The question of why the United States has not conducted systematic reviews to evaluate gender-affirming care for transgender and gender-diverse (TGD) youth, as seen in Sweden, Finland, and the UK, is misleading. The U.S. has undertaken such reviews, notably through WPATH and NIH-funded research, but their findings were reportedly suppressed. This raises serious concerns about transparency and ideological bias in organizations like the American Academy of Pediatrics (AAP), the Endocrine Society, and WPATH. This article explores the buried evidence, the reasons behind its suppression, and the urgent need for evidence-based guidelines to protect TGD youth.
Evidence of Suppressed Systematic Reviews
Countries like Sweden, Finland, and the UK conducted systematic reviews, finding “inconclusive” or “very low” quality evidence for gender-affirming interventions like puberty blockers and hormones, leading to policies favoring psychotherapy. In the U.S., WPATH commissioned Johns Hopkins University for systematic reviews for its 2022 Standards of Care (SoC8), but court documents from Boe v. Marshall (2022) revealed that only one of dozens was published—a 2021 meta-analysis showing “low” evidence for hormone benefits. Similarly, a 2024 congressional probe uncovered an unpublished NIH-funded study on puberty blockers, led by Dr. Johanna Olson-Kennedy, which found no significant mental health improvements, challenging claims of “life-saving” effects.
The Role of Circular Referencing and Institutional Bias
The AAP’s 2018 policy, the Endocrine Society’s 2017 guideline, and WPATH’s SoC form a trifecta of circular referencing, where each cites the others, relying on a flawed Dutch study without robust evidence. Critics like James Cantor, Michael Biggs, and Kathleen McDeavitt exposed the AAP’s citation inaccuracies and omission of 61–98% desistance rates in gender-dysphoric youth. WPATH’s suppression of reviews was influenced by “social justice lawyers” to protect policy advocacy, while the AAP’s 2023 reaffirmation ignored international reviews. This suggests institutional capture, where advocacy and fear of being labeled “anti-transgender” override scientific rigor, burying inconvenient findings.
A Call for Transparency and Evidence-Based Reform
The suppression of U.S. systematic reviews undermines trust and risks harm, including misdiagnosis of gender nonconformity as transgender identity. Unlike Europe’s evidence-based shifts, U.S. organizations resist change due to ideological pressures and activist influence, which equate exploratory therapy with conversion therapy. To protect TGD youth, the U.S. must release buried studies, commission transparent reviews by unbiased experts, and develop guidelines free from circular referencing. Only by prioritizing rigorous, independent evidence can medical institutions ensure compassionate, safe care that truly serves young people, restoring public confidence in gender-affirming healthcare.