RFK Jr. embraces the science on trans kids

Health and Human Services Secretary Robert F. Kennedy, Jr. has plenty of unsubstantiated theories — but his latest controversy involves following the science. 

HHS is pushing back against so-called gender-affirming care for children under age 18, undertaking a number of regulatory actions to discourage doctors and hospitals from continuing the practice. 

As part of the effort, HHS released a review of the state of research into gender-affirming care.

The study establishes that this suite of interventions — involving puberty blockers and cross-sex hormone therapy, as well as surgery — has been justified by a bogus, ideologically driven scientific consensus. 

The HHS review can’t be dismissed as partisan hackery.

Writing in Newsweek, two co-authors of the report, Dr. Moti Gorin and Dr. Kathleen McDeavitt, note that they and most of the other co-authors are left of center. 

The seedbed of the mania for aggressive treatment of pediatric gender dysphoria was a pair of desperately flawed, but enormously influential Dutch studies.

In an important 2023 journal article, health-care researcher Evgenia Abbruzzese and her co-authors dismantled the Dutch research. 

Since gender reassignment surgery on adults wasn’t solving their mental distress, Dutch clinicians thought earlier interventions might be more successful, and seemed to get positive results. 

The sample size of the Dutch studies was very small, though, with only 55 cases, and there was no control group.

On top of this, the selection of the subjects skewed toward the positive cases, and the method of determining whether gender dysphoria had been resolved in the patients also tilted toward finding success. 

The studies had no way of determining whether purported modest psychological gains were the product of the medical interventions, or ultimately of psychotherapy or simply growing older and more mature. 

The physical downsides of the treatments, including sterility, were discounted. 

Finally, Dutch researchers excluded minors who experienced the onset of gender dysphoria around the time of puberty and who had pre-existing mental illnesses.

Since the wave of gender dysphoria over the last 10 years overwhelmingly involves minors with these characteristics, the Dutch studies — whatever their merits — don’t apply to this population. 

None of this mattered.

The Dutch research led to what Abbruzzese and her colleagues refer to as “runaway diffusion,” the rapid spread of an experimental treatment before it is thoroughly researched. 

Since gender-affirming care was believed to be an instrument of compassion and justice, contrary indications were dismissed as the handiwork of reactionaries and haters.

The “science” was supposedly settled — and it happened to validate exactly what trans activists, crusading clinicians and progressive politicians wanted to believe. 

Now, finally, the evidence is catching up.

Reviews elsewhere in the Western world of the state of the research have come to much the same conclusions as the HHS report.

The 2024 Cass Review in the UK found “we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”

The UK tapped the brakes on its medical treatments. 

Finland pulled back on its pediatric interventions in 2020.

Sweden followed suit, and so have Denmark and Norway.

These places aren’t red states full of alleged transphobes, but Scandinavian countries associated with adventurous progressive policies.

That they’ve been more clear-eyed about these matters than a United States still beholden to a fabricated consensus is a surprise and a scandal. 

Aggressive pediatric interventions have imposed real physical harms on children for speculative psychological benefits.

It makes more sense to take an approach of watchful waiting, using talk therapy and other forms of support until minors with gender dysphoria are adults and better suited make life-changing medical decisions. 

HHS is working to bring the United States in line with the trend toward more prudent practices in other advanced countries.

Still, there is fierce resistance: 19 states and the District of Columbia are suing over the new rules in hopes of preserving the status quo.

RFK Jr., to say the least, isn’t always very careful about evidence.

But on this one, the most painstaking research is on his side.

 X: @RichLowry