We've completed our preliminary analysis of the Cass Report. The "gender-affirming" model of care is over in England, as is the era of the gender-clinic model of care, which exists to deliver youth transitions. This will have world-wide implications./1

segm.org/Final-Cass-Rep… Puberty blockers will no longer be part of medical care in England. Cross-sex hormones are still available to 16+, but with "extreme caution," external validation of medical necessity, & further policy restrictions are likely. Systematic reviews support these recommendations. /2

Last week, England shut down the world’s largest pediatric gender clinic at the Tavistock (GIDS). Investigative journalist Hannah Barnes shares 7 lessons for the rest of the world at @segm_ebm NYC conference.
Lesson 1: When new evidence emerges, be prepared to change direction.

By now, the science in the area of gender medicine is widely recognized as “unsettled” due to poor study designs—but this was known from the start. This is why the UK gender clinic initiated its own research in 2011. But instead of waiting for research results, the clinic began to widely offer gender transitions to all youth who desired it.

This pattern of the gender-affirming interventions "escaping the lab" before the benefits and the harms were fully understood (known as "runaway diffusion") occurred not just in the UK, but also in the rest of the world.

Some speculate that it was the pressure to "keep up with the Dutch." Others note the role of special interest groups in creating undue pressure on clinicians. Yet others believe it was simply the case of a “well-meaning but ill-informed” approach. /1 At the same time as youth gender transitions became widely available, the numbers of referred gender distressed youth began to rapidly grow. Unexpectedly, the profile shifted from mostly young boys, to mostly adolescent females with serious mental health problems.

It was clear from the start that the young patients presenting with gender distress were far more complex than the cases described in the Dutch protocol. This did not deter gender clinicians, who asserted every child who wanted to medically gender transition should be assisted in doing so, regardless of their mental illness or other complexities. /2

A new publication concludes that puberty blockers for gender dysphoria undermine a child’s right to an open future, a bioethics principle stating that children must be protected from exercising certain rights to exercise these rights as autonomous adults./1
segm.org/puberty-blocke… The authors "evaluate claims that puberty blockers are reversible, discuss the scientific uncertainty about long-term benefits and harms, summarize international developments, and examine how suicide has been used to frame puberty suppression as a medically necessary, lifesaving treatment."

They conclude that "treatment pathways that delay decisions about medical transition until the child has had the chance to grow and mature into an autonomous adulthood would be most consistent with the open future principle." /2

Dr. Kaltiala just won Finland's most prestigious medical award for her work in adolescent psychiatry. Dr. Kaltiala was a speaker at @segm_ebm's NYC conference, where she described how the Finnish youth gender services moved away from the "gender-affirmative" model of care. 🎉/1
In her acceptance speech, Dr. Kaltiala discussed how current cultural trends undermine healthy adolescent development. "The slow development towards the authentic self turns into a lightning-fast self-presentation on social-media forums that are always under observation."

Dr. Kaltiala observed that "a stable, developed identity enables an individual to have a permanent self-experience from one situation and life stage to another, as well as to maintain a sense of permanence and psychological ability to function even in the face of adversity." She noted that "too much focus on the individual and individuality disconnects from stabilizing communities and shared realities." /2

laakarilehti.fi/terveydenhuolt…

The @NHSEngland landmark decision to stop using puberty blockers for gender dysphoric youth raises a key question: what do we know about the effects of puberty blockers on adolescent development?
Prof. Sallie Baxendale explored this question at @segm_ebm 2023 conference./1🧵 "Extraordinary claims demand extraordinary evidence" wrote Prof. Baxendale in a piece describing her research. "The only extraordinary evidence here is the gaping chasm of knowledge, or even apparent curiosity, of the clinicians who continue to chant 'safe and completely reversible' as they prescribe these medications to the children in their care." /2
unherd.com/2024/02/why-di…

Canada's public broadcaster aired a new documentary, Trans Express, underscoring the growing international concern with the practice of youth gender transitions. SEGM's NYC 2023 conference was profiled. /1

Full documentary (in French):
Synopsis (in French, but can be google-translated): ici.tou.tv/enquete
ici.radio-canada.ca/recit-numeriqu… The documentary interviewed several speakers from SEGM's NYC 2023 conference, including Drs. Anderson, Kaltiala, Landen, Littman, and Veissiere. /2

segm.org/NYC_2023

The American Psychological Association @APA has called for "efforts to address and rectify the dissemination of false information to ensure the well-being and dignity of transgender, gender-diverse, and nonbinary individuals."

It should heed its own advice. 🧵 /1 The APA's call for "the importance of an accurate understanding of evidence-based care" is welcome. Yet, the APA's definition of evidence-based medicine (EBM) bears no resemblance to how EBM is either understood or practiced in every other medical field in the 21st century. /2

Our recent Spotlight highlights a study from Finland, which convincingly demonstrates that suicides are uncommon in gender-dysphoric youth. The study demonstrates why youth gender transitions can’t be justified by the “suicide-prevention” argument./1

segm.org/Suicide-Gender… Using a robust methodology, the study estimated the suicide rate for GD youth at 0.3% (0.51/1,000 pt-yrs), with no evidence that transition reduced suicides. In summarizing clinic-reported rates, we noted that the highest suicide rates are coming from the transitioned cases./2

On Jan 15, @WHO amended its previously described plans for "trans" (TGD) treatment guidelines. This was a response to worldwide concern about the effort's credibility. What makes guidelines trustworthy? An expert at SEGM's 2023 conference explains./1
Not all guidelines that claim to be evidence-based, are. Many are "consensus" guidelines developed using the "GOBSAT" method: good old boys sat around the table. This acronym was coined by a former WHO guideline expert who worked to promote rigor in guideline development. /2

