Talk:Puberty blocker/Archive 2

Intro edit war
The following paragraph in the lead of this article is relatively new and clearly a point of contention:

"The use of puberty blockers in transgender youth has also been challenged on ethical and medical grounds, causing controversy over the legality of their use in certain jurisdictions."


 * 1) This is a prime example of weasel words, where the nature of the "challenges" is obscured so that the reader is not able to understand them or appraise their legitimacy in any way.
 * 2) While the paragraph is overly vague and uncited, editors have argued in their edit notes that further explanation and citation is available in the "Legal and political challenges" section. Problem is, that section likewise weasels around who these opponents are, with statements like, "some opponents argue...". It doesn't name any particular opponent who may be deemed authoritative on the matter who opposes them, nor does it make clear why the opponents should be deemed credible or noteworthy in the first place. Most of the citations given are from popular magazine articles, or one pediatrician's article co-authored by a "part-time paediatrician [and] church youth worker", and a retiree. The only opponent who is actually named is Michael Biggs, a sociologist and political campaigner on trans issues.
 * 3) The Manual of Style was cited as an excuse for there being no citations given in this lead paragraph. However, other lead paragraphs in this article do provide citations, and the Manual of Style itself explicitly says, "Complex, current, or controversial subjects may require many citations [in the lead]".
 * 4) "Do not violate WP:Neutral point of view by giving undue attention to less important controversies in the lead section." It should go without saying that an article cannot just tout one side of a heated political debate in the lead. Any such statements need to be balanced in the interest of NPOV. The "Legal and political challenges" section actually discusses both proponents and opponents alike, but this intro paragraph, which supposedly summarizes it, clearly does not.

While it may be fair to bring up the political controversy in the lead, these issues must be addressed while doing so:


 * 1) Clearly state who the "opponents" are and the nature of their "challenges". Note that opponents have lost appeals and injunctions in court, so that the medications remain legal.
 * 2) Provide citations for claims about the controversy.
 * 3) Include an equivalent summary of the proponents.

Until those conditions are met, this paragraph should not be included in the lead at all, as it violates NPOV and misleads readers.

—Uiscefada (talk) 04:51, 11 March 2022 (UTC)
 * One of the editors who restored it was, so I'll ping them. As for citations, while it is true that the rest of the lead has them, that is a reason to cite this material (or a revised version) instead, not remove it entirely. I'll likely reply more in the future. Crossroads -talk- 05:48, 11 March 2022 (UTC)
 * Thank you, Crossroads. I was awaiting further response from either you or Equivamp before commenting again, but since an IP came along to resume the edit war (and cited this talk page as justification to do so), I must need to clarify:
 * The sentence in its current form is not so essential as to override the need to reach a consensus about it before re-adding it to the lead. It should remain out of the article until the discussion here has had opportunity to run its course.
 * Thank you. — Uiscefada (talk) 01:27, 12 March 2022 (UTC)
 * Without commenting on the formulation of the sentence, as I'm still forming an opinion on it, I will say that any formulation of this sentence will be contentious. Per MOS:LEADCITE The verifiability policy advises that material that is challenged or likely to be challenged, and direct quotations, should be supported by an inline citation. (emphasis mine), as such an inline citation is required here. Sideswipe9th (talk) 01:32, 12 March 2022 (UTC)
 * I have restored it with inline citations taken from the body of the article. Certainly the lede needs a summary of what makes up roughly half this article, but I agree that controversial or contentious material should have inline citations everywhere it is included. Endwise (talk) 08:22, 12 March 2022 (UTC)
 * Re: Newimpartial: this stuff makes up about half the article. It certainly needs some summary in the lede. Endwise (talk) 04:43, 13 March 2022 (UTC)
 * Well, the article as a whole just keeps getting worse and worse. Perhaps if we achieve balance in the article we can then achieve balance in the lead. Newimpartial (talk) 04:50, 13 March 2022 (UTC)
 * No one denies we should address the controversy in the lead somehow. The issue is with how it's done. No summary is better than a bad one. I think several editors have made clear the sentence should not be in the article at this point. We need to rewrite a suitable replacement.
 * I appreciate that you added citations, but that is only one step towards addressing the issues already outlined above. Uiscefada (talk) 04:59, 13 March 2022 (UTC)
 * Fair enough. For instance I see that the body of the article spends a decent amount of space documenting responses in the medical literature to the ethical/medical challenges that have been raised, which the previous lede text had not mentioned. Endwise (talk) 05:18, 13 March 2022 (UTC)
 * On a related note, the medical organisation policy changes section makes reference to the initial decision in Bell v Tavistock and the effect it had internationally in Sweden. However in doing so it gives greater weight and word count to the initial decision than the appeal, despite the appeal nullifying the judgment stating that the High Court should not have issued the guidance in the original ruling. While the impact on policy at the Karolinska Institute remains, we should make clearer what the appeal actually said as it has more weight than the initial judgement from a legal standpoint. Sideswipe9th (talk) 01:39, 12 March 2022 (UTC)
 * Since there has been little movement on this so far, I will go ahead and write a draft for people to consider:
 * "Although opposed by some pediatricians,[1] American Academy of Pediatrics policy states that puberty blockers may be indicated as part of gender-affirming care.[2] Peer-reviewed medical journals like The Lancet likewise note that clinician consensus is moving away from limiting access to hormone treatment based on chronological age.[3][4]"
 * "A lawsuit in the UK,[5] as well as a number of state-level bills[6][7] and directives[8] in the U.S., have sought to ban the use of puberty blockers in gender-affirming care. These efforts have so far not succeeded in court.[9][10][11]"
 * References:
 * Giovanardi (2017) (already in article)
 * Rafferty (2018) (already in article)
 * The Lancet (2018)
 * Ashley (2019)
 * BBC (2020) (already in article)
 * AP 2021 (already in article)
 * ABC News (2022)
 * Spectrum News 1 (2022)
 * The Guardian (2021)
 * NBC News (2021)
 * Bloomberg (2022)

