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Were there even any randomized, non-blinded studies cited? I skimmed the references and didn't see anything. And it'd make sense that there aren't any randomized trials of puberty blockers or hormones given the emotional weight everyone puts on the issue. I'm not sure how this is relevant unless there are specific 'non-blinded studies' that aren't classified as 'high quality'.
Or maybe you're referring to a more sophisticated criticism, that these "critics" are making. What critics? Where? May we have a link?
Why make this particular criticism? How does it tie into the main claims the report makes? Can you at least outline the core of the report, what it wants to tell us and how it attempts to support those claims, before you attempt to undermine it? This is like a twitter swipe - take a thing, point out a "flaw", write like this flaw is a critical flaw, and watch as everyone's satisfied that the bad guys were wrong again, without anyone involved understanding what the thing even is.
It'd be more interesting to explain the context behind the report - the politics and medical practice in youth transgender medicine in the UK for the past few years - and then explain what the report claims, and then go into the reactions it's gotten.
If you want a criticism, I think the best one is just: There are ethical (it's conversion therapy for the control group) and methodological reasons to not do RCTs in trans youth. Given that, we need to use the evidence we have, and a standard requiring RCTs is bad.
(edited because I used the wrong link)
I'd dispute that - there's a reason high quality evidence requires RCTs, it's because history has shown that observational studies are just not reliable. If you disagree, I'd suggest picking a specific study (not review) that this review considered low-quality but you think is good enough to form part of the foundation for a medical guideline, and we can critically examine it and see if it is. I don't think there are ethical reasons to not do RCTs for trans youth that wouldn't also apply to RCTs for treatments for deadly diseases, which we do all the time when it isn't clear if the treatment is beneficial or not. I think the methodological reasons are ... significant, but (guessing) not in fact worse than the problems with observational studies.
Not only were they cited, the study that got graded "high quality" wasn't even really randomized, let alone blinded. Here's a list of all the papers the systematic review of puberty blockers looked at, and a breakdown of their grades.
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