In today’s New York Times, reporter Azeen Ghorayshi investigated a leading gender clinician’s decision not to publish the results of a study into the effects of puberty suppression on the mental health of patients with gender dysphoria.

At the outset of the National Institutes of Health study, principal investigator Johanna Olson-Kennedy, one of the most vocal advocates of “gender-affirming care” in the United States, expected that young patients put on puberty blockers would experience “decreased symptoms of depression, anxiety, trauma symptoms, self-injury, and suicidality” and “increased body esteem and quality of life over time”. But that’s apparently not what the evidence showed. Rather than revise her hypotheses and share her findings with the scientific community, Olson-Kennedy and her team decided to sit on the results. Olson-Kennedy told Ghorayshi that she worried the study’s disappointing findings would be “weaponised” by critics.

Unfortunately, Olson-Kennedy and her team are not alone in taking an “affirmation-only” approach to publishing research findings. Suppressing inconvenient data is a pattern in the field of gender medicine, which has long subordinated scientific research to political expediency. Researchers and clinicians in the field tend to work backwards from their desired conclusions (“gender-affirming care is safe and effective,” “the science is settled”), then tell patients, parents, policymakers, and the public what they think these audiences need to hear in order to fall in line. Forget the ideal of impartial scientific research. What we have here are clinicians and researchers acting as “agents of lawfare,” with one eye on the courts and one eye on their reputations. In the process, they lose sight of their patients.

Researchers and clinicians have decided — in advance — that “gender-affirming care” is safe and effective, no matter what the evidence shows. At the European Professional Association for Transgender Health conference in Killarney, Ireland, in April 2023, researchers presented an array of discouraging findings, bracketed by statements like “as you all know, there are improved mental health outcomes following puberty blockers and gender-affirming hormones” — even when the research being presented suggested the opposite.

Because researchers and clinicians perceive the political climate as hostile to the “life-saving” work they do, they appear to feel justified in suppressing research that fails to paint a sufficiently positive picture of their exertions.

Just this summer, documents unsealed in a legal discovery process underway in the state of Alabama revealed that the World Professional Association for Transgender Health (WPATH) “interfered with the production of systematic reviews that it had commissioned from the Johns Hopkins University Evidence-Based Practice Centre.” Ultimately, researchers at Johns Hopkins conducted evidence reviews relating to 13 key questions in the field of transgender health, but published reviews addressing just three questions. The Economist concluded that “research into trans medicine has been manipulated.”

Sometimes, research findings get a glossy makeover before being presented to the public, like a 2022 study that reporter Jesse Singal summarised as thus: “Researchers found puberty blockers and hormones didn’t improve trans’ kids mental health at their clinic. Then they published a study claiming the opposite.”

At times, this approach is made explicit. At the US Professional Association for Transgender Health conference in Denver, Colorado, last year, Kellan Baker dispensed public-relations advice to an audience of clinicians and researchers: don’t tell the public anything that might make them think twice about what they’re being asked to support. Avoid specifics, like the ages of patients and the details of interventions. Baker even advised against using the term “gender-affirming care”. “When [people] hear it,” he said, “they think ‘trans kids in the driver’s seat’”.

In recent years, the field of gender medicine has sustained itself in an increasingly polarised political climate through a systematic campaign of suppressing, obfuscating, and misrepresenting research. This strategy operates behind the scenes, quietly distorting public understanding of the issue at hand. But such an approach cannot survive scrutiny from mainstream media outlets and exposure in court cases. As reporters dig in and legal discovery makes secretive practices public, proponents of “gender-affirming care” will come under increasing pressure. Either advocates will need to make their case to the public, or their claims — that the care they provide is safe, effective, and settled science — will crumble.

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Eliza Mondegreen is a researcher and freelance writer.

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