— Uiscefada (talk) 23:49, 13 March 2022 (UTC)
 * This is better, though I think it would be good to explain why some pediatricians/bioethicists/politicians/whoever oppose it, even if it is just a very short explanation. Also I would replace gender-affirming care with the wikilinked transgender health care, as that is what our article on it is called. The court decision in the UK was overturned, but in Arkansas and Texas the laws are in the books but on hold while legal challenges to the bills are litigated. In the UK it makes sense to say it didn't succeed, but in the US it remains to be seen whether those laws will succeed in court. Endwise (talk) 01:47, 14 March 2022 (UTC)
 * 1. Explaining the objections:
 * I don't think we can effectively summarize the opposition's arguments in the lead. They raise a large number of objections, which only incidentally deal with the use of puberty blockers. They effectively disagree with children undergoing gender-affirming care in general, and puberty blockers are an intensification of this process that they already disagree with for an array of reasons.
 * The only puberty-blocker-specific argument they have is the potential side-effects and need for more research on them. But this is not one of their main objections, and that is also a point that the proponents agree with (so that alone isn't a reason to support/oppose them).
 * Also, if we explain the opposition's arguments in the lead, we would need to do the same for the proponents. At that point it's no longer a brief introduction.
 * I think these issues just need to be dealt with further down in the article.
 * 2. "Gender-affirming care":
 * "Gender-affirming care" is not the same as transgender health care, it's a specific subset of it. It's one approach to trans pediatrics, in contrast to the "wait-and-see" (a.k.a. "Dutch") approach. I think we need to use this term that the literature and pediatricians are using, otherwise we are stripping the discussion of puberty blockers from their proper context. Puberty blockers aren't just prescribed in isolation as some standalone medication, which is why it's not just "transgender health care". They are being indicated by pediatricians as a part of this specific, comprehensive approach to treatment.
 * We can, however, still link to the transgender health care article. But it doesn't look like that article actually names or explains what gender-affirming care is.
 * 3. Court cases:
 * I was aiming for brevity, but maybe we can say it more like this:
 * "There have been a number of efforts to ban the use of puberty blockers as part of gender-affirming care. One lawsuit in the UK which resulted in a ban was ultimately overturned on appeals. In the U.S. there are multiple state-level bills and one governor's directive banning puberty blockers, all of which have been stayed pending judicial review."
 * — Uiscefada (talk) 03:10, 14 March 2022 (UTC)
 * That all makes sense to me, I'd be happy to sign off on that then. Endwise (talk) 03:21, 14 March 2022 (UTC)
 * Alright, I think we can add it to the article then if no one else has any issues with it. Maybe just wait a day or so to see. — Uiscefada (talk) 03:31, 14 March 2022 (UTC)
 * I think we need to retain the term "gender-affirming care", since this is the main term used by both mainstream RS supporting it and by its opponents. Newimpartial (talk) 02:45, 14 March 2022 (UTC)
 * Although opposed by some pediatricians,[1] American Academy of Pediatrics policy states that puberty blockers may be indicated as part of gender-affirming care.[2] Okay, but America isn't the whole world - far from it. This seems to downplay the pediatricians who don't agree with that approach, who may be more dominant in Europe, as seen by the Karolinska Institute's decision and the Dutch protocol.
 * Peer-reviewed medical journals like The Lancet likewise note that clinician consensus is moving away from limiting access to hormone treatment based on chronological age.[3][4] First off, this doesn't seem to be in the body, and WP:LEADFOLLOWSBODY. But more importantly, this isn't really derivable from the underlying sources. In the first source, The Lancet does endorse the new approach of an Australian hospital, but note: The guidelines stand apart from existing recommendations... In other words, they aren't representative of other places' approaches to this - and we can't assume that everyone else followed suit, or conclude that this represents a new medical "consensus" or that other journals agree. The second paper is a "correspondence", which is often not peer-reviewed, and while it argues that the gender-affirmative approach is displacing watchful waiting, it also says, the watchful waiting approach remains common in many countries. It does also say that both approaches support use of puberty blockers (I'd want to check recent watchful-waiting sources directly on this though to see the exact extent of this support), differing in extent of assessment necessary and in prepubertal social transition, but doesn't seem to say anything about access based on age. Another issue with this sentence is that "hormone treatment" is ambiguous; this term is often used to refer to estrogen or testosterone rather than blockers per se. Crossroads -talk- 01:20, 15 March 2022 (UTC)
 * No one said "America is the whole world" and I can't understand how that is the reaction to citing the American Academy of Pediatrics' policy. The current state of the article raises the objections of a single British pediatrician and a couple of his co-workers. Shouldn't the policy of an official organization made up of tens of thousands of professionals in relevant fields be a more noteworthy perspective to raise? I'm not opposed to including the former's objections, but how can we not counter-balance that with a large organization of relevant experts? It would be irresponsible not to.
 * Besides the AAoP, I included The Lancet. That is an international medical journal that was founded in the UK, is published by a Dutch company, and is specifically discussing Australian guidelines. That should suffice to be not Americentric.
 * If you read the citation I added from Ashley (2019), you will find that the Dutch model does, in fact, also prescribe puberty blockers as indicated. "It is false that the watchful waiting approach does not prescribe any transition-related intervention prior to 16 years old. On the contrary, the watchful waiting approach, also known as the Dutch approach, is known for traditionally initiating puberty blockers beginning at 12 years old."
 * I'm taken aback that you say my inclusion of The Lancet (2018), "isn't really derivable from the underlying sources." I quoted them virtually verbatim. At the time they published their article (June 2018), the Australian guidelines may have been the first of their kind. But in October of the same year, the American Academy of Pediatrics published their own similar guidelines. More importantly, there is no contradiction in saying that clinician consensus has converged towards a position that had not yet been included in formal guidelines. All that means is that the existing guidelines had grown outdated relative to the clinician consensus.
 * — Uiscefada (talk) 15:54, 15 March 2022 (UTC)
 * It remains, however, that you can't say Peer-reviewed medical journals like The Lancet when the only medical journal mentioned in the sources is just The Lancet. The idea that clinician consensus is moving away from limiting access to hormone treatment based on chronological age seems to be your inference based on the more specific changes mentioned in the sources, which makes it original research if no source supports it. This also doesn't address the ambiguity of hormone treatment, or that the dispute over puberty blockers is not chronological age per se but the approach to transition in children in general (puberty blockers are always applied at the same stage of development). Crossroads -talk- 04:40, 17 March 2022 (UTC)
 * Though it hasn't been mentioned/cited here, what has been said about clinical consensus moving away from age is factual and not OR. If you recall, the draft WPATH 8 SoC contains similar text in its child and adolescent chapters. Furthermore, prescribing of puberty blockers at Tanner stage 2 or 3 has been in the Endocrine Society guidelines since 2009, and reaffirmed in 2017. As for a secondary source covering this, the background section of this paper by Dr Johanna Olson-Kennedy corroborates the acceptance of the Endo Soc guidelines both in the US and worldwide. Sideswipe9th (talk) 04:59, 17 March 2022 (UTC)
 * Sure, the sentence says "journals" (plural) while only citing The Lancet (singular) so far. Fair enough, and that can be addressed.
 * Describing it as "original research" is quite a stretch. The source says that the Australian guidelines move away from limiting access according to chronological age, and it in turn says those same guidelines were formulated based on "clinician consensus". Ergo, the clinician consensus obviously moved away from limiting according to chronological age. Paraphrasing as such is not "original research".
 * That said, we can reformulate it to be more precise about that point (e.g., contextualizing it to Australian pediatrics rather than speaking generally), which I think should address your concern. We can also look into citing The Royal Children's Hospital guideline itself, if available.
 * I must disagree that "hormone treatment" is ambiguous in any relevant way here. Hormone treatment for minors as part of "gender affirming care" would certainly mean using puberty blockers. I think this also addresses your subsequent point about the nature of the opposition. If not, please elaborate on that. I would need more detail and specificity to understand this objection (including citations, please).
 * — Uiscefada (talk) 14:50, 17 March 2022 (UTC)

Was there a recent House Committee hearing on this Topic?
Are there any actual studies done on the Long term effects of Puberty blockers? Or even just short term effects?

