPOV.
The other references for those first three sentences are Buzzfeed News, CBS Miami, The Advocate and Medpage today. The Economist is also quoted, however, it does not support those sentences, in fact it says that different guidelines disagree (Europe vs. America section, for instance). Jdbrook talk 21:54, 10 October 2022 (UTC)[reply]
No, I am not automatically disqualifying sources that accept SEBGM at face value. However, it is clearly a minority of sources that do so in their own editorial voice. Newimpartial (talk) 22:10, 10 October 2022 (UTC)[reply]
@Newimpartial None of the statements at the top report what SEBGM says it does, what AP says it does, what the Economist says it is, or what Medscape says it does. An accusation against it is the second sentence and its non-recognition as a scientific organization (what does that mean??) is the third sentence. (Does it claim anywhere on its web pages that it is a scientific organization?)
Instead an "accusation" is listed with high priority--even there, in the article saying an accusation, following the link to its Buzzfeed source, it says "SEGM member Roberto D’Angelo said the group was concerned with the “low quality of evidence” in gender-affirming treatment." https://www.buzzfeednews.com/article/avivastahl/transgender-trans-kids-healthcare-science
How many references are required for this information to actually appear in Wikipedia?
"The Society for Evidence-Based Gender Medicine, a nonprofit group of health professionals who are concerned about medical transition risks for minors"--https://apnews.com/article/science-health-gender-identity-79a844a84cbc3fc1ff178476cc16cf2e Associated Press
"Mason is a clinical advisor to SEGM, an organization set-up to evaluate current interventions and evidence on gender dysphoria." https://www.medscape.com/viewarticle/964604 Medscape Medical News
"the Society for Evidence-Based Gender Medicine, an international group of doctors and researchers." https://www.economist.com/international/2020/12/12/an-english-ruling-on-transgender-teens-could-have-global-repercussions Economist (agreed, not as descriptive as the other two)
"We are an international group of over 100 clinicians and researchers concerned about the lack of quality evidence for the use of hormonal and surgical interventions as first-line treatment for young people with gender dysphoria. We represent expertise from a range of clinical disciplines.
Our objectives include evaluating current interventions for gender dysphoria, providing balanced evidence summaries, promoting the development of effective and supportive psychosocial approaches for the care of young people with gender dysphoria and generating good, answerable questions for research.
Young people with gender dysphoria deserve respect, compassion, and high quality care. Please join us in our mission to promote evidence-based care for children, adolescents, and young adults that prioritizes life (i.e. measures of mortality), quality of life, long-term outcomes, and fully informed consent. SEGM is free from political, ideological, religious, or financial influences." https://segm.org/about_us SEBGM itself
And for the misinformation claim, SEBGM is saying the evidence is low quality, which is what all the evidence reviews are saying, and why several countries have changed their policies drastically. The op-ed in the WSJ that somehow is not a SEBGM activity (see discussion below) is exactly about this issue.
This page does not appear to be an accurate representation of this organization: its stated goals are not even listed anywhere, even though high quality publications like AP and Medscape believe them and report them and the Economist uses them as a source.
Thanks.
Jdbrook talk 03:53, 14 October 2022 (UTC)[reply]
Why are you only quoting from sources sympathetic to the organization? Are you unable to find more mainstream sources? Newimpartial (talk) 04:50, 14 October 2022 (UTC)[reply]
