Medical Associations Trusted Belief Over Science on Youth Gender Care

American advocates for youth gender medicine have insisted for years that overwhelming evidence favors providing gender dysphoric youth with puberty blockers, hormones and, in the case of biological females, surgery to remove their breasts.

It didn’t matter that the number of kids showing up at gender clinics had soared and that they were more likely to have complex mental health conditions than those who had come to clinics in years earlier, complicating diagnosis. Advocates and health care organizations just dug in. As a billboard truck used by the L.G.B.T.Q. advocacy group GLAAD proclaimed in 2023, “The science is settled.” The Human Rights Campaign says on its website that “the safety and efficacy of gender-affirming care for transgender and nonbinary youth and adults is clear.” Elsewhere, these and other groups, like the American Civil Liberties Union, referred to these treatments as “medically necessary,” “lifesaving” and “evidence-based.”

The reason these advocates were able to make such strong statements is that for years, the most important professional medical and mental health organizations in the country had been singing a similar tune: “The science” was supposedly codified in documents published by these organizations. As GLAAD puts it on its website, “Every major medical association supports health care for transgender people and youth as safe and lifesaving.”

But something confounding has happened in the last few weeks: Cracks have appeared in the supposed wall of consensus.

After expressing concerns about the evidence base in 2024, on Feb. 3, the American Society of Plastic Surgeons became the first major American medical group to publicly question youth gender medicine since its widespread adoption. The organization published a nine-page “position statement” advising its members against any gender-related surgeries before age 19 and noting that “there are currently no validated methods” for determining whether youth gender dysphoria will resolve without medical treatment. (The document also acknowledged a similar level of uncertainty surrounding blockers and hormones, though that’s less directly relevant to the practice of plastic surgeons.)

The next day, the American Medical Association — which has long approved of such procedures — announced that “in the absence of clear evidence, the A.M.A. agrees with A.S.P.S. that surgical interventions in minors should be generally deferred to adulthood.”

These statements were released days after a woman named Fox Varian became the first person to win a malpractice case after undergoing gender transition care and later regretting it. Ms. Varian and her lawyer argued that her psychologist and plastic surgeon in suburban New York, despite her serious mental health problems and apparent ambivalence over her transgender identity, failed to safeguard her by going forward with a double mastectomy when she was 16. (Many gender medicine practitioners and advocates believe that to carefully scrutinize or even explore claims of a transgender identity is to engage in de facto conversion therapy.) The jury’s $2 million award will most likely give pause to hospitals and clinics that continue to provide these treatments without substantial guardrails.

Read the rest here.

One of the world’s best universities has been captured by trans-obsessed zealots

I came to Cambridge because I wanted to learn how to think, not what to think: how to weigh arguments, test premises, spot evasions and follow a thought wherever it leads, even when it becomes uncomfortable. I did not come to be preached at, or for slogans. I expected the university – which for generations has jostled for position as the best in the world – to be a place where everything was up for discussion. Although I had long-held settled views on the sex-gender debate, they were not something I dwelt on.

That changed over the Easter holidays last year, when I attended a talk featuring the writers Julie Bindel and Helen Joyce. I met women that day who changed the course of my life. Not because they proselytised, or demanded loyalty, but because they spoke plainly, without fear. It became impossible to remain comfortably disengaged. I read Joyce’s book – Trans: When Ideology Meets Reality – and returned to Cambridge with it, as well as Kathleen Stock’s Material Girls. Both women, as well as Bindel, have been pilloried (that’s putting it mildly) for stating the truth: that biological sex and women’s rights must trump gender identity.

Back in college, I showed the books to a friend. I had been self-censoring on this subject for some time: trimming sentences and avoiding questions. I believed that a careful, private introduction to these ideas would be safe. I was wrong. Soon after, I was systematically ostracised by people I had considered close friends. Many told me they could no longer speak to me because of my views. I was branded a Terf (trans-exclusionary radical feminist) and the word was scratched into the board on my door. I was told that buying books written by bigots was morally equivalent to being one. Argument was unnecessary; association enough to convict.