I ask, because I recently heard of a House Committee hearing, which asked proponents if they could cite any reliable studies on such. (Recent, meaning last 6 months.) And that they could not do so.

Idk the specifics, and am somewhat at a loss as to how I might fact check without specific information about the hearing. (Namely, it's name & date.)

So I figured asking Wikipedia couldn't hurt. Because ostensibly, any encyclopedia should be non-biased, & truth focused on the subject. As opposed to Twitter hate, and auto labeling this question as transphobic.

I would say that I have doubts that anything meant to be used as (part of) a means of permanently changing one's physical characteristics, could be fully reversible after anything beyond short term use. (At the very least, without first having to "detox" for some period period, in relation to the amount of time spent taking puberty blockers. ) 205.213.240.43 (talk) 13:35, 23 June 2022 (UTC)


 * Hi there! Wikipedia's talk pages are for discussing how to improve an article, not a forum for general discussion on its subjects. In the future, you should direct this kind of question (i.e. one not directly focused on improving the encyclopedia) toward the Reference Desk, where volunteers answer questions. I've done my best to answer it below.
 * It sounds like you're looking for Ohio House Bill 454 (the "Save Adolescents from Experimentation (SAFE) Act"), which recently had its 4th committee hearing on June 1, 2022. The dates of these hearings is available on the Ohio House of Representatives website, although I'm not sure if any direct recordings or transcripts exist. Searching for the name of the bill might return some useful results.
 * As for the rest of your question, the fact that Research on the long-term effects on brain development is limited, and related criticisms and legal challenges, is reflected in due weight on this article. But as for physical changes, the thing that permanently changes one's physical characteristics is puberty. According to the NHS, the physical effects of delaying puberty are understood to be fully reversible in the short term, i.e. desisting causes development to proceed as normal. Individuals who persist in the long-term tend to go on to cross-sex hormone treatment, which is understood to have some semi-reversible or irreversible physical effects. See and  for more information.
 * The right-wing push to ban gender-affirming care for teenagers claims to be concerned with the absence of research on long-term psychological effects, not evidence of such effects. The medical community still overwhelmingly opposes such bans, as the limited research points to treatment of gender dysphoria with puberty blockers as contributing to improved mental health and reduced suicide risk.
 * Best wishes, RoxySaunders 🏳️‍⚧️ (talk · contribs) 18:17, 23 June 2022 (UTC)

Claims of negative effects on the brain
I can find no reference to any unknown brain effects in any of the referenced citations. This claim should be removed unless verifiable documentation of the claim can be provided.

The first referenced study said no effects were found, the second only references adult trans people and not anything to do with puberty blockers. I suspect the claims were added in an attempt to create fear, uncertainty, and doubt for concerned parents of transgender kids and this is harmful and medical misinformation. Bl968 (talk) 00:26, 23 July 2019 (UTC)
 * The cited study does say that it has "unknown effects on brain development", but then it goes on to say that the one study that has been performed didn't really find anything. That paper is from 2016, and a more recent policy statement from The American Academy of Pediatrics doesn't really mention anything about brain functioning, so it's possible that this is just not really considered to be an "unknown" anymore. I've tried to reword it in a way that makes this sound less ominous, but it might be reasonable to simply remove it all together unless there are other WP:MEDRS sources that still talk about this. Nblund talk 15:09, 23 July 2019 (UTC)

Thanks for your work, If there was evidence of effects on the brain they wouldn't be unknown, would they. Bl968 (talk) —Preceding undated comment added 10:15, 24 July 2019 (UTC) A quick internet search showed this: According to the results obtained through the cognitive evaluations, the patient presented a decrease in their overall intellectual performance after the onset of pubertal block, pointing to immaturity in her cognitive development (Table 1). - https://www.frontiersin.org/articles/10.3389/fnhum.2017.00528/full

There is also the well known study in sheep - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333793/ — Preceding unsigned comment added by 176.254.1.119 (talk) 09:25, 9 November 2022 (UTC)

Small Sample Size in the Carmichael P et al. Paper
Under the Legal and political challenges chapter, the paper used in reference for low detransition rate has a very small sample size of 44 individuals. I suggest using a source with larger sample size, such as Davies, Skye; McIntyre, Stephen; Rypma, Craig (April 2019). Detransition rates in a national UK Gender Identity Clinic. This source give the same conclusion that detransition rate is extremely small, but has a larger sample size of 3398 individuals. LT1211 (talk) 21:35, 13 November 2022 (UTC)

False statement should be deleted or new source needed: The British Medical Association does *not* say that they support the use of puberty blockers
The BMA does not state that they support puberty blockers in the reference provided. They also are not on record as saying that they oppose a ban on puberty blockers as claimed. Either this claim needs to be deleted, or a source for this claim needs to be added. The below source attributed does not back-up the claim made on this wiki page. It is an opinion piece by a single author, but regardless it does not support the statement made.

https://www.bma.org.uk/news-and-opinion/push-for-progress-on-transgender-rights-in-healthcare Yellowbentine23 (talk) 12:44, 25 March 2023 (UTC)
 * I removed it as the source does not seem to support the specific claim, as you note. It's somewhat vague and perhaps the BMA does support puberty blockers for this purpose, but we need a source specifically saying so, ideally a direct position statement. Crossroads -talk- 18:28, 26 March 2023 (UTC)
 * Still implies BMA supports puberty blockers. They do not. 81.103.209.248 (talk) 04:51, 26 May 2023 (UTC)

