Keynote Speech: Evidence Based Practice
Since the emergence of paediatric gender medicine, recurring concerns have been raised regarding potential effects on bone mineral density, neurocognitive development, sexual function, fertility, regret, detransition, capacity for informed consent, and others. Although empirical studies have sought to address these issues, the responses often fail to resolve the debate. Questions are repeatedly revisited, and new areas of concern continue to arise. This pattern suggests that discussions are not solely determined by the availability of empirical data but also by underlying philosophical and ethical considerations.
This presentation examines how divergent frameworks influence the evaluation of evidence in this field. Drawing on perspectives from the philosophy of science and medicine, the argument situates current debates within the context of what Thomas Kuhn described as “periods of revolutionary science,” during which competing paradigms emerge and shape contrasting interpretations of evidence.
A distinction is proposed between two categories of claims: (1) those that concern genuinely incomplete or insufficient empirical data, and (2) those that reflect deeper moral, metaphysical, or societal concerns about human development and the proper role of medicine. Recognising this distinction may help clarify where further scientific research can provide meaningful contributions and where debate must instead address normative and conceptual questions.
The presentation aims to support clinicians and researchers by offering a framework for interpreting ongoing controversies in paediatric gender medicine. By identifying the extent to which disputes are rooted in empirical uncertainty versus fundamental differences in values or worldviews, it becomes possible to better understand the limits of evidence, the sources of persistent disagreement, and the pathways toward more productive dialogue.
