I hadn’t read the statement.
I expected it to be pages long.
it was this:
Systematic reviews related to gender-affirming care
Posted on August 14, 2025
Members and allies of 2SLGBTQIA+ communities have raised concerns about recent systematic reviews related to gender-affirming care. These concerns center on the funding source, and specifically on the potential for the research to be misused to harm trans youth and to deny gender-affirming care.
Prompted by these concerns, the authors of the systematic reviews have shared the following:
In contrast to the way findings and presentation of our systematic reviews have been misrepresented and misinterpreted, they in fact show that, like the majority of what we do as physicians, the outcomes of specific aspects of care for transgender patients remain uncertain. The appropriate response to such uncertainty is shared decision-making that fully respects the autonomy of the individuals involved. Therefore, we have prepared the following letter related to our SEGM-sponsored systematic reviews:
Authors of scientific articles have a responsibility to attend to how their contributions will be used and to modify their presentation in the articles, or other communications, accordingly. We, five authors of recent systematic reviews related to gender-affirming care, are concerned that the conclusions of our work–that only low certainty evidence exists (as determined by the GRADE [Grading of Recommendations Assessment, Development, and Evaluation] approach) regarding the benefits of the gender-affirming care interventions addressed in our systematic reviews–will be misused. Specifically, we are concerned that the assessments of the certainty of evidence using established and standard methodology are interpreted as evidence supporting denial of care to trans, nonbinary, and gender-diverse (TGD) individuals, including youth. We are concerned our findings will be used to justify denying care such as puberty blockers and hormone replacement therapy to TGD individuals. Indeed, our prior work has been used in exactly this highly problematic way.
We therefore feel compelled to make explicit our view regarding how our findings should and should not be used. Following fundamental principles of humane medical practice, clinicians have an obligation to care for those in need, often in the context of shared decision making. It is unconscionable to forbid clinicians from delivering gender-affirming care.
Moreover, following the principles of evidence-based decision-making, clinicians should always have a high respect for the autonomy of patients and their advocates. The high respect for autonomy becomes particularly important when the certainty of the evidence is low or very low. In such circumstances, clinicians should work with patients to ensure that care reflects the experience, goals, and priorities of those needing care – that is, their values and preferences.
It is profoundly misguided to cast health care based on low-certainty evidence as bad care or as care driven by ideology, and low-certainty evidence as bad science. Many of the interventions we offer are based on low certainty evidence, and enlightened individuals often legitimately and wisely choose such interventions. Thus, forbidding delivery of gender-affirming care and limiting medical management options on the basis of low certainty evidence is a clear violation of the principles of evidence-based shared decision-making and is unconscionable. The appropriate use of our work is in ensuring patients receive needed care and in helping TGD patients and their clinicians in decision making.
We write this in the hope that all those who use our work to inform the care of TGD patients receiving gender-affirming care, and those using our work in consideration of policy decisions, prioritize the delivery of compassionate and conscientious care that fully respects the autonomy of the TGD patient.
We acknowledge concerns that have been raised.1 Our research agreement with SEGM ended in 2024. When the agreement started in 2021, the organization appeared to us as non-trans, cis-gender researchers to be legitimately evidence-based.
We will no longer accept funding from SEGM. As recommended by community advocates, we have also personally made a donation to Egale Canada’s legal and justice work, noting their litigation efforts aimed at preventing the denial of medically necessary care for gender-diverse youth.
Gordon Guyatt, MD, MSc
Romina Brignardello-Petersen, DDS, MSc, PhD
Sara Ibrahim, BHSc, PhD student
Yetiani Roldán-Benitez, MD, MSc
Rachel Couban, MA, MISt