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Problems with consistent miscitations

Posted by JLCederblom on 11 Mar 2021 at 02:52 GMT

I'd like to join others in acknowledging the value of more research on this topic. It is a highly politicized area and the only thing that will bring progress is more and better research. That said, I would like to highlight an associated problem with published research on this topic in general and this paper in particular.

There is continued use of miscitations and while the very welcome public peer review process shows some attention was given to this, a considerable amount remains incorrect.

This includes the statement "GD in adolescence is highly likely to continue into adult life where gender dysphoria persists after the onset of puberty", for which the provided reference [1] in turn cites a single primary source (of a small number of qualitative interviews) and states that "little empirical evidence exists to support this association".

The same review as well as the one paper providing qualitative interview data from a small cohort [2] are provided for the statement "Those with earlier onset or more intense GD and those in whom the development of secondary sexual characteristics in puberty is associated with increasing gender dysphoria or psychological distress are more likely to have persistent GD". While this is often simply assumed to be true - sometimes based on clinical experience, sometimes not - citing a paper that calls it speculative yet describing it as “likely” appears somewhat self-defeating to me - surely this goes against the claim.

It is stated that "A recent systematic review included data on the physical and mental health outcomes of pubertal suppression using GnRHa in over 500 young people", however the total number for GnRHa across all the papers in the review [3] is around 400, and as that came out of just two centers, the overlap that can be confirmed by reading the papers puts the number around 300, although the number could be significantly lower.

It is stated that "In adolescents with severe and persistent GD, international and national guidelines recommend the use of treatments to suppress the rise in sex hormones in young people during puberty", which accurately describes two of four guidelines referenced but not the other two. One [4] makes no note of the severity or persistence of the GD. The final one comes in two forms, first the cited version [5] which recommends puberty suppression after 16, not "during puberty". The full guidelines [6] disagree with both the version published in the The New Zealand Medical Journal and the description here, providing no criteria at all for puberty suppression.

While any one of these small issues on their own would be relatively minor, taken together they serve to highlight the care one must take when dealing with a topic as politicized as this, both as authors and in peer-review.


1. Mahfouda, S., Moore, J. K., Siafarikas, A., Zepf, F. D., & Lin, A. (2017). Puberty suppression in transgender children and adolescents. The Lancet Diabetes & Endocrinology, 5(10), 816–826.

2. Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590.

3. Chew, D., Anderson, J., Williams, K., May, T., & Pang, K. (2018). Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review. Pediatrics, 141(4), e20173742.

4. Rafferty, J. (2018). Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, 142(4), e20182162.

5. Oliphant, J., Veale, J., Macdonald, J., Carroll, R., Johnson, R., Harte, M., Stephenson, C., Bullock, J., Cole, D., & Manning, P. (2018). Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa, New Zealand. The New Zealand Medical Journal, 131(1487), 86–96.

6. Oliphant J, Veale J, Macdonald J, Carroll R, Johnson R, Harte M, Stephenson C, Bullock J. Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand. Transgender Health Research Lab, University of Waikato, 2018.

No competing interests declared.