Talk:Transgender health care misinformation#c-OsFish-20250526125600-Samuelshraga-20250526114600

{{Wikipedia:Good article reassessment/Transgender health care misinformation/1}}

{{Template:Did you know nominations/Transgender health care misinformation 2}}

The concept of manufactured uncertainty is extremely prominent in this article. It appears in the second line of the lede: "The claims have primarily relied on manufactured uncertainty", and in the first line of the body: "Transgender healthcare misinformation primarily relies on manufactured uncertainty from a network of conservative legal and advocacy organizations."

There are two pieces cited for this: [https://en.wikipedia.org/wiki/Transgender_health_care_misinformation#cite_note-Wuest-3][https://en.wikipedia.org/wiki/Transgender_health_care_misinformation#cite_note-splc-captain-4-11].

One of these is to the Southern Poverty Law Center whose views, per WP:SPLC should be attributed (they are not). The other is to an article in Social Science & Medicine (by Wuest, Joanna; Last, Briana S.). Crucially neither of these are WP:MEDRS. Wuest and Last are academics in the fields of politics and psychology.

There is at root here a biomedical claim: the gender-affirming care that is offered to minors in the jurisdictions that they study (in the US) is safe and effective, and that there is no uncertainty around this fact. If it is not a matter of clear scientific consensus that there is certainty over the safety and efficacy of gender-affirming care for minors (beyond "some degree of clinically acceptable uncertainty"), the sentences I quote in the first paragraph of this section should be rewritten. This is because it is incoherent to claim that purveyors of one side of a scientific debate are spreading "misinformation".

I submit that therefore all that is needed is for MEDRS to show that there is genuine and meaningful uncertainty over the safety and efficacy of gender-affirming care for minors in order to necessitate the removal of all references to manufactured uncertainty from the article.

Secondly, the sourcing for the "manufactured uncertainty" claims are entirely focused on how uncertainty has been used as a justification of bans on gender-affirming care by US states. Nothing about the way manufactured uncertainty is discussed in the lede or the first paragraph of the body suggest that they are discussing the USA in particular, and this seems like a further deficiency in the sourcing. Samuelshraga (talk) 14:08, 8 May 2025 (UTC)

:The two lines about manufactures uncertainty do not meet the criteria outlined in WP:BMI and therefore do not require a MEDRS source. {{TQ| the gender-affirming care that is offered to minors in the jurisdictions that they study (in the US) is safe and effective, and that there is no uncertainty around this fact}} I don't quite agree with this assessment as this article is not just about medical treatments and to say that those two sentences are implying this is a bit of a stretch imo. IntentionallyDense ^(Contribs) 15:43, 8 May 2025 (UTC)

::This is what you said in the GA3 review too. I don't see how it is tenable really - the sources make numerous claims about what is "true" with respect to biomedical matters, then classify differing opinions as "misinformation". The SPLC source (which is itself largely the recycled blogposts of the report's authors) makes judgements about plausible explanations for eg. sex-shifts in clinical referral patterns, or changing desistance rates, and classifies different clinical viewpoints as manufactured uncertainty. Likewise, Wuest & Last makes claims about sex-ratio shifts (which are so well-established in the literature that they aren't in any doubt) by citing literally the one (weak, survey-based, two-timepoints) study that shows a small sex-ratio shift the opposite way. Quantitative systematic reviews demonstrate a pronounced sex-ratio shift, and the sex-ratio shift is fundamental to the plausibility of the social contagion hypothesis, yet none of this is mentioned on this page.

::These sources are not simply making biomedical claims, they are making claims to be the arbiter of what is correct on biomedical matters - claims which disagree with systematic reviews - and these "truth claims" from these non-MEDRS are the scaffold for the separate subsections of the page describing what is "misinformation" using only the MEDRS that support this POV. Without these as a basis, this page would not exist. Void if removed (talk) 09:39, 9 May 2025 (UTC)

::Hi @IntentionallyDense, I agree with @Void if removed basically about how these sources {{tq|are making claims to be the arbiter of what is correct on biomedical matters}}.

::When we say "manufactured uncertainty" in the article, we link to a page that describes that term as referring to "a contrived disagreement, typically motivated by profit or ideology, designed to create public confusion concerning an issue about which there is no substantial academic dispute." Yes, I know wikipedia is not a source, but does anyone disagree with this description?

::So if we break down our sentence "Transgender healthcare misinformation primarily relies on manufactured uncertainty from a network of conservative legal and advocacy organizations", one of the many claims it contains is clearly biomedical: That the safety and efficacy of transgender healthcare is a fact, not a matter of substantial academic dispute.

::Inasmuch as your objection is that {{tq|I don't quite agree with this assessment as this article is not just about medical treatments}} - then yes, it has direct implications about medical interventions, that these sources are not usable on wikipedia to make. Samuelshraga (talk) 13:12, 9 May 2025 (UTC)

:::I'm actually glad you brought up the definition as its allowed me to see things in a slightly different light. Although we do have a (non-MEDRS, but still imo reliable) source saying there is manufactured uncertainty, if we are using the definition that Wikipedia provides (which as Samuel mentioned may not be the best source) then I would say that some of the misinformation talked about in this article doesn't fit this definition.

:::What I mean is, things like Blanchard's transsexualism typology most definitely fit this definition. There is no academic dispute around that topic. However, regardless of which opinion you agree with in the debates of hormone therapy and "detransitioning" there has been significant academic debates on the topic. This all of course relies on the current definition of manufactured uncertainty being accurate.

:::To amend this I would propose either a) providing a correct definition of manufactured uncertainty in the article if the definition we have on wikipedia isn't correct or b) editing the sentence to reflect that not all the misinformation is based on manufactured uncertainty (as we all know sometimes misinformation happens without malicious intent, even if the end result was damaging or unhelpful).

:::Is this a reasonable compromise? (pinging those who I feel would have useful opinions here): @JonJ937@LunaHasArrived@Samuelshraga@Void if removed {{u|Your Friendly Neighborhood Sociologist}} IntentionallyDense ^(Contribs) 18:25, 9 May 2025 (UTC)

::::I'm not sure we need to do anything. I was about to support {{tq| b) editing the sentence to reflect that not all the misinformation is based on manufactured uncertainty}}, but I checked and we already do that anyways, with the sentence saying {{tq|The claims have primarily relied on manufactured uncertainty}} Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:31, 9 May 2025 (UTC)

:::::I would have to disagree here as "the claims primarily relied on" (at least in my opinion) implies that all of the claims relied on MU and other factors, not so much that some of the claims don't strictly meet the definition of MU. Maybe something along the lines of "Some of the claims have primarily relied on..." IntentionallyDense ^(Contribs) 03:13, 10 May 2025 (UTC)

::::::The issue is that the strong implication is that the entire article in its conception is about manufactured uncertainty. This does not come across as an attempt to clarify innocent mistakes or common misconceptions - it reads like "conservative legal and advocacy organisations manufacture uncertainty and everything that follows is an example of such".

::::::Given that the subtopics are all the same subjects focused on by SPLC and Wuest & Last, I don't see how that isn't the clear intent of the article - and these are categorically not sources suitable for such a starting point. I don't think you can resolve that with a minor wording tweak.

::::::A different version of this article might be titled "controversies in transgender healthcare" and might give the different views in MEDRS in each of these topics. It might even explain how some of these are misrepresented or exaggerated to a greater or lesser degree legally or politically by various opposing factions. But that isn't what's happened - instead, a highly partisan non-MEDRS with no expertise in this space is used as a starting point, and each of the subsections is then supported by selecting only the MEDRS that support treating any controversy as the manufactured misinformation alleged. The section on desistance for example continues to obscure the historic quantitative estimate in Karrington and cites none of the conflicting literature, or even the literature that says we don't know. Void if removed (talk) 10:30, 10 May 2025 (UTC)

:::::::I do not see at all how {{tq|the subtopics are all the same subjects focused on by SPLC and Wuest & Last}}.{{pb}}Could you respond to #c-Your_Friendly_Neighborhood_Sociologist-20250509224800-Void_if_removed-20250509221100? I feel like you're repeating some things people have responded to. Aaron Liu (talk) 14:53, 10 May 2025 (UTC)

::::::::Let's see, the topics we have in the article:

::::::::1. Detransition, regret & Desistance

::::::::2. Mental health, social contagion, validity of psychotherapy / conversion therapy

::::::::3. Blanchard

::::::::4. Untrustworthiness of medical orgs

::::::::5. Transition with inadequate oversight / rushed, schools

::::::::6. European shifts

::::::::Section 1 directly cites Wuest & Last and SPLC, and section 2 directly cites SPLC. If they aren't based on those sources, why are they cited?

::::::::Both Wuest & Last and SPLC both directly address the themes of desistance, detransition, regret, validity of psychotherapy, plausibility of social contagion as major subjects of supposed misinformation, but neither source is competent to make this judgement.

::::::::Wuest & Last have both {{tqq|Desistance, Detransition, and Regret}} and {{tqq|Social Contagion}} as misinformation headings, and much of the rest overlaps with the theme of inadequate oversight/rushed paediatric transition and idea that medical orgs are untrustworthy/overstating the evidence base.

::::::::The first two, most extensive sections, which make the most direct biomedical claims are both heavily dependent on the framing in these non-MEDRS, and a neutral assessment of MEDRS would not inevitably reach such a conclusion. As such, I reiterate my point that non-MEDRS are being used as a starting point not just for biomedical claims, but of which biomedical claims in a heated controversy are true. Void if removed (talk) 14:52, 11 May 2025 (UTC)

:::::::::Which specific statements in the article that require MEDRS are not currently sourced to MEDRS, in your opinion?  Tewdar  15:05, 11 May 2025 (UTC)

::::::::::Well for starters {{tqq | Data suggests that regret and detransitioning—however defined—are rare, with detransition often caused by factors such as societal or familial pressure, community stigma, or financial difficulties}} is cited to two papers in Social Science & Medicine, one of them being Wuest & Last.

::::::::::This is a very strong claim on a subject where definitive claims can't really be made. The data simply isn't there and lack of followup a constant problem with what studies exist. The suggestion seems to be these social science papers know regret is rare, to the point any other suggestion is "misinformation". Else, why is it on this page? Void if removed (talk) 15:14, 11 May 2025 (UTC)

:::::::::::See [https://link.springer.com/article/10.1007/s11930-025-00404-w this study] which came out yesterday reiterating {{tq | the rates of detransition and regret remain unknown }}. Void if removed (talk) 15:21, 11 May 2025 (UTC)

::::::::::::Or [https://academic.oup.com/jsm/article-abstract/22/2/356/7933251?redirectedFrom=fulltext this recent systematic review] which basically says all the data is terrible and low quality and we need to get better data.

::::::::::::{{tqq | their numbers were too small to be statistically relevant, their time frame was insufficient, they did not use patient-level data, or they did not consider confounding factors.}}

::::::::::::{{tqq | the results of the present analysis show that detransition in persons undergoing gender-affirming treatment has been insufficiently investigated, highlighting the need for long-term follow-up studies.}} Void if removed (talk) 20:58, 11 May 2025 (UTC)

:::::::::::::That review explicitly says the research finds detransition "rare" 3 times, twice saying that even that rate is likely an overestimate...

:::::::::::::* {{tq|While the choice to detransition is proportionally rare, it is expected that an overall increase in the number of adults who identify as transgender would result in an increase in the absolute number of people seeking to halt or reverse a transition.}}

:::::::::::::* {{tq|Data in the literature have shown that the decision to detransition appears to be rare. Estimates of the number of people who detransition due to a change in identity are likely to be overinflated due to research blending different cohorts}}

:::::::::::::* {{tq|The current literature shows that the decision to detransition appears to be rare. By not controlling for these factors, pooled estimates of the number of people who detransition due to a change in identity are likely to be overinflated because research blends different cohorts}}

:::::::::::::That review also notes {{tq|Among the reasons for discontinuation reported by the different studies were not only doubts regarding transgender identity but also financial barriers, side effects, poor compliance, social issues or goals of treatment met.}}

:::::::::::::It is also cited in Detransition#Occurrence to support {{tq|Detransition has been heterogenously defined in the literature, but available estimates indicate detransition is rare.}} Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:23, 11 May 2025 (UTC)

::::::::::::::This review doesn't find detransition to be rare. Selecting instances of "rare" from the commentary and discussion and disregarding the actual findings means you're not actually using the outcome of the systematic review and bypassing the methodology that is what makes systematic reviews useful.

::::::::::::::If you're citing this to support the claim that detransition is rare, you really shouldn't. This is a review that says "current literature says its rare, we looked but all the studies are abysmal so we don't really know and we need better data".

::::::::::::::Likewise [https://adc.bmj.com/content/109/Suppl_2/s57 Taylor et al], which similarly said there was not much data and more was needed with longer followup since mean time to detransition was about 4 years.

::::::::::::::Both of these have low quality estimates in the up to 8% range, but in the 2025 review that is at multiple stages (so 1-7% pre blockers, 1-7% post blockers, 1-7% post hormones). Is this cumulative? No idea, we can't make between cohort comparisons.

::::::::::::::A range from 1 in 100 to 1 in 10 is not "rare". That's common.

::::::::::::::But these two systematic reviews really say: we don't know, and we need better data with longer followup.

::::::::::::::The page on detransition should be much clearer that we don't know, and this page should not be classifying the idea detransition is unknown as misinformation, based on non-MEDRS. Void if removed (talk) 21:52, 11 May 2025 (UTC)

:::::::::::::::@Your Friendly Neighborhood Sociologist, @Aaron Liu & @Void if removed, this seems relevant to the page but may be a digression from this section (which was opened with reference to the second sentence of the lede and the first of the body). I understand how this happened, and I think that VIR is right to say that because these sentences say that the misinformation has "primarily relied on manufactured uncertainty", {{tq|the strong implication is that the entire article in its conception is primarily about manufactured uncertainty}} (primarily is my addition).

:::::::::::::::However, I think it would be easier to separate discussion the level of scientific consensus/certainty or otherwise of each sub-topic of the article. This is because even if we maximally accept YFNS' take on that scientific consensus, the source for the second sentence of the lede does not support the claims within it - please see this comment for why (and inasmuch as it helps, skip the first point in it which overlaps with the discussion of certainty here). I see that @IntentionallyDense is thinking along similar lines here.

:::::::::::::::Hopefully limiting the scope of the section will help us find consensus about small improvements to the verifiability of the article. Samuelshraga (talk) 06:26, 12 May 2025 (UTC)

::::::::::::::::It is a digression, you're right, I've started a new topic for this sentence. Void if removed (talk) 08:33, 12 May 2025 (UTC)

::::::::::::::::I encourage you to check out my GAN review where I did just that: Talk:Transgender health care misinformation/GA3 I know not everyone will agree with the conclusions I came to and that it is just my one opinion but I did put significant time into the topics of the Cass Review, Desistence myth validity, and GET therapy. IntentionallyDense ^(Contribs) 14:43, 12 May 2025 (UTC)

:::::::::::::This is interesting and remarkably sounds like the Karrington review. We should probably treat both as what we currently have for the Karrington review in the section on desistance but also add the (caveated) percentage (range) in the abstract's "Results" section to both the detransition and desistance sections.{{pb}}That said, for just regret and not "detransition", I think the [https://pmc.ncbi.nlm.nih.gov/articles/PMC8099405/] review cited within "A thematic" unquestionably establishes that regret is low. Aaron Liu (talk) 04:15, 12 May 2025 (UTC)

:::::::::::Perhaps because detransition has multiple systematic reviews noting it's rare by any definition and nobody takes the claim it isn't seriously except WP:QUACKS. Where are your MEDRS saying it isn't rare? Perhaps add them to the detransition article.

:::::::::::[https://link.springer.com/article/10.1007/s11930-025-00404-w That study] is written by a SEGM member (Cohn), paid for by SEGM, and from their own words {{Tq| is not a systematic review}} (unlike the ones noting detransition is rare). The citation for the claim {{tq|the rates of detransition and regret remain unknown}} is to The Detransition Rate Is Unknown, a commentary by Cohn[https://link.springer.com/article/10.1007/s10508-023-02623-5]. We do not contradict real MEDRS because a dude cited his own opinion piece in an article on a separate topic.

:::::::::::* If you're going to claim this article is not based on MEDRS, don't try and contradict it with the least reliable source possible

:::::::::::Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:31, 11 May 2025 (UTC)

::::::::::::I will add, the Cohn paper also seems to conclude it's not evidenced based only on an assessment of mental health outcomes. Not all outcomes for GAC will be mental health outcomes and he's perhaps revealing his bias that he's taken that approach (well, he and his co-authors). Lewisguile (talk) 14:36, 14 May 2025 (UTC)

:::::::::{{tq|a neutral assessment of MEDRS would not inevitably reach such a conclusion.}}

:::::::::* Can you point to the MEDRS that say detransition is not rare or that most trans kids desist?

:::::::::** We have multiple systematic reviews at detransition noting it's rare, an the Karrington systematic review of desistance (which notes that the desistance myth is used by those opposed to trans healthcare) found the claim bunk, so MEDRS seem to disagree with you

:::::::::* Do you have any RS that say evangelical organizations don't claim these things without evidence?

:::::::::{{tq|The first two, most extensive sections, which make the most direct biomedical claims are both heavily dependent on the framing in these non-MEDRS,}}

:::::::::* Transgender health care misinformation#Transgender identity as a mental health condition Does not cite Wuest and Last - it cites the American Psychological Association, WPATH standards of care

:::::::::* Transgender health care misinformation#Social contagion and rapid onset gender dysphoria - ROGD is bunk, so says our article on it, so says the last RFC on it[https://en.wikipedia.org/wiki/Talk:Irreversible_Damage/Archive_10], so say the multiple RS, including the statement by a few dozen psychological and psychiatric professional medical associations explicitly calling out misinfo about it cited there

:::::::::* Transgender health care misinformation#Psychotherapy and conversion therapy - gender exploratory therapy is still considered bunk. You've been arguing it shouldn't be for years now, and IIRC AE has told you to drop the stick with it

:::::::::Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 15:19, 11 May 2025 (UTC)

:::::::::I don't see how one could claim that the article is mostly based these two over e.g. "A thematic" as a starting point. It just means we happen to cover the same topics all reviews that cover this topic generally also cover, making us adhere to RS. Aaron Liu (talk) 04:08, 12 May 2025 (UTC)

::::To respond to your suggestions:

::::a) If someone has an alternative that they think we should define and use instead, I'm open to that but I tend to think the definition I lifted from the wikipedia page above is a reasonable definition of manufactured uncertainty. I also think using a term and immediately having to define it to exclude what I think are its intuitive and most-common meanings is likely to be an unwieldy solution.

::::b) I think editing the sentence to limit the claims made in it is a very good suggestion. As I've said, the sourcing doesn't support the claims beyond just the problem of MEDRS (which it seems we disagree on). Our first two sentences of the lede have: {{tq| False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used to justify legislative restrictions on transgender people's right to healthcare. The claims have primarily relied on manufactured uncertainty generated by various conservative religious organizations, pseudoscientific or discredited researchers, and anti-trans activists.}} The "claims" referred to in the second sentence are explicitly the ones in the first. Given that we use the term "primarily", this means that we go far further than our source (which addresses some legislation in some US states).

::::There are other reasons to rewrite the sentences referencing manufactured uncertainty beyond the MEDRS objection and the limited scope of the sourcing, such as the vagueness of "relied upon". Samuelshraga (talk) 18:28, 10 May 2025 (UTC)

:::::I found nothing to suggest "manufactured uncertainty" is the same thing as the "manufactured controversy" that was defined, despite what the manufactured controversy article claimed failing verification. I've since merged that article into fear, uncertainty, and doubt. Do you object characterizing the claims as the latter? Aaron Liu (talk) 21:02, 10 May 2025 (UTC)

::::::Regardless of wiki-links, I have concerns about the sentence:

::::::{{tq|The claims have primarily relied on manufactured uncertainty generated by various conservative religious organizations, pseudoscientific or discredited researchers, and anti-trans activists.}}

::::::# My original objection which I think still stands: using the term "manufactured uncertainty" in my opinion makes the claim that an uncertainty is being asserted that does not meaningfully exist. I don't think the source provided is competent (on wikipedia) to verify claims about the level of certainty of safety or efficacy of healthcare interventions.

::::::# The use of "primarily", when the source addresses restrictions on the provision of transgender healthcare to minors in 21 US jurisdictions, but the scope of the "claims" includes transgender healthcare for all ages and in all countries.

::::::# The vagueness of the words "relied on". Does the misinformation consist of manufactured uncertainty? Or does it rely on them in another way, for instance by using the uncertainty to promote alternatives to transgender healthcare (and this, rather than the uncertainty itself, is the misinformation)?

::::::# "pseudoscientific or discredited researchers". The terms "pseudoscientific" or "discredited" don't appear in the cited article (apart from an unrelated use calling conversion therapy "discredited"). The terms we use are significantly stronger and more pejorative than those in the cited source, and readers can scroll down a short way to find the names of the individuals referred to, so this seems particularly problematic. The source also doesn't reference "anti-trans activists". Samuelshraga (talk) 21:40, 10 May 2025 (UTC)

:::::::How about switching the order of the sentence around something like "there are various conservative religious organisations, anti-trans activists and fringe scientists who use misinformation to manufacture uncertainty". I'd expect there to be work on the words we use for the groups but I'm more interested in whether you think this covers points 1-3. Maybe we could say "as part of a FUD strategy" instead of "to manufacture uncertainty" instead. LunaHasArrived (talk) 09:31, 12 May 2025 (UTC)

::::::::That doesn't address the fact that these are non-MEDRS making MEDRS claims about the level of certainty. Merchants of Doubt references deliberate fake science that was used to create uncertainty where none actually existed. Here, we have a lot of actual uncertainty in MEDRS - every single systematic review in whatever area seems to come to the conclusion the evidence is poor - and these non-MEDRS sources are not competent to judge this uncertainty to be "manufactured".

::::::::A better way to describe this is that uncertainty or certainty is possibly overstated by some parties for political ends. Void if removed (talk) 10:14, 12 May 2025 (UTC)

:::::::::Does it? I'm very sure that FUD is primarily based on excessively aggrandizing the need for continued research, not faking results, which would be hard under peer review. In fact, our article on manufactured controversy also says the first part, and here's a quote from its predominant source:{{pb}}{{tqb|The first of these has been called an “epistemological filibuster” because it magnifies the uncertainty surrounding a scientific truth claim in order to delay the adoption of a policy that is warranted by that science. Languaging expert Frank Luntz admitted as much in his now infamous talking points memo on the environment, leaked to the public in 2002, where he confessed that the window for claiming controversy about global warming was closing, but he nonetheless urged Republican congressional and executive leaders “to continue to make the lack of scientific certainty a primary issue in the debate.” ExxonMobil was doing this when it published its “Unsettled Science” advertisement about climate science on the editorial pages of the New York Times in March 2000. A more recent guest editorial by a reader made the same claim in the pages of the Seattle Post-Intelligencer in January 2008. All three seemed to be following the playbook of the tobacco industry when scientists discovered that their products cause cancer; when a threat to their interests arises from the scientific community, they declare “there are always two sides to a case” and then call for more study of the matter before action is taken.|source=https://web.archive.org/web/20190821212147/https://scienceprogress.org/2008/04/manufactroversy/}} Aaron Liu (talk) 12:22, 12 May 2025 (UTC)

::::::::::@Aaron Liu, how do you differentiate cases of FUD that consist of {{tq|excessively aggrandizing the need for continued research}} from legitimate cases of non-excessively stating the need for continued research? Samuelshraga (talk) 13:24, 12 May 2025 (UTC)

:::::::::::Great question. I think it depends on what the researchers think about how much doubt there is; if reviews say doubt is excessive then it's probably excessive. There's also the bad thing where some use the kind-of-preliminary status of research to restrict care against the will of medical academics, which is especially improper here with the WPATH SOC having matured to its eighth revision. Anyways, my point is that manufactured uncertainty is in fact primarily overstated uncertainty. Aaron Liu (talk) 13:48, 12 May 2025 (UTC)

::::::::::::We have a case where researchers in the field have published in MEDRS variously saying that some transgender healthcare interventions either:

::::::::::::a) have been shown to be necessary

::::::::::::b) lack an evidentiary basis to show that they are effective.

