12,080
Views
8
CrossRef citations to date
0
Altmetric
Review Articles

Randomized-controlled trials are methodologically inappropriate in adolescent transgender healthcare

, , &

References

  • Academy of Medical Royal Colleges. (2011). Induced abortion and mental health: A systematic review of the mental health outcomes of induced abortion, including their prevalence and associated factors. https://perma.cc/N8ZP-L77C
  • Achille, C., Taggart, T., Eaton, N. R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T. A. (2020). Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: Preliminary results. International Journal of Pediatric Endocrinology, 2020(1), 8. https://doi.org/10.1186/s13633-020-00078-2
  • Alexander, P. E., Bero, L., Montori, V. M., Brito, J. P., Stoltzfus, R., Djulbegovic, B., Neumann, I., Rave, S., & Guyatt, G. (2014). World Health Organization recommendations are often strong based on low confidence in effect estimates. Journal of Clinical Epidemiology, 67(6), 629–634. https://doi.org/10.1016/j.jclinepi.2013.09.020
  • Allen, L. R., Watson, L. B., Egan, A. M., & Moser, C. N. (2019). Well-being and suicidality among transgender youth after gender-affirming hormones. Clinical Practice in Pediatric Psychology, 7(3), 302–311. https://doi.org/10.1037/cpp0000288
  • Andrews, G. (1999). Randomised controlled trials in psychiatry: Important but poorly accepted. BMJ, 319(7209), 562–564. https://doi.org/10.1136/bmj.319.7209.562
  • Ashley, F. (2019). Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth. Clinical Child Psychology and Psychiatry, 24(2), 223–236. https://doi.org/10.1177/1359104519836462
  • Ashley, F. (2022). Adolescent medical transition is ethical: An analogy with reproductive health. Kennedy Institute of Ethics Journal, 32(2), 127–171. https://doi.org/10.1353/ken.2022.0010
  • Bass, M., Gonzalez, L. J., Colip, L., Sharon, N., & Conklin, J. (2018). Rethinking gender: The nonbinary approach. American Journal of Health-System Pharmacy, 75(22), 1821–1823. https://doi.org/10.2146/ajhp180236
  • Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in Ontario, Canada. BMC Public Health, 15(1), art. 525. https://doi.org/10.1186/s12889-015-1867-2
  • Baum, M. (1999). Reflections on randomised controlled trials in surgery. The Lancet, 353, S6–S8. https://doi.org/10.1016/S0140-6736(99)90220-9
  • Bell, M. L., Kenward, M. G., Fairclough, D. L., & Horton, N. J. (2013). Differential dropout and bias in randomised controlled trials: When it matters and when it may not. BMJ, 346, e8668. https://doi.org/10.1136/bmj.e8668
  • Benson, K., & Hartz, A. J. (2000). A comparison of observational studies and randomized, controlled trials. The New England Journal of Medicine, 342(25), 1878–1886. https://doi.org/10.1056/NEJM200006223422506
  • Black, N. (1996). Why we need observational studies to evaluate the effectiveness of health care. BMJ, 312(7040), 1215–1218. https://doi.org/10.1136/bmj.312.7040.1215
  • Bondemark, L., & Ruf, S. (2015). Randomized controlled trial: The gold standard or an unobtainable fallacy? European Journal of Orthodontics, 37(5), 457–461. https://doi.org/10.1093/ejo/cjv046
  • Branstetter, G. (2016, August 31). Sketchy Pharmacies Are Selling Hormones to Transgender People. The Atlantic. https://www.theatlantic.com/health/archive/2016/08/diy-hormone-replacement-therapy/498044/
  • Brewin, C. R., & Bradley, C. (1989). Patient preferences and randomised clinical trials. BMJ, 299(6694), 313–315. https://doi.org/10.1136/bmj.299.6694.313
  • Caputo, M. (2022, June 2). DeSantis moves to ban transition care for transgender youths, Medicaid recipients. NBC News. https://www.nbcnews.com/politics/politics-news/desantis-moves-ban-transition-care-transgender-youth-medicaid-recipien-rcna31736