changes
Azposse (talk) 01:52, 10 June 2023 (UTC)
 * Red information icon with gradient background.svg Not done: Why? Do you have reliable sources that contradict the sources currently provided in the article? Actualcpscm (talk) 19:39, 10 June 2023 (UTC)
 * The edit to "may" above is more accurate, as the most we can say is that puberty blocker may improve well-being etc. We cannot say how much the puberty blockers contributed to positive outcomes because the many of the studies cited have a confounding factor in that children who received hormone blockers also received behavioral gender-affirming care. The articles cited in the body of this page cannot tease separate the effects of psychosocial gender affirming care (e.g., therapy or a supportive family) from hormonal puberty blockers. Currently, the page is over-attributing positive outcomes to puberty blockers, when in reality more research is required to confirm this.
 * Additionally, the Introduction oversells the positives without mentioning the real side effects that might impact people using puberty blockers, such as changes in bone density, unknown long-term cognitive effects, and the possible effects on fertility if puberty is suppressed too soon (Mahfouda et al., 2017).
 * Consider the Mahfouda et al., (2017) article cited throughout the page. They note that "the limited available evidence suggests that puberty suppression, when clearly indicated, is reasonably safe." While this statement generally supports hormone therapy, the support is heavily qualified with "limited available evidence" and "reasonably safe."
 * The evidence they present is mixed. For example, in one study, researchers found a decrease in depression yet they also found that "neither the gender dysphoria nor the dissatisfaction with primary or secondary sexual characteristics had subsided at follow-up" (de Vries et al., 2011). In that same study, the "patients had also received regular appointments with a clinical psychologist or psychiatrist; it is therefore unclear to what extent these benefits could be specifically attributed to puberty suppression."
 * Altogether, the research on puberty blockers (including the research cited in this article!) reveals a much more nuanced picture than the wikipedia page currently presents.
 * To express an opinion here, I understand that people have huge emotional and cultural investments in this cause and want to support it. However, misrepresenting the current evidence for puberty blockers is not doing the children who could benefit from puberty blockers any favors. Those people deserve more rigorous research studies and a well-informed public who can advocate and push for more research in the area. Nobody can make an informed decision without all the information. Grassy654 (talk) 19:15, 19 June 2023 (UTC)

Language regarding European policy
The statement, “In Europe some medical groups and countries have taken a somewhat more precautionary stance” is vague. The word, “somewhat” waters-down the sentence overall, and doesn’t provide a clear picture of the legal status or medical guidelines of puberty blockers for youth use. Wouldn’t it be more accurate to say something like, “In Europe, some medical groups and countries have prohibited the use of puberty blockers in adolescents”? 2600:1700:19E0:BB60:2826:E2D4:D820:CB35 (talk) 00:08, 21 June 2023 (UTC)


 * This change would also more closely resemble the language used elsewhere in the article, under “stances of medical organizations.” 2600:1700:19E0:BB60:2826:E2D4:D820:CB35 (talk) 00:17, 21 June 2023 (UTC)
 * That wouldn’t be more accurate as those European countries haven’t prohibited them, they have done things like restrict their use to exceptional cases, or only support their use in the context of clinical research. I do agree though that the lead suffers from a promotional tone that doesn’t adequately reflect the growing schism between the US and Europe: U.S. Becomes Transgender-Care Outlier as More in Europe Urge Caution. Barnards.tar.gz (talk) 09:32, 21 June 2023 (UTC)


 * That doesn't reflect the sources, which say only that The American situation contrasts with Europe, where some medical groups are moving in the opposite direction and In Europe, concern that too many children might be unnecessarily put at risk has prompted countries like Finland and Sweden that were early to embrace gender care for children to now limit access to care. If anything, the current wording slightly overstates that already. --Aquillion (talk) 10:30, 21 June 2023 (UTC)
 * Consider this BMJ source: : European authorities are urging caution because of a lack of strong evidence.
 * Urging caution is significantly stronger than ...a somewhat more precautionary stance.
 * The WSJ article also uses this phrasing: Having allowed these treatments for years, five countries—the U.K., Sweden, Finland, Norway and France—now urge caution in their use for minors, stressing a lack of evidence that the benefits outweigh the risks.
 * I think a more accurate first sentence for the third paragraph would be: In Europe some medical groups and countries have taken a more precautionary stance following systematic reviews of the evidence base. Barnards.tar.gz (talk) 14:51, 21 June 2023 (UTC)
 * Your characterization of the source material is clearer than mine, and I think gets at the heart of what I'm trying to convey. The tone feels misleading in light of the divide between medical guidelines/regulations of some European countries and some US regulatory bodies. 2600:1700:19E0:BB60:9094:6014:C115:ECA6 (talk) 19:42, 22 June 2023 (UTC)
 * I have updated the lead accordingly. Barnards.tar.gz (talk) 09:21, 23 June 2023 (UTC)

Tordoff study misrepresented
This sentence, in Wikivoice, misrepresents the cited study's findings (emphasis mine):


 * "2022 study [sic] published in the Journal of the American Medical Association found a 60% reduction in moderate and severe depression and a 73% reduction in suicidality among transgender youth aged 13–20 who took puberty blockers and gender-affirming hormones over a 12-month follow-up."

In fact, the study claims (emphasis mine):


 * "[R]eceipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up."

These are very different things: our article claims that there was an absolute reduction in symptoms—while the article only claims lower odds relative to the untreated group. Indeed, as eTable 3 in the Supplemental Material reveals, treatment was not associated with any significant reduction in either depression or suicidality. Rather than being the result of any improvement in the treated group, the "lower odds" are entirely a function of the untreated group becoming dramatically more depressed and suicidal. The authors fail to make this clear; offer no explanation as to why the untreated group appeared to have so rapidly and profoundly worsened; and have apparently refused to make public their data—all of which have contributed to inaccurate reporting on the paper's actual, very limited findings.

In short: if the Tordoff study is worth including as "evidence" regarding the efficacy of blocker/hormone treatments, then our article must at least clarify that it found treatment did not reduce mental-health problems, but instead was associated with a stable, unchanged (and extremely high) incidence of depression and suicidality in the treated population.

Look forward to any thoughts and suggestions as to how we should proceed. Thanks! ElleTheBelle 22:02, 8 July 2023 (UTC)
 * You seem to be doing your own interpretation and original research on the results of the study. We can change our summary to "an association of" or something to that effect if you feel the wording used isn't specific enough to the wording of the study. But anything involving supplemental data interpretation is not something Wikipedia editors can make. You need a reliable secondary source making that interpretation. Silver  seren C 22:36, 8 July 2023 (UTC)
 * You are interpreting the research. That’s not appropriate. Change it to “a strong association” or something like that, but anything beyond that is not how wikipedia works. 24.87.104.15 (talk) 20:49, 9 July 2023 (UTC)
 * (Apologies; meant to respond to ElleTheBelle) 24.87.104.15 (talk) 23:57, 9 July 2023 (UTC)
 * "We separately examined the association of PB and GAH with the outcomes of interest, although we a priori did not anticipate being powered to detect statistically significant associations due to our small sample size and the relatively low proportion of youth who accessed PB (n=19)".
 * This is why we can't use supplemental material and why we rely on the statements of the people who actually did the study as opposed to editors.
 * Moreover; your statement that treatment was not associated with reduced suicidality is highly misleading. It's more complicated than that. Again, I really need to be clear here; this is why we don't have editors make arguments from supplementals. There were significant effects found in the analysis, but the authors caution against over-interpreting P-values given that it's a pretty complicated multivariate model that they are using, but even if you're only caring about P-values they found 'significant' p-values for an association between reduced depression and accessing PB's. Did you look at the actual supplemental tables?
 * "Our study provides quantitative evidence that access to PBs or GAHs in a multidisciplinary gender-affirming setting was associated with mental health improvements among TNB youths over a relatively short time frame of 1 year. The associations with the highest aORs were with decreased suicidality, which is important given the mental health disparities experienced by this population, particularly the high levels of self-harm and suicide. Our findings have important policy implications, suggesting that the recent wave of legislation restricting access to gender-affirming care19 may have significant negative outcomes in the well-being of TNB youths.20 Beyond the need to address antitransgender legislation, there is an additional need for medical systems and insurance providers to decrease barriers and expand access to gender-affirming care".
 * This is the conclusion of the authors. 24.87.104.15 (talk) 21:12, 9 July 2023 (UTC)