::::::::::::Leaving aside questions of which have greater weight (a question which is doubtless very important in many contexts), I believe that both positions here at least meet the threshold of being legitimate and non-fringe positions in the field of transgender healthcare. If we can't say that positions (a) or (b) are exaggerating certainty or uncertainty but having a legitimate scientific disagreement, how can we say that anyone who is not an expert in the field but espouses position (a) or (b), perhaps arguing for policy changes as a result, is exaggerating certainty or uncertainty? This clearly disambiguates cases like climate change from situations of genuine scientific disagreement. Samuelshraga (talk) 15:06, 12 May 2025 (UTC)

:::::::::::::If the consensus among most RSes (including specialist bodies) is (a), then (b) may indeed be exaggerating. Arguing that a mainstream consensus is based on shaky evidence is not the same as there being no consensus, no matter how hard or frequently the argument is made by those on the fringe who wish otherwise. EBM should also include expert opinion and the views of those affected, which most sources disputing the evidence base lack in one or both cases. Lewisguile (talk) 16:24, 12 May 2025 (UTC)

::::::::::::::{{tq|If the consensus among most RSes (including specialist bodies) is (a), then (b) may indeed be exaggerating.}} If we use the basic meaning of "most", a majority, then I disagree.

::::::::::::::WP:FRINGE makes a three-way demarcation that is interesting here:

::::::::::::::* Pseudoscience: "Proposals that, while purporting to be scientific, are obviously bogus may be so labeled and categorized as such without more justification."

::::::::::::::* Questionable science: "Articles about hypotheses that have a substantial following but which critics describe as pseudoscience, may note those critics' views; however, such hypotheses should not be described as unambiguously pseudoscientific if a reasonable amount of academic debate still exists."

::::::::::::::* Alternative theoretical formulations: "Alternative theoretical formulations from within the scientific community are not pseudoscience, but part of the scientific process. They should not be classified as pseudoscience but should still be put into context with respect to the mainstream perspective."

::::::::::::::You seem to be treating the argument that the case for transgender healthcare interventions lack a sufficient evidentiary basis as pseudoscience. This article, lede and body, certainly does describe that camp as pseudoscientific. I would argue that it falls under the category of questionable science inasmuch as its critics (including some editors who wrote this article) certainly describe it as pseudoscience, but largely under alternative theoretical formulations, which as it says there:

::::::::::::::"Alternative theoretical formulations generally tweak things on the frontiers of science, or deal with strong, puzzling evidence—which is difficult to explain away—in an effort to create a model that better explains reality." I think this is a reasonable description of scientists in good standing who publish in top-tier journals, and are not making broad theoretical dissensions but simply applying basic tests of whether evidentiary thresholds for certain interventions have been met, and coming to conclusions that other - maybe most - scientists in the field dissent from. Samuelshraga (talk) 18:30, 12 May 2025 (UTC)

::::::::::FUD and "manufactured controversy" aren't really the same thing though. FUD has been commonly used to describe marketing as much as anything historically, Microsoft being masters of it. The competitor's system is buggier, will lose your data etc. Or in politics ("but her emails").

::::::::::The manufactroversy that Oreskes etc write about goes beyond that, involving the manufacturing of fake science or junk science or misleading science and trying to get it published in crappy journals without declaring it was industry-funded, and then promoting this research and building talking points around that. The tobacco industry was directly manufacturing controversy (or attempting to) to use as the basis of its campaign to stall legislative restrictions etc. Same with climate change denial. FUD pretty much relies on what's already there and plays up uncertainty, while a manufactroversy aims to create the appearance of (scientific) uncertainty where in reality none actually exists.

::::::::::With tobacco, after a point there was no meaningful controversy that smoking was harmful, but the industry pressed for decades to push research showing there was no conclusive evidence for this and suppress damaging research.

::::::::::But with youth transition we have 10-20 recent systematic reviews across a whole range of subjects by independent teams using independent methods all saying that there is a weak evidence base and few meaningful conclusions that can be drawn, with some stark clinical disagreements in best practice.

::::::::::That's not a manufactured controversy - it is a genuine one. And a non-MEDRS source is not the right one to interpret this complex and hotly contested field and declare any controversy to be fake. Void if removed (talk) 13:36, 12 May 2025 (UTC)

::::::::I think that these are constructive suggestions. They certainly satisfy point 2 above, and point 3 too insasmuch as we'd now be saying that these groups and individuals "use misinformation". However, they make the problem of point 1 more acute. Inasmuch as the source says that the subjects here used misinformation (i.e. made false or misleading claims) about healthcare interventions, this source is not competent to determine whether those claims are false because it is not MEDRS.

::::::::There's also a new issue which is that we now need to verify the claim that the parties we are describing "use misinformation", and that claim is not directly in the article. Are we to consider - and describe in wiki-voice - as misinformation the sentence in the introduction which says they "distort scientific findings to generate uncertainty" about gender-affirming care, and a couple of paragraphs in section 4.2 with statements like "ban proponents cited–and frequently misrepresented–policies adopted by other countries"? If so, is every incorrect statement made about transgender healthcare misinformation, whether or not it is described as such in the sources? If we have an answer to this question, we need to apply it consistently. Samuelshraga (talk) 10:31, 12 May 2025 (UTC)

:::::::::How about using misleading claims instead of misinformation. Both "distort scientific findings" and "frequently misrepresented policies" I think can be summarised as misleading claims. LunaHasArrived (talk) 10:56, 12 May 2025 (UTC)

::::::::::Maybe specifically "misleading claims about research and healthcare policy". LunaHasArrived (talk) 10:57, 12 May 2025 (UTC)

::::::::::I think "misleading claims" would bring the sentence a lot closer to verifiability. Samuelshraga (talk) 11:04, 12 May 2025 (UTC)

:::::::::::Just double checking , the main problem to work out with the statement "there are various [People] who use misleading claims about research and healthcare policy to manufacture uncertainty" would be working out how we describe the people? And you'd be happy to continue working on that statement LunaHasArrived (talk) 11:09, 12 May 2025 (UTC)

::::::::::::To separate the claims in the source, I don't think we can use Wuest and Last's claim of "distort scientific findings" because of the MEDRS issue (especially as they don't source that claim themselves). I think we can use their claims of "ban proponents cited–and frequently misrepresented–policies" as this is not a biomedical claim, and the examples of this they give in that paragraph can be described as "misleading claims". So yes, I think we can take that as the basis and then work out how to describe the people.

::::::::::::The source describes them as "ban proponents", so I would suggest we describe them as "proponents of bans on transgender healthcare provision to minors in the US". Samuelshraga (talk) 11:21, 12 May 2025 (UTC)

:::::::::::::Sorry, should have read more carefully - I think we would have to strike "about research" from that sentence then, so it would read: "there are various [People] who use misleading claims about healthcare policy to manufacture uncertainty". Samuelshraga (talk) 11:22, 12 May 2025 (UTC)

::::::::::::::What you could do is collapse the two sentences into one to sidestep the issue of "manufactured controversy" and overstating things from Wuest & Last:

::::::::::::::{{tq | False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used by various conservative religious organizations to justify legislative restrictions on transgender people's right to healthcare.}}

::::::::::::::Possibly adding "in the US" in the middle too. What I'd then expect to see in the body is an example of exactly when and how and by whom a false or misleading claim was used to justify a legislative restrictions. Void if removed (talk) 11:26, 12 May 2025 (UTC)

:::::::::::::::I think we'd have to edit "conservative religious organizations", add "in the US" as you suggest and also change "transgender people's right to healthcare" to something like "minors' access to transgender healthcare". That said, I think joining the two sentences could be an improvement here. Samuelshraga (talk) 12:04, 12 May 2025 (UTC)

::::::::::::::::How about {{tq | False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used by various conservative religious organizations in the US to justify legislative restrictions on transgender healthcare for minors.}} Void if removed (talk) 12:14, 12 May 2025 (UTC)

:::::::::Wuest & Last is citing (a Wuest book that cites) MedRS reviews for what is true and then applying the sociology definitions for which false/misleading claims are misinformation, no? Aaron Liu (talk) 00:33, 13 May 2025 (UTC)

::::::::::Wuest & Last don't accuse anyone of misinformation in the article we cite. They actually make very few direct accusations of false/misleading claims:

::::::::::* There is an unsourced statement in the introduction that conservative political and legal organizations "distort scientific findings" about gender-affirming care.

::::::::::* In section 4.2 they say "ban proponents" (unspecified which) misconstrued health policy from other countries (this one, I agree, is a claim that doesn't need to be MEDRS).

::::::::::* In the same section, they say ban proponents occasionally "misrepresented statements by scholars on the need for additional research as indicating a dangerous lack of present knowledge".

::::::::::On that last, I think that the question of whether the state of current knowledge is sufficient to establish the safety of medical interventions is clearly one that requires MEDRS, and so Wuest and Last are not a valid source for the statement that one side of that debate have "misrepresented" those statements. But even if they were, it's a bit ludicrous to describe it as "misinformation" when experts on one side of a debate quote experts on another side to make a point. When opponents of the Cass review use quotes from it to make a point and come to a different conclusion about care pathways, is it "misinformation"? Samuelshraga (talk) 06:47, 13 May 2025 (UTC)

:::::::::::Most of the misinformation accusations are in Supplemental Table 3.{{pb}}The table also elaborates on the third point, although it is still weirdly less clear than ideal. I am pretty sure it means that the paper cited the impetus to begin a long-term study to claim the support behind youth interventions lacks long-term studies to prove such interventions and when the quoted long-term study had already finished. (The table doesn't say this, but the amicus brief mostly quotes that study's statements that there is a critical gap in knowledge on physiologic and metabolic effects to say {{tq|Olson-Kennedy, et al. squarely support the Legislature’s observation that long term research into the safety and efficacy of medical gender affirmation treatment is seriously lacking.|q=y}}) Aaron Liu (talk) 01:29, 14 May 2025 (UTC)

::::::::::::Thanks for the pointer, I hadn't looked at the supplemental tables. I tried to find accusations of misinformation in Supplemental Table 3 and didn't get anywhere, but it's long so if you could point me to where I should look I'd appreciate it.

::::::::::::I also don't understand how what you've written clarifies the 3rd point (the relation between the misinformation and manufactured uncertainty). Is the idea that an amicus brief in one of the legal cases around the state's bans quotes Olson-Kennedy to say that the evidence base for interventions is lacking? I don't think this on its own verifies the statement at all. Samuelshraga (talk) 18:51, 14 May 2025 (UTC)

:::::::::::::# Because long-term research was lacking, a longitudinal (and long-term) study on TYC is started. It finishes enrollment in 2018 and publishes its protocol in 2019, the latter of which cites the need for longitudinal research for its exigence.

:::::::::::::# [https://reporter.nih.gov/project-details/10122677#publications The project progresses], gradually releasing reports, including positive findings on [https://pmc.ncbi.nlm.nih.gov/articles/PMC10081536/ psychosocial efficacy] by Jul 2023, [https://pmc.ncbi.nlm.nih.gov/articles/PMC9629364/ the (lack of) adverse effects on renal function] by Jan 2022, and [https://pmc.ncbi.nlm.nih.gov/articles/PMC9673472/ the (lack of) adverse effects on prepubertal growth rate] by Jul 2021.

:::::::::::::# A November 2023 amicus brief cites the pre-study 2019 protocol to claim there is a lack of long-term studies on the safety and efficacy of TYC treatment, ignoring the above results that studied the exact same thing.

:::::::::::::{{pb}}Other examples of misinformation pointed out by the table include using a very-much–since-updated 2009 practice guideline to claim the current evidence is of extremely low-quality (while the current edition of that guideline says no such thing) and citing the correction of the critical "Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study"'s conclusion from "lower use of mental health treatment" to "reduced likelihood of mental health treatment" to claim the entire study and thus all the conclusions based on it were flawed. These are the second and third entries in the table, respectively. Aaron Liu (talk) 22:04, 14 May 2025 (UTC)

::::::::::::::So you're saying that the claim in the article "misrepresented statements by scholars on the need for additional research as indicating a dangerous lack of present knowledge" should be referred to as a shorthand for the 3 steps that you lay out above? If so:

::::::::::::::# The article makes no mention of your second piont about the progression of the project and data it puts out.

::::::::::::::# {{tq|ignoring the above results that studied the exact same thing}} is an original synthesis, not a claim made in the article.

::::::::::::::# Is the suggestion that by 2023 Olson-Kennedy et. al. had definitively solved the problem of inadequate evidence-based date for transgender youth interventions? That saying that there was still inadequate evidence became, at that point, misinformation?

::::::::::::::There's a general question here which maybe needs to be separated out into its own section because it affects the whole article, but is certainly relevant to our discussion: Under what can we call something misinformation in wiki-voice? (Particularly when the sources say a claim is false, or misleading, or cast doubt on it etc., but do not call it misinformation).

::::::::::::::I've looked through the archives, and variations of this has been asked several times. I might have missed some, but I only saw two substantive responses to this. @Aaron Liu, you gave what I think is the only direct answer to this question so far: {{tq|When a very strong proportion of academia thinks something is wrong, that something would be misinformation indeed.}} @IntentionallyDense gave a quite different answer - albeit one I read as more related to a specific example: {{tq|the presentation of unfounded claims as facts.}}

::::::::::::::I don't really agree with either of your answers, but while I think I could see how we would use ID's as a basis for editing the article, I think AL's is unworkable. Minority opinions in the scholarship are not automatically misinformation.

::::::::::::::My answer would be this that to make a claim in wiki-voice that something is misinformation, we should have:

::::::::::::::# Sourcing that describes it as misinformation.

::::::::::::::# The sourcing should be commensurate with the subject of the claim - e.g. saying a claim that appears in a peer-reviewed journal from a subject-matter expert is misinformation should require exceptional sourcing. A non-MEDRS source should not be able to say that a claim in a MEDRS source is misinformation.

::::::::::::::# The claim should be false, or at least significantly misleading. It should not be a difference of opinion, or admit of alternative interpretation in which it is not false or significantly misleading.

::::::::::::::If a source meets criterion 1 but not 2 and/or 3, it should be attributed.

::::::::::::::If you think we should discuss this in a separate section, feel free to split out the second part of this comment into one (or ask me to). Samuelshraga (talk) 07:52, 15 May 2025 (UTC)

:::::::::::::::My definition was more a functional one based on the article at hand. Regarding your 3 proposed criteria,

:::::::::::::::# I feel as though this may be asking a bit too much in a sense. For example if one source says something blatantly untrue with some motive (like saying Saturn is the biggest planet and therefore all space funding should go towards Saturn), do we really need a source saying it is misinformation or can we reasonably infer (with of course sources allowing us to) that based on the fact that what the claim is saying is untrue (or without strong evidence) it could constitute as misinformation?

:::::::::::::::# I for one love a good quality MEDRS. I work almost exclusively with them. However all MEDRS sources tell us is what the authors conclude based on clinical information. I do absolutely think this holds a lot of weight most of the time however even experts can make mistakes and there is often a significant lag time with research. What I mean by this is that even MEDRS sources need to be interpreted with caution.

:::::::::::::::# I do agree with this one and this comes right back to WP:NPOV which sets out that facts should be labelled as facts and opinions as opinions.

:::::::::::::::I don't necessarily disagree with all that you are saying here, I was just tagged here and wanted to give you some food for thought as I believe challenging our opinions only makes them stronger. IntentionallyDense ^(Contribs) 03:03, 16 May 2025 (UTC)

::::::::::::::::@IntentionallyDense, thanks for the thoughtful response.

::::::::::::::::#I see what you mean. I quite like that you included {{tq|with some motive}} to {{tq|blatantly untrue}}. It seems to me that misinformation, even though it need not be deliberately incorrect (like disinformation), does have to be in support of some kind of agenda. To use your example, the statement "Saturn is the biggest planet" is not, on its own misinformation, until you add "and therefore all space funding should go towards Saturn". Maybe we could split this, to require either:

::::::::::::::::##A source describe something as misinformation; or

::::::::::::::::##A source report on a factual error and the agenda supported by it.

::::::::::::::::#I don't mind saying MEDRS should be interpreted with caution, but I don't know what you're arguing here. Let me clarify and see if we can agree on this as an example of commensurate weight in sourcing: If a non-MEDRS source accuses a MEDRS source of being/containing biomedical misinformation, we could carry that claim attributed. However, we couldn't put it in wiki-voice. The question of sources commensurate to the claim isn't only about MEDRS and biomedical information though. If a normal RS source claims that Libs of TikTok or Donald Trump posted misinformation, that on its own would satisfy this criterion. If the New York Times accuses the Washington Post of misinformation (or vice versa), we should attribute on the basis that these sources are of roughly equal credibility for us.

::::::::::::::::Hopefully if we can agree on some principles like these, and more editors weigh in and refine them, we can have a more consistent and transparent rubric for how and why claims of misinformation might be included or excluded here. I think this would lower the temperature somewhat. Samuelshraga (talk) 11:10, 18 May 2025 (UTC)

:::::::::::::::::I do like your modifications to the first criteria and yes the whole point of adding "and therefore funding should be high" was to illustrate that misinformation comes with an agenda (although real life examples aren't usually that clear cut).

:::::::::::::::::And my point with the second bit was just to say that MEDRS sources are not without errors. I do like your idea of attribution being needed for claims that go against a MEDRS source, however I will note that there is debate over whether or not the Cass Review and similar publications are truly MEDRS. While this isn't easy for newer editors to wrap their heads around, I see MEDRS as more of a spectrum. There are a couple components to a MEDRS and every source has different "ratings" for those factors. For example if we looked at a source that was published in 2025 by a group of experts in their field, was peer reviewed and a systemic review, published in a reliable and relevant journal by a reputable publisher, we could probably say that this source scores a 10/10 on all the different factors that make up a MEDRS. However the reality is that most sources don't fall under this explanation. I absolutely love that we have such a detailed explanation of what a MEDRS is and I think the majority of the time the detailed breakdown of each factor doesn't really matter, in CTOP areas it sometimes does. This is all to say that if implementing this we will certainty get people arguing over what a MEDRS is. I don't think all of these arguments have merit and this is what the reliable sources noticeboard is for, but just another thing to keep in mind. IntentionallyDense ^(Contribs) 23:41, 18 May 2025 (UTC)

::::::::::::::::::@IntentionallyDense I'm not going to get into the question of whether the Cass Review is MEDRS - you're right that there will be discussions about what constitutes RS and MEDRS, and even comparisons of quality of different MEDRS, which is fine. What I'd like to know is if what you've written above means you would edit the second criterion above, which I'll summarise like this:

::::::::::::::::::Wikipedia should only describe a claim as misinformation if the sources which describe it that way (per criterion 1) are of greater credibility regarding the underlying claim than the sources which actually make that claim. Samuelshraga (talk) 06:33, 19 May 2025 (UTC)

:::::::::::::::::::The criteria I would agree with (using the ones you came up with):

:::::::::::::::::::# A source describe something as misinformation; or

:::::::::::::::::::# A source report on a factual error and the agenda supported by it.

:::::::::::::::::::# The sourcing should be commensurate with the subject of the claim - - e.g. saying a claim that appears in a peer-reviewed journal from a subject-matter expert is misinformation should require exceptional sourcing. Or the claim must be attributed

:::::::::::::::::::# The claim should be false, or at least significantly misleading. It should not be a difference of opinion, or admit of alternative interpretation in which it is not false or significantly misleading.

:::::::::::::::::::(bolded my revisiom to your claim)

:::::::::::::::::::Points 1 and 2 give us a clearer definition of what misinformation is. Points 3 and 4 are more caveats to the outline. This is the criteria I personally would support and I think it's a good compromise on all parts. If you think this would be a good idea to implement I think starting a new section to discuss would be best. Hopefully there we can gain some consensus. IntentionallyDense ^(Contribs) 16:35, 19 May 2025 (UTC)

::::::::::::::::::::Yep, I'll start a new section for this. Thanks! Samuelshraga (talk) 17:15, 19 May 2025 (UTC)

:::::::::::::::{{tqb|Minority opinions in the scholarship are not automatically misinformation.}}{{pb}}I believe you're describing Wikipedia:Fringe theories#Alternative theoretical formulations. I don't think academics would call those "wrong"; in my admittedly-limited experience reading review papers in my studies I've seen the majority of minority opinions with reasonable amounts of debate just called that, minority opinions, and not incorrect. Meanwhile, if an extremely strong proportion of relevant academic material go beyond that and call something wrong, that is very short of reasonable amounts of academic debate, and that is manufactured uncertainty. Aaron Liu (talk) 01:17, 19 May 2025 (UTC)

::::::::::::::::@Aaron Liu I addressed what you're saying in this comment. There I say that in some respects the "minority opinions" here fall between WP:Fringe theories#Questionable science and WP:Fringe theories#Alternative theoretical formulations. What you're saying sounds a lot like the description of "Questionable Science": "Articles about hypotheses that have a substantial following but which critics describe as pseudoscience". I argued there that in some ways, "Alternative theoretical formulations" seems appropriate, but let's leave that aside for a second.

::::::::::::::::Even if something falls under the Questionable Science category, WP:FRINGE says it "should not be described as unambiguously pseudoscientific if a reasonable amount of academic debate still exists." I would say that it's fairly clear that the guideline would also argue against calling QS "misinformation". So for instance, in our sentence:

:::::::::::::::::"Misinformation has affected the decision of the UK National Health Service (NHS) to restrict the use of puberty blockers for transgender individuals."

