Leading EBM Authority Gordon Guyatt Faces Scrutiny Over Pediatric Gender Medicine Stance

Professor Gordon Guyatt, a foundational figure in evidence-based medicine (EBM), is facing intense scrutiny following a public exchange regarding a signed statement on pediatric gender medicine, which he initially disavowed. The controversy, highlighted by author Colin Wright on social media, centers on Guyatt's apparent shift in position on the "medical necessity" of gender-affirming care for minors, despite his own team's research indicating a low certainty of evidence for such interventions.

The incident gained traction when @_CryMiaRiver reportedly presented Guyatt with a statement he had signed, asserting pediatric gender medicine was "medically necessary." According to Colin Wright's tweet, Guyatt had previously stated he would "jump off a bridge" if he ever discovered he had signed such a document. However, upon being confronted, Guyatt allegedly "responds by downplaying it and claiming he hadn’t written that part and should only be held accountable for the sections he 'clearly' wrote, even though nobody can possibly know who wrote what."

This recent development underscores a broader debate within the medical community regarding the application of EBM principles to pediatric gender care. Guyatt's research team at McMaster University, Canada, notably conducted systematic reviews that found only "low certainty" evidence for the benefits of gender-transition treatments and mastectomies for youths. Despite these findings, a statement co-signed by Guyatt and four colleagues condemned the use of their research to support bans on such interventions, employing terms like "medically necessary" and "hormone replacement therapy" to describe these treatments.

Critics, including bioethicists and researchers, argue that Guyatt's emphasis on patient "values and preferences" in the face of low-certainty evidence risks reducing pediatric gender medicine to a consumer-driven model, particularly for vulnerable youth with complex mental health issues. Dr. William Malone, an endocrinologist and co-founder of the Society for Evidence-Based Gender Medicine (SEGM), questioned how a 12-year-old could consent to "a lifetime of infertility and sexual dysfunction," highlighting the profound, irreversible impacts of these treatments.

The Department of Health and Human Services (HHS) has also published a review of evidence and best practices for pediatric gender dysphoria, which cites Guyatt's work and acknowledges the weak evidence base. The review notes that "the use of pharmacological and surgical interventions as treatments for pediatric gender dysphoria has been called 'medically necessary' and even 'lifesaving,' " but emphasizes that "systematic reviews of the evidence have revealed deep uncertainty about the purported benefits of these interventions."

Colin Wright directly challenged Guyatt in his tweet, stating, "Dr. Guyatt, given that you were misled and clearly manipulated by activists into signing a statement you reject, will you make a public statement clarifying this and requesting that either your name or the claim that gender medicine is 'medically necessary' be removed?" The incident highlights the intense pressure and politicization surrounding pediatric gender medicine, even for leading figures in medical research.