The World Health Organization has announced the complete panel developing transgender health guidelines in 2024. The panel's unmanaged conflicts of interest will undermine the guidelines' credibility. Public comment deadline (hiv-aids@who.int) is Jan 8. /1 segm.org/world-health-o… Besides a biased panel, 2 other key concerns are a short public comment period held over the Xmas & New Year's holiday, and a rushed guideline development process, with the group already scheduled to meet in February at the @WHO headquarters in Geneva to make decisions. /2

Do puberty blockers improve mental health? The original Dutch studies claimed so, but a replication attempt in the UK failed, finding no impact. A new peer-reviewed reanalysis of the UK data shows that up to 34% of youth actually "reliably deteriorated"./1
tandfonline.com/doi/full/10.10… The original conclusions of the Dutch research in 2011/2014 claimed modest improvements in mental health of gender dysphoric minors following puberty blockers. The study's actual conclusions were quite modest yet they launched the practice of youth gender transitions worldwide./2

The debate over the practice of youth gender reassignment has reached the Netherlands, the birthplace of the Dutch Protocol. Our spotlight profiles the latest medical, legal & cultural Dutch debates. The significance of this debate cannot be overstated./1
segm.org/Dutch-protocol… Like other Western teens, the Dutch youth began to seek gender transition in record numbers starting mid 2010's. As numbers surged and sex ratios flipped to favor females, the explanations that this shift merely reflects “more freedom to come out" kept the Dutch debate at bay./2

The journal of the Danish Medical Association Ugeskrift for Læger has confirmed that Denmark is restricting medical transition of gender-dysphoric minors. Only 6% of the gender clinic referrals were approved for transition in 2022, down from 65% in 2018./1
segm.org/Denmark-sharpl… While the Danish Minister of Health, Sophie Løhde, already suggested that youth with post-pubertal onset of gender dysphoria or mental health problems won't be medically transitioned, the recent publication provides the rationale for this practice shift./2
https://t.co/8uAAwRZrWYugeskriftet.dk/videnskab/sund…

The claim that youth whose breasts are removed "can always get them later" contributes to the U.S. gender medicine establishment's promotion of mastectomies for minors 12-13+. However, the surgical technique in masculinizing mastectomy makes reversals unfeasible in most cases. /1 As our Spotlight explains, unlike mastectomies for breast cancer, masculinizing mastectomies' focus on nipple repositioning, lower breast pole shape, and scar placement makes a successful breast reconstruction unlikely for most, and cost-prohibitive. /2
segm.org/long-term-regr…

Our latest Spotlight focuses on research from Denmark, which found that trans-identified individuals have a significantly elevated rate of suicide attempts, suicide-related deaths and non-suicide-related deaths, as compared to the general population. /1
segm.org/transgender_su… The study data allow to calculate the "number needed to treat," or the "NNT." A clinician would need to treat 1,333 trans-identifying individuals for a year to encounter 1 suicide death. However this is not the NNT, as gender transition has not been shown to reduce suicides /2.

According to the NHS England's final interim specifications for treating gender dysphoric (GD) youth, published earlier today, the primary intervention for GD children & young people <18 will be psychosocial & psychological support and intervention. /1 england.nhs.uk/publication/in… twitter.com/i/web/status/1… The main objective of the intervention is to alleviate distress associated with gender incongruence & promote the individual’s global functioning and wellbeing. Clinicians are reminded that trans identification may be a transient phase for many youth. /2

A systematic evidence review by the Swedish health authority has just been published in an English-language peer-reviewed journal. It concluded that puberty blockers & cross-sex hormones in <18s are not a medical treatment but experimental procedures./1

onlinelibrary.wiley.com/doi/10.1111/ap… The Swedish-language version of this review was published on the SBU site in February 2022. The review was conducted in order to update Sweden's national guidelines for gender dysphoria treatments. The updated guidelines were published in December 2022. /2
sbu.se/contentassets/…

A new article, Current Concerns About Gender-Affirming Therapy in Adolescents, provides an overview of the current state of evidence about gender transition in youth in the Western world and discusses the debates surrounding this controversial practice./1
segm.org/current-concer… twitter.com/i/web/status/1… The key challenge is the unknown long-term outcomes of gender-transitioning youth. Since transitioning minors was uncommon before 2015, systematic reviews of evidence of youth outcomes are limited by short-term followup. Long-term studies of adults, however, signal problems. /2

The Norwegian Healthcare Investigation Board, (NHIB/UKOM) has deemed puberty blockers, cross-sex-hormones & surgery for children & young people experimental, determining that the current “gender-affirmative” guidelines are not evidence-based and must be revised. /1 The UKOM report asserts that future guidelines must rely on a systematic review of evidence rather than cherry-picking studies, and that all hormonal and surgical interventions must be restricted to research settings to ensure clear protocols, safeguarding & adequate follow-up./2

A new study from Amsterdam’s gender clinic finds that puberty blockers may predispose gender-dysphoric children toward eventual full gender transition.

SEGM's analysis of the study is below. /1

segm.org/20-years-of-th… The study accurately reported the following:
-A sharp increase in recent referrals driven by adolescent females
-A flip in the sex ratios toward females (among older adolescents only)
-Extremely high rate of conversion from puberty blockers to cross-sex hormones (93%-98%). /2

A new peer-reviewed open-access study exposes deep flaws in the Dutch studies that formed the foundation for youth gender transition. These studies should have never been used to launch the practice into mainstream medicine, conclude the authors./1
segm.org/Dutch-studies-… The Dutch studies reported only the best-case scenario outcomes while ignoring the serious risks that emerged; wrongly concluded that gender dysphoria "disappeared" post-treatment; and failed to separate the effects of psychotherapy from those of blockers, hormones &surgery. /2