::::::::::::::::This is cited to a bona fide source and I wouldn't want to omit the accusation from the article. However, that source cites it to the Yale Integrity Project's white paper, a non-RS (let alone MEDRS), and the basis for the NHS's decision was a MEDRS systematic review of the use of puberty blockers for gender dysphoria in adolescents. So I would say we should attribute such a sentence, because the sourcing is not commensurate with the claim (that viewpoints published in peer-reviewed high-quality scientific journals are misinformation). Samuelshraga (talk) 06:03, 19 May 2025 (UTC)

:::I am very confused about the manufactured uncertainty article. Is that not just fear, uncertainty, and doubt? The article even puts the latter as a "see also" but fails to identify a difference. The cited sources in this article for describing the provenance as "manufactured uncertainty" just say "manufactured doubt", which I would say is another word for FUD if I had not known that the seemingly duplicate concept of manufactured uncertainty exists. Aaron Liu (talk) 19:02, 9 May 2025 (UTC)

::::Isn't manufactured uncertainty just the 'U' in FUD?  Tewdar  19:17, 9 May 2025 (UTC)

:::::It seems to describe the whole tactic as manufactured controversy (the actual title of the article; "...uncertainty" is just a redirect). Do you think I should just BLAR that article to FUD? Aaron Liu (talk) 19:25, 9 May 2025 (UTC)

::::::Maybe you should create the Manufactured fear and Manufactured doubt companion articles. 😁  Tewdar  19:35, 9 May 2025 (UTC)

:::::::Oh dear, FUD is overwhelming Wikipedia! Aaron Liu (talk) 20:27, 9 May 2025 (UTC)

::::::::You've certainly manufactured uncertainty LunaHasArrived (talk) 20:42, 9 May 2025 (UTC)

:I don't see how you got to the biomedical claim from the statements in the article {{TQ| the gender-affirming care that is offered to minors in the jurisdictions that they study (in the US) is safe and effective, and that there is no uncertainty around this fact}} Firstly because as you yourself say it should not be {{TQ| No uncertainty}} but instead {{TQ| not beyond reasonable uncertainty}}. Secondly because the claims in the article do not state minors anywhere, in fact most of the misinformation claims in the article (4 of 5 main sub topics) are about all trans people and not just minors. In my mind the claim made in the article would be closer to {{TQ| There is more certainty than claimed by those distributing misinformation in the precise topic areas that those misinformation claims are made}} looking through our article all of those sections where certainty could be judged to be a biomedical claim seem to be backed up by medorg statements or at least Parity complaint statements which given this entire article is discussing fringe claims would certainly be enough.LunaHasArrived (talk) 16:16, 8 May 2025 (UTC)

::I agree with Samuelshraga. The sources cited in the opening paragraph are selectively chosen, overlooking the fact that evidence supporting the benefits of medical transition for minors is limited/weak. Several countries have restricted these treatments due to potential health risks. Presenting opposition to such interventions as solely driven by misinformation does not align with WP:NPOV, which requires a balanced and fair representation of all significant viewpoints. Alternative perspectives reflecting legitimate concerns regarding potential health risks to minors are not fairly represented. NHS decision, mentioned in the lede, concerns minors.JonJ937 (talk) 09:42, 9 May 2025 (UTC)

:::You've debated this in GA3 already. Aaron Liu (talk) 20:47, 9 May 2025 (UTC)

::Hi @LunaHasArrived. To respond to the points you make in the order you make them:

::Firstly, on the question of uncertainty. When you contrast “no uncertainty” and “not beyond reasonable uncertainty”, I agree that some form of the latter is what needs to be demonstrated. So let's amend the claim that you quote at the beginning to: {{tq|... and that there is no meaningful uncertainty around this fact.}} On the basis that for uncertainty to be manufactured, it can’t meaningfully exist.

::We should use the term "manufactured uncertainty" similarly to how it is used around the deleterious effects of smoking or anthropogenic climate change. There the term is used presupposing a settled scientific consensus that these phenomena are not the subject of genuine scholarly disagreement (as to their existence at the very least), and that arguments to the contrary are contrived and meritless.

::So too here with the safety and efficacy of gender affirming care for minors. If there is in fact meaningful uncertainty, then the phenomenon attested by the two sources in our article is at most the exaggeration or weaponisation of uncertainty (and these too are somewhat value-laden terms). Therefore, what is at issue is fundamentally the biomedical claim that you quoted.

::As to your second question, why minors? Again, I agree with you that the article overall does have a broader scope. However, the sources used in the article deal overwhelmingly with (justification for bans on care for) minors. This is a further deficiency in our presentation, that we introduce manufactured uncertainty as the primary component of our topic which includes all transgender healthcare worldwide, and then source it in the context of minors in some US jurisdictions. Samuelshraga (talk) 12:38, 9 May 2025 (UTC)

:Sociologists are qualified to evaluate the origin and impact of information that affects society, including those with certificates on GenSex studies. Not to mention it's a peer-reviewed journal for social science research on health, though it is debatable as you say whether that journal counts as MedRS (#c-Aaron_Liu-20250304002900-Void_if_removed-20250303154700). Wuest is also a gender studies expert, so I would hesitate to remove this right now.{{pb}}However, I agree with above that the definition used for the cited manufactured uncertainty is too extreme, especially when the source seems to be just saying it's fear, uncertainty, and doubt. I would replace the former reference with the latter. Aaron Liu (talk) 20:55, 9 May 2025 (UTC)

::{{tq | Sociologists are qualified to evaluate the origin and impact of information that affects society}}

::They aren't equipped to judge which medical information is false, though. They have to reflect a consensus, and they do not, but instead show all the signs of cherrypicking that manufactured uncertainty cautions about.

::As I said above {{tqq|Wuest & Last makes claims about sex-ratio shifts (which are so well-established in the literature that they aren't in any doubt) by citing literally the one (weak, survey-based, two-timepoints) study that shows a small sex-ratio shift the opposite way.}} There is no serious dispute anywhere that there is a sex ratio shift in clinical presentation. If anything, this looks more like manufactured certainty. Void if removed (talk) 22:11, 9 May 2025 (UTC)

:::To paraphrase Inigo Montoya, "I don't think that source says what you think it says"

:::{{tq|Experts and amici considered environmental causes (e.g., social media exposure) for increased rates of GD. Social contagion theories draw from Littman (2019) on ROGD, which four documents cited, and Shrier's (2020) related claims about peer contagion effects in AFAB adolescents, which five documents cited. Ban proponents also cited clinical data and statistics on Genspect's website demonstrating disproportionate increases in GD among AFAB adolescents (Women's Liberation Front, 2021, p.22). Observing that “[a]dolescent female social contagion effects in psychiatric illness are well-known and well documented,” Hruz (2021, p.86) compared AFAB adolescents' GD to the spread of eating disorders, depression and anxiety, or a general pressure to conform. Notably, a study of almost 200,000 adolescents found a slight increase in AMAB adolescents identifying as trans or gender expansive (Turban et al., 2022).}} - Nowhere in that paper do they make claims about sex ratio shifts themselves. They just note it's often cited to support ROGD, and note one study (which tracked more people than all those other studies put together for the record) had a different finding. What claim did they make about the shift that you're objecting to?

:::{{Tq| Quantitative systematic reviews demonstrate a pronounced sex-ratio shift, and the sex-ratio shift is fundamental to the plausibility of the social contagion hypothesis, yet none of this is mentioned on this page.}} - ROGD continues to be unevidenced bullshit. The data does suggest there's been a shift, and "kids are catching trans from the internet" continues to be the most pathologizing and least likely explanation for it. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:48, 9 May 2025 (UTC)

::::Agreed. I'm not sure why ROGD relying on a sex-ratio shift means we should include it, unless one is arguing from the position that ROGD itself must be included. Which I don't think anyone would do, because it's obviously pseudoscience.

::::As for medical consensus: there is still a consensus in support of GAC, despite several high profile changes in policy. The Cass Review itself notes this—it just disagrees with that consensus. When people want to exaggerate the weaknesses to suggest there isn't a consensus (or to suggest the consensus is the opposite of what it is), that certainly does seem like manufactured uncertainty. Is our comments page unintentionally proving the point for us? I would laugh, but we seem to keep having the same debates over and over again. Lewisguile (talk) 16:10, 10 May 2025 (UTC)

::I read Wikipedia:Identifying reliable sources (medicine)#Biomedical journals again. Though it is not in the two "core" lists (which have also long stopped udpating), Social Science & Medicine [https://www.ncbi.nlm.nih.gov/nlmcatalog/8303205 is indexed in MEDLINE], describes itself as interdisciplinary social science research on health, and thus it should be MedRS. @Tewdar You mentioned above (in the GAR) that you don't think we should cite it for biomedical information. Could you elaborate? Aaron Liu (talk) 14:55, 10 May 2025 (UTC)

:::So Wikipedia:Identifying_reliable_sources_(medicine)#Biomedical_journals gives the example of Journal of Medical Biography (also indexed in MEDLINE, btw) which it tells us {{tq|can be valuable for History sections, but is rarely useful for current medicine}}. I think we're in a similar situation with Social Science & Medicine - it's not a medical journal, it's a social science journal about medicine. For biomedical information, we should be using medical journals in most (or all) cases. In the particular case of Wuest & Last (2024), this article certainly does not meet the criteria for MEDRS, and any biomedical claims sourced to this article alone (if there are any) should be removed.  Tewdar  18:16, 10 May 2025 (UTC)

::::WP:PARITY says {{tq|Parity of sources may mean that certain fringe theories are only reliably and verifiably reported on, or criticized, in alternative venues from those that are typically considered reliable sources for scientific topics on Wikipedia.}}

::::This is besides the point as the the source is not used for biomedical claims, it's used about the purveyors of the misinformation. This is exactly the kind of thing WP:FRINGE/WP:PARITY covers - this is an academic RS identifying purveyors of what is considered misinfo. A MEDRS such as a systematic review would not devote time to misinformation, much less an analysis of who created it, while a peer reviewed article in one of the top ranked journals on the sociology of medicine is exactly where you'd expect to find that latter analysis.

::::WP:NOTBMI notes relevant examples this falls under:

::::* {{tq|Society and culture: Social stigma against a condition or treatment, information about disease awareness campaigns or advocacy groups, public perception, public funding for research or treatment, etc.}}

::::Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:39, 10 May 2025 (UTC)

:::::{{tq|A MEDRS such as a systematic review would not devote time to misinformation}} - how about [https://pmc.ncbi.nlm.nih.gov/articles/PMC9421549/ this one]? In any case , I am relieved to hear that Wuest & Last is {{tq|not used for biomedical claims}} in this article.  Tewdar  19:43, 10 May 2025 (UTC)

::::::That is a review of studies about misinformation, not a systematic review about a medical issue that includes analysis of misinformation about that issue. OsFish (talk) 15:50, 11 May 2025 (UTC)

::::That makes sense. Aaron Liu (talk) 20:58, 10 May 2025 (UTC)

:Looking at the Waldman source that's been added for "manufactured uncertainty".

:This is a law review piece, and not MEDRS - yet is (once again) classifying biomedical claims as false when it has no business doing so. See:

:{{quote frame | Another brief tells the story of ten parents who objected to their children receiving gender-affirming care. One parent was “shocked”; another did “her own research” to conclude that hormone therapy causes “loss of bone density and diminished cognitive development.” Another parent who signed onto the brief lost custody of his child because he opposed their gender transition; this parent also conducted his own research online about the risks of hormones. And a brief from four physicians and researchers who self-identify as “experts in gender-identity theory” argued that there are “serious gaps in the research underlying” gender-affirming hormone therapy [..] Any one of these briefs allows courts to manufacture factual uncertainty despite a medical consensus}}

:I mean, there is evidence for bone density loss, to the extent that providers offer ways to mitigate this, such as calcium supplements. That's not even controversial. There's weak evidence for cognitive impacts (especially in animal trials) but it remains uncertain and not something anyone knows for sure there aren't. There's a dozen or so systematic reviews that all say there are serious gaps in the research. [https://adc.bmj.com/content/109/Suppl_2/s33 Which part of this is supposed to be misinformation]?

:{{quote frame | Systematic reviews have consistently found mainly low-quality evidence, limited data on key outcomes or long-term follow-up. These reviews report that while puberty suppression may offer some benefit, there are concerns about the impact on bone health, and uncertainty regarding cognitive development, psychosocial outcomes and cardiometabolic health. They conclude there is insufficient evidence to support clinical recommendations.}}

:I get that people attached to ADF and ACPeds are baised, unreliable, untrustworthy, and not at all above exaggeration and misrepresentation etc, and I get that opponents of climate change have used similar tactics to play up uncertainty - but at some point we have to accept that WPATH are not in any way equivalent to the IPCC and that - unlike climate change - the body of evidence on offer for the safety and effectiveness of things like blockers and hormones has been overwhelmingly found to be poor. To the extent that bad actors overplay uncertainty, so too sources such as thus underplay it significantly, and we cannot use a source like this to say something is "manufactured uncertainty" when we have MEDRS saying the opposite. Void if removed (talk) 10:36, 16 May 2025 (UTC)

::Others have already disagreed that we need only WP:MEDRS sources for the subject of misinformation because, as has already been said, there isn't generally a body of appropriate medical literature looking at medical misinformation in this (or any?) area. It's not generally a topic medical science itself deals with; there aren't systematic reviews of medical misinformation conducted by medics in medical journals. Social scientists, language experts and, yes, lawyers, are the people who'd be appropriate for this information. WP:NOTBMI gives some examples of things that may not be biomedical information:

::* {{tq|Social issues: Social stigma against a condition or treatment, information about disease awareness campaigns or advocacy groups, public perception, public funding for research or treatment, etc.}} This seems very relevant.

::* {{tq|Legal issues: What laws regulate related provider conduct, whether a disease needs to be reported to the government, what constitutes medical malpractice, who can or did sue whom, etc.}} These cases are about legal bans on treatment. The litigants often allege medical malpractice. They sue or are sued in these cases.

::* {{tq|Regulatory status: Whether a substance is legal or illegal or available only by prescription has significant practical effects on the everyday practice of medicine, but it is medico-legal information, not biomedical information.}} This directly relates to bans, since those necessitate the cessation of prescription.

::* {{tq|Medical ethics: Discussions about the ethics of a treatment, publication, set of rules or practices, or the handling of an event do not constitute biomedical information. Some issues in medical ethics (e.g., how to handle requests from a delusional patient) are frequently discussed in biomedical sources, but ethicists can also be used as sources.}} This also clarifies that some issues can be sourced to more than just medical sources.

::* {{tq|For legal information, use a source that is reliable for legal information, such as an article in a law review.}} This paper is being cited to discuss what's happening in court cases, so a law review is an appropriate source.

::The third gives a specific carve-out for medico-legal info versus biomedical info, for example. This source isn't being quoted for any biomedical claims; it's being quoted for the who, what, where, why and how of these court cases. I agree it would be an issue if we said "lawyer x says this is the treatment you should use", but an account from lawyer x of "this is what has been said and done in courts around the country by group y" is not a biomedical recommendation. Notably, the paper itself (rightly) defers to the expert consensus on what counts as suitable treatment, but we aren't quoting it to make biomedical claims anyway. Lewisguile (talk) 11:20, 16 May 2025 (UTC)

:::{{tq | This source isn't being quoted for any biomedical claims}}

:::Sure it is - I just gave you the example. It is saying that these cases employed medical misinformation - which requires a biomedical claim about what constitutes medical misinformation - and the examples given are not misinformation.

:::This source OTOH seems to be, itself, an example of medical misinformation. Void if removed (talk) 11:49, 16 May 2025 (UTC)

::::You have made your opinion on what constitutes "biomedical information" quite clear and I do see the point you are trying to make, but I also disagree with it. Several other editors have also disagreed with your definition on that point.

::::I also don't think we have the same interpretation of "misinformation" here — your interpretation seems to be closer to "disinformation" instead. Misinformation doesn't have to be factually untrue, it only needs to be misleading, exaggerated, etc. Disinformation is intentionally deceptive and untrue information. Saying that there are "concerns" in the evidence-base about a risk to bone health (one you admit can be at least partially mitigated with OTC calcium supplements) isn't misinformation, of course. But the issue is people saying or implying it's a much bigger risk than it is to create fear and doubt in order to enact bans on healthcare.

::::I also do not agree that only WP:MEDRS can say what is or isn't medical misinformation, in part because such sources don't usually make such statements anyway. I have also listed several situations, per WP:NOTBMI, in which non-medical sources can be used to discuss issues related to medicine (such as the ethics, social context, or legal/regulatory status of treatments, but also what counts as "malpractice" or not).

::::If we take malpractice as an example, your definition of what counts "biomedical information" would seem to rule out most legal experts as sources on the basis that they would be making biomedical claims. In order to say someone has committed malpractice, they would be making a judgement about the validity or quality of any treatments offered (e.g., that the treatments offered were wrong, that the treatments weren't delivered in the right way, or that the right treatments were withheld). That seems like it would have unintended consequences, and so I don't think it can reasonably be the intent here. And if it's okay for legal experts to interpret whether someone has committed malpractice (whether the standard of care delivered was safe, necessary and evidence-based, etc), then they can do the same with misinformation (whether the person promoted or shared misleading information about whether care is safe, necessary and evidence-based, etc). The legal expert in question would presumably be deferring to medical expertise to make this argument, just as this paper is apparently judging misinformation against a "medical consensus" (and there remains a medical consensus in this case, even if there have also been some major and high profile objections to it). Lewisguile (talk) 14:31, 16 May 2025 (UTC)

:::::{{tq | If we take malpractice as an example}}

:::::That's not a valid analogy - malpractice is a fact-based matter that hinges on personal harm. This is about non-medical experts making general assessments of medical evidence in a legal context where particular interpretations favour certain positions in ongoing legal and political battles in the US. Saying the evidence is weak when it is not is no different from saying the evidence is strong when it is not.

:::::Claiming that the statement {{tq | “serious gaps in the research underlying” gender-affirming hormone therapy}} is misinformation is simply wrong in the context of children and young people. And this Waldman law piece was published in 2023; in the two years since since that date there have been more than a dozen systematic reviews from diverse teams and a range of methodologies that all agree the evidence in this entire field is poor. Void if removed (talk) 08:51, 19 May 2025 (UTC)

::::::I don't think malpractice is always so clear-cut. Mere medical harm caused by a clinician is not necessarily malpractice. Harms can also be subjective as well as objective, so it depends on an adjudication of harm, as well as an adjudication of whether best practice and medical standards have been followed (and therefore an assessment of what counts as best practice/medical standards).

::::::I can see there still isn't a general consensus about the tagged text anyway, but I wonder if the easiest way to fix the ongoing debate is just to attribute the relevant sentence of the lede? It would potentially mean including multiple people who have made such statements, which might get a bit clunky, but it could be summarised as "some scholars/lawyers/whatever have said..." That may be an easy fix that people can agree on. Lewisguile (talk) 16:31, 19 May 2025 (UTC)

It came up in response to a question in the above topic but is a digression so starting a new topic for this. Right now the sentence {{tqq | Data suggests that regret and detransitioning—however defined—are rare, with detransition often caused by factors such as societal or familial pressure, community stigma, or financial difficulties}} is cited to two papers in Social Science & Medicine, one of them being Wuest & Last. This is a biomedical claim which requires MEDRS. Citing what the Detransition page says isn't responsive because wikipedia is not a reliable source.

Counter to this, I have raised:

• [https://link.springer.com/article/10.1007/s11930-025-00404-w This 2025 study]], which says it is not rare and actually largely unknown with lots of poor quality studies with inadequate followup.
• [https://adc.bmj.com/content/109/Suppl_2/s57 This 2024 systematic review] which does not make any finding that it is "rare", but draws attention to the lack of adequate study and followup, since mean time to detransition is 4 years, most followup isn't long enough to capture this. Top end estimate of the low quality papers assessed was 8%.
• [https://academic.oup.com/jsm/article-abstract/22/2/356/7933251?redirectedFrom=fulltext This 2025 systematic review] which also does not find it is "rare" but once again highlights all existing studies are inadequate and true rates are unknown. Best low quality top-end estimates are up to 7% pre blockers, up to 7% post blockers, and up to 7% post hormones, but cohorts cannot be combined to establish an overall rate. All papers are criticised as {{tq | numbers were too small to be statistically relevant, their time frame was insufficient, they did not use patient-level data, or they did not consider confounding factors}}.

Counterpoints to these sources are that YFNS considers one of the co-authors of the first a WP:QUACK, and that since the 2025 systematic review uses the word "rare" three times that means it found detransition to be "rare". I find neither compelling, especially not the second when two mentions are in the introduction, and the third - in the discussion - only says {{tq | The current literature shows that the decision to detransition appears to be rare}}. These are relevant caveats about current published perspectives (see the citations, which are to three papers that aren't part of the review scope or synthesis) and not the finding of the review itself.

The unfortunate conclusion we have to draw from the systematic reviews - which are the best available MEDRS - is that we don't actually know and the data is terrible - which is why we should not be sourcing stronger claims from non-MEDRs like Wuest & Last.

This is not a basis upon which we can make the MEDRS claim that detransition is "rare", and especially not on a page that describes discussion of detransition as "misinformation", and is striving for a DYK placement.

When sources disagree or give uncertain results, we explain that to the reader, not pick the maximal interpretation to the exclusion of all else. Void if removed (talk) 08:32, 12 May 2025 (UTC)

:Copying what I said above:{{tqb|[These reviews are] interesting and remarkably [sound] like the Karrington review. We should probably treat both as what we currently have for the Karrington review in the section on desistance but also add the (caveated) percentage (range) in the abstract's "Results" section to both the detransition and desistance sections.{{pb}}That said, for just regret and not "detransition", I think the [https://pmc.ncbi.nlm.nih.gov/articles/PMC8099405/] review cited within "A thematic" unquestionably establishes that regret is low.}} Aaron Liu (talk) 11:31, 12 May 2025 (UTC)

::I note that this paper on surgical regret is cited on Detransition to justify saying detransition is rare over there too, which is inappropriate.

::I agree that the Karrington estimate should be restored, not sure why it keeps being removed. We have to explain the paucity of information and give readers the best estimates, complete with caveats. Void if removed (talk) 12:04, 12 May 2025 (UTC)

::Sorry, but I'm with YFNS on the study by Feigerlova. We can't cherry pick the parts we want; the paper as a whole gives a clear impression. The paper clearly outlines, in several places, the following:

::(i) desistance is defined in several different ways which may be inconsistent and this is a problem;

::(ii) despite this, it appears to be rare based on what data there currently is;

::(iii) these numbers are likely overestimates, in part because of the weaknesses in the evidence base; and

::(iv) more and better research is needed to provide more accurate data.

::So, to be clear, the author says better research is needed but she suggests this research will ultimately support lower overall numbers, not higher numbers.

::In the abstract, the results are summarised as:

::{{tq|Fifteen observational studies involving 3804 children and adolescents and 3270 adult participants were included in the 3212 screened studies. Five studies reported a change in request before starting GnRHa, five studies reported GnRHa discontinuation, and nine studies reported GAHT discontinuation. The point-prevalence proportions of shifts in requests before any treatment ranged from 0.8–7.4%. The point-prevalence proportions of GnRHa discontinuation ranged from 1–7.6%. The point-prevalence proportions of GAHT discontinuation ranged from 1.6–9.8%.}}

::These are the findings. These numbers would indeed appear to show that detransition is rare based on these measures. The abstract goes on to say:

::{{tq|All of the included studies were heterogeneous regarding definitions of detransition used and the study design: their numbers were too small to be statistically relevant, their time frame was insufficient, they did not use patient-level data, or they did not consider confounding factors.}}

::These are the limitations in the data. These limitations do not contradict the data; they just add caveats. They also don't imply that the evidence is an underestimate. So, her calling for better research to determine more accurate numbers is not the same as saying we have no idea at all, and the author still clearly says she thinks the poor quality has led to an overestimate in numbers, not an underestimate.