Read the rest here.

A (rare) Victory for Legal Sanity

LONDON — Britain’s highest court ruled Wednesday that the legal definition of a woman is based on biological sex.

Study on treatment of gender dysphoria goes unpublished over political concerns

An influential doctor and advocate of adolescent gender treatments said she had not published a long-awaited study of puberty-blocking drugs because of the charged American political environment.

The doctor, Johanna Olson-Kennedy, began the study in 2015 as part of a broader, multimillion-dollar federal project on transgender youth. She and colleagues recruited 95 children from across the country and gave them puberty blockers, which stave off the permanent physical changes — like breasts or a deepening voice — that could exacerbate their gender distress, known as dysphoria.

The researchers followed the children for two years to see if the treatments improved their mental health. An older Dutch study had found that puberty blockers improved well-being, results that inspired clinics around the world to regularly prescribe the medications as part of what is now called gender-affirming care.

But the American trial did not find a similar trend, Dr. Olson-Kennedy said in a wide-ranging interview. Puberty blockers did not lead to mental health improvements, she said, most likely because the children were already doing well when the study began.

“They’re in really good shape when they come in, and they’re in really good shape after two years,” said Dr. Olson-Kennedy, who runs the country’s largest youth gender clinic at the Children’s Hospital of Los Angeles.

That conclusion seemed to contradict an earlier description of the group, in which Dr. Olson-Kennedy and her colleagues noted that one quarter of the adolescents were depressed or suicidal before treatment.

In the nine years since the study was funded by the National Institutes of Health, and as medical care for this small group of adolescents became a searing issue in American politics, Dr. Olson-Kennedy’s team has not published the data. Asked why, she said the findings might fuel the kind of political attacks that have led to bans of the youth gender treatments in more than 20 states, one of which will soon be considered by the Supreme Court.

“I do not want our work to be weaponized,” she said. “It has to be exactly on point, clear and concise. And that takes time.”

Read the rest here.

Why Is the U.S. Still Pretending We Know Gender-Affirming Care Works?

Imagine a comprehensive review of research on a treatment for children found “remarkably weak evidence” that it was effective. Now imagine the medical establishment shrugged off the conclusions and continued providing the same unproven and life-altering treatment to its young patients.

This is where we are with gender medicine in the United States.

It’s been three months since the release of the Cass Review, an independent assessment of gender treatment for youths commissioned by England’s National Health Service. The four-year review of research, led by Dr. Hilary Cass, one of Britain’s top pediatricians, found no definitive proof that gender dysphoria in children or teenagers was resolved or alleviated by what advocates call gender-affirming care, in which a young person’s declared “gender identity” is affirmed and supported with social transition, puberty blockers and/or cross-sex hormones. Nor, she said, is there clear evidence that transitioning kids decreases the likelihood that gender dysphoric youths will turn to suicide, as adherents of gender-affirming care claim. These findings backed up what critics of this approach have been saying for years.

“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Cass concluded. Instead, she wrote, mental health providers and pediatricians should provide holistic psychological care and psychosocial support for young people without defaulting to gender reassignment treatments until further research is conducted.

After the release of Cass’s findings, the British government issued an emergency ban on puberty blockers for people under 18. Medical societies, government officials and legislative panels in Germany, France, Switzerland, Scotland, the Netherlands and Belgium have proposed moving away from a medical approach to gender issues, in some cases directly acknowledging the Cass Review. Scandinavian countries have been moving away from the gender-affirming model for the past few years. Reem Alsalem, the United Nations special rapporteur on violence against women and girls, called the review’s recommendations “seminal” and said that policies on gender treatments have “breached fundamental principles” of children’s human rights, with “devastating consequences.”

But in the United States, federal agencies and professional associations that have staunchly supported the gender-affirming care model greeted the Cass Review with silence or utter disregard.

Read the rest here.