Errors, Omissions, and Pediatric Gender Medicine

As philosophers and bioethicists working on topics at the intersection of pediatric gender medicine and ethics, we read with interest Sinead Murano-Kinney's Guest Editorial, "Banning Puberty-Pausing Medications Endangers Transgender Adolescents". In this ethically and socially contentious area of medicine, bioethics journals have a vital role to play in shedding light on issues at the heart of public debates, debates that too often generate little more than heat. Unfortunately, Murano-Kinney's editorial exacerbates the problem by mischarachterizing the scientific evidence on which the essay's central claims depend and by ignoring important scientific developments and related policy transformations in the United Kingdom and Scandinavia.
The central thesis of Murano-Kinney's essay is that GnRH agonists, colloquially known as "puberty blockers," are safe and effective treatment for gender dysphoria and related mental health challenges in minors and that opposition to their provision relies on "misinformation" spread by "anti-trans extremists". Relatedly, Murano-Kinney also claims that transition-related medical interventions are "lifesaving," an oft-repeated claim intended to provide the strongest possible support for medical intervention, given the great moral weight medical professionals place on the prevention of premature death. But there is no evidence that puberty blockers, cross-sex hormones, or transition-related surgery save lives. Non of the studies Murano-Kinney cites in this regard show these treatments leading to any reduction in suicide or mortality more generally. For example, while Murano-Kinney cites Tordorff et al's paper - an observational study rated as "low quality" in a recent systematic review - this study did not examine mortality. The only study to date that has examined mortality and medical transition in young patients found that, "the suicide mortality of both those who proceeded and did not proceed to gender reassignment did not statistically differ from that of controls". A 2021 systematic review commissioned by the World Professional Association of Transgender Health (WPATH) examining the effects of hormonal treatments "could not draw any conclusions about suicide". Despite their direct relevance to the question of whether hormonal interventions are "lifesaving," Murano-Kinney's editorial omits any mention of these studies.
A second problem concerns [...]