Medscape and AP are as mainstream as it gets. We don't define "mainstream" based on POV or as "agrees with anti-gatekeeping activists". Crossroads -talk- 16:08, 14 October 2022 (UTC)[reply]
I find it difficult to believe that this article represents a mainstream view. Newimpartial (talk) 16:12, 14 October 2022 (UTC)[reply]
@Newimpartial @Crossroads Medscape is a mainstream medical journal. Sources are just being dismissed because of their content.
I really don't know what to say.
This Medscape article is being thrown out because an editor doesn't think this Medscape article is representing a mainstream opinion of what SEBGM is? Is the article about what some people think SEBGM is or what it is? AP is being thrown out for what SEBGM is but quoted otherwise. Buzzfeed quotes a member saying that the group is concerned with low quality evidence. This is not mentioned either.
There are repeated sources saying that SEBGM is concerned with the quality of evidence behind these medical treatments. By the group itself, by others. This is not being mentioned.
Currently this page does not say what SEBGM does besides the incorrect claim that it disagrees with standard medical care for gender dysphoria, as there is no standard medical care, there are a wide diversity of approaches. I gave an article that has someone from SEBGM saying that WPATH is not doing evidence based care. This would be a correct statement, where SEBGM disagrees with a policy.
(Some other countries are doing evidence reviews, and putting together policies based on them, that would be evidence based medicine. Is SEBGM against them?)
So the lead is currently this incorrect statement about the group and then an accusation about it (what misinformation is it spreading in particular??) and then a claim that it is also not recognized as a scientific organization (who recognizes scientific organizations? who gets to decide this?)?
"The Society For Evidence-Based Gender Medicine (SEGM) is an activist non-profit organisation and group that opposes standard medical care for gender dysphoria. The group has been accused of spreading misinformation about gender dysphoria and gender-affirming care. It is not recognized as a scientific organization."
This doesn't actually tell you what SEBGM does.
Another questionable statement:
"In Texas, Attorney General Paxton cited SEGM's statement that "childhood-onset gender dysphoria has been shown to have a high rate of natural resolution, with 61-98% of children reidentifying with their biological sex during puberty" in a bill that would restrict gender-affirming care for transgender youth. However, the statistic is cited from a paper which showed a strong association between the intensity of a child's dysphoria and its persistence."
The 61%-98% statement is a standard result from a review article by Ristori & Steensma (2016), because....the group is quoting the evidence. The second sentence is a non sequitur. What is it doing there? What does the "however" imply, did SEBGM say something incorrect?
Ditto:
"In April 2022, the Florida Department of Health wrote a memo which misrepresented the scientific consensus to stop minors in the state from socially or medically transitioning and cited Malone."
There isn't a "scientific consensus."
And they cited Malone for what exactly? Here is the memo: https://www.floridahealth.gov/_documents/newsroom/press-releases/2022/04/20220420-gender-dysphoria-guidance.pdf As far as I can see it quotes medical research and evidence reviews.
Why didn't the Wikipedia page actually link to the memo? I would put the actual link in now except then the whole sentence doesn't make sense, because I don't see Malone cited anywhere in the memo.
"The U.S. Department of Health and Human Services stated "gender-affirming care for minors, when medically appropriate and necessary, improves their physical and mental health. Attempts to restrict, challenge, or falsely characterize this potentially lifesaving care as abuse is dangerous.""
SEBGM criticized the US department of Health and Human services for not using the evidence when it made these statements. That would be accurate to report. So did Florida, in the memo.
