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I picked one of your studies at random (Achille) and it is garbage. They started with about 100 people and after treatment sent them questionnaires over a period of time. If someone stopped answering the questionnaire, they were dropped from the study. This left them with 50 people. Based on that, they found improvements in depression over time (though only significantly in MtF).
There are obvious problems with this study. First, those who stopped participating may not be random. It may be those who had a hard time stopped participating precisely because the intervention failed for them.
Second, the age group was quite large and was from 2013-2018. Attitudes were different back then and therefore the cohort getting the treatment back then is different from those getting treatment today. That is, is it possible that the people getting treatment back in the mid 2010s were more psychologically stable compared to trans people in general?
Third, they relied on surgery data; not what people actually did. We should be looking for actions not words.
In short, if that is among the best evidence for so called gender affirming care the evidence is very weak; especially since the study merely looked at “mental health” and ignored physical health.
Yes, the evidence is weak. That is precisely what the authors of the meta-analysis meant by:
If you look at the "Discussion" section, you will note that most of it is dedicated to pointing out problems with the studies under review. The article also notes that de Vries, 2014 has a "serious" risk of bias and the other three adolescent studies have a "moderate" risk of bias, and of the 20 studies they looked at, only three have a "low" risk. All of this means that further research is needed (it always is), but based on the evidence we have now I think it's perfectly reasonable to adopt a working hypothesis that puberty blockers and hormone therapy are beneficial.
Your points about self-selection among participants only imply that doctors should exercise care when choosing which treatments to administer to whom. Clearly some patients do benefit from hormone therapy, therefore the therapy should not be banned.
That’s not how this works. You don’t use a study that literally cannot prove anything (ie isn’t evidence of well anything) and say we should provide life altering drugs and surgeries to kids on those ground. This is an extraordinary intervention and therefore requires extraordinary evidence. Not dogshit level evidence that shouldn’t have been published.
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