Post

@EsteemLabYale

@karolinska

@kashmiragander

More from @segm_ebm

SEGM

@segm_ebm

Apr 2

After Utah passed a moratorium on medical youth gender transitions in 2023, activist groups lobbied for an evidence review to prove this practice is safe and effective. The result was the "Utah Review," which produced the desired answer by scrapping methodological standards. /1

SEGM's recent analysis shows that the Utah Review is not objective nor independent. The Review was overseen by advisors with serious conflicts of interest, including ties to Utah’s leading children’s gender clinic. /2
segm.org/utah-evidence-…

The Utah Review is also, to put it bluntly, not a systematic review of evidence, despite claims to the contrary. It failed to synthesize the evidence and assess it for quality/certainty—a crucial step in any systematic review. /3

Read 14 tweets

SEGM

@segm_ebm

Mar 10

📢NHS England just published 10 new systematic evidence reviews on PB and CSH for binary and “non-binary” youth. Because of the weak evidence, the NHS paused new cross-sex hormones prescriptions and is conducting a 90-day consultation to review evidence for a potential permanent ban. /1

Of the 10 new evidence reviews, 8 cover masculinizing & feminizing hormones, with and without GnRH analogues, for “binary” and “partial”/NB transition. Two additional reviews examine GnRH monotherapy specifically for male and female youth who ID as NB. /2

england.nhs.uk/publication/co…

The new reviews add to a list of now over 20 systematic reviews, all of which come to the conclusion: evidence is insufficient to support the practice of pediatric medical gender transition.

Puberty blockers are already permanently banned in the UK in both public (NHS) and private settings. Cross-sex hormones for minors were still technically allowed but with significant restrictions implemented post-Cass as we described in our spotlight.

The March NHS England announcement indicates a permanent ban on puberty blocker in the NHS settings is being considered. Whether or not it will be extended to private settings is as yet unknown. The consultation period for the proposed NHS ban ends on June 7, 2026. /3

segm.org/England-UK-Pub…

Read 13 tweets

SEGM

@segm_ebm

Feb 5

🚨 In a watershed moment, the American Society of Plastic Surgeons has put an end to youth gender surgeries. But a far bigger story is what this implies for the rest of "gender-affirming care," from social transition to puberty blockers & hormones—as our new analysis explains. /1

About 1,000+ mastectomies for gender-dysphoric minors are performed each year in the U.S, most done by plastic surgeons. The ASPS statement suggests this practice will be upended. But the analysis that ASPS offers for the rest of the transition pathway signals far more profound changes are likely to come.
The ASPS asserts that all steps in youth transition—from social transition and puberty blockers to cross-sex hormones and surgery— are interconnected; that all share similarly problematic risk–benefit profiles; and the risk compounds with each subsequent step.
This puts other medical associations on notice. At the very least, they have to review and adjust their own positions—or justify why they continue to stand by a practice that is not evidence-based and is profoundly ethically challenged. /2

segm.org/ASPS-position-…

It is no accident that plastic surgeons are the first professional association to take a strong stance against a key intervention in the "gender-affirming" care pathway for youth.

1. Unlike endocrine interventions, where physical changes unfold gradually and the extent of irreversibility may only become clear over time, surgery is universally understood as irreversible from the outset. When the risk–benefit ratio is unfavorable, surgeons have no gray area to retreat into—they must decide whether to operate.
2. Because surgery is typically the final step in the transition pathway, surgeons inherit the cumulative risks and uncertainties of the upstream interventions. That vantage point likely contributed to why the professional association representing plastic surgeons was among the first to recognize the full scope of the problem.
3. Most importantly, plastic surgery is unusual among medical specialties in routinely providing both elective cosmetic procedures and medically necessary care. This positions plastic surgeons to distinguish between interventions that are medically indicated and those that may primarily offer patient satisfaction without improving health outcomes. /3

Read 8 tweets

SEGM

@segm_ebm

Dec 4, 2025

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

Read 5 tweets

SEGM

@segm_ebm

Nov 3, 2025

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…

Read 10 tweets

SEGM

@segm_ebm

Oct 25, 2025

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

Read 11 tweets

Share this page!

Enter URL or ID to Unroll

SEGM

Try unrolling a thread yourself!

More from @segm_ebm

SEGM

SEGM

SEGM

SEGM

SEGM

SEGM

Did Thread Reader help you today?

Don't want to be a Premium member but still want to support us?

Send Email!