  • Carlile, A., Butteriss, E., & Sansfaçon, A. P. (2021). “It’s like my kid came back overnight”: Experiences of trans and non-binary young people and their families seeking, finding and engaging with clinical care in England. International Journal of Transgender Health, 22(4), 1–17. https://doi.org/10.1080/26895269.2020.1870188
  • Charlton, B. G. (1994). Understanding randomized controlled trials: Explanatory or pragmatic? Family Practice, 11(3), 243–244. https://doi.org/10.1093/fampra/11.3.243
  • Costa, R., Dunsford, M., Skagerberg, E., Holt, V., Carmichael, P., & Colizzi, M. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. The Journal of Sexual Medicine, 12(11), 2206–2214. https://doi.org/10.1111/jsm.13034
  • de Vries, A. L. C., McGuire, J. K., Steensma, T. D., Wagenaar, E. C. F., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696–704. https://doi.org/10.1542/peds.2013-2958
  • de Vries, A. L. C., Steensma, T. D., Doreleijers, T. A. H., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. The Journal of Sexual Medicine, 8(8), 2276–2283. https://doi.org/10.1111/j.1743-6109.2010.01943.x
  • Deaton, A., & Cartwright, N. (2018). Understanding and misunderstanding randomized controlled trials. Social Science & Medicine (1982), 210, 2–21. https://doi.org/10.1016/j.socscimed.2017.12.005
  • Detry, M. A., & Lewis, R. J. (2014). The intention-to-treat principle: How to assess the true effect of choosing a medical treatment. JAMA, 312(1), 85–86. https://doi.org/10.1001/jama.2014.7523
  • Deutsch, M. B., Radix, A., & Reisner, S. (2016). What’s in a Guideline? Developing collaborative and sound research designs that substantiate best practice recommendations for transgender health care. The AMA Journal of Ethic, 18(11), 1098–1106. https://doi.org/10.1001/journalofethics.2016.18.11.stas1-1611
  • Duhem, P. (1976). Physical theory and experiment. In S. G. Harding (Ed.), Can theories be refuted? (pp. 1–40). Springer Netherlands. https://doi.org/10.1007/978-94-010-1863-0_1
  • Edenfield, A. C., Holmes, S., & Colton, J. S. (2019). Queering tactical technical communication: DIY HRT. Technical Communication Quarterly, 28(3), 177–191. https://doi.org/10.1080/10572252.2019.1607906
  • Everhart, A. R., Ferguson, L., & Wilson, J. P. (2022). Construction and validation of a spatial database of providers of transgender hormone therapy in the US. Social Science & Medicine (1982), 303, 115014. https://doi.org/10.1016/j.socscimed.2022.115014
  • Feinstein, A. R., & Horwitz, R. I. (1997). Problems in the “Evidence” of “Evidence-based medicine. The American Journal of Medicine, 103(6), 529–535. https://doi.org/10.1016/S0002-9343(97)00244-1
  • Fleming, P. S., Koletsi, D., Ioannidis, J. P. A., & Pandis, N. (2016). High quality of the evidence for medical and other health-related interventions was uncommon in Cochrane systematic reviews. Journal of Clinical Epidemiology, 78, 34–42. https://doi.org/10.1016/j.jclinepi.2016.03.012
  • Medicaid, F. (2022). Generally accepted professional medical standards determination on the treatment of gender dysphoria. Florida Agency for Health Care Administration. https://www.ahca.myflorida.com/letkidsbekids/docs/AHCA_GAPMS_June_2022_Report.pdf
  • Foster Skewis, L., Bretherton, I., Leemaqz, S. Y., Zajac, J. D., & Cheung, A. S. (2021). Short-term effects of gender-affirming hormone therapy on dysphoria and quality of life in transgender individuals: A prospective controlled study. Frontiers in Endocrinology, 12, 717766. https://doi.org/10.3389/fendo.2021.717766
  • Freedman, B. (1987). Equipoise and the ethics of clinical research. The New England Journal of Medicine, 317(3), 141–145. https://doi.org/10.1056/NEJM198707163170304
  • Frieden, T. R. (2017). Evidence for health decision making—Beyond randomized, controlled trials. The New England Journal of Medicine, 377(5), 465–475. https://doi.org/10.1056/NEJMra1614394