::In the introduction, she clearly says:

::{{tq|Data in the literature have shown that the decision to detransition appears to be rare. Estimates of the number of people who detransition due to a change in identity are likely to be overinflated due to research blending different cohorts.}}

::Again, this is the author giving her informed opinion based on these results. This is not the same as saying there's no evidence that desistance is rare. She also says:

::{{tq|While the choice to detransition is proportionally rare, it is expected that an overall increase in the number of adults who identify as transgender would result in an increase in the absolute number of people seeking to halt or reverse a transition. The existence of these requests does not mean the interruption of medically necessary care, including hormonal and surgical treatments, for the vast majority of transgender adults.}}

::I.e., evidence of desistance is not necessarily evidence against GAC (as is often claimed by those pushing misinformation in this area).

::In the discussion section, she also repeats the following:

::{{tq|Among the reasons for discontinuation reported by the different studies were not only doubts regarding transgender identity but also financial barriers, side effects, poor compliance, social issues or goals of treatment met. The current literature shows that the decision to detransition appears to be rare. By not controlling for these factors, pooled estimates of the number of people who detransition due to a change in identity are likely to be overinflated because research blends different cohorts.}}

::She also says:

::{{tq|The term “desistance” remains poorly defined in the literature and does not seem to predict gender outcomes.}}

::So, her conclusion is "yes, the evidence is poor, but the numbers are likely to be lower than the evidence shows, not higher". Which generally supports "detransition is rare", but it would also be fine to say "detransition rates appear to be low and may be overinflated but better research is needed". Lewisguile (talk) 13:22, 12 May 2025 (UTC)

:::{{tq | These numbers would indeed appear to show that detransition is rare based on these measures}}

:::One in ten is not rare, it is common, and regardless we should not be applying our own interpretation to these findings that the review does not, we should be presenting this neutrally and explaining the limitations.

:::{{tq | informed opinion based on these results}}

:::No, that line cites to existing opinions in literature, not the papers in the review or the review's findings. This systematic review itself does not find detransition to be "rare" and presenting a line from the discussion as if it were the findings of the review itself is not an accurate representation of this source.

:::The author's speculation that numbers may be higher or lower also aren't really germane when the only findings of the review are the data is too poor to say what the rate of detransition is.

:::Now, it would be completely legitimate to say, for the sake of argument, "the true rate of detransition is unknown, here are the estimates, religious conservatives trying to ban trans healthcare wrongly exaggerate by focusing on a single study which says it is 34% and don't account for the range of uncertainty or poor quality of the data" or whatever. That is a plausible way this material could be presented given the state of MEDRS.

:::But that's not what is happening - it is being presented as definitely rare, with the indication that anyone saying otherwise (even that it is actually uncertain) is spreading misinformation. Void if removed (talk) 14:23, 12 May 2025 (UTC)

::::You appear to be cherry-picking again and have ignored most of what I wrote. For example, you say "1 in 10", but she gives a range with 9% as the maximum in one category and says those numbers are likely overstated anyway.

::::Read the whole article again. The author makes the same statement in the introduction but also in her discussions of the results (twice—once in the abstract's results section and once in the full discussion section). She doesn't qualify the comments on rarity in the way you do. She says it appears rare and even says the numbers are likely overstated. That's her opinion based on her findings. If she disagrees, why does she say the numbers are "likely" overstated? That doesn't make sense.

::::I've cited numerous times where she indicates this in the paper. Can you cite multiple places where she clearly says "this is what they say, but I disagree"? If not, we have to read her words per their obvious meaning: if she says it's rare in the article, she's actually saying it's rare. Lewisguile (talk) 16:32, 12 May 2025 (UTC)

:::::A systematic review is a top-of-the-pyramid evidence source for its findings. However, what you are doing with reference to "rare" is citing sections of the introduction and discussion which are not part of the systematic review's findings, ie these are not conclusions drawn from the papers that were part of the review search and synthesis. Where the author mentions what extant literature on regret says or what they think plausible future findings might be with better data is, again, interesting background and context but immaterial because what we care about are what this review itself actually found.

:::::Which, I repeat, is not much, because the data is so bad. The author is unable to say what the rate of detransition is. The author is only able to give point estimates at various stages. We cannot draw any stronger conclusions from the findings of this review than, roughly:

:::::* Existing studies are all low or very low quality, with inadequate followup, lack of patient-level data, statistically insignificant findings, and confounding factors, and lacked the ability to actually detect detransition rates

:::::* Detransition pre-blockers based on this low quality data is possibly 0.8–7.4%

:::::* Detransition post-blockers based on this low quality data is possibly 1–7.6%

:::::* Detransition post-hormones based on this low quality data is possibly 1.6–9.8%

:::::* None of this is robust and better research is needed with longer followups and consistent parameters

:::::I know this is an unsatisfying conclusion, but that's basically it.

:::::If you're going to cite a systematic review to state in wikivoice that something is rare, I think you need the systematic review to say quite clearly that the systematic review itself found it to be rare. It does not. Indeed, it frustratingly (as with Taylor et al) avoids drawing any clear conclusions. As with so many reviews in this area, it finds the evidence base to be too poor to do much with, and calls for better research.

:::::And I disagree with your interpretation of these low quality numbers that a rate that can plausibly be 1 in 10 can be inferred to be "rare". Void if removed (talk) 21:29, 12 May 2025 (UTC)

::::::{{tqb|However, what you are doing with reference to "rare" is citing sections of the introduction and discussion which are not part of the systematic review's findings, ie these are not conclusions drawn from the papers that were part of the review search and synthesis.}}Is there precedent for your claim that only the "Conclusion" section can be cited? I don't think that's how it works. I see anything from the Results and Conclusion sections, including the Discussion, cited across Wikipedia all the time.{{tqb|And I disagree with your interpretation of these low quality numbers that a rate that can plausibly be 1 in 10 can be inferred to be "rare".}}That such a rate is common is not a conclusion of the review either. Aaron Liu (talk) 21:53, 12 May 2025 (UTC)

:::::::{{tq|Is there precedent for your claim that only the "Conclusion" section can be cited? }}

:::::::That's not what I'm saying. Anything is potentially citable.

:::::::But a systematic review is only strong evidence for what it systematically reviews. You can't just pick any part of a systematic review and say "this is true because it's in a systematic review" and ignore the context or the actual output of the review.

:::::::What we are trying to establish here is that the rate of detransition is rare. This is a biomedical claim that needs MEDRS. This systematic review is an ideal MEDRS. However, it doesn't actually find a rate of detransition that's particularly useful, nor does it's own synthesis find detransition is rare.

:::::::So we shouldn't speculate that it is rare. We should recount what this source actually finds, which is that the data is poor. Sometimes that's the best we can do, rather than overstate things.

:::::::Citing bits from the introduction or discussion is fine, but it shouldn't be confused with anything this systematic review actually found or given weight in wikivoice as if it was. Void if removed (talk) 22:39, 12 May 2025 (UTC)

::::::::The discussion is a part of the actual output of the review. Aaron Liu (talk) 00:28, 13 May 2025 (UTC)

:::::::::Do you think this citation would support the hypothetical statement "{{tq | A 2025 systematic review found detransition to be rare}}"? Void if removed (talk) 09:12, 13 May 2025 (UTC)

::::::::::It certainly better supports {{em|that}} statement than it does {{tq|A 2025 systematic review found a rate that can plausibly be 1 in 10, which cannot be inferred to be "rare"}}. On account of it saying multiple times that it appears to be rare. Which would, on a literal reading of the words on my screen, indicate that it is a plausible interpretation that the author of the paper means that it appears to be rare. Alpha3031 (t • c) 10:06, 13 May 2025 (UTC)

:::{{tqb|So, her conclusion is "yes, the evidence is poor, but the numbers are likely to be lower than the evidence shows, not higher".}}Sure, let's say that! Aaron Liu (talk) 21:51, 12 May 2025 (UTC)

::::Seems like we may have an agreeable solution. Lewisguile (talk) 11:47, 13 May 2025 (UTC)

:1) {{Tq|Counterpoints to these sources are that YFNS considers one of the co-authors of the first a WP:QUACK, }} - That misrepresents my argument. Let us ignore that it was funded by a group known for misinformation and a member was an author.

:* A) That narrative review is explictly not systematic

:* B) it is not a review of detransition research so not a MEDRS for that

:* C) If we look at the claim in the paper {{tq| Further, the rates of detransition and regret remain unknown [123]}} - 123 is a commentary by aforementioned author.

:* This is not a case of "anything SEGM says is bad!!!!", it's a case of "we don't cite letters to the editor because those aren't MEDRS, even if the author cites themself in an unrelated paper"

:2) You have tried to cite this source repeatedly for all kinds of things it doesn't support. The review states {{tq|For masculinising/feminising hormones, six studies reported discontinuation, with very low rates (0–2 individuals) reported.57 High rates of continuation were also reported in the recent Dutch study, with 98% still prescribed them at follow-up (average 3.2 years for birth-registered females, 6.1 years for birth-registered males), and the UK study which found no discontinuation at 2–3 years of follow-up.59 A second UK study which reported discharge outcomes (length of follow-up unclear) found that of 1089 adolescents referred to the endocrine pathway, 90 (8.3%) stopped identifying as gender incongruent, 58 (5.3%) of whom had started puberty suppression or hormones and subsequently stopped these and reverted to their birth-registered sex.}}

:** It does not provide any estimate of detransition. It does not claim the rate of detransition is high. In reviewing discontinuation (which does not translate to detransition), the rates found are all low to nonexistent.

:3) My earlier comments stand. It was repeatedly stated the literature shows detransition is rare, and the studies were of a poor quality so likely overestimating. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 22:10, 12 May 2025 (UTC)

You repeatedly pushing [https://link.springer.com/article/10.1007/s11930-025-00404-w this study] by the fringe group Society for Evidence-Based Gender Medicine is immediately disqualifying for any argument you're making. Silverseren^C 21:33, 12 May 2025 (UTC)

:I don't think that's how it works. The RfC you're probably referring to has not been closed yet, and while it seems apparent that SEGM would be closed as a Fringe organization, we still need the closer to decide what an organization being Fringe actually means. I also feel like Springer would have standards for who can make such a prominent review. (The title's deviation from the norm of reviews I've seen indeed doesn't inspire confidence, though.) Aaron Liu (talk) 21:57, 12 May 2025 (UTC)

::{{tq|I also feel like Springer would have standards for who can make such a prominent review.}}

::I mean, that exact sort of argument was made about The Lancet when Andrew Wakefield published his nonsense. I don't see anything there that isn't completely consistent with the usual fringe pushing studies. Silverseren^C 22:02, 12 May 2025 (UTC)

:::That was data fraud in a study. The Lancet could not scrutinize Wakefield's data directly, and IIRC such things usually have to wait for replication studies for disproval. Meanwhile, everything needed to scrutinize this review is in the review already. Aaron Liu (talk) 22:08, 12 May 2025 (UTC)

:::All that said, I am convinced by YFNS's other points regarding that narrative review. Aaron Liu (talk) 22:12, 12 May 2025 (UTC)

::I think it is quite clear that the intent is that it means anything co-authored by - or citing, or whose open-access fees are paid by, or that was commissioned by, or quotes approvingly - anyone who has ever had anything to do with SEGM gets binned, and anyone who mentions it accused of PROFRINGE, which is quite the policy overreach IMO. Void if removed (talk) 10:56, 13 May 2025 (UTC)

This was posted on the Talk:Cass Review page but on the 10th May, a study critiqueing the Cass Review was published. I've not had a chance to give it a read-through yet, but it may be of relevence to this article

The study in question:

{{Cite journal |last=Noone |first=Chris |last2=Southgate |first2=Alex |last3=Ashman |first3=Alex |last4=Quinn |first4=Éle |last5=Comer |first5=David |last6=Shrewsbury |first6=Duncan |last7=Ashley |first7=Florence |last8=Hartland |first8=Jo |last9=Paschedag |first9=Joanna |last10=Gilmore |first10=John |last11=Kennedy |first11=Natacha |last12=Woolley |first12=Thomas E. |last13=Heath |first13=Rachel |last14=Goulding |first14=Ryan |last15=Simpson |first15=Victoria |date=2025-05-10 |title=Critically appraising the cass report: methodological flaws and unsupported claims |url=https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-025-02581-7 |journal=BMC Medical Research Methodology |volume=25 |issue=1 |pages=128 |doi=10.1186/s12874-025-02581-7 |issn=1471-2288 |pmc=12065279}} Bejakyo (talk) 20:56, 12 May 2025 (UTC)

:Very interesting. I'm not sure if that's a systematic review though, thus per WP:MedRS we probably shouldn't cite it as it would be a primary source. Aaron Liu (talk) 20:50, 13 May 2025 (UTC)

Further to the discussion of the second sentence of the lede/first of the body above, I checked of a couple of sources, it seems to me that there are a number of claims unsupported by their citations in this article - especially bearing in mind that per WP:RS, "Sources should directly support the information as it is presented in the Wikipedia article". I'll lay out my issues here, in separate subsections to keep things focussed and readable. This absolutely isn't exhaustive, so I think further issues of WP:V can be added here by anyone as they are found (but please add new subsections). Samuelshraga (talk) 17:17, 13 May 2025 (UTC)

{{Tq|In the United States and the United Kingdom, conservative media outlets and the Alliance Defending Freedom have promoted high-profile detransitioners and advocacy groups who claim that detransition and transition regret are prevalent.}}

The [https://www.sciencedirect.com/science/article/abs/pii/S0277953623008900?via%3Dihub source for this claim] says "Several high-profile detransitioners and advocacy groups, however, frame detransition as prevalent and representative of GAC’s failings. The ADF and conservative media outlets have courted these detransitioners in the U.S. and U.K." It's not clear to me that courted and promoted are synonymous. Samuelshraga (talk) 17:17, 13 May 2025 (UTC)

:It's sourced to "How a few stories of regret fuel the push to restrict gender transition care", which analyzes the detrainsitioners' close ties to such groups and says "The group recruited her and others who had detransitioned to file an amicus brief to the Supreme Court arguing that federal law didn’t prohibit anti-transgender discrimination." How about "recruited" instead? Aaron Liu (talk) 20:53, 13 May 2025 (UTC)

::If we're going to cite the NYT article (and I think we should if we're relying on it rather than the Wuest and Last one), that's fine. But we'll have to drop the reference to the UK, and a further issue is that the section you quote has nothing to do with prevalence of detransition or regret. The sections discussing Chloe Cole (which do address detransition and regret) do not talk about recruitment. So this still fails verification for now, we'll need to rejig the claim in line with the source. Samuelshraga (talk) 21:14, 13 May 2025 (UTC)

:::It's clear that "courted" and "recruited" are synonymous here, and we've established that save for "promoted" the sentence is verified. If you want to we could also just use "courted", though I feel like "recruited" is much clearer. Aaron Liu (talk) 21:21, 13 May 2025 (UTC)

::::Ironically, "courted" is arguably more POV than "promoted", but I'd be happy to include it if "promoted" is verboten. However, they "recruited" them to file an amicus brief which made lots of headlines, so "promoted" is closer to the truth than merely "courted". Lewisguile (talk) 11:16, 14 May 2025 (UTC)

:::::It's odd to me that if we have to go to the source cited by our source to properly understand what it means, that we wouldn't just cite that source. Still, it seems that now my issue is that Wuest & Last have casually synthesised claims from two sources (and from different parts of a source) to say something that they didn't originally say. Given that despite this, it is printed in an academic journal, I'll just drop the stick. Samuelshraga (talk) 08:13, 15 May 2025 (UTC)

In our article, this statement describes SEGM and Genspect. [https://www.sciencedirect.com/science/article/abs/pii/S0277953623008900?via%3Dihub In the source], it is very clearly describing SEGM to the exclusion of Genspect. This seems clear to the point that I will just go fix it, but if anyone wants to revert and discuss, here's the place. Samuelshraga (talk) 17:17, 13 May 2025 (UTC)

:I see @Your Friendly Neighborhood Sociologist has [https://en.wikipedia.org/w/index.php?title=Transgender_health_care_misinformation&diff=prev&oldid=1289937096 already fixed this one], so thanks. Not sure what the additional line sourced to an as-yet unpublished (and is it peer-reviewed?) paper from the Yale Law school website adds though. Doesn't seem to be about misinformation. Samuelshraga (talk) 17:31, 13 May 2025 (UTC)

::Looks like [https://law.yale.edu/yls-today/news/new-report-refutes-flawed-science-texas-and-alabama-transgender-legal-actions it was published] as a Yale Medicine [https://web.archive.org/web/20250216194713/https://medicine.yale.edu/lgbtqi/clinicalcare/gender-affirming-care/ Deans' Advisory Council on LGBTQI+ Affairs] Gender-Affirming Care report before the entire portion of the website for that Council got taken down/locked behind a login (try clicking on the "Deans' Advisory Council on LGBTQI+ Affairs" link on what now-404ing page) for some reason. Aaron Liu (talk) 19:29, 13 May 2025 (UTC)

::At first publishing, before being moved to the Council's Gender-Affirming Care section, the report [https://web.archive.org/web/20220502033347/https://medicine.yale.edu/childstudy/policy/lgbtq-youth/ was under the "Child Study Center: Policy" section]. The title is different here but it's the same thing. Aaron Liu (talk) 19:32, 13 May 2025 (UTC)

{{tq|Mainstream media outlets such as The Atlantic, Washington Post, and The New York Times have platformed and amplified misinformation, with the New York Times's coverage of transgender healthcare particularly criticized.}}

Per WP:RSPVOX "Some editors say that Vox does not always delineate reporting and opinion content". On reading, it seems very clear to me that the [https://www.vox.com/culture/23652475/trans-issues-in-the-media-healthcare-disinformation source for this claim] is opinion content. Samuelshraga (talk) 17:17, 13 May 2025 (UTC)

:It's hard to tell what the discussion behind that "does not always delineate" sentence recommends. How about we just attribute Vox for that? Aaron Liu (talk) 19:51, 13 May 2025 (UTC)

::Well, if we're accepting per your comments below that Vox articles that read like opinion pieces are in fact RS, then I'd still say we should attribute at a minimum. Samuelshraga (talk) 20:52, 13 May 2025 (UTC)

:::I would be fine with that. Aaron Liu (talk) 20:54, 13 May 2025 (UTC)

::::Me too. Lewisguile (talk) 14:31, 14 May 2025 (UTC)

:Now I wonder if that phrase should be removed from RelSourcesPerennial: It looks like that discussion had far, far more participants disagree, citing the following reasoning:{{tqb|in the absence of any other real evidence, some of the arguments above, by saying "it reads as opinion to me", are basically saying "I disagree with their analysis and the conclusions they make, therefore it is mere opinion and not staid factual analysis." That isn't how it works - their articles go through a rigorous fact-checking and editorial process comparable to those at other high-quality news sources, and are therefore appropriate to cite for facts in the article voice. It's also factually incorrect to say that they do not segregate opinion - they have a First Person section for that.}} Aaron Liu (talk) 19:55, 13 May 2025 (UTC)

::I wouldn't say "far far more" just counting them, but it does seem like the consensus changed very sharply towards status quo in reaction to Aquillion's comment. Taken as a whole, and especially ignoring the one sock in the discussion, there was a reasonably clear consensus against that line in RSP. Loki (talk) 20:33, 13 May 2025 (UTC)

:It does read like opinion and - aside from having had to be corrected multiple times since publication - it still has some untrue or at least highly misleading/weasel worded claims that are typical in opinion content, eg:

:{{tqq | First, the “detransition” myth: That trans kids will regret their decision later on and detransition. Research overwhelmingly shows that teens who transition rarely regret their decisions. Multiple large-scale studies have found that trans kids know they’re trans from a young age; nearly 95 percent remain committed to their transition years later. One large, 50-year study conducted in Sweden found that only about 2 percent ever express regret.}}

:This really reads like the author is saying the Swedish study is about kids, when it is not.

:And I'm unaware of "multiple large scale studies" showing anything of the sort, that smacks of hyperbole - we know that two recent systematic reviews have both concluded the evidence is too poor to really say. Void if removed (talk) 08:45, 14 May 2025 (UTC)

::A source can be reliable and biased at the same time. News is often written in a tabloid fashion. But it does seem there wasn't consensus for this statement at RSP anyway, hence why it only says "some editors say..." It is also not a statement in Wikivoice that Vox actually does this—and a count of the votes indicates that a majority didn't agree anyway. I agree, though, that the bit about 2% is potentially misleading if it's not about kids. Do you know which study it was that they're referring to? Lewisguile (talk) 11:23, 14 May 2025 (UTC)

:::[https://link.springer.com/article/10.1007/s10508-014-0300-8 Dhejne 2014] is a followup on Swedish transitioners since 1960-2010. It found a rate of regret of 2.2%. These are virtually all adults, with the majority over 30 (median 27-32). To be clear, in the time period covered, Sweden required surgery and sterility in order to change legal gender, so applicants underwent extensive psychological assessment before permission for any of this is granted. 11% were either denied permission, or withdrew their application.

:::So the definition of regret is: of the 681 who successfully applied for a legal change of gender and underwent surgery and sterilisation, 15 applied to change it back. This strikes me as quite an extreme definition.

:::This tells us nothing about detransition among children and adolescents whose trajectory - especially in the last 10-20 years in the US and UK and the shift to an affirmative approach and away from "gatekeeping" - is very different. Void if removed (talk) 10:05, 15 May 2025 (UTC)

::::I agree that it doesn't say stuff about youth (other sources are for that) but I don't see a problem for the regret definition in Sweden. Aaron Liu (talk) 11:41, 15 May 2025 (UTC)

:@Samuelshraga @Aaron Liu@Lewisguile@LokiTheLiar

:AFAICT the current wording ({{tq|According to Aja Romano, mainstream media outlets such as The Atlantic, Washington Post, and The New York Times have platformed and amplified misinformation, with the New York Times's coverage of transgender healthcare particularly criticized.}}) is a NPOV/FRINGE violation:

:* 1) WP:RSPVOX says {{tq| Vox is considered generally reliable. Some editors say that Vox is a partisan source in the field of politics. }}, I'm not sure where "does not always delineate" comes from

:* 2) As the paragraph goes into, and the source goes into, the NYT was criticized for misinformation by WPATH and dozens of human rights groups. Trying to frame it as just one author's opinion is misleading

:* 3) The Washington Post did verifiably run an op-ed promoting gender exploratory therapy, which we have had consensus is FRINGE nonsense for a while,

:I think we should change it to {{tq|Mainstream media outlets such as the Washington Post and The New York Times have platformed and amplified misinformation, with the New York Times's coverage of transgender healthcare particularly criticized. Newspaper opinion sections, which undergo less scrutuiny and fact checking, are often used to promote anti-trans views and bunk science}} Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 14:45, 14 May 2025 (UTC)

::"does not always delineate" comes from an earlier version of RSPVOX and was recently [https://en.wikipedia.org/w/index.php?title=Wikipedia:Reliable_sources/Perennial_sources/8&diff=prev&oldid=1290281198 cut] by {{yo|Aaron Liu}}. I have no opinion on what the article says other than 'that mainstream media outlets have platformed transgender health care misinformation' would make a good DYK hook, but I'll let you propose that at the nom.--Launchballer 14:56, 14 May 2025 (UTC)

::I don't see problems with attributing to Vox (though not to a random name; as mentioned in the Aquillon quote above Vox has an editorial process). This is a bit of a contentious claim and I can see the argument that we should only state it in Wikivoice with stronger sourcing. Aaron Liu (talk) 15:47, 14 May 2025 (UTC)

:::@Aaron Liu I'm fine with attributing it to Vox - (it seems odd to me but whatever, not looking to litigate the point).

