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Establishment of Rat Models Mimicking Gender-affirming Hormone Therapies

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Why Do the Bells Toll? : How to Understand and Address the Disputes Around Evidence in Support of the Use of Puberty

Simona Giordano¹

¹Centre for Social Ethics and Policy (CSEP), School of Social Sciences, Law Department, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK. simona.giordano@manchester.ac.uk.

Journal of Bioethical Inquiry

|June 3, 2026

Summary

Disputes over medical interventions for transgender youth stem from differing worldviews, not just weak evidence. Resolving these requires ethical discussion and understanding diverse perspectives, not just more data.

Keywords:

Evidence-based medicine Gender medicine Normativity in science Paradigm shifts Puberty blockers Transgender youth

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Published on: October 13, 2018

Area of Science:

Medical Ethics
Philosophy of Science
Paediatric Endocrinology

Background:

Current debates on puberty blockers and gender-affirming hormones for transgender and gender-diverse youth (TGDY) often focus on the perceived weakness of supporting evidence.
Reviews by NICE (2020) and the Cass Review (2024) have highlighted evidentiary limitations, leading to calls for more research and restrictions.

Purpose of the Study:

To explain why generating more data is unlikely to resolve disputes regarding medical interventions for TGDY.
To demonstrate that disagreements reflect deeper metaphysical and normative divergences, not merely evidentiary deficits.

Main Methods:

Analysis drawing on Thomas Kuhn's concept of paradigms and the theory-ladenness of observation.
Examination of how conceptual frameworks and value commitments influence the definition and interpretation of evidence in paediatric gender medicine.

Main Results:

Disagreements in paediatric gender medicine are rooted in competing paradigms concerning sex, gender, health, and medical intervention goals.
What constitutes relevant evidence and important outcomes is contingent on underlying worldviews and value commitments.
The persistence of disputes and dissatisfaction with research findings indicate a paradigmatic crisis rather than a simple lack of data.

Conclusions:

Appeals to "evidence" can obscure the crucial normative dimensions of clinical judgment in paediatric gender medicine.
Resolution of these complex issues necessitates explicit ethical deliberation, clinical experience, and engagement with diverse worldviews.
The limits of data-driven resolution highlight the need for nuanced approaches in clinical guideline development and evidence review processes.