Medical Treatment for gender identity evidence archive thread

https://www.mumsnet.com/talk/womens_rights/5469068-detransitioner-legal-cases-going-to-trial-in-usa-january-2026?reply=150222055

The thread.

DETRANSITIONER CASES IN THE USA

Here is a list from Ben Ryan of the court cases that have been lodged already about the medical treatments for people with transgender identities.

The first that is going to trial starts week commencing 5th January 2026 and is in New York State. At this stage, Camille Keifel's suit will be going ahead in Oregon also in January 2026.

There are several sites now tracking these law suits and much depends on the outcomes of these initial trials.

NEWSWEEK ARTICLE ON US HHS REPORT ON PUBERTY BLOCKERS

https://archive.is/ZFK2n

Liberals Should Read the HHS Review of Pediatric ‘Gender Affirming’ Care

Moti Gorin and Kathleen McDeavitt
26 December 2025

“The Department of Health and Human Services (HHS) recently published Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. Given current widespread distrust of HHS, especially regarding vaccines, we knew this review, which we co-authored, would be met with skepticism. So, it is worth noting that we, along with most of the other authors, are liberals.

While everyone should be concerned when vulnerable populations do not receive appropriate medical care, those of us on the left side of the political spectrum need to pay special attention. This is because many of the organizations and individuals we trust have gotten this issue wrong.”

and

“While it may sound jarring to readers who have, reasonably, deferred to U.S. medical societies and civil rights advocacy groups on this issue, there is no longer any legitimate scientific controversy about the weak evidence underlying the purported benefits of the “gender affirming” model for youth. Readers may also be surprised to learn that the first countries to restrict these practices were politically progressive Finland and Sweden, whose socialized health care systems are widely admired. It was these Scandinavian social democracies—not U.S. red states—that were first to conduct systematic reviews and conclude there is no reliable evidence supporting pediatric medical transition. Finland sharply restricted the practice in 2020, followed by Sweden in 2022. The U.K. was next, and other nations are pulling back, too.

The HHS review’s evidence analysis arrives at the same conclusion regarding the sorry state of the evidence. Weighing the purported benefits against the risks (which include not only infertility and sexual dysfunction but also decreased bone density, delayed cognitive development and inability to breastfeed after mastectomy) the review concludes that the harms of pediatric medical transition far outweigh the unproven mental health benefits."

And

"While recent polling shows that a majority of Democratic voters oppose pediatric medical transition, the issue remains intensely polarized among politicians and policymakers. Conservatives and liberals alike can agree that all people, and especially children, deserve ethical, evidence-based care. We recognize that liberals distrust anything coming from the current administration, but we hope they will take the time to read this review and see that it puts science first".

Moti Gorin, PhD, MBE, is a bioethicist and philosopher at Colorado State University. He was a contributor to HHS’ Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices and has published on issues at the intersection of pediatric medical transition and medical ethics.

Kathleen McDeavitt, MD, is a psychiatrist and associate professor at Baylor College of Medicine. She was a contributor to HHS’ Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices and has published on topics related to the evidence base and clinical guidelines in pediatric gender medicine.

IPSOS POLL REGARDING US OPINION ON MEDICALISED TREATMENT FOR CHILDREN

NY Times poll - IPSOS
Interview dates: January 2 to January 10, 2025
Number of interviews: 2,128

static01.nyt.com/newsgraphics/documenttools/f548560f100205ef/e656ddda-full.pdf

https://archive.is/jWgkV

Q 32. Thinking about medications used for transgender care, do you think doctors should be able to prescribe puberty blocking drugs or hormone therapy to minors between the ages of 10 and 18?

Results

Yes, minors ages 10 to 18 should have access - 10% (Rep 2% | Dem 19% | other 2%)

Yes, but only minors aged 15 to 18 should have access - 16% (Rep 7% | Dem 24% | other 10%)

No one under age 18 should have access - 71% (Rep 90% | Dem 54% | other 61%)

refused 4% (Rep 1% | Dem 3% | other 27%)

(lots of other interesting questions asked)

PAPER BY MARCUS EVANS

Beyond affirmation: Lessons from Tavistock —A psychoanalytic critique of identity certainty and institutional defence

https://onlinelibrary.wiley.com/doi/10.1111/bjp.70011

Abstract

This paper offers a psychoanalytic critique of the affirmation model in gender identity care, drawing on clinical experience from the Tavistock Gender Identity Development Service (GIDS). It argues that institutional and therapeutic responses to gender distress in young people are increasingly shaped by pressures to affirm rather than to reflect. Drawing on psychoanalytic concepts including symbolic thinking, identity foreclosure, claustro-agoraphobic anxieties and the “third position”, the paper explores how certainty and identity fixity can function as defences against psychic pain, rather than signs of psychological integration. The paper critiques the avoidance of transference, the foreclosure of thought and the emotional pressure placed on clinicians and institutions. It concludes by advocating for a model of care that restores reflective capacity and supports the difficult psychological work of identity development, rather than bypassing it through premature affirmation.

CONCLUSION: THOUGHT, MOURNING AND ETHICAL CARE

The development of Tavistock's GIDS marks a transition from psychoanalytic approaches to procedural affirmation, shifting the emphasis within both individual and institutional frameworks.

The service began to emphasise efficiency and certainty rather than exploration and interpretation.
These changes appeared in three related areas: on the intra-psychic level, adolescents' distress was frequently managed through established identity beliefs that addressed ambiguity or trauma; in interpersonal settings, therapeutic relationships experienced pressures such as countertransference and reduced reflective containment; and institutionally, systems responded with increased reliance on policy and compliance over deliberation and inquiry.
Wilfred Bion's concept of “attacks on linking” describes ways in which psychic and organisational structures may affect the capacities for integration, reflection and psychological growth. When institutions focus on managing anxiety at the expense of symbolic functions, they may influence conditions relevant to care.