:::What's more important to me is that the Vox piece does not actually state that all of the outlets we mention platformed or amplified misinformation. For example, the criticism of the Atlantic is for prominently spotlighting the story of a detransitioner. Of course that criticism was real and significant, but the idea that it is "misinformation" is not directly supported by the source that we cite. Samuelshraga (talk) 19:23, 14 May 2025 (UTC)

{{tq|Other notable producers of anti-LGBTQ misinformation and disinformation include evangelical organizations such as the Alliance Defending Freedom, the American College of Pediatricians, and the Family Research Council.}}

Two citations given for this sentence: Wuest & Last, and the SPLC.

1. Wuest & Last: The only source for anything resembling this claim is a sentence in section 2.2 "think tanks like the Manhattan Institute have promoted ACPeds members’ disinformation about GAC". There's nothing like this about the other organizations. Since the wiki-voice claim says that the organizations (and not particular members) are the producers of misinformation and disinformation, this claim is not verified by the source even in part.
2. SPLC: It's long but searching the names of the organisations, I find no corroboration of this claim for Alliance Defending Freedom or the Family Research Council. For the American College of Pediatricians they say "ACPeds remains an active node of anti-LGBTQ+ misinformation". For the small part of the claim that is sourced to them, per WP:SPLC, "an advocacy group, the SPLC is a biased and opinionated source. The organization's views, especially when labeling hate groups, should be attributed per WP:RSOPINION."

It's also not clear that all these organisations are evangelical. Samuelshraga (talk) 20:32, 13 May 2025 (UTC)

:Wuest & Last does say that the Family Research Council is evangelical, but you're right that none of the others are, and it doesn't say the FRC or the ACP produced misinformation. Aaron Liu (talk) 21:22, 13 May 2025 (UTC)

:The Alliance Defending Freedom is primarily known as an anti-abortion organization founded by Christian right figures, and currently serves as a legal interest group with its own "network of allied attorneys". The American College of Pediatricians is a socially conservative advocacy organization, but has no particular religious affiliation. It has variously formed alliances with Catholic, Lutheran, Calvinist, and Creationist organizations in pursuit of its goals. The Family Research Council is actually an evangelical think-tank with a particular focus on opposing LGBTQ rights. It was formerly a division of the Focus on the Family organization. Dimadick (talk) 08:34, 14 May 2025 (UTC)

::Corrected. Lewisguile (talk) 11:39, 14 May 2025 (UTC)

I've now added page refs to a bunch of RSes. The rest are links or online articles, or cover a page range, so don't strictly speaking need exact page refs. I think it's more than fine to remove the "needs page numbers" tag now.

If there are specific articles without page references which need them, then it might make more sense to tag those directly? Otherwise it will take a really long time—like the few hours I've just spent—going through them to find out which ones need adding. Lewisguile (talk) 14:27, 14 May 2025 (UTC)

:Usually if there is more than 3 inline tags per section I'll add a section tag and if there is more than 2 sections with those tags I'll add the template at the top of the article. However books and articles don't need exact pages unless it is unreasonably difficult to find the information cited. IntentionallyDense ^(Contribs) 23:24, 14 May 2025 (UTC)

::That was my understanding, too (re: books and articles, but especially articles). Thanks for the clarification. Lewisguile (talk) 12:54, 15 May 2025 (UTC)

:That seemed arduous! I wonder where in source 4 mentions manufactured uncertainty, though? Aaron Liu (talk) 12:43, 15 May 2025 (UTC)

::I will remove that one, as I've used the wrong page and quote. On p. 255, it talks about:

::{{tq|In litigation, the state of Alabama described gender-affirming care as "unproven, sterilizing, and permanently scarring medical interventions pushed by ideological interest groups" and charged that "the American Medical Association and the American Academy of Pediatrics continue to follow the popular zeitgeist when it comes to unproven gender-affirming interventions.' The state of Florida went a step further, casting gender-affirming care as analogous to past discredited therapies including eugenics, lobotomies, opioids, and cigarettes: "[M]edical history is littered with such groups and prominent physicians getting things wrong, often with disastrous consequences."}}

::This is about states, however, and doesn't directly address the groups involved in those states' decisions. So this requires a bit of rewording or can be used elsewhere. Lewisguile (talk) 13:32, 15 May 2025 (UTC)

:::I've gone ahead and reworded a smidge. I've also added some other refs about manufactured uncertainty (one medical, one medicolegal) which have been added to the relevant parts of the article. These have quotations included about them. Lewisguile (talk) 14:54, 15 May 2025 (UTC)

I WP:BOLDly made some changes to the Legislative Imacts -> UK section. @Your Friendly Neighborhood Sociologist has [https://en.wikipedia.org/w/index.php?title=Transgender_health_care_misinformation&diff=prev&oldid=1290567768 reverted them]. Let's discuss!

YFNS' edit summary says: {{tq|The Cass Review section has been extensively discussed on talk, and the "Added sentence about misrepresentation of Cass in US)" is not supported by the source}}.

Re: discussions of the Cass review, I'm sure it has been extensively discussed here - what hasn't! I'd welcome being pointed to any discussion here where a consensus formed which my edits overrode.

As far as the idea that the sentence that is unsupported by the source, this is the sentence: "Proponents of gender-affirming care in the United States have misrepresented the Cass Review's purpose, processes and findings, in order to support ongoing legal cases against bans on gender-affirming treatment there." And the source is [https://adc.bmj.com/content/110/4/251 this article]. Supported from the source:

• The Cass Review's role: "The central criticism is based on a fundamental misunderstanding of the role and process of independent reviews in the UK’s healthcare regulatory systems".
• Misrepresentation of the Cass Review's processes (there are actually a lot here, just bringing 2 for brevity):
• "McNamara et al state that the Review is not trustworthy because ‘many of the Review’s authors’ identities are unknown’. This reflects a misunderstanding of the Review process."
• "The criticisms range from assertions that York should not have adapted its evidence appraisal methods after the protocol registration, even when the evidence called for this (although such adaptations are in fact common in research25 26); to inaccurate claims that York’s ‘single search’ methodology was not inclusive enough (in fact, the search was the most comprehensive of any systematic reviews to date, yielding the highest number of studies)."
• The Cass Review's findings (again, there's more but here's one): "McNamara et al state the Cass Review ranked WPATH guidelines among the top five of 23 guidelines, particularly for rigour of development and editorial independence. This is incorrect. The Appraisal of Guidelines, Research and Evaluation II assessment of WPATH’s SOC8 placed it among the lowest, scoring 35% for rigour of development, 39% for editorial independence and an overall score of 3/7, with a majority view that it could not be recommended for clinical use."
• That the misrepresentations supported ongoing litigation in the US: "Although McNamara et al resembles an academic critique, its primary purpose is to support litigation. On the same day the paper was published on The Integrity Project website which is hosted by Yale Law School, a version of it was introduced into evidence in a landmark US legal case in which the lead author served as an expert witness."

So I'd like to know what part of the sentence is unsupported please. Samuelshraga (talk) 17:19, 15 May 2025 (UTC)

:Sorry, have I missed when the Cass review became synonymous with transgender health care. As far as I can tell the statement you made is specifically about the Cass review and does not claim that the Yale review misrepresented transgender healthcare at all. This seems rather Wikipedia:Coatrack articles like. LunaHasArrived (talk) 20:12, 15 May 2025 (UTC)

::@LunaHasArrived, this seems a much narrower tailoring of the article than I understood from reading it. What definition of transgender healthcare are we using? Bearing in mind that we include plenty of material about parties who we say misrepresent the scientific basis for gender-affirming care, this seemed extremely on-theme to me. Samuelshraga (talk) 20:43, 15 May 2025 (UTC)

::Are you looking to remove the entire section on the United Kingdom, seeing as it pretty much all pertains to the Cass Review? Samuelshraga (talk) 20:45, 15 May 2025 (UTC)

:::Misinformation about transgender healthcare repeated by the Cass review is obviously on topic. Misinformation about just the Cass review (such as it's purpose and process) is very unlikely to be about Transgender health care and more likely to be about just the Cass review. Most of the above source mentioned seems to be criticising claims made about the Cass review not claims made about healthcare in general and therefore it would be better suited in an article titled "misinformation about the Cass review" not one about transgender health care. It is also very unclear what impacts this supposed misinformation had on the UK as would be necessary considering thats the section of the article you want to put it in. LunaHasArrived (talk) 22:37, 15 May 2025 (UTC)

::::I think that "a review of transgender healthcare" is sufficiently close to the topic of "transgender healthcare" that I would argue inclusion in any case. However, a number of things strengthen the case for inclusion:

::::#We don't draw the line nearly so narrowly in other areas of the article. Misinformation about topics that are not themselves transgender healthcare (like rates of detransition, or whether transgender) but have implications for transgender healthcare have very much been included.

::::#The current UK legislative impact section is almost entirely concerned with the Cass review, including the Mermaids and Amnesty quotes that are clearly {{tq|about just the Cass review}}.

::::Your comment about it not fitting a section entitled "Legislative impacts" is one I agree with. That said, the section as it is now has almost nothing to do with "legislative impact" either. I think finding or making a more appropriate section, or renaming the sections to better fit the content (including current content) would be a good path forward. Samuelshraga (talk) 13:19, 16 May 2025 (UTC)

::::{{tq | Misinformation about transgender healthcare repeated by the Cass review is obviously on topic}}

::::This whole section goes further. This states that use of puberty blockers was banned as a direct result of misinformation in the Cass Review.

::::This is WP:SYNTH, with not a single source supporting this WP:EXTRAORDINARY claim.

::::Since this is a section on legislative impacts of misinformation, you need to work backwards from there, ie legislation was enacted on the basis of misinformation. Void if removed (talk) 16:59, 19 May 2025 (UTC)

:Your original edit summary claimed that no RS had covered Mermaid's response. Attitude (magazine) had in fact [https://www.attitude.co.uk/news/the-cass-review-explainer-463447/ reported precisely what Mermaids had said]. OsFish (talk) 04:54, 16 May 2025 (UTC)

::Good catch. That source will be useful. Lewisguile (talk) 10:28, 16 May 2025 (UTC)

::Thanks for finding this, I hadn't heard of Attitude which is probably why I didn't spot it when I looked. I don't see the connection between what Mermaids said and the topic of misinformation, but I'm not going to argue about it if you or anyone else wants to keep it in at this point. Samuelshraga (talk) 12:55, 16 May 2025 (UTC)

:It's been 10 days and while some aspects of the added and reverted content has been discussed, I haven't seen anything related to @Your Friendly Neighborhood Sociologist's claim that the sentence "Proponents of gender-affirming care in the United States have misrepresented the Cass Review's purpose, processes and findings, in order to support ongoing legal cases against bans on gender-affirming treatment there" was not supported by the [https://adc.bmj.com/content/110/4/251.long cited source]. Posting this here in advance of reinstating the material so that anyone can engage. Also given the above in addition to these sources[https://www.thetimes.com/uk/healthcare/article/six-months-on-how-has-the-cass-review-reshaped-gender-medicine-cj33lsgnm][https://www.tandfonline.com/doi/full/10.1080/0092623X.2025.2455133], I think the section on misinformation about the Cass review should potentially be expanded to a subsection above, rather than awkwardly sat in "Legislative Impacts" where it doesn't fit very well. Samuelshraga (talk) 18:19, 25 May 2025 (UTC)

::I have been busy with work but regarding {{tq|Proponents of gender-affirming care in the United States have misrepresented the Cass Review's purpose, processes and findings, in order to support ongoing legal cases against bans on gender-affirming treatment there.}}

::* 1) I initially reverted because I misread it as opponents, which is a much truer statement the source doesn't support. The Cass Review has been cited repeatedly in the US to justify bans on gender affirming care.

::* 2) That paper is written by a group of authors who have absolutely no experience in trans healthcare, apart from one being the founder of SEGM (an organization which is solely notable for misinformation about trans healthcare)

::** The Integrity Project has been calling out SEGM for ages. Quoting their founder saying "actually, you're the ones known for misinformation", is a bad look and would definitely need some independent sourcing to back that up

::** There is also a clear conflict of interest in that SEGM / SEGM members repeatedly testify in favor of these bans, a fact unmentioned in that article. It even filed a motion in Skrmetti, the case it accuses Yale of being involved in, with no disclosure of their own affiliations.

::* 3) This paper ignores multiple pieces of misinfo the Yale report called out: the Desistance myth, exploratory therapy, etc

::* 4) {{Tq|McNamara et al state that the Review is not trustworthy because ‘many of the Review’s authors’ identities are unknown’. This reflects a misunderstanding of the Review process."}} - this is a criticism that has been levelled by dozens of medical professionals since the Review came out. The recent German Clinical Practice Guidelines for trans healthcare (ie, the most tippy-top MEDRS in the field) - explicitly called out this lack of transparency as well.

::** More generally, the Yale paper is a source that the BMJ, and the latest german clinical practice guidelines produced by a few dozen MEDORGS, and most academics writing about the Cass Review, consider reliable.

::* 5) This paper, most charitably misrepresents, and least charitably downright lies about, trans healthcare in the US. It says {{Tq|Ultimately, these cases hinge on judges deciding between two conflicting perspectives. One side, argued by transgender advocacy groups and supported by the World Professional Association for Transgender Health (WPATH)22 and the Endocrine Society,23 asserts that medical transition for minors is backed by sufficient evidence, making restrictions unnecessary and discriminatory. On the other side, some states claim the practice is experimental, harmful to youth and that the constitution allows them to protect citizens from unsafe medical treatments.}}

::** Every single major medical association/organization in the United States has vocally opposed these bans

::** The states have done this at the behest of anti-LGBT orgs such as the American College of Pediatricians or the Alliance Defending Freedom

::* 6) If we consider use by others, only WP:FRINGE activists have given this source any weight, mostly in editorials.

::Put simply, this is not an independent source, and the authors credentials are severely suspicious to say the least. The WP:USEBYOTHERS is solely FRINGE activists. If we are going to include this, and it's very questionable if we should, we should at the very least attribute it to the founder of SEGM. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:42, 25 May 2025 (UTC)

:::*1) So it seems we agree that the source does in fact support the statement?

:::*2) I'm not even going to look into the CVs of the consultant paediatricians and a former president of the Royal College of Paediatrics that you've decided are insufficiently experienced to render comment in their published article in a high-quality MEDRS journal. Why don't you specify which claim you think they are unqualified to make before we start that, given that it seems like an extraordinary claim to begin with. As for SEGM being {{tq|solely notable for misinformation}}, the word solely seems like a stretch at least but I see no relevance to the comment:

::::* We're not quoting their founder. We're quoting an article in Archives of Disease in Childhood in which someone affiliated to them (I'll take your word she's a founder) is one of five authors (and not the lead author).

::::* On the point of conflict of interest, the idea that SEGM are involved in legal cases in the US, one SEGM member is an author of this paper, and therefore this paper has a conflict of interest seems like a couple of degrees of guilt by association. And out of interest, does the Yale white paper's lead author's work as a paid expert witness in the same court cases that you reference constitute less of a conflict of interest than the one you posit here?

:::*3) If I measure the success or failure of this paper as whether it conclusively rebutted every point in the Yale one, I'd see your point. Since I didn't suggest the sentence "every accusation in the Yale paper has been conclusively rebutted by Cheung et. al.", I'll broadly accede on this point.

:::*4) I don't know what argument you think you're rebutting here. At no point did I say that the Yale paper's accusations are unique or that Cheung et. al.'s refutations are universally shared.

::::* The Yale paper, as discussed at Talk:Cass Review, is self-published. Therefore its many accusations are due for inclusion only to the extent that they are covered in RS. If we need to go to RSN to discuss this that's fine.

:::*5) I think the passage you quote is a fair description. If your argument is that the source is lying, I won't try and change your opinion. It is a MEDRS source in a reputable journal, so arguing we should exclude it because you disagree with what it says is not how we do things, and you know that.

::::*Given that this issue (the Cass Review) is at least significantly related to the UK, I think their medical associations count. Moreover, the issue here is not whether transgender healthcare should be banned or not. It's whether a published MEDRS critique of factual inaccuracy in the Yale paper is reliable. It's perfectly plausible to say that the bans are wrong but that the critiques of the Yale paper are valid.

:::*6) It's a novel, and to my mind implausible application of WP:USEBYOTHERS to apply it to individual articles. I'm not aware of this having been done before. I haven't checked if ADC has WP:USEBYOTHERS. Do you think it might not?

:::So all in all, you argument against the independence of the source and its authors' credentials are that one of the authors is a member of an organisation you consider a hate group. There are four other authors, including the lead author, whose credentials you don't appear to have considered. You haven't addressed for a moment the reliability of the publication the article is published in. You've suggested an altogether novel version of WP:USEBYOTHERS. And lastly, you say that should we include this, we should attribute it not to the lead author, nor to the authors in totality, but to the most disqualifying (in your eyes) affiliation of one of the authors. Erm... no? Why would we treat this source in such an unusual way? Samuelshraga (talk) 20:06, 25 May 2025 (UTC)

:::Also, you quite recently denied arguing that an author's affiliation to SEGM disqualifies a source, and said I should provide examples of this behaviour if I was going to allege it. Would your above comment constitute an example? Samuelshraga (talk) 20:10, 25 May 2025 (UTC)

::::Credentials of authors are often relevant. As is which other academics think it reliable. The most top tier MEDRS consider McNamara accurate. No MEDRS consider this response accurate.

::::Regarding your text, {{tq|have misrepresented the Cass Review's purpose, processes and findings}} The source says {{tq|We conclude that these sources misrepresent the Cass Review’s role and process (specifically, by mistakenly comparing the Review to clinical practice guideline development), while many of the methodological criticisms directed at the Cass Review, including its use of evidence appraisal and systematic reviews conducted by University of York (UK), are unfounded.}}

::::* So it does not say the findings were misrepresented

::::* If we look at the process/purpose section it makes 3 issues:

::::** {{tq|McNamara et al claim that the Review lacks credibility due to its leadership’s lack of experience in transgender healthcare.}} - dozens of top-tier MEDRS/MEDORGS agree

::::** {{tq| McNamara et al state that the Review is not trustworthy because ‘many of the Review’s authors’ identities are unknown’}} - the AWMF guidelines disagree

::::** {{tq|McNamara et al assert that the Review contravenes standard practice in scientific evaluations by not using GRADE in its recommendations. ... but this is because GRADE is a tool for CPGs and not designed for Reviews which make recommendations regarding system changes such as restructuring of clinical services, establishment of a research programme, workforce development and training.}} - but the Review made recommendations contravening existing CPGs

::::So you're trying to argue a source which top-tier MEDRS agree with should be described as wrong because a singular article, with an author who's the founder of a hate group, says that the criticisms top tier MEDRS agree on are wrong. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 20:28, 25 May 2025 (UTC)

:::::{{tq|The most top tier MEDRS consider McNamara accurate.}} Could you please demonstrate this?

:::::{{tq|No MEDRS consider this response accurate}}. Which MEDRS has said that the article is inaccurate? If it is directly challenged, that would of course be a strong argument for attribution over wiki-voice.

:::::{{tq|So it does not say the findings were misrepresented}} my opening comment of this section references the article showing how a finding was misrepresented very directly.

:::::Re: the 3 issues you pulled out:

:::::* I'm not super interested in litigating the benefits of direct experience in the field vs. the risks of GOBSAT. I wouldn't call this accusation by McNamara et. al. misinformation, and I wouldn't want it to be highlighted as an example of misinformation in this article, so we can put that aside.

:::::* {{tq|McNamara et al state that the Review is not trustworthy because ‘many of the Review’s authors’ identities are unknown’ - the AWMF guidelines disagree.}} The review has one author, whose identity is known. Cheung et. al. point this out. Saying it has unknown authors is a factual inaccuracy.

:::::* {{tq|but the Review made recommendations contravening existing CPGs}} is this your argument? Or is there an RS that rebuts this point?

:::::I think just saying that top-tier MEDRS all agree with McNamara and disagree with Cheung is insufficient. If that's your argument, you're going to have to demonstrate it. Samuelshraga (talk) 21:00, 25 May 2025 (UTC)

::::::{{tq|Since its publication in April 2024, the Cass review has been criticized in several methodologically critical articles (Grijseels, 2024; McNamara et al., 2024; Noone et al., 2024). In addition to a number of criticized methodological deficiencies in the Cass review, it has been pointed out that some of the report's key recommendations cannot be derived from the reported evidence. Of particular note is the comprehensive evidence-based critique of the Cass review's methodological approach by the Integrity Project at Yale University, which was written by several authors with proven expertise in the clinical application field (McNamara et al., 2024). The authors conclude that the review of available evidence was, in part, noticeably selective, and that some key recommendations cannot be supported by the reported evidence (McNamara et al., 2024). }}[https://register.awmf.org/assets/guidelines/028-014l_S2k_Geschlechtsinkongruenz-Geschlechtsdysphorie-Kinder-Jugendliche-Diagnostik-Behandlung_2025-03.pdf]

::::::{{tq|In response to rising concerns and the ban of puberty blockers the British Medical Association (BMA) released a statement citing a pre-print of our methodological critique of the Cass report [17] and a report by the Integrity Project at Yale Law School [18]. T}}[https://link.springer.com/article/10.1186/s12874-025-02581-7]

::::::We have the SEGM FTN close noting that publications from SEGM do indeed warrant higher scrutiny.