To summarize what is listed under activities:
  1. A quotation from one adviser in the Christian Post. (But a quotation from an adviser in Medscape has been rejected.) Also a sentence about social transition making gender dysphoria persist, attributed to an SEBGM member, from the AP article which was not considered ok to say what SEBGM is. The AP did not give all the research references because it is a newspaper article. There's an insinuation this statement by Malone is false, is it false?
  2. Quoting legislation saying that SEBGM says something, and then someone else saying what the legislation quotes SEBGM for is not supported.
  3. Quoting Mallory Moore's blog for what the world's leading scientific bodies think. And the controversial CAAPS statement.
  4. Quoting SEBGM for something (accurate) in a review article in the literature and then a non-sequitur about an association--is this implying SEBGM said something incorrect? Did SEBGM say something incorrect?
  5. A description of a memo that supposedly quotes Malone, but it doesn't, here is the memo: https://www.floridahealth.gov/_documents/newsroom/press-releases/2022/04/20220420-gender-dysphoria-guidance.pdf And an opinion by a Florida paper about the Florida Board and SEBGM. The description of SEBGM by Associated Press and Medscape are not, for some reason, acceptable for the page, just this opinion by a Florida paper.
For each, there are issues:
(1) What is quoted and not quoted is not consistent with what else has been allowed on the page.
(2) Is one group criticizing another group for what SEBGM supposedly said.
(3) Why is this blog being quoted? Is this a reliable source?
(4) the "however" statement should be dropped. Yes, SEBGM was quoted for something in a research article, likely from its pages which have information on studies. That is correct. The other sentence just seems to be insinuating something?
(5) The statement about the memo is just incorrect and should be dropped. I see no reason to include the Florida opinion and not include those of AP or Medscape or others.
Some accurate statements about what the group is and does include:
SEBGM is "a nonprofit group of health professionals who are concerned about medical transition risks for minors" (AP)
SEBGM Advisor Mason has criticized the WPATH SOC8 draft saying " it is not evidence based." (Medscape)
SEBGM criticized the US HHS for not using evidence when it wrote its policies.
SEBGM Advisor Mason has co-written an editorial in the Wall Street Journal calling for a review of the evidence by the American Academy of Pediatrics. (Wall Street Journal)
Thanks.
Jdbrook talk 13:21, 20 October 2022 (UTC)[reply]
Jdbrook, I think we need to start by evaluating your premise that there is no standard medical care for gender dysphoria. What is the basis for this claim? It doesn't seem to fit the available sources. If your position is that there isn't a standard because SEGBM (and its Genspect allies) defy the standard upheld by the vast majority of relevant professional bodies, that seems pretty PROFRINGE to me. Newimpartial (talk) 13:48, 20 October 2022 (UTC)[reply]
Showing there is a standard is where the burden of proof lay, and it must be cited to MEDRS.
Frankly the entire article suffers from the issue of being in a weird limbo where because it is ostensibly just about an organization, it cites non-MEDRS and activist sources that we would never allow on articles about gender dysphoria itself. However, MEDRS applies to all medical claims. And the topic is difficult because there are striking and severe differences between national intelligentsias and media-classes on this matter (and some others). What one country considers mainstream another condemns as the views of misinformed rednecks and fundamentalists.
I don't know where we go from here. I suggest trying to edit the article to improve it where possible; we may need an RfC on the first sentence. Crossroads -talk- 23:20, 21 October 2022 (UTC)[reply]

