Researcher Cites ‘Perfect Storm’ for Placebo Effect In Transgender Youth Treatments

“A perfect storm” of factors may have distorted research that is popularizing “gender-affirming” treatments, an Australian researcher says.

In a new scholarly article that cites more than 100 references, Dr. Alison Clayton asserts that expectations of positive results could have influenced studies about hormones and surgeries for gender-questioning youths.

This placebo effect—rather than the treatments themselves—may have caused patients to see improved mental health and quality of life, she says in an article that the Archives of Sexual Behavior published last month.

“Placebo-induced improvements are real and can be robust and long-lasting,” Clayton, a practicing psychiatrist, wrote. She thinks a combination of unusual factors created “a perfect storm environment” that may have nurtured the placebo effect in gender medicine research.

And, she warns: Failing to isolate the placebo effect can render medicine “little different from pseudoscience and the quackery that dominated medicine of past times.”

While the placebo effect is widely discussed in some areas of medicine, such as the use of antidepressants, it appears to be “not considered at all” in the realm of gender-affirming treatment, Clayton wrote.

Clayton’s article adds to a mounting pile of concerns about the way doctors have treated transgender minors across the globe in recent years.

Researcher Commended

Peers at the Society for Evidence-Based Gender Medicine (SEGM), an international group of more than 100 clinicians and researchers, discussed Clayton’s placebo-effect article in an essay posted on Dec. 7.

SEGM commended Clayton for being “a powerful, sober voice in the increasingly heated debates in gender medicine.”

Clayton has explored “misadventures in medicine,” such as brain-altering lobotomies on psychiatric patients, SEGM said. She found “troubling parallels between those eschewed practices of the past and the currently-celebrated practice of offering mastectomies to gender-distressed female minors,” the researchers said.

Prisha Mosley had both of her breasts removed when she believed she was transgender, she is now is hoping to receive reconstructive surgery. (Courtesy of Independent Women’s Forum)

Although “every systematic review” has concluded that studies of transgender-identifying youths suffer from low-quality evidence, Clayton’s article is “the first to call out the likely placebo effect,” SEGM wrote in a Dec. 8 tweet.

Beyond Sugar Pills

When most people hear “placebo,” they think of a sugar pill that contains no medication. While that’s true, the term, “placebo” can also refer to the complex changes that occur in a person’s body and mind as they think about the treatments they’re receiving.

The prestige, status, and authority of doctors and therapists “help engender patients’ trust and expectations of relief from suffering,” Clayton wrote. Such thoughts and feelings can trigger changes in a person’s body chemistry, activation of some regions of the brain, and improve a sense of well-being, “all of which may contribute to patients’ clinical improvement,” she said.

In addition, other study participants, views on social media, and news media reports can influence study participants.

“Anything that increases patients’ expectations is potentially capable of boosting placebo effects,” Clayton wrote.

Well-designed studies aim to minimize factors that can skew a study, such as bias and the placebo effect. This enables researchers to more confidently determine that the studied treatment is causing the observed effects.

Some people may wonder: “If the patient improves, does it really matter why? Yes, it does, particularly for treatments that have significant risk of adverse effects,” Clayton wrote.

And perils do come along with gender-affirming treatments, she notes.

Kellie-Jay Keen protests against gender transitioning children in San Francisco, Calif., on Oct. 22, 2022. (John Fredricks/The Epoch Times)

Transgender hormonal and surgical treatments may jeopardize or eliminate young patients’ ability to become parents.

Several studies challenge “the widespread assumption that many transgender people do not want to have biological children,” Clayton said.

Hormonal treatments also might increase the risk of cardiovascular problems, certain cancers, brittle bones, and memory impairment.

Given these possible severe and irreversible effects, strong evidence is needed to prove that the treatments improve mental health as claimed and “that there are no less-harmful alternatives,” Clayton wrote.

That evidence doesn’t currently exist in research, she said.

A ‘Perfect Storm’

Clayton outlined the factors that make gender-affirming treatment particularly vulnerable to the placebo effect.

During the past decade, there has been an unexplained, rapid increase in youths reporting distress over gender, a condition that cannot be diagnosed with an objective test.

At the same time, “the previous ‘common practice’ of providing psychosocial care only to those under 18 or 21 years … has largely been replaced by the gender affirmative treatment approach,” Clayton wrote.

Some clinicians at prestigious institutions “enthusiastically promote” these treatments with the help of media, social media, and “celebrity patients,” she said.

“There is intense media and social media coverage of ‘trans youth’ issues,” Clayton notes, adding that some surgeons target adolescents in their social media promotions.

Some gender clinics may condemn attempts to criticize the procedures and try to squelch any media coverage that is less than “celebratory,” she said.

Then, these advocates may “make overstated claims about the strength of evidence and the certainty of benefits … including an emphasis on their ‘life-saving’ qualities and under-acknowledge the risks,” Clayton said.

Yet “there is no robust empirical evidence that puberty blockers reduce suicidality or suicide rates,” she wrote.

She worries that too much emphasis on the “exaggerated suicide risk narrative” can create a self-fulfilling prophecy: “suicidality in these vulnerable youths may be further exacerbated,” Clayton said.

On top of that, alternative treatments, such as psychotherapy, “are sometimes denigrated as harmful … or as ‘doing nothing,’” she wrote.

What Can Be Done?

Clayton acknowledges: “There are no easy solutions to the complex research and clinical issues.”

But she thinks a good first step would be increased “awareness and debate” among professionals, notations of placebo effects in research papers, and improved studies conducted by more impartial researchers.

She also recommends that clinicians “make measured and honest statements to patients, families, policymakers, and the public about the evidence” regarding gender-affirming treatments.

Clayton calls upon the media and clinicians to tell stories of patients who have decided not to transition or have delayed their transition until adulthood, “along with accounts of patients who have benefitted from ethical psychological approaches; and accounts of those who have had negative transition experiences.”