Study cited under public opinion clearly inaccurate
Why would you cite a study that claims Republicans are slightly more supporting of gender affirming care being legal for minors? That is clearly an erroneous study for anyone who has ever talked to members of either party, and is directly contradicted by a study here: https://www.pewresearch.org/social-trends/2022/06/28/americans-complex-views-on-gender-identity-and-transgender-issues/. In this study we see 26% of Democrats strongly favor or favor making gender affirming care for minors illegal compared to 72% of Republicans. 2600:1700:30D0:9C90:58FC:7372:85D5:7991 (talk) 05:21, 24 July 2023 (UTC)

Systematic review conclusion
In Europe, some medical groups and countries have taken a more precautionary stance following systematic reviews of the evidence base which concluded that the risk-benefit ratio of youth gender transition spanned from uncertain to unfavourable.

The reasons given for the deletion of the bolded part by User:Sideswipe9th were that it's a "mix of WP:SYNTH, WP:OR, and a source that is flat out wrong versus what the systematic reviews cited later in this section actually stated."

Given that I've quoted almost directly from the source ("Systematic reviews of evidence conducted by public health authorities in Finland, Sweden, and England concluded that the risk/benefit ratio of youth gender transition ranges from unknown to unfavorable."), I don't see how these reasons are sustained. I also checked the systematic reviews cited later in this section but I don't see how they contradict that statement, unless I missed something. (talk) 22:45, 4 September 2023 (UTC)


 * I was already typing up a new section for this when DolceFW07 started this one. I've added my initial writing here, and if there's anything not covered by this I'll respond to it separately shortly.
 * A short while ago, added  to a paper authored by Stephen B. Levine and E. Abbruzzese. I  for WP:SYNTH, WP:OR, and that it was incorrect with what the systematic reviews, that we had already cited in the article, state. DolceFW07, quoting from one of the misleading parts of the paper. I was going to ask for it to be self-reverted, pending a consensus here, but I see that  has  suggesting discussion on the talk page.
 * So, expanding on my edit summary. With regards to WP:SYNTH and WP:OR, the paper mentions puberty blockers twice, solely in relation to the NICE review in 2020/2021. While NICE is a significant body in this field, its recommendations apply only to two nations (England and Wales) within a single country; the UK. We cannot use that as a citation with regards to the activities in other countries. The section on the UK also makes no mention of a risk to benefit ratio, though the paper does state this elsewhere within it.
 * With regards to incorrect content, the paper seems to be fundamentally misrepresenting some of its citations. Again with regards to the UK, the paper states that For cross-sex hormones, the review found that improvements in mental health were highly uncertain and had to be carefully weighed against the risks of hormonal interventions (italics from original text), however the citation itself does not actually use the term "highly uncertain" anywhere within it.
 * It also states, in relation to puberty blockers that In both reviews, the studies that reported positive findings were found to be unreliable due to poor methodology. That is a fundamental misunderstanding of how GRADE works. Without wanting to go too far into the technicalities, a low certainty of evidence finding during a GRADE review has a technical meaning which is divorced from the plain reading of the term (see pages 11-13), and it is not a comment on the methodology of a study.
 * Honestly I don't think we should cite this paper, due to the flaws in it. We also don't need to cite it much less add misleading text from it, as we already cite the relevant reviews directly later in the section. Sideswipe9th (talk) 22:48, 3 September 2023 (UTC)

FALSEBALANCE in Legal and political challenges section
I'm concerned that the Puberty blocker section of the article has FALSEBALANCE issues. As it is currently written, it largely takes the form of "here is something opponents to the use of puberty blockers for trans youth say" juxtaposed against "here is something proponents to the use of puberty blockers for trans youth say". This is particularly problematic in this instance, as the proponents for use seem to be either researchers with direct and relevant experience in the field, or mainstream medical organisations.

While it is true that there is an effort by social conservatives, and related fringe organisations like SEGM and ACPeds, I feel like the way that we're presenting this section is misleading to our readers. Does anyone else agree? And if so, how could we restructure this section to present it in a more policy compliant manner? Sideswipe9th (talk) 20:30, 17 September 2023 (UTC)
 * It does seem misleading to say "opponents" and "advocates" in that section when you're referring to non-scientists and usually openly pseudoscience organizations in the former group and basically all scientists and scientific organizations in the latter group. ` Silver seren C 20:34, 17 September 2023 (UTC)
 * I would agree with that. Maybe the section header could also be reconsidered, and what framing would best reflect mainstream sources, and give WP:DUE weight, etc. Hist9600 (talk) 21:14, 17 September 2023 (UTC)
 * Sure. I initially put in the segment on claims of “child abuse” because there was increasing noise on the subject and I wanted to refute the argument, but I don’t know if it has had that effect or not. It’s not encyclopedic to refer to best-practice medical care as “child abuse,” so I am open to having that part removed or reduced, provided it doesn’t give undue weight to misinformation or false claims. I appreciate this discussion. -TenorTwelve (talk) 05:29, 18 September 2023 (UTC)

Claim of Being Reversable is false
The claim that the process is reversible is incorrect. The process might have minimal impact if the individual is already fully developed or if the treatment duration is brief. The less developed a person undergoing puberty is, and the longer the treatment lasts, the more likely the effects will be permanent. It is grossly negligent to include such false medical information in a knowledge database that aims for accuracy. The claim of reversibility carries a strong undertone of a political agenda. — Preceding unsigned comment added by 2001:871:22B:8654:BC4D:22EF:1F5A:7438 (talk) 12:01, 23 September 2023 (UTC)