::::::If we contrast this with who considers the Abruzzese et al source reliable:

::::::* Stephen B. Levine (famous for the FRINGE position being trans is a result of psychopathology) and J Cohn, a SEGM member[https://www.tandfonline.com/doi/pdf/10.1080/0092623X.2025.2455133]

::::::* a perspective piece by Moti Gorin (who thinks ROGD is being silenced[https://philpapers.org/archive/BYRADS.pdf]) and Smids, who SEGM has paid both of to speak at their conferences, as the disclosure in the article notes. The latter's also been paid by the "fr:Observatoire La Petite Sirèn", a french conversion therapy org while the former is a board member for an organization which [https://lgbcouragecoalition.substack.com/p/ignoring-the-charge-of-gender-affirming defends] [https://lgbcouragecoalition.substack.com/p/lgb-courage-coalition-applauds-hhs the] Trump administration HHS gender dysphoria report and claims that gender-affirming care is a form of conversion therapy[https://jamanetwork.com/journals/jama/article-abstract/2829316]

::::::* An opinion piece saying a MEDORG is wrong[https://www.ajol.info/index.php/sajpsyc/article/view/295883/278341], where the authors are involved with [https://fdnhsa.org/ First do no harm southern africa]], a small fringe lobby group who's [https://fdnhsa.org/useful-links/ useful links page] is FRINGE activits like Genspect, SEGM, Transgender Trend, and the LGB Alliance

::::::* Opinion piece saying australian MEDORGS are wrong, with the author noted to be affiliated with SEGM [https://adc.bmj.com/content/archdischild/110/6/415.full.pdf]

::::::* A piece from Sallie Baxendale, who's [https://www.transgendertrend.com/teenage-brain/ written] for Transgender trend, and [https://www.youtube.com/watch?v=z5ZnRKqqByg&themeRefresh=1 spoke at SEGMS last conference][https://www.magonlinelibrary.com/doi/pdf/10.12968/hmed.2024.0743]

::::::So top-tier MEDRS have cited McNamara, while the only sources to cite Abruzzese et al have been SEGM members / collaborators writing opinion pieces about why they think MEDORGS are wrong. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:57, 26 May 2025 (UTC)

:::::::Just FYI, a scientific letter is not the same thing as a letter to the editor. It's a short research article. Void if removed (talk) 18:25, 26 May 2025 (UTC)

::::::::WP:MEDRS: {{tq|a page that is tagged as "Comment" or "Letter" is a letter to the editor (often not peer-reviewed)}}. If you check out PUBMED, the South African FRINGE group's "scientific letter" is indeed explicitly noted to be a "letter"[https://pubmed.ncbi.nlm.nih.gov/40357173/] It is not a "short research article", it is part of a long-standing noted pattern of these FRINGE groups to publish letters to the editor and claim they're scientifically rigorous. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:36, 26 May 2025 (UTC)

:::::::::Check your original citation pdf - it is a "Scientific Letter".

:::::::::South African journal of Psychiatry submission guidelines are here.

:::::::::https://sajp.org.za/index.php/sajp/pages/view/submission-guidelines

:::::::::Seriously, just google "scientific letter". It's not a letter to the editor. Void if removed (talk) 18:46, 26 May 2025 (UTC)

::::::::::Yep, I checked it, and per WP:MEDRS {{tq|When looking at an individual abstract on the PubMed website, an editor can consult "Publication Types", "MeSH Terms", etc. at the bottom of the page to see how the document has been classified in PubMed. For example, a page that is tagged as "Comment" or "Letter" is a letter to the editor (often not peer-reviewed).}} The PDF says it's a "scientific letter", PUBMED clarifies that this means a "letter", the SAJP submission guidelines say {{tq|Original research that is limited in scope can be submitted as a scientific letter rather than a full original research article.}} -ie not even raised to the level of an original research article. This continues to be nothing more than a letter saying a MEDORG is wrong by a group of activists known for FRINGE nonsense: at the very bottom of, if even on, the MEDRS pyramid. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 19:58, 26 May 2025 (UTC)

:::::::::::I think anybody can read the original source you provided and compare it to the journal's own publishing guidelines and see this is not a "letter to the editor", no matter how many times you repeat it, or even dismiss the very concept of "scientific letters". PubMed doesn't override what the journal itself says or the journal's own publishing standards. I've opened a discussion here because if you're going to cite MEDRS to insist we ignore what we can verify for ourselves just by reading the source then that surely needs a change.

:::::::::::This whole thread was, in any case, just an FYI. Void if removed (talk) 11:48, 27 May 2025 (UTC)

:::::::You seem to be of the opinion that the way we assess individual articles of MEDRS is WP:USEBYOTHERS. This is not what is written at WP:MEDASSESS, which only suggests giving more credence to a highly cited work if it would otherwise be dismissed for being in a predatory journal.

:::::::Frankly this discussion is being carried on in a way that just seems silly and unlikely to lead anywhere productive. Describing a source whose lead author is called Cheung as {{tq|Abruzzese et al}} suggests to me that here, POV is being prioritised way ahead of a calm discussion of a source. If your position is that the source is unreliable because of the SEGM association, let's go to RSN. If it's that the contents have no weight for that reason, let's go to NPOVN or FTN. Samuelshraga (talk) 19:31, 26 May 2025 (UTC)

::::::::USEBYOTHERS stresses that we should "not unduly represent contentious or minority claims"; if the only cites a source of dubious quality gets are from people promoting fringe claims, it would be very much in line with policy to take that into consideration. Fringe groups get up to various tricks to misrepresent how widely held their fringe views are by actual mainstream experts, as we've seen with climate change denialism.OsFish (talk) 04:16, 27 May 2025 (UTC)

:::::::::{{tq|a source of dubious quality}} like a review article in Archives of Disease in Childhood? Samuelshraga (talk) 05:28, 27 May 2025 (UTC)

::::::::::That one is an opinion piece by a historian funded by a fringe anti-trans group that wasn't sent for proper peer review. So it's not exactly top quality MEDRS.OsFish (talk) 05:57, 27 May 2025 (UTC)

:::::::::::I think you're talking about something else. Samuelshraga (talk) 07:23, 27 May 2025 (UTC)

::::::::::::I was referring to [https://adc.bmj.com/content/archdischild/110/6/415.full.pdf this piece in Archives of Disease in Childhood]. Recent PhD from the school of History and Philosophy of science, only internally reviewed, affiliated with a fringe group who also funded the open access fees. Which one were you referring to? OsFish (talk) 09:32, 27 May 2025 (UTC)

:::::::::::::[https://adc.bmj.com/content/110/4/251 This one] has been the focus of the discussion between YFNS and myself up this thread. I wasn't aware of the one you linked to. Samuelshraga (talk) 09:50, 27 May 2025 (UTC)

::::::::::::::That's the one I originally was referring to - apologies for getting confused for thinking you were referring to the most recently listed article from that journal in this convo. Yes, that is of dubious quality given that it is plainly at odds with multiple topline MEDRS view of Cass, and is written by people outside the area of medicine concerned - apart from one representative of a FRINGE organisation - which is really odd for a paper which is supposed to represent expert opinion within the field. Trying to present the issue as a one-on-one dispute between McNamara et al vs Cheung et al in isolation from all the top MEDRS that have weighed in on this issue - both in what they state and in which of these two papers they plainly see as a good source is an example of WP:FALSEBALANCE. OsFish (talk) 03:11, 29 May 2025 (UTC)

:::::::::::::::Well I'll assume that I'm misreading the tone of your apology, despite our last interaction. Assessing an RS as being of dubious quality because it holds a different viewpoint to other RS is not an argument that holds. Holding a different conclusion would be an argument about WP:DUE weight, not about the reliability of hte source itself. In any case, you've conflated two issues - the view of the Cass report and the view of the McNamara paper.

:::::::::::::::{{tq|written by people outside the area of medicine concerned}} - this quite notably august group of doctors are more than qualified to criticise a piece of research for:

:::::::::::::::* misunderstanding the role of an independent review in the NHS

:::::::::::::::* misunderstanding the positive value of "independence of the Review chair from the specific medical field"

:::::::::::::::* specific factual errors.

:::::::::::::::In fact I'm curious as to what claim they make that you think they're unqualified for (regardless of which it got through peer review in Archives of Disease in Childhood).

:::::::::::::::{{tq|one representative of a FRINGE organisation}} - you yourself are participating in an ongoing conversation with the closer who determined that there is consensus that SEGM was fringe, where he says {{tq|If an editor claims that this close bars every thing SEGM has ever touched then they have either misread the close/policy, or are a little confused.}}

:::::::::::::::{{tq|Trying to present the issue as a one-on-one dispute between McNamara et al vs Cheung et al in isolation from all the top MEDRS that have weighed in on this issue}}. I'm actually not trying to present it as a one-on-one dispute. Cheung et. al. is a review article in a highly reliable MEDRS. McNamara et. al. is an online-only self-published document that has been silently revised multiple times without notice. I'm fine with noting that McNamara et. al. is influential and that it has been cited by serious sources. However, Cheung et. al. specifically addresses false claims made my McNamara et. al., and further situates them in the context of McNamara et.al.'s purpose as a document (to support ongoing litigation), which makes it WP:DUE for inclusion on this page, per basically every opinion in the discussions of what constitutes misinformation, even the narrowest proposed definitions. Samuelshraga (talk) 06:34, 29 May 2025 (UTC)

::::::::::::::::If you're not presenting it as an isolated one-on-one of Cheung vs McNamara, then do you accept that multiple MEDRS from experts from within the field disagree with Cheung about McNamara in general, and support McNamara in detail? OsFish (talk) 08:19, 29 May 2025 (UTC)

:::::::::::::::::Given disagreement among sources, I think a discussion about what from Cheung et al is due for inclusion, and of that what should be attributed or put in wiki-voice, is a perfectly productive one to have. Samuelshraga (talk) 08:43, 29 May 2025 (UTC)

::::::::::::::::::And as part of that discussion, I wanted to know if you accept that multiple MEDRS from experts from within the field disagree with Cheung about McNamara in general, and support McNamara in detail. WP:FALSEBALANCE needs to be avoided. OsFish (talk) 08:47, 29 May 2025 (UTC)

:::::::::::::::::::In general doesn't interest me a tremendous amount. The "in detail" matters a lot. So if there are sources that say that McNamara et. al. didn't:

:::::::::::::::::::* misrepresent the York team's processes, for instance saying their search strategy wasn't inclusive enough when it yielded a higher number of studies than any previous systematic review.

:::::::::::::::::::* say that the Cass Review had highly ranked WPATH's clinical guidelines, when in fact it had given them a low ranking.

:::::::::::::::::::* wrongly claim that the Review's data showed a detransition rate of 0.3%.

:::::::::::::::::::This is far from exhaustive, but let's start there. Samuelshraga (talk) 09:10, 29 May 2025 (UTC)

::::::::::::::::::::Sure

::::::::::::::::::::* For example, Noone et al 2025 also says that the search strategy wasn't inclusive enough, while the Polish expert review says {{tq|"The common thread of many objections to the Cass report is the multifaceted downplaying of the importance of the voices of adolescents and their families, clinical practice, the scientific knowledge base, and national and global recommendations"}}

::::::::::::::::::::* I'm happy not to include any claim made by McNamara that Cass rated WPATH highly, although I would point out that Cheung does appear to conflate WPATH SoC and the Endocrinology Society Guidelines, which McNamara comments on jointly in terms of Cass' assessment; the Endocrinology Society Guidelines certainly did receive high scores in some areas from Cass. In any case, that comment is in a footnote in McNamara, and not one of the main points the paper is making. So it's kind of small beans.

::::::::::::::::::::* Cheung quibbles with the 0.3% figure as if McNamara is claiming it is a lifetime figure, but McNamara compares it with studies not of lifetime detransition but specifically detransition rates of youth passing out of youth treatment in other countries, the point being not only that GIDS figures are consistent with these other studies, but that these other studies were available to Cass but not taken up. That broader point is not challenged by Cheung. The broader points seems to be the substantive one.

::::::::::::::::::::So the first point is clearly dealt with in other MEDRS. As for the other two: I just think there should be rather more meat in the sandwich than there is.OsFish (talk) 10:35, 29 May 2025 (UTC)

:::::::::::::::::::::{{tq | Noone et al 2025 also says that the search strategy wasn't inclusive enough}}

:::::::::::::::::::::At this point you very much need to separate criticism of "The Cass Review" from criticism of "Systematic Reviews produced by York University", because what you have here is a lower-level source purporting to criticise a higher-level source.

:::::::::::::::::::::And then you need to realise that these systematic reviews are a top-tier MEDRS published in a high impact journal produced by a world-class institution with a global reputation for systematic reviews.

:::::::::::::::::::::And against that you have to weigh Noone, who is a psychology lecturer with zero expertise in this area, and an assorted band of similar non-experts and activists, complaining that the most comprehensive literature review ever performed in this field by this world class team at this world class institution - and which concurs with half a dozen other reviews using a range of different methodologies - was not comprehensive enough, despite not actually identifying any notable omissions.

:::::::::::::::::::::This is one where the weighing of sources does not favour Noone et al, especially once you factor in the extensive COI statement. Void if removed (talk) 11:11, 29 May 2025 (UTC)

::::::::::::::::::::::As you are aware, Noone et al are cited favourably by various top level MEDRS such as the German-Swiss-Austrian joint expert group, which says (via google translate):

::::::::::::::::::::::{{quote|Since its publication in April 2024, the Cass review has been criticized in several methodologically critical articles (Grijseels, 2024; McNamara et al., 2024; Noone et al., 2024). In addition to a number of methodological deficiencies in the Cass review, it has been pointed out that some of the report's key recommendations cannot be derived from the reported evidence. Of particular note is the comprehensive evidence-based critique of the Cass review's methodological approach by the Integrity Project at Yale University, which was prepared by several authors with proven expertise in the clinical application field (McNamara et al., 2024). The authors conclude that the review of the available evidence was, in part, noticeably selective and that some key recommendations cannot be supported by the reported evidence (McNamara et al., 2024). In a press release dated July 31, 2024, the British Medical Association (2024) explicitly addressed these criticisms of the Cass Review and recommended that its recommendations not be implemented for the time being. First, an evaluation of the Cass Review should be conducted by a designated commission.}} So it's not me or other editors rating Noone. It's top level in-the-right-field MEDRS. And that's the point made by YFNS: when weighing up sources, we have to look at what views align with the large preponderance of mainstream MEDRS. OsFish (talk) 05:26, 30 May 2025 (UTC)

:::::::::::::::::::::To those three points (and are we going to go through all the allegations of inaccuracy in Cheung?):

:::::::::::::::::::::* Cheung et. al. is explicitly critiquing both the McNamara and the pre-print version of the Noone paper. So saying that Noone agrees with McNamara in this instance doesn't really change anything. As for the Polish quote, (a) I don't see how it addresses this point, and (b) I wanted to look at it in context to see if it does, and I couldn't find a working link to the original.

:::::::::::::::::::::* {{tq|I'm happy not to include any claim made by McNamara that Cass rated WPATH highly}}. This misses the point. McNamara saying that Cass rated WPATH highly is an example of misinformation about transgender healthcare. More to the point, this is yet another case of us having very different readings of the same text. You say: {{tq|although I would point out that Cheung does appear to conflate WPATH SoC and the Endocrinology Society Guidelines, which McNamara comments on jointly in terms of Cass' assessment; the Endocrinology Society Guidelines certainly did receive high scores in some areas from Cass.}} Actually, Cheung doesn't mention the Endocrine Society guidelines in this contexts. Cheung says:

:::::::::::::::::::::{{quote frame| McNamara et al state the Cass Review ranked WPATH guidelines among the top five of 23 guidelines, particularly for rigour of development and editorial independence. This is incorrect.}}

::::::::::::::::::::::And what McNamara says is:

:::::::::::::::::::::{{quote frame| The Review produces data that rates the WPATH Standards of Care 8 and the 2017 Endocrine Society Clinical Practice Guidelines among the top five of 23 analyzed documents (p 129), using the AGREE II tool. Further, the Review appraises these guidelines as particularly high in the areas of “rigor of development” and “editorial independence.”}}

::::::::::::::::::::::And while you're the one who brought up the Endocrine Society guidelines (not Cheung, as you wrongly claim), the underlying study being mischaracterised by McNamara also says that the Endocrine Society lacked developmental rigour. That's an example of misinformation which isn't WP:DUE because Cheung didn't point it out, as opposed to just WP:IDON'TLIKEIT.

:::::::::::::::::::::* {{tq|Cheung quibbles with the 0.3% figure as if McNamara is claiming it is a lifetime figure}}. It appears we're having divergent comprehensions of the same text again. It's very clear, both in McNamara and Cheung. McNamara is critiquing Cass' statement that the detransition rate is unknown. She says that Cass' data shows a detransition rate of 0.3%, emphasised in italics for good measure. Cheung rebuts that in fact the detransition rate cannot be extrapolated from Cass' data. Whether McNamara has a legitimate broader point or not is besides the issue, which is "did McNamara et. al. spread false information about transgender healthcare". The information spread is (paraphrased) "Cass' data shows a detransition rate of 0.3%". A MEDRS source says that this statement is false.

:::::::::::::::::::::Given that we have such divergent views of sources, could you please provide quotes when you disagree with my reading of a source from now on? I have endeavoured to do so. Samuelshraga (talk) 12:04, 29 May 2025 (UTC)

::::::::::::::::::::::[https://journals.viamedica.pl/endokrynologia_polska/article/view/104289 Here] is the Polish expert review. Its relevance is directly about whether or not Cass looked at the full breadth of research available - which it agrees, with other sources, she and her review did not. As for your suggestion that the footnote in McNamara has been taken up and spread as misinformation, do you have evidence for this? This isn't a page about errors in footnotes that no one repeated or acted upon. By the way, I didn't claim that Cheung mentioned the Endocrinology Society. I said the exact opposite. That Cheung had taken McNamara's comments that directed jointly about WPATH and the Endocrinology Society and framed them as being only about WPATH. This sort of carelessness adds to the problem of placing the source as some equal counterbalance to the large amount of MEDRS on these issues. As for the issue of detransition rates: what precisely is the issue you think is disinformation being spread? That detransition rates are not known? There's a lot of MEDRS against that. That the detransition rate McNamara calculates is meaningless? That would mean throwing out all the other MEDRS studies using such an approach that McNamara cites in support on the same page. Seriously, the amount of work you want this one paper to do against a whole lot of expert sources is really quite extraordinary. All of which is why I think YFNS is right to look at WP:USEBYOTHERS - because so few serious sources have taken Cheung et al's paper seriously compared to the papers by McNamara et al, Noone et al etc.OsFish (talk) 05:47, 30 May 2025 (UTC)

:::::::::::::::::::::::Re: the WPATH guidelines claim, I produce the quote from McNamara again: "The Review produces data that rates the WPATH Standards of Care 8 and the 2017 Endocrine Society Clinical Practice Guidelines among the top five of 23 analyzed documents (p 129), using the AGREE II tool.”

:::::::::::::::::::::::This sentence contains two claims. One is that it rated the Endocrine Society in the top 5. The other is that it rated the WPATH SOC8 in the top 5. If someone were to say "Grover Cleveland and Winnie the Pooh are the only US Presidents to have served non-consecutive terms", and were rebutted that in fact Winnie had never been President, it's a total non sequitur of a response to say "But the statement is true of Grover Cleveland". The fact that you accuse Cheung of carelessness for this is yet another instance of your quite unique way of reading sources. Samuelshraga (talk) 12:48, 30 May 2025 (UTC)

Continuing a discussion between @IntentionallyDense and myself above, around the question of when should this article (or really any in wikipedia) describe something as "misinformation", either in wiki-voice or by attribution. We came to a set of criteria that we'd like to put in front of the other editors hopefully for consensus:

1. A source describe something as misinformation; or
2. A source report on a factual error and the agenda supported by it.
3. The sourcing should be commensurate with the subject of the claim - - e.g. saying a claim that appears in a peer-reviewed journal from a subject-matter expert is misinformation should require exceptional sourcing. Or the claim must be attributed
4. The claim should be false, or at least significantly misleading. It should not be a difference of opinion, or admit of alternative interpretation in which it is not false or significantly misleading.

I would propose further modification, to clarify that if option 1/2 are not met - or if criterion 1 is not met and criteria 3 or 4 are not - we should not describe anything as misinformation at all. Additionally, I would add the same proviso form criterion 3 to criterion 4, that if it is not met then the description of misinformation should be attributed. Hopefully we can make some progress on these. Samuelshraga (talk) 17:31, 19 May 2025 (UTC)

:Billard gives an expert definition:

:{{tq|In keeping with other scholars of political communication, I understand disinformation as referring specifically to "false or misleading information intentionally spread for profit, to create harm, or to advance political or ideological goals" (Kuo & Marwick, 2021, p. 1). In contrast, misinformation refers to generally incorrect information that is spread without malicious intent.}}

:This seems helpful. Source: Billard, T. J. (2023). "'Gender-Critical' Discourse as Disinformation: Unpacking TERF Strategies of Political Communication." Women's Studies in Communication, 46(2), 235–243. https://doi.org/10.1080/07491409.2023.2193545 Lewisguile (talk) 11:04, 20 May 2025 (UTC)

::This does not fit with the opening paragraph of the lede:

::{{quote frame | False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used to justify legislative restrictions on transgender people's right to healthcare. The claims have primarily relied on manufactured uncertainty generated by various conservative religious organizations, pseudoscientific or discredited researchers, anti-trans activists and others}}

::The thrust of this page is not merely accidental misinformation, but active disinformation.

::It seems like the article wants to have it both ways, ie claim that "misinformation" is as innocuous as "misconceptions", and thus can cast a wide net for inclusion, while also up front heavily ascribing motive and intent and alleging deliberate misrepresentation. No distinction is drawn between common understandable errors or imprecise or innocently overstated claims, while a nefarious strategy originating with the US christian right to sow disinformation for political ends is woven throughout. Void if removed (talk) 11:17, 20 May 2025 (UTC)

:::I don't see the discrepancy. Such claims used to justify legislative restrictions originated in pushes from such groups before being independently propagated without intent. And I don't see what will change if we moved the article to "disinformation". Aaron Liu (talk) 11:54, 20 May 2025 (UTC)

::::I agree with Aaron. That line is throwing things a bit, and I'm not entirely happy with it either, but I don't think it follows that the entire article has to be read through that lens.

::::I think we may need a "terminology" section to outline the distinction between misinformation and disinformation, to clarify things, and we can summarise those distinctions in the lede. However, they're not always separate—misinformation that is later "weaponised" (as Billard puts it) would become disinformation. So one can certainly lead to or arise from the other. But I think it's fine for the article to cover both misinformation and disinformation, so long as we're clear which is which.

::::Coming back to "manufactured uncertainty", I think we may want to reword the claim that misinformation is "primarily" based on this. I think it's fair to say that misinformation can result from manufactured uncertainty or that manufactured uncertainty is an element of disinformation, but those things seem subtly different to what we currently say. Lewisguile (talk) 13:15, 20 May 2025 (UTC)

::@Lewisguile, if we used that definition, literally any "generally incorrect information" on transgender healthcare becomes ripe for inclusion. I wouldn't use it for a few reasons:

::# I think it's not great for this article. I think drawing the borders so wide will make the article lose coherence.

::# It's not at all generalisable to the rest of the project. If we were to use the term misinformation as described, it would be an option each and every time we cover a factual error. I think that actually practicing this in the rest of the project (and not on articles with "misinformation" in the title) would be viewed as disruptive and spark NPOV concerns.

::The discussion between ID and myself that sparked this section considered that while misinformation is not necessarily deliberately false, it is in service of some kind of agenda. I still support this as a distinction between misinformation and general factual error, and I think the article will be better with such a distinction. Samuelshraga (talk) 12:25, 20 May 2025 (UTC)

:::@Lewisguile, I'd also suggest that if we did adopt Billard's definition of "generally incorrect information", this would replace criteria 1 & 2 that @IntentionallyDense and I suggested above. Criteria 3 & 4 could still be used, as a framework for deciding when a claim of misinformation should be attributed or put in wiki-voice. Samuelshraga (talk) 12:34, 20 May 2025 (UTC)

::::The issue is, Billard's piece is titled "disinformation" and refers throughout to disinformation and misinformation pretty well interchangably, at one point stating {{tq | misinformation about transgender issues was mobilized for the sole purpose of justifying opposition }}, which actually ascribes intent. It then clarifies {{tq | Misinformation—or, more specifically, disinformation}}, and then throughout it isn't really clear which is which, but overall the author gives the strong impression of both meaning deliberate spreading of untruth for political ends.

