Given that treatment of gender dysphoria currently includes such drastic measures as the removal of healthy, functioning body parts, the protracted and experimental use of cross-sex hormones, and the permanent circumvention of the normal pubertal process, this is nothing short of scandalous.

The treatment for this particular disorder is severe: lifelong experimental medicalization, sterilization, and complete removal of healthy body parts—a treatment Dr. Ray Blanchard, one of the world’s foremost sexologists, calls “palliative.” In spite of its severity, however, medical gender transition is no longer a rarity. It is the recommended treatment for gender dysphoria, a diagnosable disorder of incongruence between one’s felt “gender” and one’s natal sex, the prevalence of which is increasing tremendously throughout the world. More and more children and adolescents are being diagnosed with gender dysphoria, and are undergoing medical treatment prior even to completing puberty.

For those who express caution or concern there is a familiar retort: “Trust the experts.” If you don’t, “you’re a bigot.”

This argument, however, makes a mockery of the fact that three of the most influential sex researchers of the last couple decades—Ray Blanchard, Michael Bailey, and the recently vindicated Ken Zucker—all have problems with the affirmation-only transition narrative that is currently being promoted. You could add to this list names like James Cantor, Eric Vilain, Stephen Levine, Debra Soh, and Lisa Littman.

I invite you to look with me at the data that these and other researchers draw from. What does the peer-reviewed research say about the effectiveness of medical transition for gender dysphoria? Do puberty blockers, cross-sex hormones, mastectomies, vaginoplasties, and phalloplasties successfully alleviate the mental and emotional distress that gender-dysphoric persons face? Findings are varied, as are the political and philosophical perspectives of the researchers; but a careful reading of the literature demonstrates that the best studies show the worst outcomes for those who undergo medical transition.

The mainstream narrative often says that medical transition is well-studied, and that there is academic consensus on its effectiveness. In reality, the literature is fraught with study design problems, including convenience sampling, lack of controls, cross-sectional design, small sample sizes, short study lengths, and enormously high drop-out rates among participants. Very few studies on transition escape these issues. For example, a 2018 systematic review of quality-of-life studies of transitioned adults rated only two out of twenty-nine studies as high-quality.

Two of the largest issues are study length (time since treatment) and lost-to-follow-up rates. It is well recognized in the literature that the year after medical transition is a “honeymoon period,” which “does not represent a realistic picture of long-term sexual and psychological status.” At what point, however, does a patient’s psychology stabilize? After three years? Five years? Ten years? And at what level? Given that pre-pubertal children are being administered cross-sex hormones (at twelve years old) and undergoing surgeries (at thirteen years old), and that this transitioned experience may span sixty to eighty years of their lives, shouldn’t we know whether outcomes are positive after ten years?

Complicating study lengths is the issue of follow-up. Many researchers state that, once 20 percent of a study’s participants are lost to follow-up, there are significantly detrimental effects to the study’s reliability. One study investigated those who were lost to follow-up for another surgical procedure and concluded that “patients with problems are likely to avoid follow-up.” Transgender advocates have pointed to a large 2015 German study that shows positive long-term outcomes for those who transition. However, the study has a 49.3 percent lost-to-follow-up rate, raising enormous questions about how almost half the initial group fared.

Three long-term studies have addressed the problem of follow-up loss by looking at objective measures from national registry data. These studies have either no loss, or extremely low loss to follow-up, and so they supply what may be missing in many other studies.

The largest and longest of these, a Dutch study in 2011 of those on cross-sex hormones, found that, while outcomes for the female-to-males seemed generally positive, for the much larger male-to-female group—72.6 percent of the total—“total mortality was 51 percent higher than in the general population, mainly from increased mortality rates due to suicide, acquired immunodeficiency syndrome [AIDS], cardiovascular disease, drug abuse, and unknown causes.” The timing of the suicides also provides important information. None occurred within two years of treatment, but “there were six suicides after two to five years, seven after five to ten years, and four after more than ten years of cross-sex hormone treatment”.

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