 * The article already hedges this issue at least as far as is justified. If you can uncover any genuine medical sources supporting these claims then we can consider adding them to the article however most noise on this topic comes from non-medical sources and consists of strident assertions made on supposition with little to back them up except dubious anecdotes and gut feelings. If you are going to try to find valid sources then take care. Weighing the validity of purported medical sources is a genuinely tricky thing to do. (That's why there is a whole guideline document about it.) There is a lot of pseudo-medical material out there which may look plausibly medical on a first glance. Sometimes even actual doctors express opinions outside of their field of medical expertise. It is in such sources that you are most likely to find a political agenda. --DanielRigal (talk) 12:36, 23 September 2023 (UTC)
 * Sure, the article 'hedges' the issue while claiming numerous times that it is reversible, thus affirming the claim.
 * All doctors with expertise in puberty blockers agree that people who use them will grow taller in stature. How is being taller reversible? Just that one variable alone should make every scientifically conscious person exercise caution when claiming it is "reversible", especially in such a nascent field of science, where all variables have not been scientifically proven.
 * Yes, I agree. There is a lot of pseudo-medical science that claims one can halt aging or growth and then resume from where it was originally intended. In this context, 'reversible' means that a 13-year-old remains a 13-year-old while using puberty blockers and when that individual reaches the age of 16 and discontinue the use of blockers, normal development will resume. This is the general understanding that anyone reading Wikipedia would come to. If the term 'reversible' has a different meaning in the medical field, then it would be prudent to define exactly what that means. This article is misleading and does a disservice to those who are investigating the matter. That is why I stand by my claim that the wording "reversable" carries a strong undertone of a political agenda. 2001:871:22B:8654:BC4D:22EF:1F5A:7438 (talk) 22:28, 23 September 2023 (UTC)

Reversibility
The lede includes the statement "[studies indicate that] these treatments are reasonably safe, are reversible, and can improve psychological well-being". The four given sources seem to focus on the psychological aspect. One of the quotations says that the effects on bone development, reproducton and the brain need to be studied more. Which source supports reversibility? –St.nerol (talk) 09:04, 1 November 2023 (UTC)


 * Copied a citation from body to support it. Zenomonoz (talk) 07:43, 9 November 2023 (UTC)

Vaginoplasty
The claim that the puberty blocker does not leave enough material to perform vaginoplasty is misleading. Cessation of the puberty blocker without continuing with HRT will allow puberty to continue as per the assigned sex at birth, including increased penis length - It is therefore not the puberty blocker alone that causes the loss of penis shaft material. However, modern techniques of vaginoplasty in trans women no longer require penis shaft length but instead use peritoneum pull through technique that has been used in cis women who were born without a vaginal canal for over 60 years. After 9 months in cis girls the peritoneal tissue is indistinguishable from vaginal tissue under a microscope. The method SRS-PPV Penile Peritoneal Vaginoplasty results in a self-lubricating and elastic vagina that unlike older techniques does not require a lifetime of dilation (https://www.kamolhospital.com/en/service/SRS-PPV/). — Preceding unsigned comment added by 146.198.127.221 (talk • contribs) 00:46, 31 August 2021 (UTC)

United Kingdom
I'm not sure about the wisdom of a United Kingdom section because, despite what the text currently says, there isn't, today, a "British" NHS. For some time now, NHS in Scotland and in Wales have been devolved. The latest ruling about banning puberty blockers in children (outside of clinical trials) is for NHS England alone. The first paragraph is now out of date, due to the ban, though the NHS Wales website has text very similar to what was claimed for NHS England. The NHS England text is quite different now, due to the ban. I haven't been able to find an equivalent text for NHS Scotland. This article in the Scotsman emphasises how different Scotland is, in that they think a ban unlikely at present. -- Colin°Talk 08:51, 19 March 2024 (UTC)

Science based medicine
@Void if removed You do realize that WP:FALSEBALANCE applies to the views themselves, not the sources, right? Like, SBM is an RSP green source, so it's considered reliable for this exact purpose, and it is a valid criticism not at all fringe within the field. Snokalok (talk) 16:21, 15 March 2024 (UTC)