::::It is also "commentary" and so best you could do is say this is Billard's opinion of the distinction. Its not a great guide.

::::Plus Billard's citation [https://misinforeview.hks.harvard.edu/article/critical-disinformation-studies-history-power-and-politics/ is also a commentary], and doesn't actually draw any distinction between misinformation and disinformation itself, uses both terms, and is published in an outlet titled "Misinformation Review". I find the distinction clear as mud with these sources. Void if removed (talk) 12:53, 20 May 2025 (UTC)

:::::[https://www.dictionary.com/e/misinformation-vs-disinformation-get-informed-on-the-difference/ More straightforward source] - so if we accept misinformation is lacking in intent, then the content in this article that conflates misinformation and disinformation needs revisiting and distinguishing much more clearly IMO, because allegation of "intent to mislead" permeates the article. Void if removed (talk) 12:57, 20 May 2025 (UTC)

:::::I'm reading this differently to you:

:::::{{tq|misinformation about transgender issues was mobilized for the sole purpose of justifying opposition}}

:::::This doesn't necessarily ascribe intent to the person spreading the misinformation, but rather to the person "mobilising" them to do so or exploiting that misinformation.

:::::Let's say a group of people believes that vitamin C supplements can cure cancer. They genuinely believe that, even though it's wrong. They would be sharing misinformation if they told their friends about that belief. If they actively share that information for nefarious ends, then they're spreading disinformation instead.

:::::However, if someone else came along and exploited that genuine belief to replace cancer treatments with vitamin C, that misinformation would have been "mobilised" for nefarious ends. The person doing the "mobilising" is taking advantage of the genuine-but-incorrect belief or is otherwise encouraging it to spread further. That's what I think the author is saying.

:::::{{tq| Misinformation—or, more specifically, disinformation}}

:::::This is not a contradiction because one is a subset of the other. Disinformation is a kind of misinformation. It's misinformation with nefarious intent. Lewisguile (talk) 13:32, 20 May 2025 (UTC)

::::::I don't see how the line {{tq | Transgender healthcare misinformation primarily relies on manufactured uncertainty from a network of conservative legal and advocacy organizations}} in this article is compatible with the idea we're just talking about accidental errors. The overall tenor is in line with a discussion of malicious disinformation. Void if removed (talk) 14:01, 20 May 2025 (UTC)

::::::You're assuming disinformation isn't also a type of misinformation, which isn't supported by the sources. See [https://en.m.wikipedia.org/wiki/Special:Diff/1291324463/1291325737 this post]. Every definition says misinformation is wrong or incorrect information, while disinformation is misinformation+intent. It's quite clear. In which case, the sentence belongs because disinformation is also misinformation. Lewisguile (talk) 14:18, 20 May 2025 (UTC)

:::Well we should probably consult the experts on what misinformation is, rather than creating our own definition. I'm open to other expert sources being used here, if you can find them. The part I believe you've overlooked, though, is the "spreading" part. Lewisguile (talk) 13:40, 20 May 2025 (UTC)

::::Okay, from the WP page:

::::{{tq|Misinformation is incorrect or misleading information.{{Cite web|last=Merriam-Webster Dictionary|date=19 August 2020|title=Misinformation|url=https://www.merriam-webster.com/dictionary/misinformation|access-date=19 August 2020|archive-date=25 February 2019|archive-url=https://web.archive.org/web/20190225044837/https://www.merriam-webster.com/dictionary/misinformation|url-status=live}}{{Cite journal |last=Fetzer |first=James H. |date=2004-05-01 |title=Information: Does it Have To Be True? |url=https://doi.org/10.1023/B:MIND.0000021682.61365.56 |journal=Minds and Machines |volume=14 |issue=2 |pages=223–229 |doi=10.1023/B:MIND.0000021682.61365.56 |s2cid=31906034 |issn=1572-8641}} Misinformation and disinformation are not interchangeable terms: misinformation can exist with or without specific malicious intent, whereas disinformation is distinct in that the information is deliberately deceptive and propagated.{{Cite journal |last1=Woolley |first1=Samuel C. |last2=Howard |first2=Philip N. |date=2016 |title=Political Communication, Computational Propaganda, and Autonomous Agents |url=https://ijoc.org/index.php/ijoc/article/view/6298 |url-status=live |journal=International Journal of Communication |volume=10 |pages=4882–4890 |archive-url=https://web.archive.org/web/20191022194727/https://ijoc.org/index.php/ijoc/article/view/6298 |archive-date=2019-10-22 |access-date=2019-10-22}}{{cite book |doi=10.1109/icict50521.2020.00076 |chapter=An Exploration of Disinformation as a Cybersecurity Threat |title=2020 3rd International Conference on Information and Computer Technologies (ICICT) |year=2020 |last1=Caramancion |first1=Kevin Matthe |pages=440–444 |isbn=978-1-7281-7283-5 |s2cid=218651389 }}{{Cite web |last1=Karlova |first1=Natascha A. |last2=Fisher |first2=Karen E. |date=2013-03-15 |title=A social diffusion model of misinformation and disinformation for understanding human information behaviour |url=https://informationr.net/ir/18-1/paper573.html |access-date=2023-05-11 |website=informationr.net |archive-date=2023-05-11 |archive-url=https://web.archive.org/web/20230511204310/https://informationr.net/ir/18-1/paper573.html |url-status=live }}https://muse.jhu.edu/article/579342{{Cite journal |last=Diaz Ruiz |first=Carlos |date=2023-10-30 |title=Disinformation on digital media platforms: A market-shaping approach |journal=New Media & Society |doi=10.1177/14614448231207644 |issn=1461-4448|doi-access=free }}}}

::::The bolded part is a tad poorly worded, but the sources clarify that it means disinformation is a subset of misinformation. I.e., disinformation is also misinformation, but misinformation is only disinformation if it's intentionally misleading. The last source above, Diaz Ruiz, says: {{tq|This article focuses on two terms: disinformation and misinformation. The main difference between them is the presence of intent (Fallis, 2015: 402).}}

::::For disinformation, he says: {{tq|Unlike misinformation, disinformation is an orchestrated activity in which actors insert "strategic deceptions that may appear very credible to those consuming them . . . [per] intentional falsehoods spreading as news stories or simulated documentary formats to advance political goals" (Bennett and Livingston, 2018: 124). The term originates in military intelligence, as an adaptation from the Russian language (dezinformatsiya, дезинформация; Newman, 2022: 86). During the Cold War, the Soviet Union used disinformation to influence policies, distract the public, and manipulate the media, for example, by instilling uncertainty, shape expectations, and tarnish the reputation of political opponents (Samoilenko and Karnysheva, 2020).}}

::::Fallis says: {{tq|disinformation is misleading information that has the function of misleading}}.

::::Karlova says: {{tq|misinformation (inaccurate information) and disinformation (deceptive information)}}

::::Caramancion says: {{tq|Disinformation or fake news, often considered as a subset of misinformation, is the deliberate spread of misleading or false information. The salient and distinctive characteristic of disinformation from the latter is the intent that comes with, acting as the primal motivator for the source, usually humans.}}

::::Merriam-Webster says:

::::* {{tq|misinformation: incorrect or misleading information}}https://www.merriam-webster.com/dictionary/misinformation

::::* {{tq|disinformation: (1) false information, as about a country's military strength or plans, disseminated by a government or intelligence agency in a hostile act of tactical political subversion}} or {{tq|(2) deliberately misleading or biased information; manipulated narrative or facts; propaganda}}https://www.merriam-webster.com/dictionary/disinformation

::::That seems pretty consistent to me. Lewisguile (talk) 14:12, 20 May 2025 (UTC)

:::::Some more:

:::::Cambridge:

:::::* {{tq|misinformation: wrong information, or the fact that people are misinformed}}https://dictionary.cambridge.org/dictionary/english/misinformation

:::::* {{tq|disinformation: false information spread in order to deceive people}}https://dictionary.cambridge.org/dictionary/english/disinformation

:::::The UK government:

:::::* {{tq|Misinformation: the inadvertent spread of false information}}

:::::* {{tq|disinformation: [the] deliberate creation and spreading of false and/or manipulated information that is intended to deceive and mislead people, either for the purposes of causing harm, or for political, personal or financial gain.}}https://commonslibrary.parliament.uk/research-briefings/cdp-2024-0003/https://www.gov.uk/government/news/fact-sheet-on-the-cdu-and-rru

:::::BBC Bitesize (so in line with the curriculum in England):

:::::* {{tq|Misinformation is fake news that is created and spread by a MIStake – by someone who doesn’t realise that it’s false}}

:::::* {{tq|disinformation is fake news that is created and spread deliberately – by someone who knows full well that it’s false}}https://www.bbc.co.uk/bitesize/articles/z3hhvj6

:::::The APA:

:::::* {{tq|Misinformation is false or inaccurate information—getting the facts wrong.}}https://www.apa.org/topics/journalism-facts/misinformation-disinformation

:::::* {{tq|Disinformation is false information which is deliberately intended to mislead—intentionally misstating the facts.}}

:::::These are quite disparate sources and yet, they all have the same basic definitions. I think this makes things easier for us. Lewisguile (talk) 14:41, 20 May 2025 (UTC)

::::::@Lewisguile, would using "misinformation" as a shorthand for "false or inaccurate information" not fall foul of WP:WIKIVOICE? Specifically:

::::::{{quote frame | * Prefer nonjudgmental language. A neutral point of view neither sympathizes with nor disparages its subject (or what reliable sources say about the subject), although this must sometimes be balanced against clarity. Present opinions and conflicting findings in a disinterested tone. Do not editorialize. When editorial bias towards one particular point of view can be detected the article needs to be fixed. The only bias that should be evident is the bias attributed to the source.}} I think that a claim of misinformation is significantly stronger (and more disparaging/judgemental) than a claim of factual error. Perhaps this is one for NPOV/N?

::::::That aside, I interpret what you're proposing (some synthesis of all these very similar definitions) as replacing criteria 1 & 2 in the criteria for inclusion with which I opened this section. If that's so, and we adopted something along the lines of "spreading false information", would you support using criteria 3 & 4 as a basis for determining whether we should characterise something as misinformation in wiki-voice or attribute the characterisation? Samuelshraga (talk) 17:16, 22 May 2025 (UTC)

:::::::Perhaps for NPoVN indeed. I personally find "misinformation" as neutral as "false and inaccurate information". Aaron Liu (talk) 18:26, 22 May 2025 (UTC)

:::::::Well if we accept that misinformation is not always done with any bad intent then I would say it is a pretty neutral term. IntentionallyDense ^(Contribs) 18:36, 22 May 2025 (UTC)

:I was tagged here so I'll state my opinions a little bit more clearly based on information that has come forward. I do not think this is an easy thing to propose. What I mean is that this will take a considerable amount of consensus to be put into place. I am not proposing we go against what the definition of misinformation is persay but rather that we create a working definition to allow us to decide what fits the scope of the article and what doesn't. This is commonly used in lists on Wikipedia and isn't something completely new. I am fine with the wording being modified and I just wanted to create a starting point here. IntentionallyDense ^(Contribs) 03:59, 21 May 2025 (UTC)

::No problem, @IntentionallyDense. The main thing for me is that we shouldn't require something to be disinformation (i.e., intentionally misleading or deceptive), only misinformation (i.e., wrong/incorrect). Otherwise, we're making up our own definition of what misinformation is. I take @Samuelshraga's point about Wikivoice, and agree that we should rely on what experts say, allowing for synonyms and context to lead us. Other considerations such as WP:DUE and WP:WEIGHT would still apply, in any case. Disinformation should be easier to assess, because that's intentionally spreading false information, and we would require a source to be clear about both intent/agenda and the fact that the information was wrong/misleading to use that term over misinformation.

::Re: criterion 4, I think the following is problematic:

::{{tq|It should not be a difference of opinion, or admit of alternative interpretation in which it is not false or significantly misleading.}}

::Climate change denial and anti-vaxx theories are both "differences of opinion" or could "admit of alternative interpretation" to someone. I think we have to refer to what the consensus is among the relevant experts, and how information diverges from that consensus. I'm not sure how I'd reword it based on that.

::Notably, I think we should also consider the views of experts in misinformation, where appropriate, just as we might consult ethicists on issues of medical ethics (per MEDRS). This can be attributed where we're unclear as to how much it reflects the expert consensus. As I and others have said elsewhere, stuff that's considered WP:FRINGE, conspiratorial or pseudoscientific might not be officially deprecated or described as such in WP:MEDRS. Was there ever a systematic review into the effects of conversion therapy for sexuality before it was declared unethical and fringe, for example? As far as I'm aware, there wasn't; medical authorities just decided this was the case based on ethical reasons and consensus among themselves. There's also the fact that research tends to follow positive outcomes, rather than negative ones, so not only are negative findings less likely to be published, but people are also less likely to pursue theories that they consider a dead end or "settled". Of course, position statements by medical or professional organisations can help here, as well. Lewisguile (talk) 17:33, 22 May 2025 (UTC)

:::Yes I mixed up the definition a bit initially which is my bad but I'm glad you guys pointed that out to me! You're point about difference of opinion is a good one but I think in this case it's important that we redirect people to the appropriate definition of an opinion. Without that caveat we are inviting people to make claims based on opinions although even with it I'm sure we will run into issues. That point will most likely have to be expanded to clarify. I did touch on the issues you brought up in your last paragraph in my conversation with Samuel above. Not all MEDRS source is created equally and there is significant debate about whether leading publications in gender studies are even MEDRS. This will be something that will require time put into dissecting the individual reliability of publications. IntentionallyDense ^(Contribs) 18:41, 22 May 2025 (UTC)

:2: As mentioned above, agenda is not required.
3: Which systematic reviews that make misinformed claims are we talking about? Would this criteria remove something from this article?
4: As mentioned above this should be evaluated against the "Spectrum of Fringe theories" section. (I also still have things to say above which I haven't yet had the time to type up.) Aaron Liu (talk) 18:30, 22 May 2025 (UTC)

::2: I think the point about agenda is related to the issues around WP:WIKIVOICE. You've said you consider "misinformation" equally neutral to "false", so I can understand why that's not a concern for you.

::3: I don't think anyone said specifically that systematic reviews make misinformed claims. But an example would be the line "Mainstream media outlets such as The Atlantic, Washington Post, and The New York Times (NYT) have been criticized for platforming and amplifying misinformation". Are a social scientist in a journal article and a Vox piece commensurate sourcing for a claim of misinformation against WaPo, the NYT and Atlantic? Could we put it in wiki-voice ("these outlets have spread misinformation"), would we have to attribute, or is it not WP:DUE at all?

::4: Not everything falls into the domain of fringe/not fringe. Specific factual/historical claims (e.g. "the Cass review threw out 98% of the evidence") are not fringe/mainstream, they are true/untrue. Some claims are subjective (if the Pope says "transgender medical interventions should be avoided", it is not taken to be fringe science but mainstream religious teaching. Describing such a statement from such a source as misinformation would be extremely contentious). Samuelshraga (talk) 20:34, 22 May 2025 (UTC)

:::2: I don't get what you mean. Doesn't 2 say falsities not outright called misinformation must have a documented weaponization, which is not aligned with the intent-free definition of "misinformation"? (That said, only the Due falsities and thus the more common ones should be included.)
3: I wouldn't go as far as to say "exceptional" but as I've said above I do think that is a contentious claim that requires stronger sourcing than just Vox to not attribute. Due is a bit of a separate issue but in this specific case I don't see any Due concerns with Vox; hopefully I'm not driving us off a tangent here.
4: {{tq|a difference of opinion, or admit of alternative interpretation}} must qualify under Spectrum. I'm glad we can agree that certain things are untrue. I don't see anything approaching your Pope example in this article and I agree that things that make no claim relating to facts cannot be misinformation. Aaron Liu (talk) 20:58, 22 May 2025 (UTC)

:::Why wouldn't a social scientist be suitable, since they would look at social issues like the spread of misinformation? In this case, for an attributed claim, I think it's fine. I wouldn't state it in Wikivoice, because it's clearly an opinion and there isn't consensus that they have done that (yet/as far as I know). Lewisguile (talk) 22:14, 22 May 2025 (UTC)

::::The issue really comes when the social scientist is both the source about spread (fine) and the source of what is actually misinformation (not fine if it's out of their competence). Specifically, if the social scientist is talking about the spread of something medical that they describe as "misinformation" but in MEDRS is just a difference of opinion. Void if removed (talk) 22:37, 22 May 2025 (UTC)

:::::By that logic, no one but a medical scientist could publish on this area, and as has said, medical scientists don't do that. What is and isn't misinformation is generally something covered by specialists in communication, language, politics, etc. See also medical ethics and ethicists. Lewisguile (talk) 22:51, 22 May 2025 (UTC)

:::::They cite MedRS for what is and isn't. The cited MedRS is the source. Aaron Liu (talk) 00:54, 23 May 2025 (UTC)

::::::Fair. That means we should be careful about how we source such claims. Perhaps "paper x, citing paper y"? That's what I've seen used in historical topics where one source is quoting a claim made by another. Lewisguile (talk) 10:01, 23 May 2025 (UTC)

:::::::If it was that clear, we whould cite the MEDRS ourselves - but it is not. Here for example, is the entire section from Wuest & Last on social contagion:

:::::::{{quote frame | Social Contagion. Experts and amici considered environmental causes (e.g., social media exposure) for increased rates of GD. Social contagion theories draw from Littman (2019) on ROGD, which four documents cited, and Shrier's (2020) related claims about peer contagion effects in AFAB adolescents, which five documents cited. Ban proponents also cited clinical data and statistics on Genspect's website demonstrating disproportionate increases in GD among AFAB adolescents (Women's Liberation Front, 2021, p.22). Observing that “[a]dolescent female social contagion effects in psychiatric illness are well-known and well documented,” Hruz (2021, p.86) compared AFAB adolescents' GD to the spread of eating disorders, depression and anxiety, or a general pressure to conform. Notably, a study of almost 200,000 adolescents found a slight increase in AMAB adolescents identifying as trans or gender expansive (Turban et al., 2022). Ban proponents have benefited from several respected clinicians who have suggested environmental explanations for rising rates of GD. Dutch protocol co-founder Annelou L.C. de Vries (2020) cited Littman (2019) while noting that “a new developmental pathway … involving youth with postpuberty adolescent-onset transgender histories” (p.1) may prompt additional considerations when deciding whether to prescribe GAC. In an interview with Shrier (2021), WPATH leaders Marci Bowers and Erica Anderson indicated concern over rising rates of adolescent gender transition, although both oppose bans (“GAMC,” n.d.). Additionally, several ban proponents cited Zucker (2019)–a commentary published in the journal which he edits–entertaining the validity of ROGD.}}

:::::::There are eight citations here. None support the idea this is misinformation. Wuest & Last present "social contagion/ROGD" as misinformation without establishing that it is, and there are no citations we can use in here to substantiate it ourselves or attribute it. So when we use social scientists like Wuest & Last to talk about the deliberate spread of medical misinformation, what constitutes misinformation in the first place is never clearly established by the authors with any sort of serious MEDRS. Void if removed (talk) 10:57, 23 May 2025 (UTC)

::::::::I strongly agree with VIR here. The only cite that could possibly point to misinformation is Turban 2022. His study, based on a national bi-yearly public health survey, even shows that the AMAB/AFAB ratio shifted in between 2017 and 2019 (1.5:1 to 1.2:1). Regardless, the data Turban uses to determine assigned sex at birth is pretty flimsy. The survey just asks "what is your sex", not specifically the assigned at birth sex and it's pretty easy for an adolescent to confuse sex and gender. I just don't think we this source can be used for claims of misinformation. PositivelyUncertain (talk) 19:21, 23 May 2025 (UTC)

::::::::I don't understand, is there some indication that this part is supposed to say social contagion is misinformation? You just quoted the part where Wuest & Last describe their taxonomy of categorizing scientific claims made in amicus briefs—{{tq|We created 8 content categories based on how expert witnesses and amici invoked citations to support Arkansas's ban. Below we list each category and the scientific arguments that relate to each category.|q=yes}}, no matter whether or not such claims are misinformation—and social contagion is simply one of those categories. Is anything mentioned in that section wrong or a biomedical claim unsubstantiated by what the claim cites?{{pb}}Neither do we say the idea of social contagion is misinformation in the first place; we basically say that ROGD is a(n as-of-yet unfounded and experience-contradicting) hypothesis of GD spreading through social contagion rather than the misinformation that it is accepted in the medical field (we summarize {{tq|Despite the lack of evidence for ROGD and its significant potential for creating harm, it has garnered increased attention in the general public and is being misused within and beyond the field of psychology. For example, recent medical articles have started including ROGD in their overview of adolescents with gender incongruence, and there has been an increase in books, videos, podcasts, and training directed to parents and clinicians offering strategies for diagnosing and treating ROGD. The proliferation of misinformation regarding ROGD is also infiltrating policy decisions.|q=yes}}) Aaron Liu (talk) 20:08, 23 May 2025 (UTC)

:::::::::It says it right in the lede:

:::::::::{{tq | Common false claims include [...] that gender dysphoria can be socially contagious}} Void if removed (talk) 17:02, 26 May 2025 (UTC)

::::::::::Ah, I didn't see that. Not sure about that. The claim is cited to McNamara, SPLC, and Billard (which doesn't include Wuest & Last either, btw). McNamara at most says it's a discredited theory, while Billiard says it's misinformation that trans identity "is" a social contagion. I'll replace that part with what Billiard actually says and make the sourcing clearer if @Your Friendly Neighborhood Sociologist doesn't mind. Aaron Liu (talk) 18:12, 26 May 2025 (UTC)

:::::::::::Perhaps? This to me is a silly argument, we have the CAAPS statement, signed by dozens of MEDORGs, saying {{tq|there is no evidence that ROGD aligns with the lived experiences of transgender children and adolescents.}}[https://www.caaps.co/rogd-statement]. MEDRS have been clear for years there is no evidence that social contagion theory is accurate. We've had a longstanding consensus, that VIR is aware of, that ROGD is indeed FRINGE[https://en.wikipedia.org/wiki/Talk:Irreversible_Damage/Archive_10#RfC:_Should_rapid-onset_gender_dysphoria_be_described_as_%22fringe%22?]. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:31, 26 May 2025 (UTC)

::::::::::::My impression is that the "rapid development" part of ROGD goes far beyond just "social contagion" which I assumed to be a hypothesis that peers can influence one's conception of gender, a theory that ROGD is a fringe subset of. (Intuitively I would also assume that simple "influence" without the transphobic undertones of complete melding and imposition is possible.) Is that not the case? Are the two the same? Are there sources that say that? Aaron Liu (talk) 20:10, 26 May 2025 (UTC)

:::::::::::::The paper that originated the term "ROGD" also originated the use of the phrase "social contagion" to describe trans-ness.

