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I harp on RCTs because most of the time I read non-RCTs (in fields like healthcare and sociology with complicated and frequently opaque mechanisms) they end up utterly failing to adequately compensate for their disadvantages. Though of course this is a biased sample, I'm generally not reading studies on obvious and non-controversial subjects. It's always stuff like "we controlled for X" where X is whatever arbitrary handful of factors the authors thought of (leaving whatever residue is left as the "effect", or conversely erasing the effect with Everest controls), or "we matched with a non-random pseudo control group" (like the puberty blockers study I discussed) where we're supposed to trust how well matched they really are and there's often obvious differences between the groups. It is with good reason that in applications like clinical trials where RCTs are possible, they are considered the "gold standard" and are often required for approval by organizations like the FDA.
It's bad enough that I think anyone trying to argue the contrary needs to very specifically justify why the non-RCTs in the case in question actually work, not vaguely gesture at the fact that sometimes we can gather adequate evidence without RCTs. Otherwise I think it is very easy for people, including medical professionals, to assume that (for instance) just because 50 studies on puberty blockers have been conducted and they have become established clinical practice we now know whether they are better or worse than nothing. Sorry, 5-HTTLPR and depression had 450 studies and turned out to be completely fake, you need the very highest quality of studies to know whether the thing you're talking about is even real. There are of course plenty of ways to mess up RCTs too, the replication crisis is filled with them, but my impression whenever I see RCTs on a subject compared with non-RCTs (as in Scott's posts I linked in the prior post) is of a huge and often unbridgeable difference in baseline reliability. Sometimes conducting RCTs really is impossible (and in those cases I expect our understanding of the issue to be much worse) but if they're possible then conducting a high-quality RCT is going to be my go-to recommendation for both understanding the issue and creating evidence compelling enough that it can potentially convince others.
What do HIV and parachutes have in common? A much clearer mechanism of action. With gender dysphoria what we instead have is the murky waters of people creating narratives about their own subjective experiences based on whatever memes their culture has lying around, something people are terrible at doing accurately. Such introspection provides a wide range of insights: miracle supplements or faith-healing producing amazing boosts in well-being, subconscious reasons for your problems accessible through dream-analysis, neurasthensia, suppressed memories, etc. So yes, I'm sure you can make the case for HIV without a RCT, but that case would have to focus specifically on evidence particular to that case, my default without such evidence is to be skeptical of non-RCTs and look for the many ways they can go wrong.
By the way, based on you posting this in reply to someone else I think you mistook his posts for mine.
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