Are you suggesting that WPATH is a non-MEDRS source for standards of care for gender dysphoria? That sounds like an EXTRAORDINARY claim that should not be taken seriously without evidence.

Also, while you have previously asserted that claims that aren't high quality MEDRS to begin with need higher quality MEDRS to offer criticism of them, I haven't seen any convincing evidence of community support for that view.Newimpartial (talk) 23:30, 21 October 2022 (UTC)[reply]

I never suggested that. WPATH is a MEDRS, among many others. We should be focusing on that class of sources. Any sort of medical claim needs a MEDRS, yes. There is no exemption for 'debunking'. Many poorly sourced incorrect claims are not noteworthy to begin with. Further use of in-text attribution and more specificity, especially in the lead sentence, can also help. Crossroads -talk- 00:01, 22 October 2022 (UTC)[reply]
So which of the claims SEBGM makes has sufficiently high-quality sourcing that they should be presented (with attribution) in article text? I assume that the RSOPINION and legislative submission content don't make the grade; am I right?
(And lest you accuse me of straw-goating you in my previous comment, I will point out the many discussions on Talk:ROGD where you have insisted that higher quality MEDRS references be used to debunk claims than the sources that made the claims in the first place. I am not by any means fabricating that, and will happily present the relevant diffs if that is important to anyone.) Newimpartial (talk) 00:12, 22 October 2022 (UTC)[reply]
@Newimpartial You keep asking the same thing over and over again. There are several different protocols in use for treating gender dysphoria. Which I have listed: Finland, Sweden, the UK's new guidelines, above. Now as of last week Florida, after an evidence review, and then WPATH and then the affirmative model which is not the same. If you agree with one, you disagree with the other. France is arguing to prioritize psychotherapy too. References are above. So you can say something is standard but it is not agreed upon. Whose standards?
As far as high quality sourcing, none of the medical evidence in this field is high quality, and very little is moderate quality, that is what the evidence reviews find. From the Endocrine Society to the UK NHS/NICE review to Sweden to the review of evidence reviews by experts at McMaster (home of evidence based medicine) that was commissioned by Florida. That is in fact the reason for the policy changes in these countries.
As for quality sources as to what SEBGM is, AP, Economist, Medscape are not ok for some reason...
I appreciate @Crossroads for looking at this too.
I believe the Wikipedia approach for trying to find what is accurate is not succeeding for this page.
Thanks.
Jdbrook talk 02:36, 10 November 2022 (UTC)[reply]
Re: That is in fact the reason for the policy changes in these countries - I think you would be hard pressed to find indeoendent sources supporting your claim that recent changes in Florida or in the UK were based primarily on evidence based medicine. But some day, some way I hope that you will indeed produce such sources - which have clearly eluded you so far. Newimpartial (talk) 02:48, 10 November 2022 (UTC)[reply]
@Newimpartial
The UK changes were recommended by the Cass Review made after they got results from two evidence reviews: https://cass.independent-review.uk/nice-evidence-reviews/
The Florida changes were made after doing an evidence review (more precisely a combination of evidence reviews, which also evaluated the quality of earlier evidence reviews): https://ahca.myflorida.com/letkidsbekids/docs/AHCA_GAPMS_June_2022_Attachment_C.pdf
Both of these reviews found the evidence to be low or very low certainty or quality, i.e., the studies cannot be used to reliably estimate outcomes. Given that the benefits cannot be established and the risks are significant, both the UK and Florida put restrictions on these medical interventions. Sweden did the same, it is not included in the Florida synthesis of reviews (by a professor at McMaster, which is where evidence based medicine was developed), because it was not in English, but here is its summary of recommendations: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf The summary is in English.
Here is a salient quotation:
"For adolescents with gender incongruence, the NBHW deems that the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases. This judgement is based mainly on three factors: the continued lack of reliable scientific evidence concerning the efficacy and the safety of both treatments [2], the new knowledge that detransition occurs among young adults [3], and the uncertainty that follows from the yet unexplained increase in the number of care seekers, an increase particularly large among adolescents registered as females at birth [4]."
They did the evidence reviews and then constructed their policies in response, that is how you do evidence based medicine.
The AAP seems to have refused to do an evidence review in preparation for their new guidelines https://www.medscape.com/viewarticle/979262 and its previous guidelines (Rafferty et al. 2018) were based on misquoting the evidence (see the peer reviewed article by Cantor, https://pubmed.ncbi.nlm.nih.gov/31838960/ ). And if you try to argue as some have in court that he hasn't treated gender dysphoric children, note that whether the AAP misrepresented its sources or not is independent of who checks, if they are doing it correctly.
Notably, the evidence review based and thus evidence based guidelines diverge from those of the AAP. That is, there is not a consensus right now.
Thanks. Jdbrook talk 01:19, 5 January 2023 (UTC)[reply]

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)[reply]