 * @Barnards.tar.gz You removed the content In 2021, NICE denied a request to provide the names and qualifications of the authors of the review, Science-Based Medicine described this as "especially concerning given the emergence of trans health ‘experts’ who actively work to remove protections and support for trans people and an utterly unacceptable state of affairs for a review or report produced by a government agency." with the edit comment Not appropriate to counterpoint a MEDRS source with a non-MEDRS source. The following paragraph provides more authoritative criticism anyway.
 * We are not counterpointing any medical information, and as WP:MEDRS says This guideline supports the general sourcing policy with specific attention to what is appropriate for medical content in any Wikipedia article, including those on alternative medicine. Sourcing for all other types of content – including non-medical information in medicine-articles – is covered by the general guideline on identifying reliable sources.
 * The fact that NICE refused a FOIA request is non-medical information.
 * The fact there is a cottage industry of anti-trans "experts" like SEGM and co who are political activists rather than objective scientists is widely recognized and the fact they may have been the one to write the review is non-medical information. I'll also note, the WP:RSP entry for SBM notes they often cover FRINGE material and per WP:PARITY are often useful (Parity of sources may mean that certain fringe theories are only reliably and verifiably reported on, or criticized, in alternative venues from those that are typically considered reliable sources for scientific topics on Wikipedia..
 * As such, saying it's a non-WP:MEDRS source is not an applicable argument, so I ask you to please self-revert. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:15, 17 March 2024 (UTC)
 * If the purpose of that sentence is to attempt to undermine a MEDRS source because it may have been written by a baddie, that’s even worse. Barnards.tar.gz (talk) 18:27, 17 March 2024 (UTC)
 * NICE are specifically named on WP:MEDRS as an example of widely respected governmental and quasi-governmental health authorities. Your attempt to redefine this as WP:FRINGE is misplaced. Void if removed (talk) 18:56, 17 March 2024 (UTC)
 * Neither of you are providing a compelling reason why readers should not be informed that a FOIA act about the authors was denied.
 * SEGM & co are undeniably WP:FRINGE. SBM are known for reporting on FRINGE groups, so raising concerns they were involved is well within their established wheelhouse in terms of our sourcing policy.
 * And, to be clear, as with all sourcing on Wikipedia, context matters. If we would not treat a review by the Russian equivalent of NICE finding homosexuality to be infectious or etc to be infallible, then we shouldn't give a lot of weight to a review by anonymous authors criticized by leading international professional groups from a country a Council of Europe report found to have a human rights problem due mass vilification of trans people, rising anti-trans sentiment, and rollbacks and attacks on transgender civil liberties due to the rise in power of the gender-critical movement. The United Kingdom's abyssal treatment of trans people is internationally considered WP:FRINGE.
 * So please, 1) why should the fact the authors are anonymous be considered "medical information" instead of "non-medical information" as explicitly permitted by WP:MEDRS? And 2) why should the United Kingdom's recognized issues with trans rights and legislative capture not be taken into account when assessing evidence quality? Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:03, 17 March 2024 (UTC)
 * I'm begging editors to please stop inserting WP:FRINGE into every discussion on this talk page. None of these topics are covered by WP:FRINGE because as this very article attests there's no consensus from high quality research or organizational bodies. If somebody starts trying to put in sentences about homeopathic puberty blocking "drugs" then that would be covered by WP:FRINGE. This topic on the other hand is something where there are competing mainstream views with differing mainstream proponents and rationales, not one where the obvious answer has been found. XeCyranium (talk) 00:48, 18 March 2024 (UTC)
 * WP:FRINGE does not mean "pseudoscience". That's a common misconception. WP:FRINGE covers anything that's outside of the mainstream of its academic field. This of course includes pseudoscience, but it also explicitly includes questionable science and alternative theoretical formulations.
 * Despite the Council in Europe report and the NICE study, it's still pretty clear that the consensus of the field is set by WPATH. International medical organizations with guidance on this follow WPATH, as do American ones and Australian ones (as well as, frankly, still most of Europe.) The WHO doesn't have guidelines out yet but just looking at the panel of people they assembled to make their guidelines, they pretty clearly think WPATH is at least credible. And if the consensus of the field is set by WPATH, that would leave SEGM as very firmly WP:FRINGE. if your defense is just that some Europeans question the consensus, that's still WP:FRINGE. Loki (talk) 06:47, 18 March 2024 (UTC)
 * Why are you talking about SEGM? This is about:
 * - A top-of-the-pyramid MEDRS source (a systematic review by a highly respected institution)
 * - Which has been reinforced by a second, more recent systematic review, in Germany, in 2024
 * - Being "balanced" with a 2021 blogpost, which insinuates with no evidence whatsoever that because an FOI request for personal information made by GenderGP was legitimately refused - as confirmed on two appeals - the NICE review *might* have had people the author doesn't approve of associated with it in some unspecified way.
 * NICE are not fringe. The Cass review is not fringe. The NHS service specifications are not fringe. A German systematic review is not fringe. WPATH is not fringe. None of these are fringe.
 * some Europeans question the consensus, that's still WP:FRINGE
 * Fringe does not just mean "anyone who disagrees with WPATH", nor does it mean "anyone who disagrees with NICE", nor does it mean a significant minority position in a global debate over standards of care and evidence in the medical community.
 * The constant claims that completely mainstream sources are fringe in talks in these areas are way off base, can we please move on. Void if removed (talk) 10:31, 18 March 2024 (UTC)
 * Why are you talking about SEGM? That's who the source is referring to. SBM is known to be a RS on FRINGE groups. They list SEGM and the ADF, known FRINGE groups, as examples of fake experts who may have been involved due to the refusal of the FOI request. Again, is a FOI request for the authors was refused "medical information" or "non-medical information"? Because your MEDRS argument only applies if we use the source to comment on the former, not the latter as this does. To clarify, I'm mostly ambivalent though leaning towards include on "SBM stated xyz about this" due to their RSP status, but here I am referring solely to information about the FOI.
 * a systematic review by a highly respected institution - did you mean a systematic review by a quasi-governmental institution in a country that has received international criticism for it's treatment of trans people and lack of healthcare provided them? Because you haven't addressed my question about the UK's track record...
 * In that linked discussion and the original one it referred to, consensus found "Gender Exploratory Therapy" (a rebranding of conversion therapy, funny enough pushed by Genspect and SEGM & co) was, in fact, fringe (so not way off base). As I recall you left walls of text saying it wasn't fringe largely due to a progress update on a review you kept insisting should be treated with the weight of an actual review. That being said, please focus on the discussion at hand instead of bringing up (and misinterpreting) old ones.
 * We can't work towards consensus if you refuse to engage with my points, so I'll ask again:
 * 1) why is "a FOI request was refused" "medical information" requiring MEDRS comparisons as opposed to "non-medical information" as is explicitly permitted by WP:MEDRS? By your argument it seems you think we can only mention that if a systematic review does
 * 2) does the fact the UK have a recognized human rights problem with respect to trans healthcare and civil rights factor into this discussion, and if it doesn't, why not?
 * Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:09, 18 March 2024 (UTC)
 * 1a) The "a FOI request was refused" sentence had the effect of poisoning the well of a MEDRS source, using a non-MEDRS source as justification. The way to challenge the credibility of a MEDRS source is with another MEDRS source.
 * 1b) The suggestion that a MEDRS source should be discounted/downgraded/undermined because someone may have been involved (despite there being no evidence for this), is literally a conspiracy theory.
 * 2) This is more well poisoning, and is far removed from the point when the conclusions of the UK study have been re-affirmed and strengthened by a German study. Does Germany also have a recognized human rights problem with respect to trans healthcare and civil rights? Barnards.tar.gz (talk) 12:13, 19 March 2024 (UTC)
 * To answer your second question: no, the country of origin of the researching body doesn't in any way have an impact on the quality of the research, said body is independent and exceedingly reputable when it comes to medical research. XeCyranium (talk) 01:32, 20 March 2024 (UTC)
 * I'd strongly disagree with the idea that consensus in an actively researched field is "set by" an organization through decree. Invoking WP:FRINGE as that editor did to argue against the use of high quality sources is improper, because things which are still actively researched and debated in mainstream science aren't even "alternative theoretical formulations", they're simply unsettled questions. XeCyranium (talk) 01:23, 20 March 2024 (UTC)
 * Editors really need to stop invoking WP:FRINGE to describe medical views on the use of puberty blockers in children that they disagree with. This very article lists several European countries, all free liberal democracies, who have decided the evidence is lacking and to take a more cautious approach than before, to varying degrees. This is absolutely not fringe, while we are talking about such countries, whose collective populations are over 100 million people. Indeed, the degree to which the USA is an outlier globally may be worth examining, never mind breaking the USA into states as it is not homogeneous in its approach.
 * This is not MMR autism fraud or weaponised Covid genetically designed to kill non-Chinese, which is what WP:FRINGE is for. And this isn't just a political controversy. Real genuine doctors and scientists disagree on what's best. We need to report that accurately. This is not Twitter. -- Colin°Talk 08:53, 20 March 2024 (UTC)
 * You again are talking about WP:FRINGE as if it's synonymous with pseudoscience. While this is a common misconception, it clearly is a misconception just from the text of the guideline, which explicitly states that alternative theoretical formulations are WP:FRINGE.
 * The clear majority view worldwide is that of WPATH. WPATH is not an American organization, it's an international organization. The (large) majority of national medical bodies endorse its conclusion. There are some who disagree, but they are currently a clear minority internationally, and therefore are currently still WP:FRINGE. Loki (talk) 20:01, 20 March 2024 (UTC)
 * And again, you are misunderstanding what "alternative theoretical formulations" means, which is frustrating given it has a pretty clear definition in the link you posted but I can only assume you didn't read. A set of organizations publishing research on the effectiveness of a set of drugs in treating certain conditions and coming to different conclusions isn't an alternative theory or model. Medical consensus is not set by WPATH declaring support for a procedure, nor is it even set by a majority headcount of organizations that offer support. This isn't climate change or dinosaurs or tectonic plates; the science really is not settled, as every study cited in this article makes clear in their own words. Insisting that your preferred conclusion should be treated as sacrosanct and others as WP:FRINGE isn't in line with the reality of the situation. XeCyranium (talk) 22:27, 20 March 2024 (UTC)
 * WP:FRINGE full title is Fringe theories. The idea that puberty blockers have limited and low quality evidence to support their use is entirely mainstream. The very sources cited in this article that to support a view they should be used all admit, as any evidence based medical scientist is forced to do, that the evidence base is weak. This is indisputable. There's nothing fringe about that at all.
 * Some bodies recommend their use, despite this low quality evidence, because in their judgement, the limited evidence is persuasive to them, combined with their own clinical experience and expert opinion (which is the very bottom of the evidence pyramid pictured on MEDRS). Some other bodies take a view that their use be restricted, sometimes heavily. There are plenty European countries that have taken this restrictive approach and they all do so in their own way. That the UK does it one way and France another and Norway another doesn't magically make the UK or France or Norway into some kind of lunatic fringe that Wikipedia cannot mention. Nor does it mean the core of this article should pretend to our readers that it is universally agreed that puberty blockers be used in trans children. There is disagreement on how and when to use them and that those on the various cautious ends of that spectrum are not FRINGE. Repeatedly using the WP:FRINGE tag in this matter is disruptive. -- Colin°Talk 10:08, 21 March 2024 (UTC)