  • Ginsburg, A., Smith, M. S. (2016). Do randomized controlled trials meet the “Gold Standard”? A study of the usefulness of RCTs in the what works clearinghouse. American Enterprise Institute. https://www.carnegiefoundation.org/wp-content/uploads/2016/03/Do-randomized-controlled-trials-meet-the-gold-standard.pdf
  • Grannis, C., Leibowitz, S., Gahn, S., Nahata, L., Morningstar, M., Mattson, W. I., Chen, D., Strang, J. F., & Nelson, E. E. (2021). Testosterone treatment, internalizing symptoms, and body image dissatisfaction in transgender boys. Psychoneuroendocrinology, 132, 105358. https://doi.org/10.1016/j.psyneuen.2021.105358
  • Green, A. E., DeChants, J. P., Price, M. N., & Davis, C. K. (2022). Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. Journal of Adolescent Health, 70(4), 643–649. https://doi.org/10.1016/j.jadohealth.2021.10.036
  • Grossman, J., & Mackenzie, F. J. (2005). The randomized controlled trial: Gold standard, or merely standard? Perspectives in Biology and Medicine, 48(4), 516–534. https://doi.org/10.1353/pbm.2005.0092
  • Gupta, S. (2011). Intention-to-treat concept: A review. Perspectives in Clinical Research, 2(3), 109. https://doi.org/10.4103/2229-3485.83221
  • Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J, GRADE Working Group (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336(7650), 924–926. https://doi.org/10.1136/bmj.39489.470347.AD
  • Haneuse, S., VanderWeele, T. J., & Arterburn, D. (2019). Using the E-value to assess the potential effect of unmeasured confounding in observational studies. JAMA, 321(6), 602–603. https://doi.org/10.1001/jama.2018.21554
  • Hariton, E., & Locascio, J. J. (2018). Randomised controlled trials—The gold standard for effectiveness research. BJOG: An International Journal of Obstetrics and Gynaecology, 125(13), 1716–1716. https://doi.org/10.1111/1471-0528.15199
  • Hawkins, N. G., Sanson-Fisher, R. W., Shakeshaft, A., D’Este, C., & Green, L. W. (2007). The multiple baseline design for evaluating population-based research. American Journal of Preventive Medicine, 33(2), 162–168. https://doi.org/10.1016/j.amepre.2007.03.020
  • Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 102(11), 3869–3903. https://doi.org/10.1210/jc.2017-01658
  • Hernán, M. A. (2018). The C-Word: Scientific euphemisms do not improve causal inference from observational data. American Journal of Public Health, 108(5), 616–619. https://doi.org/10.2105/AJPH.2018.304337
  • Hernán, M. A. (2021). Methods of public health research—Strengthening causal inference from observational data. The New England Journal of Medicine, 385(15), 1345–1348. https://doi.org/10.1056/NEJMp2113319
  • Hernán, M. A., & Robins, J. M. (2016). Using big data to emulate a target trial when a randomized trial is not available: Table 1. American Journal of Epidemiology, 183(8), 758–764. https://doi.org/10.1093/aje/kwv254
  • Horton, C. (2021). “It felt like they were trying to destabilise us”: Parent assessment in UK children’s gender services. International Journal of Transgender Health, 24(1), 70–85. https://doi.org/10.1080/26895269.2021.2004569
  • Horton, C. (2022). Experiences of puberty and puberty blockers: Insights from trans children, trans adolescents, and their parents. Journal of Adolescent Research. Advance online publication. https://doi.org/10.1177/07435584221100591
  • Howick, J. (2020, September 2). Only one in ten medical treatments are backed by high-quality evidence. The Conversation. https://theconversation.com/only-one-in-ten-medical-treatments-are-backed-by-high-quality-evidence-145224
  • Howick, J., Koletsi, D., Pandis, N., Fleming, P. S., Loef, M., Walach, H., Schmidt, S., & Ioannidis, J. P. A. (2020). The quality of evidence for medical interventions does not improve or worsen: A metaepidemiological study of Cochrane reviews. Journal of Clinical Epidemiology, 126, 154–159. https://doi.org/10.1016/j.jclinepi.2020.08.005
