Bewley, S

Byng, R

English

Plymouth Electronic Archive and Research Library

GENDER DYSPHORIAGender dysphoria: scientific oversight falling betweenresponsible institutions should worry us allRichard Byng professor in primary care research and general practitioner 1, Susan Bewley emeritusprofessor of obstetrics and women’s health 21Community and Primary Care Research Group, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK; 2King’s College London,London, UKThe troubles around the Gender Identity Development Service’sstudy1 2 seem to be symptomatic of our wider collective failureto determine whether, and when, we should prescribe pubertyblockers, or cross sex hormones, to children and young peopleidentifying as transgender.The ethics of research conduct belongs to the Health ResearchAuthority (HRA), and the quality of science is an importantconsideration when determining ethics. Some procedural issuesmight not be serious, but the HRA did not try to determine ifits first research ethics committee (which advocated the needfor a trial) was right, and yet defended a resubmission withouttackling the first committee’s concerns.3 Effectively, the HRAabsolved itself from responsibility for judging the science indeliberations about ethics, leaving it wholly to the academicinstitution (as investigator and sponsor).Although many paediatricians prescribe off-label drugs,4 haltingnatural puberty in gender dysphoria could have far reachingconsequences, so a stringent research design is required. Bygaining permission to study individuals without controls orpiloting procedures for a (no doubt complex) randomised trial,an opportunity to determine harms and benefits was missed.The changing and growing demographic—mainly natal femaleswith high rates of trauma—make the need for proper studiesmore urgent.Instead, we have now moved from a small, uncontrolled studywith unpromising, unpublished results to the scaled upcommissioning by NHS England of interventions that are ofunproven benefit.5 The new study funded by the NationalInstitute for Health Research is again designed only to observe,not test, effects.6 This illuminates the greater issue of howcommissioners, service providers, and research institutions havefailed this vulnerable group of people who deserve equitablestandards of research. The UK has the potential to create thebest service for young people questioning their gender. To doso, key institutions will need to embrace equipoise and worktogether effectively.Competing interests: None declared.Full response at: https://www.bmj.com/content/366/bmj.l5647/rr-7.1 Cohen D, Barnes H. Gender dysphoria in children: puberty blockers study draws furthercriticism. BMJ 2019;366:l5647. 10.1136/bmj.l5647 315409092 Gender Identity Development Service. An evaluation of early pubertal suppression in acarefully selected group of adolescents with “gender identity disorder.” https://gids.nhs.uk/our-early-intervention-study3 Health Research Authority. Investigation into the study “Early pubertal suppression in acarefully selected group of adolescents with gender identity disorders.” https://www.hra.nhs.uk/about-us/governance/feedback-raising-concerns/investigation-study-early-pubertal-suppression-carefully-selected-group-adolescents-gender-identity-disorders/4 Scott S, Ford T. Puberty blockers study: much ado about nothing? [electronic responseto Cohen D, Barnes H. Gender dysphoria in children: puberty blockers study draws furthercriticism]. BMJ 2019. https://www.bmj.com/content/366/bmj.l5647/rr-15 Heneghan C, Jefferson T. Gender-affirming hormone in children and adolescents. BMJEvidence Based Medicine Spotlight 2019. https://blogs.bmj.com/bmjebmspotlight/2019/02/25/gender-affirming-hormone-in-children-and-adolescents-evidence-review/6 Kennedy E. Longitudinal outcomes of gender identity in children. ISRCTN registry. http://www.isrctn.com/ISRCTN98564473Published by the BMJ Publishing Group Limited. For permission to use (where not alreadygranted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissionsrichard.byng@plymouth.ac.ukFor personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribeBMJ 2019;367:l6439 doi: 10.1136/bmj.l6439 (Published 4 December 2019) Page 1 of 1LettersLETTERSProtected by copyright. on 16 November 2021 at University of Plymouth - Library A. Henderson-Lib & Media Ser.http://www.bmj.com/BMJ: first published as 10.1136/bmj.l6439 on 4 December 2019. Downloaded from 

Gender dysphoria: scientific oversight falling between responsible institutions should worry us all

https://pearl.plymouth.ac.uk/bitstream/10026.1/18386/1/8.%20Gender%20dysphoria%20scientific%20oversight%20falling%20between%20responsible%20institutions%20should%20worry%20us%20all.pdf

Gender dysphoria: scientific oversight falling between responsible institutions should worry us all.

Abstract

Similar works

Full text

Available Versions

Plymouth Electronic Archive and Research Library