I note the above discussion contains efforts by to discredit National Institute for Health and Care Excellence (NICE) because the UK is TERF Island or some such and everyone in this island is clearly mad and should be ignored as a source of anything trans on Wikipedia. NICE is at the very very top of the MEDRS "ideal source" pyramid. Like any institution, it can be imperfect and sometimes one finds a review is older than one would prefer. But it is the very kind of thing MEDRS bangs on about when people try to discredit a top line source with lesser ones. Per WP:RIGHTGREATWRONGS we cannot as editors just go around dismissing the very best of reliabe source because we find its conclusions disagreeable or are hugely prejudiced against an entire nation. If one has a problem with what NICE concluded, write to NICE, write to your MP, write a blog, but Wikipedia cannot shift it from being top tier because trans politics.

Oh, and per my comments below, NICE is for England and Wales. The Scots have Scottish Intercollegiate Guideline Network (SIGN). -- Colin°Talk 15:24, 19 March 2024 (UTC)


 * No one is saying that a reviewer being British makes them unreliable, they’re saying that the government of the United Kingdom, and especially England (which NICE is a part of), has a specific history towards trans people, and that that’s worth thinking about when considering a source; and it feels telling that you would reduce this valid criticism to a bigoted assault on the British people as a whole at the behest of what you call “trans politics” Snokalok (talk) 05:01, 20 March 2024 (UTC)
 * Every country has a specific history towards every marginalized group within that country.
 * Colin is correct that the process for evaluating sources (at least wrt to Biomedical information) is to evaluate the source first on objective criteria, and not primarily on whether the source got the right answer according to Wikipedia editors. If, having reviewed all of the nominally reliable sources (or a representative subset thereof), it turns out that NICE's view is a minority viewpoint, then that's fine; follow the WP:YESPOV policy for handling that viewpoint.  But don't try to say that it's unreliable, because it's not. WhatamIdoing (talk) 05:06, 20 March 2024 (UTC)
 * It doesn't take a detective to realize that some editors here prefer the conclusions of WPATH and are arguing for discounting other sources based on that preference. XeCyranium (talk) 22:30, 20 March 2024 (UTC)
 * Sure, but that's going to be true for every subject. We each believe our considered views to be rational, so whatever we believe is (as far as we're concerned) close enough to correct that it must be The Truth™.  It doesn't matter whether the subject is drug treatments for trans people or how to teach reading to children or the best kind of smartphone.  The reason we have to have an NPOV policy in the first place is because it's very hard for humans to differentiate between "thing I personally believe" and "what reliable sources say". WhatamIdoing (talk) 23:14, 20 March 2024 (UTC)
 * Luckily I am a perfect arbiter of neutrality at all times. But seriously I think the issue is that reliable sources in this case disagree, so it's easy to pick a preferred conclusion. Really we should just present that they disagree. XeCyranium (talk) 16:55, 21 March 2024 (UTC)
 * Glancing through the discussion above, it appears that the problem is that editors are complaining about "reliability" when they ought to be talking about WP:Due weight.
 * I recently used this list of the main MEDRS points to show the process of evaluating a source that you want to use to support Biomedical information, and I paste it below with some notes in case it might be useful to editors here.
 * WP:MEDPRI: What type of source is it (e.g., case study, clinical trial, review article, legally binding practice guideline, etc.)?
 * WP:MEDSCI: Is it published in a peer-reviewed medical journal?  Is the journal's main topic area relevant?  Is the publisher reputable?  Is the journal listed in MEDLINE and/or otherwise reputable?  What does https://www.scopus.com/sources say about its relative ranking?  There is No magic number for impact factors, but anything below 1.0 might prompt further investigation.  If it is not a journal article, is it a typical med school textbook like Harrison's Principles of Internal Medicine?  A respected reference work (e.g., a drug handbook, a guide to lab procedures)?  An major national or international body (e.g., WHO, NICE, NIH, AMA, APA, WPATH, etc.)?
 * WP:MEDASSESS: Is it "high-level evidence, such as systematic reviews"?  If it is a medical guideline or a position statement by internationally or nationally recognized expert bodies, does it provide information about the levels of evidence, or is it just conventional wisdom?
 * WP:MEDDATE: Is it less than five years old?  Some older sources might be useful, but you should use up-to-date sources.
 * WP:MEDINVITRO: Does it rely on pre-clinical/non-human research?
 * WP:MEDINDY: Does the source have a conflict of interest (e.g., funded by the drug's manufacturer) that would make it not be an Wikipedia:Independent source?
 * But mostly I think the task here is to say that different sources have differing views, and to describe those views. WhatamIdoing (talk) 05:02, 20 March 2024 (UTC)