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)[reply]
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)[reply]
Please read WP:RS and WP:RSOPINION. Whatever Malone said that isn't repeated in independent sources is unlikely to be due for inclusion in WP article. Newimpartial (talk) 11:23, 10 October 2022 (UTC)[reply]
@Newimpartial this section is about activities of the Society for Evidence Based Gender Medicine.
The essay in the WSJ co-authored by adviser J. Mason is one such activity. What is your basis for claiming that the article in the WSJ written by someone on the board of the Society for Evidence Based Gender Medicine is not an activity that Wikipedia should report?
Thanks.
Jdbrook talk 21:57, 10 October 2022 (UTC)[reply]
It is only an activity Wikipedia should report insofar as it is covered in independent, reliable sources. Wikipedia editors are not supposed to engage in WP:OR about SEBGM's success or otherwise in using media and professional bodies to spread its message. Newimpartial (talk) 22:08, 10 October 2022 (UTC)[reply]
What is your basis for claiming that the article in the WSJ written by someone on the board of the Society for Evidence Based Gender Medicine is not an activity that Wikipedia should report? It's a question of WP:WEIGHT and WP:OR. Per policy, Wikipedia articles are based primarily on reliable, secondary sources, as secondary sources are needed to establish notability and avoid novel interpretations of primary sources. Mason writing an op-ed in the Wall Street Journal is inherently a primary source, and doesn't give us any information about how that statement has been regarded by the author's peers. Of the many words in Mason's op-ed, why is his comments on the AAP noteworthy? We cannot tell that from a primary source.
In the case of William Malone, if you check the citations you'll see that we never cite Malone's contributions to The Christian Post directly. We only do so via reliable secondary sources; BuzzFeed News and an ABC affiliate station. Those secondary sources provide us with some information to contextualise which parts of Malone's interview with The Christian Post were noteworthy to others. That said, it's definitely a weaker paragraph and seems out of place in the activities section. Sideswipe9th (talk) 22:11, 10 October 2022 (UTC)[reply]
@Sideswipe9thThis section is about activities of SEGM. A WSJ editorial by a SEGM Advisor is relevant as it is a SEGM activity. The op-ed is entitled "The American Academy of Pediatrics’ Dubious Transgender Science," so yes, the AAP is the focus of the article.
Primary and secondary arguments for medical information are very different than talking about what an organization stands for or supports publicly. These are statements Mason plus co-author chose to appear in one of the most influential publications in the United States under their names. Asking that someone else tell you that Mason said these things in this op-ed, i.e., a secondary, is there actually any reason to doubt that Mason did not write these things?
Thanks.
Jdbrook talk 03:06, 14 October 2022 (UTC)[reply]

Rewording the lead: "accused" of spreading misinformation

Can we just describe them as as spreading misinformation in the lead? From just the content in this article, they:

1) Claim it's not conversion therapy when you do it to trans people (despite every medical organization in the world disagreeing)
2) Claim ROGD exists and use it as a basis for attacking transgender rights, when it doesn't and medical orgs agree it shouldn't be used
3) Claim most kids with dysphoria grow out of it, despite that having been debunked numerous times and the study they base it off even making a pretty large caveat
4) Have been described as spreading medical misinformation (or even pseudoscience) by multiple other researchers in the field, reliable scientific sources, and reliable sources in general.

Generally speaking, that they spew misinformation is pretty agreed upon by reliable sources and per WP:FRINGE we should describe it as such instead of making a false equivalency with "accused of spreading misinformation" and leaving whether or not it's misinformation up for question.

Would it be better to just update that portion of the lead to The group is known for spreading misinformation about gender dysphoria and gender-affirming care or a more detailed The group is known for spreading misinformation about gender dysphoria, gender-affirming care, and the scientific evidence base concerning transgender healthcare. They have mischaracterized current clinical best practices, supported the discredited theory of rapid onset gender dysphoria, and claimed that conversion therapy can only be applied to LGB people, not transgender people. SEGM is routinely cited in anti-trans legislation and court cases, sometimes testifying directly? TheTranarchist ⚧ Ⓐ (talk) 21:04, 31 October 2022 (UTC)[reply]

I've updated the language to be more clear about what they do. Skyerise (talk) 16:06, 15 November 2022 (UTC)[reply]
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