“The current investigation by the BMJ centers on the most recently published guidelines for gender-affirming care by WPATH, their eighth revision. I would note at this juncture that it might be better to refer to guidelines as evidence-informed because our understanding of disease changes with time; it is not static, as the phrase evidence-based implies. The basis of the WPATH guidelines came from an independent systematic review done by faculty at Johns Hopkins. But as the BMJ article details, WPATH sent a letter to Johns Hopkins lead investigator, Karen Richards, PhD, indicating,

“It is paramount that any publication based on the WPATH SOC8 data is thoroughly scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender healthcare in the broadest sense.”

Moreover, the BMJ article alleges that Admiral Rachel Levine, MD, Assistant Secretary for Health, “asked authors to remove minimum age recommendations for gender-related hormones and surgeries.” While WPATH initially declined the request, further pressure by the AAP resulted in the WPATH removing the age restriction. The culture warriors can posit whatever intent they wish to those requests; I would be content saying it allows for clinical judgment, but irrespective of intent, it does reflect “the smoking thumb,” in this instance.

The GRADE system is an accepted means of mapping the quality of a study [2] in making recommendations. That mapping has caveats that allow weak evidence to result in strong recommendations and strong evidence to result in weak recommendations. “

https://www.acsh.org/news/2024/10/31/thumb-scale-hidden-influence-gender-affirming-care-guidelines-49088