Mon 25 Jul 2022 — 5 min

Hate-group linked psychiatrist Stephen B Levine has claimed a role within a cochrane review committee investigating child and adolescent puberty blockers and hormone replacement therapy (HRT).

Cochrane is an international network which produces systematic reviews of medical studies, to help doctors, patients and organisations like the NHS decide what the most effective treatments are. These are a summary and analysis of the available scientific studies on particular treatments. They’re internationally respected for the quality of their work, and Cochrane reviews are influential in determining treatment guidelines both in the UK and internationally. The results of a Cochrane review on any aspect of medical transition are likely to have a significant impact on trans people’s ability to access treatment, either positively or negatively.

Only one previous Cochrane review has been done on trans related healthcare (Haupt et al 2020), which examined HRT for transfem people. However that review has had little impact because it focused strongly on randomised control trials (RCTs) and found that only one study met its inclusion criteria (a comparison between cyproterone and spironolactone as an androgen blocker). RCTs are generally a poor choice for evaluating the efficacy of transgender healthcare (Ashley, 2022). In RCTs participants are randomly assigned to either different treatments, or to receive or not receive treatment. Participants wishing to start hormones would obviously be unwilling to participate in a study which may randomly assign them to the group not receiving hormones, so RCTs are not possible or ethical for trans healthcare. Even if a trial was randomised, it couldn’t be blinded because participants would notice whether or not they were experiencing body changes. Apparently a further review is planned to include cohort studies (which follow participants in a particular group over time), which is likely to produce more useful results.

According to court documents discovered by Zinnia Jones, there is currently a Cochrane group in Ireland conducting a review into puberty blockers and hormone treatment in adolescents. Jones is a researcher, writer and activist who encountered these documents as part of her work looking into court filings involving anti-trans expert witnesses, their affidavits, or depositions of them, in order to compare their public claims and activism against trans healthcare with their private and more limited statements under oath.

Information on the apparent Cochrane reviews comes from Stephen B. Levine, who is a psychiatrist and an advisory member of anti-trans medical group SEGM, that has multiple ties to conversion therapy advocacy. Levine’s claim to be involved in a Cochrane review appears in the transcript of a deposition for a case (Fain v. Crouch) in West Virginia; in the deposition Levine claims to be on both a Cochrane committee reviewing the use of puberty blockers and on a committee reviewing HRT for adolescents.

In the Fain v Crouch deposition Levine also admits to having been paid $5,000 by SEGM for his work on a paper critical of informed consent practices. The paper argues that informed consent procedures are too positive about transition and don’t include anti-trans misrepresentations of evidence. Levine has outspoken views on treatment of transgender adolescents and advocates against even social transition for trans children.

Levine is also a frequent expert witness in anti-trans legal cases. He has previously given evidence as an expert witness for far right group Alliance Defending Freedom (ADF), (A SPLC designated hate group) opposing social transition in schools. ADF are an extremist group who have advocated for the recriminalisation of consensual sex between LGBTQ adults, and members have made virulently transphobic and homophobic public comments, including claims that LBTQ people are more likely to be pedophiles. Can a psychiatrist who is happy to work for a group like this be trusted to take an unbiased approach to conducting a systematic review of trans healthcare?

Worryingly, Levine also implies in the deposition that at least one other member of the Cochrane committee on puberty blockers is also a member of SEGM. If Levine’s testimony is accurate then the presence of multiple members of SEGM on these committees raises broad concerns for the trans community. The presence of one or more openly anti-trans advocates or, potentially, conversion therapy practitioners calls the impartiality of the group into question.

If a Cochrane review examining healthcare for trans adolescents (in particular the use of puberty blockers or HRT) is published then it will likely have wide-reaching long-term impact on care practices at the national and international level1. If such a review were to be critical of HRT and puberty blockers this could lead to withdrawal of their use by healthcare bodies worldwide. This is especially important for the transgender community at a time where lobbying groups and politicians worldwide are making moves to systematically remove healthcare for trans youths and, increasingly, trans adults.

Cochrane Ireland has been approached for comment but as of the time of publication has not responded.