:::::::::::::Now, I wouldn't put the idea that there's any social influence on trans identity into the WP:FRINGE bucket (wasn't that hard to find [https://www.sciencedirect.com/science/article/pii/S2352250X22001889 this] for instance). But I definitely would say that ROGD and "social contagion" mean the same thing in this context. Loki (talk) 16:57, 27 May 2025 (UTC)

::::::::::::::I think it's confusing if we don't clarify that "social contagion" means the same thing here, and I can't find a source to add that clarification with. Aaron Liu (talk) 12:01, 28 May 2025 (UTC)

Going over the sourcing for this page, I keep finding use of sources that require attribution. For example, I have just removed a line from the lede which was not reflected in the body, and which was cited solely to a "perspective" piece.

{{quote frame | Misinformation has affected the decision of the UK National Health Service (NHS) to restrict the use of puberty blockers for transgender individuals.}}

A perspective piece is RSOPINION, and should be attributed - and attributed opinion is insufficient for this strong claim in the lede.

This source is also cited to support the opening line of the lede:

{{quote frame | False and misleading claims about gender diversity, gender dysphoria, and gender-affirming healthcare have been used to justify legislative restrictions on transgender people's right to healthcare}}

And to support:

{{quote frame | Misinformation and disinformation have led to proposed and successful legislative restrictions on gender-affirming care across the United States}}

All of these are wikivoice claims this source should not be used to support. It should be removed and then any claim reduced to whatever can be supported with the second citation for each of these. Whatever else, we should not be reduced to using a source which requires attribution as the first citation on the opening sentence of the lede of a GA.

I'm sure there are other similar sources. Void if removed (talk) 13:32, 20 May 2025 (UTC)

:I've also removed an unattributed sentence in the lede cited to Billard's "Gender Critical Discourse as Disinformation: Unpacking TERF Strategies of Political Communication", as this is a commentary piece and requires attribution. It also wasn't in the body.

:I also removed an unattributed citation to a perspective piece in the NEJM. Not sure what this was adding anyway, it was combined with 3 other citations that surely must support the claim on their own. Void if removed (talk) 16:49, 20 May 2025 (UTC)

{{reflist-talk}}

We have a short section on this topic. Further to discussions of what exactly constitutes misinformation above, I think some scrutiny on this section is warranted. I'll separate out the claims that I think need attention as potentially not misinformation in the section's two sentences.

{{tq |the mainstream medical community is untrustworthy}} - this appears to me an entirely subjective question. Especially given that there is in fact serious international divergence on the evidence base and appropriateness of different forms of transgender healthcare, the idea that it is "incorrect" to distrust one country's health establishment needs significant justification.

{{tq |it ignores the evidence}} - again, the idea that this is "misinformation" seems quite a stretch. Given we have RS talking about WPATH suppressing or manipulating its own commissioned research. [https://www.economist.com/united-states/2024/06/27/research-into-trans-medicine-has-been-manipulated][https://bmjgroup.com/the-bmj-investigates-dispute-over-us-groups-involvement-in-whos-trans-health-guideline/][https://adc.bmj.com/content/110/4/251.long#ref-29], and given that the president-elect of USPATH has quite openly admitted not publishing findings of a study because of their potential political implications[https://www.nytimes.com/2024/10/23/science/puberty-blockers-olson-kennedy.html], I think we would need significantly stronger sourcing to call this misinformation.

{{tq|doctors are pushing transgender youth into transition due to political ideology and disregard for their well-being.}} - it's not immediately clear whether this is referring literally to doctors, or to medical organisations. I think the intent is the latter, and that the relevant line in the source (cited at the end of the section) is a quote from an amicus brief saying "these organizations are demonstrably motivated by politics, not science, or the best interests of young people". I don't think we should determine the truth or falsity a claim about organisations' motivations in wiki-voice without considerably stronger sourcing.

{{tq|This extends to claims that standards of care and clinical practice guidelines from reputable medical organizations such as WPATH and the Endocrine Society do not reflect clinical consensus}} - I think the relevant line in the source is: "The Florida Brief asserts that “WPATH’s and the Endocrine Society’s standards of care and guidelines do not reflect professional consensus"". I don't know how we're measuring consensus, but it occurs to me that "clinical" and "professional" consensus are not exactly synonymous. Perhaps more importantly, given that there are standards of care and clinical practice guidelines in use that differ significantly from the WPATH and Endocrine Society ones, the claim is not in fact misinformation, but true.[https://adc.bmj.com/content/109/Suppl_2/s65] Samuelshraga (talk) 19:40, 24 May 2025 (UTC)

:You say with regard to mainstream medical expertise in transgender health {{tq|there is in fact serious international divergence on the evidence base and appropriateness of different forms of transgender healthcare}}, but that simply doesn't appear to be the case. As has been shown in recent RFCs, what divergence there is, is limited in scope and to a very small number of countries, and has been very much exaggerated by fringe organisations opposed to transgender health in general.

:You also say {{tq|we have RS talking about WPATH suppressing or manipulating its own commissioned research}}. The RFC on SEGM has now been concluded, with the finding that it is a fringe organisation. Claims made by representatives of that organisation that WPATH reviewers raising concerns on one report but not preventing publication represents evidence of WPATH's widespread suppression of evidence should be discounted.

:You say {{tq|the relevant line in the source (cited at the end of the section) is a quote from an amicus brief saying "these organizations are demonstrably motivated by politics, not science, or the best interests of young people". I don't think we should determine the truth or falsity a claim about organisations' motivations in wiki-voice without considerably stronger sourcing.}} As far as this encyclopedia is concerned, it's sourced to [https://www.sciencedirect.com/science/article/abs/pii/S0277953624003873?via%3Dihub an RS article] reviewing such texts as examples of disinformation in legal submissions. It isn't wikipedia editors making that interpretation. That article has in turn been cited by other RS to make exactly the same point.

:You say {{tq|"The Florida Brief asserts that “WPATH’s and the Endocrine Society’s standards of care and guidelines do not reflect professional consensus"". I don't know how we're measuring consensus, it occurs to me that "clinical" and "professional" consensus are not exactly synonymous}}. You fail to make clear in what sense, in this context, they are meaningfully different such that professional and clinical consensus are known to diverge. In addition, the source you kindly provide states that

:{{quote|two international guidelines, the Endocrine Society25 and World Professional Association for Transgender Health (WPATH)34 guidelines (specifically the 2009 Endocrine Society guideline48 and WPATH V.7 published in 2012)49 have influenced nearly all the national and regional guidelines identified. }} which is a clear indication that that they do represent consensus. Overall, I don't think the section has the problems you suggest. OsFish (talk) 10:57, 26 May 2025 (UTC)

::{{tq| the mainstream medical community is untrustworthy}} - this was the context for your piont about {{tq|what divergence there is, is limited in scope and to a very small number of countries, and has been very much exaggerated by fringe organisations opposed to transgender health in general}}. I think that inasmuch as there is a meaningful difference - and I don't think we need to precisely debate the scope of that to establish this - one cannot describe a position of distrusting one part of the medical establishment as "misinformation".

::{{tq|Claims made by representatives of that organisation that WPATH reviewers raising concerns on one report but not preventing publication represents evidence of WPATH's widespread suppression of evidence should be discounted.}} I cited articles in the Economist, the British Medical Journal and Archives of Disease in Childhood. The Economist piece makes no mention of SEGM, the BMJ piece quotes someone from SEGM but makes the claim itself in article voice (explicitly verifying the claim: "emails seen by The BMJ"), and the ADC piece has one of its five authors affiliated to SEGM. I will ask the closer of the RfC if discounting sourcing like this is what they had in mind.

::{{tq|As far as this encyclopedia is concerned, it's sourced to an RS article reviewing such texts as examples of disinformation in legal submissions.}} I explicitly said we shouldn't make the claim in wiki-voice. To be even clearer, I'm not opposed to attributing it. Claims about motivations (including claims that somebody else's claims about motivations are incorrect) are obviously much dicier in terms of WP:V than claims about things that observably happened, and I think attribution of a claim about motivation is prudent on that basis.

::{{tq|You fail to make clear in what sense, in this context, they are meaningfully different}} - I think that clinical consensus is between medics who practice in a particular area, and professional consensus is among the medical profession as a whole. Nonetheless, this was perhaps the least problematic part of the section, at least in the context of the US. It would probably be better to specify that. Samuelshraga (talk) 11:46, 26 May 2025 (UTC)

:::"inasmuch as there is a meaningful difference" - that's for you to establish. Multiple MedRS have pointed out that claims of significant divergence are unfounded. The BMJ piece does not make the claim in its own voice that WPATH is systematically suppressing evidence. It reports a "she said, he said" claim where WPATH denies stopping anyone publishing anything. It's the contributions from the SEGM figures (Guyatt is also connected to SEGM) - again, absolutely not made in the voice of the BMJ - that elevate it to some sort of grander conspiracy theory. At base, we have a case of one set of researchers clashing with reviewers at WPATH over one report one time. Storm in a teacup stuff.

:::As for this distinction you construct between the expert consensus of specialists in a medical field, and the opinion of the worldwide medical profession as a whole: which other fields of medicine operate like this, whereby the opinion of field-relevant experts is set against the opinion of all medical professionals in all fields? Can you give examples? OsFish (talk) 12:56, 26 May 2025 (UTC)

::::{{tq|"inasmuch as there is a meaningful difference" - that's for you to establish.}} The UK only prescribes puberty blockers in a research setting. Many other countries don't have this restriction. This isn't the only meaningful divergence, but it's one very high-profile one.

::::{{tq|The BMJ piece does not make the claim in its own voice that WPATH is systematically suppressing evidence.}} I did not say {{tq|systematically}}. I said {{tq|we have RS talking about WPATH suppressing or manipulating its own commissioned research.}} The BMJ article in its own voice directly supports the claim that WPATH attempted to do this: "In June this year, however, documents from two US lawsuits over the provision of treatment for gender dysphoria showed that WPATH had attempted to institute an “approval process” over manuscripts emanating from the independent systematic reviews it commissioned." Karen Robinson, Johns Hopkins research lead contracted to deliver the research goes further saying that “we have been having issues with this sponsor trying to restrict our ability to publish.” I don't get why these aren't reasonable reasons to feel less trust towards an organisation than we otherwise would? At least towards an organisation's research in this specific instance that is subject to such constraints?

::::As for the distinction between clinical and professional, I really don't think this was the most important thing about what I wrote, and I already said that this was {{tq|the least problematic part of the section, at least in the context of the US}}. Samuelshraga (talk) 14:34, 26 May 2025 (UTC)

:::::Correct me if I'm wrong but the bmj peice is attributing that this is an attempt to restrict publishing to Karen Robinson. This really does seem like a he said she said where the official position is, some systematic reviews weren't published for a variety of reasons. It's really more a case of "we have RS quoting some people who believe WPATH suppressed research it commissioned" this is far far away from "the mainstream medical community ignore the evidence around GAC" which is the statement you're actually arguing against with this line of reasoning LunaHasArrived (talk) 15:18, 26 May 2025 (UTC)

::::::No, there are two quotes in my last comment. The first is the BMJ in its own voice stating that an attempt was made by WPATH to impose editorial control over the research. The second is from Karen Robinson saying that the suppression happened. Karen Robinson is the person who was commissioned to perform the research, so it's not a case of "some people", but a case of "somebody central to the endeavour extremely well positioned to know". But that aside, if the distinction you are drawing is between "WPATH suppressed evidence" and "the mainstream medical community disregards evidence" around GAC, I think that in general we portray WPATH as fairly central to the US medical community's understanding of transgender healthcare. Especially as they write the Standards of Care. Samuelshraga (talk) 16:54, 26 May 2025 (UTC)

:::::::No, Karen Robinson does not say the suppression happened. She is quoted as saying "we have been having issues with this sponsor trying to restrict our ability to publish". It is worth reading [https://www.bmj.com/content/387/bmj.q2227 the full article by Block]. The quote is actually from an email written in 2020 in response to guidelines, not an intervention in any one review. The write up in the short summary is really very misleading. I have added emphasis where appropriate:

:::::::{{quote|In a separate exchange three years earlier with Christine Chang, a director at the US Agency for Healthcare Research and Quality, Robinson had referred to submitting “reports of reviews (dozens!)” to WPATH, but she added that “we have been having issues with this sponsor trying to restrict our ability to publish.”}}

:::::::{{quote|Johns Hopkins is one of nine centres contracted with the Agency for Healthcare Research and Quality to conduct systematic reviews on a wide variety of topics, and the agency was considering having one done on treating gender dysphoria in children and adolescents. Exactly how many systematic review manuscripts Johns Hopkins drafted remains unknown, and neither Robinson nor anyone from the university responded to The BMJ’s email requests for comment.}}

:::::::{{quote|Robinson emailed Chang about problems with WPATH just days after receiving a letter from several members of its executive committee outlining new “policy and procedures,” which instructed the Hopkins team to submit manuscripts to WPATH for an approval process that involved a vote by the SOC8 chair and co-chairs, as well as WPATH’s board. Only then would the Johns Hopkins researchers be given a “green light to be published.”}}

:::::::{{quote|WPATH sent an update to Robinson and all SOC8 coauthors in October 2020 stating, “It is paramount that any publication based on the WPATH SOC8 data is thoroughly scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender healthcare in the broadest sense.”}}

:::::::{{quote|The approval process was to be overseen by the organisation’s president elect at the time, Walter Bouman, a specialist in trans health at the University of Nottingham, UK. Gail Knudson, a physician at the University of British Columbia and former WPATH president, had also signed the letters to Robinson. Bouman and Knudson were appointed to WHO’s guideline development group for transgender health and remain members. Neither responded to The BMJ’s request for comment.}}

:::::::The article goes on to quote WPATH and from the work of Robinson's John Hopkins colleague Ian Saldanha:

:::::::{{quote|WPATH stood by its guidelines, commenting that “WPATH could not and did not prohibit the [Johns Hopkins] evidence based review team from publishing.” Others have come to WPATH’s defence, among them Robinson’s colleague Ian Saldanha, associate director of the Johns Hopkins Evidence-Based Practice Center. He cowrote a recently filed “friend of the court” brief that calls the SOC8 development process “rigorous” and “methodologically sound” and states, “While in theory it might be ideal for every aspect of a clinical practice guideline to be directly supported by a systematic review, in practice this is extraordinarily rare if not impossible.”}}

:::::::In general, the article reveals that the whole story exists because of a letter writing campaign by fringe activist groups, again something rather unhelpfully omitted by the summary article.

:::::::{{quote|When the World Health Organization (WHO) announced the roster last December for its first guideline panel “on the health of trans and gender diverse people,” it seemed heavily weighted towards the “gender affirming” approach, which promotes patient led access to hormonal and surgical treatments.12 The endeavour quickly became mired in controversy, including a mass letter to WHO from more than 100 clinicians. Signatories charged that most of the panel’s 21 members favoured the affirming approach, reporting affiliations with organisations including Global Action for Trans Equality (GATE) and the World Professional Association for Transgender Health (WPATH).}}

:::::::(...)

:::::::{{quote|Letters to WHO from the Society for Evidence Based Gender Medicine (SEGM), which has itself commissioned several forthcoming relevant systematic reviews,4567 and the Clinical Advisory Network on Sex and Gender (CAN-SG), a network of mainly UK and Irish clinicians, raised the question of whether WHO would be evaluating the benefits and harms of hormonal treatments for gender incongruence—or if instead it “has taken a policy position on this without critically appraising the evidence,” as a letter from CAN-SG put it.}}

:::::::So, to sum up, the quote from Robinson's email was not about the suppression of a report, and instead it does seem rather like an attempt from a bunch of fringe activists to gain false respectability for their positions. That's how these fringe groups work. They try to short circuit their way into public esteem with these sorts of things. OsFish (talk) 05:01, 27 May 2025 (UTC)

::::::::Your note about the timeline is well taken. We can add the Robinson quote to evidence of WPATH attempting to impose editorial control over the research. Other sources (like the Economist one) say that the suppression actually happened.

::::::::Re: the Saldanha quote, this doesn't directly address the allegation. But even if it did, my point has never been "WPATH is untrustworthy and SOC8 is fraudulent". It's that one's opinion of their trustworthiness is just that - an opinion. Therefore the position of trusting/mistrusting them is not one that could be described as misinformation.

::::::::Re: {{tq|the article reveals that the whole story exists because of a letter writing campaign by fringe activist groups}} - we don't downgrade RS coverage of something because a non-RS source raised the profile of a story/got them to cover it. Here the BMJ talks in its own voice about the emails and court documents that it uses as the source for the claims it makes in the story. It does not attribute the claims to SEGM. Therefore I don't think your point is relevant. Samuelshraga (talk) 05:21, 27 May 2025 (UTC)

:::::::::You say {{tq|We can add the Robinson quote to evidence of WPATH attempting to impose editorial control over the research}}. No. Because that's simply not what the full article says. The article contains quotes directly disputing any such claim, and there is no direct statement that any suppression actually happened. Robinson certainly doesn't say it. And if the Economist says something that the Block article shows is false, it's a good reason to question the use of the Economist article in general on this topic, given that it isn't MEDRS and one of the key issues at stake is medical research design. In addition, the full BMJ article does in fact attribute such views to members of these fringe groups. It is incorrect to argue that contentious readings of the summary article are somehow more correct about the full article than the full article itself.OsFish (talk) 05:42, 27 May 2025 (UTC)

::::::::::I think the BMJ article (yes the full article) is quite clear - that there was an attempt to impose editorial control. I think that the BMJ says it in its own voice and that the Karen Robinson quotes also state it. It does not contradict the Economist article - the Economist corroborates the BMJ article, and further says that the attempt was later successfully resumed. The BMJ does not say that the suppression of research actually took place, but it very strongly implies it (I don't support using an implication as a source, but you claim that these sources contradict each other, which is ludicrous).

::::::::::As for what the BMJ article directly states in its own voice: "That same month, however, documents emerged showing that two members of WHO’s guideline committee, in their capacity as executives of WPATH, had attempted to interfere with an independent evidence review commissioned by that organisation for its 2022 guidelines". That Robinson received "a letter from several members of [WPATH's] executive committee outlining new “policy and procedures,” which instructed the Hopkins team to submit manuscripts to WPATH for an approval process that involved a vote by the SOC8 chair and co-chairs, as well as WPATH’s board. Only then would the Johns Hopkins researchers be given a “green light to be published.”"

::::::::::As for using the Economist, the question is not one of medical research design - it's one of editorial interference. The claim "group X attempted to exert editorial control over the research of group Y" is not a biomedical claim, even if the research is biomedical. Unlike allegations of misinformation on biomedical topics (extensively discussed in other sections of this talk page, it doesn't even contain an implied biomedical claim. Samuelshraga (talk) 09:48, 27 May 2025 (UTC)

:::::::::::You say {{tq|The BMJ does not say that the suppression of research actually took place, but it very strongly implies it}} - the idea that the BMJ is hinting at something behind the curtain and asking us to read the runes is kind of conspiracist thinking that isn't appropriate for an encyclopedia. And as fringe groups are the driving force behind this story, we do have to be aware as responsible editors of what their tactics are. They dig until they find something they can sell to the public as prima facie anomalous, allowing them to insinuate hints of a bigger scandal behind the curtain, a scandal which nothing in the article supports in any way; you yourself have conceded there is no evidence of any wider suppressive approach. Each claim about suppression falls apart once you read the article closely. The same article contains non-fringe people attesting that nothing untoward happened. This is all rather reminiscent, in miniature, of the Climatic Research Unit email controversy. The only "demand" that WPATH put through was that for one paper the researchers make clear it did "not necessarily reflect the official views of or imply endorsement by WPATH". That isn't interference in content. The issue is about research design because it is about the feasibility of systematic reviews to answer certain questions, as the article does make directly plain, no insinuations or implications necessary. OsFish (talk) 11:59, 27 May 2025 (UTC)

::::::::::::Sure, take a small part of what I wrote out of context, use it to suggest I'm saying something I don't and then accuse me of suggesting something that "isn't appropriate for an encyclopedia". I'm done with this. Let's put it this way - I've provided quotes from the BMJ in article voice saying precisely that WPATH attempted to interfere with what was supposed to be independent research. You believe that the article says the opposite, and we'll have to leave it there. I have no faith that I will convince you. I took on board your point about the timeline of Robinson's quote, but for the rest, I just think you're reading something very different to what I am, and given the tone of your last comment, I'm not willing to entertain the dialogue with you further. Samuelshraga (talk) 12:27, 27 May 2025 (UTC)

::::::::::::The CRU email hack was absolutely nothing like this. That was largely about taking one word from one informal email out of context ("trick") and claiming it was a smoking gun of malfeasance, whipped up by know-nothing partisan hacks. Respected figures in evidence-based medicine expressing some concern in the BMJ that WPATH prevented the publication of systematic reviews is a whole different kind of issue. Using an analogy like this is begging the question. Void if removed (talk) 09:20, 29 May 2025 (UTC)

:It is also kind of missing the point - "consensus" is the weakest form of medical evidence. The criticism of WPATH and the Endocrine Society in the linked systematic review is that their guidelines are not evidence based.

:Here's what the citation currently on the page says on that:

:{{quote frame | The documents also assert that professional organizations are out of touch with evidence-based medicine. The Fifteen AGs Amicus claims that “the rise of evidence-based medicine casts doubt on the reliability of expert consensus.” (p. 22) The Florida Brief quotes researchers who claimed that “‘research in this field is rapidly evolving,’ with unscrupulous researchers ‘trumpet[ing]’ ‘positive outcomes of medical interventions in abstracts’ but hiding ‘their profound limitations’” (p. 26) The Arkansas Brief claims that clinical practice guidelines “represent a political, consensus-seeking process (i.e., voting) - a process with a known error rate - as opposed to an evidence-seeking scientific research process, they have never been accepted by the scientific community as establishing what practices are or are not experimental.” (pp. 22–23).}}

:It is clear to me this source is classifying questioning if the consensus is sufficiently evidence based as misinformation. But we have a systematic review making the same criticism. Void if removed (talk) 14:52, 26 May 2025 (UTC)

:{{tqb|and given that the president-elect of USPATH has quite openly admitted not publishing findings of a study because of their potential political implications}}I don't get that NYT article. By the time it was published, the study mentioned had already published "Psychosocial Functioning in Transgender Youth after 2 Years of Hormones", "Laboratory Changes During Gender-Affirming Hormone Therapy in Transgender Adolescents", and 10 other papers; this January they published "Emotional Health of Transgender Youth 24 Months After Initiating Gender-Affirming Hormone Therapy". The article also immediately mentions that she intends to publish the data and that this was being delayed by a then-recent funding cut. I agree with the POV [https://www.cnn.com/2024/10/25/health/puberty-blocking-medications-transgender-kids CNN mentions] in its opening: that such is just {{tq|the normal caution being taken by researchers to carefully present and interpret scientific data}}. Aaron Liu (talk) 11:54, 29 May 2025 (UTC)