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

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

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…

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

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 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…

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…

🧵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…

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…

🚨 Italy's National Bioethics Committee (CNB) just updated its stance on puberty blockers (PB) for gender dysphoria. The November 2024 guidance states that PBs should only be provided after mental health internvetions failed, and only in the context of proper research trials./1 The Italian National Bioethics Committee's (CNB) key recommendations are:

* Puberty blocker prescriptions for gender dysphoria should occur only after the documented failure of psychotherapy or psychiatric interventions.

*All clinical assessments must be multidisciplinary, and decisions thoroughly documented.

*Clinical trials should follow the double-blind, randomized, controlled model, ensuring robust data.

*Use of puberty blockers outside clinical trials for this indication must adhere to the same rigorous criteria, with all data transmitted to a national registry. /2

A new investigation by @BMJ_latest examines the influence of top @WPATH officers over the development of new @WHO TGD (trans-identified and gender diverse) clinical practice guidelines for adults, which includes the vulnerable subgroup of young adults. /1 bmj.com/content/387/bm… .@SEGM_EBM has repeatedly raised concerns about the robustness of the WHO guideline process, as @writingblock reports. /2
segm.org/world-health-o…

The recent criticism of the Cass Review, misrepresented as "Yale critique," is not a genuine scientific effort but an attempt to influence U.S. litigation in youth gender medicine, new BMJ peer-reviewed paper by leading UK medical professionals finds. /1

segm.org/Cass_Integrity… Last July, the so-called Integrity Project posted a "critique" of Cass Review. The authors, including notable gender medicine activists McNamara, Olson-Kennedy & Turban, alleged that the Cass Review is invalid as it "misuses data and violates its own evidentiary standards." /2

A new study of insurance records from Germany suggests that the diagnosis of gender dysphoria in youth aged 5-24 is usually not permanent. Over 60% of youth diagnosed with "Gender Identity Disorder" no longer have the diagnosis after 5 years. /1

segm.org/gender-dysphor… Like other Western countries, Germany has experienced a rapid rise of gender dysphoria in young people in the last decade. Adolescent females have the highest prevalence of gender dysphoria, increasing 12-fold in a decade. /2

The World Health Organization @WHO just announced its updated plans for the transgender guidelines. The new deadline to comment is July 5th. This timing is challenging, as it coincides with the UK & French elections and the US Independence Day celebrations.

As stated previously, the upcoming guideline will address the care for gender-dysphoric adults, who, like all patients, deserve access to evidence-based care informed by evidence-based clinical practice guidelines. The Cass Report identified the group of gender-dysphoric young adults as a key vulnerable group. England has initiated a Cass-style inquiry into the care for this vulnerable population.

In this context, proceeding with developing guidelines that bypassed systematic evidence reviews, and instead will rely on WHO's previous HIV-focused recommendations that promote wide access to hormones (as WHO's documentation suggests), is alarming.

/1

who.int/news/item/20-0… The prior guideline development group (GDG) composition was called out for being biased. A cursory review of the updated GDG suggests that members with conflicts of interests will continue to serve on the GDG, but several new members have been added. /2
who-decides.org

The 128th German Medical Assembly 2024 just passed 2 resolutions: to restrict puberty blockers, cross-sex hormones, and surgeries for gender-dysphoric youth under 18 to controlled clinical trials; and to restrict the self-id laws to those over 18. This is a major development. /1 The first resolution focuses on "gender-affirming care" for youth. The resolution, upvoted by the majority of physician delegates, stated:

"The 128th German Medical Assembly 2024 calls on the Federal Government to only permit puberty blockers, sex-change hormone therapies or gender reassignment surgery in under 18-year-olds with gender incongruence (GI) or gender dysphoria (GD) in the context of controlled scientific studies and with the involvement of a multidisciplinary team and a clinical ethics committee and after medical and, in particular, psychiatric diagnosis and treatment of any mental disorders.
The therapy results of any interventions of this kind must be followed up sociologically, medically, child and adolescent psychiatrically, socially and psychologically over a period of at least ten years and the evaluation results incorporated into the revision of the
'Guideline on gender incongruence and gender dysphoria in childhood and adolescence:
diagnosis and treatment.' "

The justification stated:

"The current medical evidence clearly and unambiguously states that puberty-blocking drugs
(PB), opposite-sex hormone treatments (so-called cross-sex hormone administration [CSH]) and gender reassignment surgery (e.g. a mastectomy) do not improveGI/GD symptoms or mental health in minors with GI/GD. These are irreversible interventions in the human body in physiologically primarily healthy minors, who cannot give informed consent in the absence of evidence for such measures. Such interventions also
influence the human psyche, especially in minors during their development.

Most minors who receive PB and CSH later wish to have sex surgery. The use of interventions such as PB or CSH administration is a form of experimental medicine on children, which is very likely to be followed by interventions in the child's body, such as the amputation of the breast or penis, and which result in the loss of reproductive capacity and a reduction in the ability to experience sex, including anorgasmia.

A child or adolescent is not in a position to decide for themselves - without medical advice and parental consent - on the use of PB or CSH before the end of puberty and the physical maturation process and before the age-typical age-role conflicts or body image disorders of puberty have been overcome, especially in the absence of medical evidence for their
respective clear and sustainable benefits in this very population.

Gender or sex dissatisfaction is most common at around the age of eleven, and the frequency of this
symptomatology then decreases with age. The clear majority of minors show no persistent gender or sex dissatisfaction over the course of their lives.

The administration of PB, CSH and the performance of gender reassignment surgery must not be made dependent solely on the will of a developing child or adolescent. Given the existing evidence on the treatment of GI/GD, concern for the child's welfare must
prevail. " /2

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