  • Jin, H., Restar, A., Goedel, W. C., Ogunbajo, A., Biello, K., Operario, D., Kuhns, L., Reisner, S. L., Garofalo, R., & Mimiaga, M. J. (2020). Maternal support is protective against suicidal ideation among a diverse cohort of young transgender women. LGBT Health, 7(7), 349–357. https://doi.org/10.1089/lgbt.2020.0219
  • Karalexi, M. A., Georgakis, M. K., Dimitriou, N. G., Vichos, T., Katsimpris, A., Petridou, E. T., & Papadopoulos, F. C. (2020). Gender-affirming hormone treatment and cognitive function in transgender young adults: A systematic review and meta-analysis. Psychoneuroendocrinology, 119, 104721. https://doi.org/10.1016/j.psyneuen.2020.104721
  • Kennedy-Martin, T., Curtis, S., Faries, D., Robinson, S., & Johnston, J. (2015). A literature review on the representativeness of randomized controlled trial samples and implications for the external validity of trial results. Trials, 16(1), art. 495. https://doi.org/10.1186/s13063-015-1023-4
  • Kuper, L. E., Stewart, S., Preston, S., Lau, M., & Lopez, X. (2020). Body dissatisfaction and mental health outcomes of youth on gender-affirming hormone therapy. Pediatrics, 145(4), e20193006. https://doi.org/10.1542/peds.2019-3006
  • Lakatos, I. (1976). Falsification and the methodology of scientific research programmes. In S. G. Harding (Ed.), Can theories be refuted? (pp. 205–259). Springer Netherlands. https://doi.org/10.1007/978-94-010-1863-0_14
  • Lash, T. L., Fox, M. P., & Fink, A. K. (2009). Applying quantitative bias analysis to epidemiologic data. Springer.
  • Lash, T. L., Fox, M. P., MacLehose, R. F., Maldonado, G., McCandless, L. C., & Greenland, S. (2014). Good practices for quantitative bias analysis. International Journal of Epidemiology, 43(6), 1969–1985. https://doi.org/10.1093/ije/dyu149
  • Lett, E., Abrams, M. P., Gold, A., Fullerton, F.-A., & Everhart, A. (2022). Ethnoracial inequities in access to gender-affirming mental health care and psychological distress among transgender adults. Social Psychiatry and Psychiatric Epidemiology, 57(5), 963–971. https://doi.org/10.1007/s00127-022-02246-6
  • Lewis, S. C., & Warlow, C. P. (2004). How to spot bias and other potential problems in randomised controlled trials. Journal of Neurology, Neurosurgery, and Psychiatry, 75(2), 181–187. https://doi.org/10.1136/jnnp.2003.025833
  • London, A. J., & Kadane, J. B. (2002). Placebos that harm: Sham surgery controls in clinical trials. Statistical Methods in Medical Research, 11(5), 413–427. https://doi.org/10.1191/0962280202sm300ra
  • Macklin, R. (1999). The ethical problems with sham surgery in clinical research. The New England Journal of Medicine, 341(13), 992–996. https://doi.org/10.1056/NEJM199909233411312
  • Marshall, W. L., & Marshall, L. E. (2007). The utility of the random controlled trial for evaluating sexual offender treatment: The gold standard or an inappropriate strategy? Sexual Abuse: A Journal of Research and Treatment, 19(2), 175–191. https://doi.org/10.1177/107906320701900207
  • Meng, M., Zhou, Q., Lei, W., Tian, M., Wang, P., Liu, Y., Sun, Y., Chen, Y., & Li, Q. (2022). Recommendations on off-label drug use in pediatric guidelines. Frontiers in Pharmacology, 13, 892574. https://doi.org/10.3389/fphar.2022.892574
  • Mul, D., Versluis-den Bieman, H., Slijper, F., Oostdijk, W., Waelkens, J., & Drop, S. (2007). Psychological assessments before and after treatment of early puberty in adopted children. Acta Paediatrica, 90(9), 965–971. https://doi.org/10.1111/j.1651-2227.2001.tb01349.x
  • Mykhalovskiy, E., & Weir, L. (2004). The problem of evidence-based medicine: Directions for social science. Social Science & Medicine (1982), 59(5), 1059–1069. https://doi.org/10.1016/j.socscimed.2003.12.002
  • Newport, O. (2021, March 18). Current wait times for Tavistock and Portman Gender Identity Clinic. WhatDoTheyKnow. https://perma.cc/E54Q-JYML
  • NICE (2020a). Evidence review: Gender-affirming hormones for children and adolescents with gender dysphoria.
