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SEGM

@segm_ebm

Jun 18

The new study from the early Dutch cohort of puberty suppressed youth will require substantial analysis, but several important preliminary points can be made. /1

👉To cut to the chase, the study cannot answer the key question of whether early pubertal blockade (at Tanner stage 2) leads to worse adult sexual outcomes, because there were only 5 cases of early puberty blockade.

To increase the sample, the authors lumped early puberty (Tanner 2) with mid puberty (Tanner 3). The resulting sample (n=17) was still too small, and it was not possible to perform statistical analysis comparing sexual function outcomes of early/mid puberty suppression with later pubertal suppression (Tanner 4/5).

Therefore, no conclusions can be made about the effects of earlier vs. later pubertal suppression on future sexual function, and it is unclear how the authors concluded that early PB has no adverse effects on sexual function. /2

👉The only conclusion that can be made with some degree of confidence is that puberty-suppressed individuals have high rates of sexual dysfunction in adulthood (at average age 29). About 30% have not been sexually active in a year. In addition, 50% of males (MtF) and 58% of females (FtM) reported having one or more sexual dysfunction.

Not all typical domains of sexual dysfunction are accounted for in the study. There is no reporting on pain during sexual activity - previous studies have shown this is a frequent problem identified in transgender people after gender affirming medical treatment. Thus, this study may seriously underestimate sexual dysfunction.

Still, assuming the respondents' answers focused on recent sexual experiences as adults, the reported rate of sexual dysfunction (50-58%) compares unfavorably to the general Dutch population, where only 7%–17% report sexual dysfunction in the last 12 months (see table below).

However, even that cannot be assumed, since the respondents were asked if they had *ever had sexual difficulties, which means such difficulties may have occurred at any stage in their life: during puberty blockade; while on cross-sex hormones pre-surgery, immediately post-surgery, or well after the surgery.

Failure to differentiate between the stages when the sexual difficulties occurred is a major methodological limitation which makes the data shared by the authors extremely challenging to interpret. /3
rutgers.nl/wp-content/upl…

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SEGM

@segm_ebm

Jun 13

Given the skewed sex ratios among gender-dysphoric youth, most attention has focused on females. But the number of males has sharply risen as well—and the effects of androgen blockers & estrogen on males remain under-discussed. A new peer-reviewed paper addresses this gap. /1 ⬇️

While systematic reviews provide only low-certainty evidence of harms of estrogen and testosterone blockers in males, in reality the harms are likely, as explained by the authors of the paper. Lack of evidence of harm ≠ evidence of lack of harm. /2
link.springer.com/article/10.100…

The authors highlight a broad range of risks from estrogen use in males: sterility, stroke, brain volume loss, cognitive impairment, dementia risk, autoimmune disease, metabolic dysfunction, pancreatitis, and elevated rates of breast, thyroid, and testicular cancer and brain tumors, and early mortality. Many of these risks remain under-discussed in clinical settings. /3

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SEGM

@segm_ebm

Jun 7

📢 The volume of research in youth gender medicine has exploded in recent years. To meet the growing need for rigorous analysis, we’re launching SEGM Digest: concise, scientifically grounded reviews of influential publications. Issue 1 covers 7 major papers from Apr–May 2025. /1

📄 HHS Review (2025):
Issue 1 of SEGM Digest opens with an overview of the landmark 2025 HHS Review of pediatric gender dysphoria treatments. The Review's evidence and ethics analysis do not support the provision of hormones and surgery as the standard of care for GD youth. /2
segm.org/SEGM-Digest-Is…

📄 Utah Report (2024):
Utah’s Department of Health commissioned an assessment of safety and efficacy of hormones in GD minors. Puzzlingly, the report omits an evidence synthesis—the primary aspect of any credible evidence review, limiting its utility. /3
segm.org/SEGM-Digest-Is…

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SEGM

@segm_ebm

May 10

New peer-reviewed study finds that the evidence base for pediatric gender medicine is weak: individual studies are inconsistent, and systematic reviews show no clear benefits. Guidelines that state or imply that medical transition is the standard of care aren't evidence-based. /1

The study is not a systematic review (a limitation that the authors note), but it provides a comprehensive overview about what's known about the evidence base underpinning youth gender medicine. /2
link.springer.com/article/10.100…

Studies originating from gender clinics tend to focus on measuring the magnitude of the hypothesized psychological benefits. There is less focus on studying the risks and harms. This new publication provides a succinct summary of expected harms, along with the rationale. /3

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SEGM

@segm_ebm

Mar 28

🧵Germany’s new GD guidelines represent a shift toward caution, by acknowledging that most youth with gender distress have temporary "gender non-contentedness" and should not be medically transitioned. Still, significant problems remain, as we explain in our Spotlight. Link⬇️ /1

The final Guidelines are the result of a year-long debate and revisions following the release of the earlier draft. The final recommendations are now more cautious, but core issues remain.

Chief among them: the guidelines are not evidence-based. /2

segm.org/German-guideli…

Originally, the Guidelines were intended to be “evidence-based.” However, the team abandoned its systematic reviews in 2020, and chose to rely on WPATH's. When WPATH suppressed its own systematic reviews, the guidelines lost the ability to claim the evidence-based "S3" status. /3

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SEGM

@segm_ebm

Feb 4

A new peer-reviewed article examining the criticisms of the Cass Review, just published. The authors found that the primary source of the criticism, a non-peer-reviewed paper published on the Yale Law School website, contains numerous inaccurate and misleading claims.
Link👇/1

The link to the article is below:

/2tandfonline.com/doi/full/10.10…

The authors of the new publication conclude:
"The Cass Review’s careful, balanced investigations and judgments were a comprehensive, evidence-based response to the controversies in this pediatric clinical arena. Recently-published critiques of the Review have contained incorrect or inadequately contextualized claims. Because accurate information about medical interventions is essential to informed consent, it is important to correct errors in potentially influential publications." /3

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