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SEGM

@segm_ebm

Dec 4

A must-listen/read interview between @DouthatNYT and Chase Strangio in the NYT today. While the tone toward critics of youth gender transition is more collegial, Strangio still misstates the evidence, claiming hormones are proven to significantly reduce distress & suicidality. /1

When pressed on psychotherapy for gender dysphoria, Strangio concedes it should be available, and does NOT level the charge of "conversion therapy." Still, Strangio conflates therapy with changing identity. Letting go of one's drive to medicalize has no such requirement. /2

Strangio laments that states imposed restrictions on youth transitions without a chance for more measured steps. But professionals (incl. @segm_ebm, @JuliaMasonMD1 ) have pleaded for years with @AmerAcadPeds and other medical organizations to course-correct, only to be ignored./3

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SEGM

@segm_ebm

Nov 3

Medical societies have replaced merit, empiricism, and open inquiry with fashionable political orthodoxies advanced under the banner of social justice, argues a new paper in the American Journal of Medicine. Our experience with @AmerAcadPeds supports this troubling observation:🧵

Medical societies are accountable to their members, yet they often ignore their members' preferences, instead superimposing their own agendas, the authors point out.

SEGM's @JuliaMasonMD1 experienced this first-hand when she, along with a group of fellow pediatricians, tried to convince the @AmerAcadPeds to align its recommendations for treating gender-dysphoric youth with systematic reviews of evidence. The AAP policy promotes gender transition of minors as the first-line treatment of gender dysphoria, yet systematic reviews do not find any trustworthy evidence of benefit of youth transitions.

While short- or long-term benefits are uncertain, biological harms such as infertility/sterility, bone health impairment, and likely adverse effects on brain development are much more certain. /2

For several years, a group of pediatricians committed to the long-term health and well-being of gender-dysphoric youth followed AAP's due process to introduce resolutions calling on their medical society to evaluate the evidence and to update its outdated, non-evidence-based policy.

Even when a resolution was upvoted by the majority of participating pediatricians, rising to the top-5 based on positive member engagement, the AAP leadership refused to discuss the resolution during the leadership meeting. /3

buttonslives.news/p/the-american…

wsj.com/opinion/pediat…

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SEGM

@segm_ebm

Oct 25

Recent claims of a “free fall” in youth trans identities may have been greatly exaggerated. A sample of 45K+ students shows trans & nonbinary identities at an all-time high. The claimed drop may stem from flawed weighting and poorly designed survey questions. SEGM's analysis⬇/1

Per the NCHA data, in 2025, 8% of women & nearly 5% of men attending U.S colleges had a non-"cisgender" identity. While there is no evidence of a drop in transgender/nonbinary identities, the data suggest that we may be approaching a plateau. /2

segm.org/transgender-id…

Youth with "nonbinary"- type identities far outnumber those who identify as "trans men" or "trans women." Since 2022, the nonbinary numbers have leveled off, leading to an overall "trans identification" plateau— just as the cross-sex identity, esp. FtM, is still increasing./3

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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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