  • NICE (2020b). Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria.
  • Norris, S., Atkins, D., Bruening, W., Fox, S., Johnson, E., Kane, R., Morton, S. C., Oremus, M., Ospina, M., Randhawa, G., Schoelles, K., Shekelle, P., & Viswanathan, M. (2008). Selecting observational studies for comparing medical interventions. In Methods guide for effectiveness and comparative effectiveness reviews. Agency for Healthcare Research and Quality. http://www.ncbi.nlm.nih.gov/books/NBK47093/
  • Patsopoulos, N. A. (2011). A pragmatic view on pragmatic trials. Dialogues in Clinical Neuroscience, 13(2), 217–224. https://doi.org/10.31887/DCNS.2011.13.2/npatsopoulos
  • Piaggio, G., Elbourne, D. R., Altman, D. G., Pocock, S. J., & Evans, S. J. W, for the CONSORT Group. (2006). Reporting of noninferiority and equivalence randomized trials: An extension of the CONSORT statement. JAMA, 295(10), 1152–1160. https://doi.org/10.1001/jama.295.10.1152
  • Popper, K. (2005). The logic of scientific discovery. Routledge. https://doi.org/10.4324/9780203994627
  • Quine, W. V. O. (1951). Two dogmas of empiricism. The Philosophical Review, 60(1), 20–43. https://doi.org/10.2307/2181906
  • Reeves, B. (1999). Health-technology assessment in surgery. The Lancet, 353, S3–S5. https://doi.org/10.1016/S0140-6736(99)90413-0
  • Rhoda, D. A., Murray, D. M., Andridge, R. R., Pennell, M. L., & Hade, E. M. (2011). Studies with staggered starts: Multiple baseline designs and group-randomized trials. American Journal of Public Health, 101(11), 2164–2169. https://doi.org/10.2105/AJPH.2011.300264
  • Rogers, J. R., Lee, J., Zhou, Z., Cheung, Y. K., Hripcsak, G., & Weng, C. (2021). Contemporary use of real-world data for clinical trial conduct in the United States: A scoping review. Journal of the American Medical Informatics Association: JAMIA, 28(1), 144–154. https://doi.org/10.1093/jamia/ocaa224
  • Roland, M., & Torgerson, D. J. (1998). Understanding controlled trials: What are pragmatic trials? BMJ, 316(7127), 285–285. https://doi.org/10.1136/bmj.316.7127.285
  • Ross, J. S. (2014). Randomized clinical trials and observational studies are more often alike than unlike. JAMA Internal Medicine, 174(10), 1557. https://doi.org/10.1001/jamainternmed.2014.3366
  • Rotondi, N. K., Bauer, G. R., Scanlon, K., Kaay, M., Travers, R., & Travers, A. (2013). Nonprescribed hormone use and self-performed surgeries: “Do-it-yourself” transitions in transgender communities in Ontario, Canada. American Journal of Public Health, 103(10), 1830–1836. https://doi.org/10.2105/AJPH.2013.301348
  • Sanson-Fisher, R. W., Bonevski, B., Green, L. W., & D’Este, C. (2007). Limitations of the randomized controlled trial in evaluating population-based health interventions. American Journal of Preventive Medicine, 33(2), 155–161. https://doi.org/10.1016/j.amepre.2007.04.007
  • Sibbald, B., & Roland, M. (1998). Understanding controlled trials: Why are randomised controlled trials important? BMJ, 316(7126), 201–201. https://doi.org/10.1136/bmj.316.7126.201
  • Simon, S. D. (2001). Is the randomized clinical trial the gold standard of research? Journal of Andrology, 22(6), 938–943. https://doi.org/10.1002/j.1939-4640.2001.tb03433.x
  • Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793. https://doi.org/10.1016/j.jadohealth.2013.07.019
  • Smith, G. C. S., & Pell, J. P. (2003). Parachute use to prevent death and major trauma related to gravitational challenge: Systematic review of randomised controlled trials. BMJ, 327(7429), 1459–1461. https://doi.org/10.1136/bmj.327.7429.1459
  • Sorbara, J. C., Chiniara, L. N., Thompson, S., & Palmert, M. R. (2020). Mental health and timing of gender-affirming care. Pediatrics, 146(4), e20193600. https://doi.org/10.1542/peds.2019-3600
  • Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., Henry, D., Altman, D. G., Ansari, M. T., Boutron, I., Carpenter, J. R., Chan, A.-W., Churchill, R., Deeks, J. J., Hróbjartsson, A., Kirkham, J., Jüni, P., Loke, Y. K., Pigott, T. D., … Higgins, J. P. (2016). ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 355, art. i4919.https://doi.org/10.1136/bmj.i4919
  • Stirman, S. W., DeRubeis, R. J., Crits-Christoph, P., & Brody, P. E. (2003). Are samples in randomized controlled trials of psychotherapy representative of community outpatients? A new methodology and initial findings. Journal of Consulting and Clinical Psychology, 71(6), 963–972. https://doi.org/10.1037/0022-006X.71.6.963
  • Sullivan, G. M. (2011). Getting off the “Gold Standard”: Randomized controlled trials and education research. Journal of Graduate Medical Education, 3(3), 285–289. https://doi.org/10.4300/JGME-D-11-00147.1
  • Tan, K. K. H., Byrne, J. L., Treharne, G. J., & Veale, J. F. (2022). Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand. Journal of Public Health. Advance online publication. https://doi.org/10.1093/pubmed/fdac131
  • Tordoff, D. M., Sequeira, G. M., Shook, A. G., Williams, F., Hayden, L., Kasenic, A., Inwards-Breland, D., & Ahrens, K. (2022). Factors associated with time to receiving gender-affirming hormones and puberty blockers at a pediatric clinic serving transgender and nonbinary youth. Transgender Health. Advance online publication. https://doi.org/10.1089/trgh.2021.0116
  • Tordoff, D. M., Wanta, J. W., Collin, A., Stepney, C., Inwards-Breland, D. J., & Ahrens, K. (2022). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open, 5(2), e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978
  • Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2), e20191725. https://doi.org/10.1542/peds.2019-1725
  • Turban, J. L., King, D., Kobe, J., Reisner, S. L., & Keuroghlian, A. S. (2022). Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. PloS One, 17(1), e0261039. https://doi.org/10.1371/journal.pone.0261039
  • VanderWeele, T. J., & Arah, O. A. (2011). Bias formulas for sensitivity analysis of unmeasured confounding for general outcomes, treatments, and confounders. Epidemiology, 22(1), 42–52. https://doi.org/10.1097/EDE.0b013e3181f74493
  • White, I. R., Horton, N. J., Carpenter, J., & Pocock, S. J. (2011). Strategy for intention to treat analysis in randomised trials with missing outcome data. BMJ, 342(feb07 1), d40. https://doi.org/10.1136/bmj.d40