The Cass (2024) recommends a model that is developmentally informed and psychologically reflective, supporting clinical judgement, accommodating uncertainty and valuing thoughtful engagement. It suggests that new regional hubs should reserve space for reflection, allowing patients, clinicians and organisations to avoid repeating previous challenges.

According to this perspective, ethical care is associated not only with addressing distress but also with creating environments that facilitate integration and symbolic thought. Affirmation alone does not eliminate psychological pain. Supporting young people in developing the ability to manage contradictions, navigate uncertainty and seek meaning is suggested as a way to offer adequate care.

GENSPECT’S TIMELINE SUMMARY FOR THE DEPATHOLOGISATION OF GENDER DISTRESS TREATMENT

Depsychopathologization Campaign Timeline

https://genspect.org/depathologization-campaign-timeline/

Late 80s-91- Houston “Roundtable Years”▼
Houston trans-identified attorney Phyllis Fryeconvenes grassroots meetings of trans activists and legal experts that form the precursor for the International Conference on Transgender Law and Employment Policy.

1992-1994 International Conference on Transgender Law and Employment Policy (ICTLEP)▼
Early trans activists view psychiatry itself as the main obstacle to accessing medical interventions. At the annual ICTLEP conferences, activists and legal experts reframe transgender identities as healthy in order to circumvent psychiatric “gatekeeping” and advance self-declaration of “gender identity” as a human right.

December 1995 - International Bill of Gender Rights▼
At the 4th ICTLEP conference in Houston, the International Bill of Gender Rights is adopted. This declaration asserts the right to self-declare gender identities and access medical interventions, stating that “individuals should not be subject to psychiatric diagnosis…on the basis of their gender identity.”

2004 - The Transgender Emergence by Arlene Istar Lev▼
Social worker Arlene Istar Lev’s book The Transgender Emergencebecomes foundational in the movement to depsychopathologize transgender identities, arguing that clinicians should treat transgender identification as a healthy variation to be affirmed. Lev is a prominent HBIGDA member and later contributes to WPATH’s Standards of Care 7.

2006 - Yogyakarta Principles▼
Drafted by human-rights lawyers and trans activists, the Yogyakarta Principles draw on the 1995 International Bill of Gender Rights, asserting the right to self-declaration of gender identity without psychiatric approval. While not legally binding, it forms the blueprint for modern trans activism

2007- HBIGDA Rebrands as WPATH▼
The Harry Benjamin International Gender Dysphoria Association rebrands as the World Professional Association for Transgender Health(WPATH). Trans-identified legal scholar Stephen Whittle, a strong proponent of depsychopathologization, is WPATH president at the time.

2010 - WPATH Depsychopathologization Statement▼
The WPATH Board of Directors strongly urges the depsychopathologisation of “gender variance” worldwide, framing transgender identities as healthy and psychopathologisation as stigmatizing. This is a political move with no grounding in scientific discovery.

2012 - WPATH Standards of Care 7▼
SOC7 frames transgender identities as healthy and shifts the goal of psychotherapy to facilitating medical transition.

2012 - Depsychopathologization Introduced to Pediatrics▼
Psychologist and prominent WPATH member Diane Ehrensaft introduces depsychopathologization for children and adolescents with her article “From gender identity disorder to gender identity creativity: true gender self child therapy.”

2013 - American Psychiatric Association Publishes DSM-5▼
This pivotal moment shifts the pathology from the identity to the distress felt because body and mind are misaligned. This revision is the result of activist pressure on the APA, largely from WPATH, to depsychopathologize transgender identities.

2014 - Time Magazine: “The Transgender Tipping Point”▼
Laverne Cox appears on the cover of Time magazine, launching the modern trans rights movement. This marks the beginning of an aggressive international messaging campaign pushing trans identities as healthy and celebrated

2014 - Pediatric Gender Clinics See Surge of Referrals▼
Coinciding with the widespread media promotion of transgender identities as healthy, a new cohort of adolescents, most girls, starts to appear in pediatric gender clinics. The inflection point strongly indicates a social contagion.

2015 - APA Calls for Depsychopathologization in Schools▼
In its Resolution on Gender and Sexual Orientation Diversity in Children and Adolescents in Schools, the American Psychological Association urges educators to treat “diverse gender identities” as “normal and positive variations of the human experience.”

2016 - WPATH Position Statement on Medical Necessity▼
This statement frames transgender identity as healthy and declares all hormonal and surgical interventions “essential” to the well-being of trans-identified people. This becomes a key document used to pressure insurance companies to cover gender-related medical procedures.

2018- Gender Identity Disorder▼
Under pressure from trans activists, WHO reclassifies gender identity disorder (ICD-10) as gender incongruence in ICD-11, moving it out of Mental and Behavioral Disorders into the newly created Conditions Related to Sexual Health—a chapter created specifically for depsychopathologization

2018 - AAP Endorses Depsychopathologization for Minors▼
The American Academy of Pediatrics statementcalls for affirmation and social and medical transition for minors, calling watchful waiting “outdated” and pathologizing.

2018- AACAP Defines Psychotherapy as Conversion Therapy▼
The AACAP policy on “Conversion Therapies”states defining “gender diverse identities” as pathological is a “false premise,” urging that therapeutic intervention for gender identities be considered conversion therapy

2022- WPATH Standards of Care 8▼
SOC8 asserts transgender identities are natural and must not be considered pathological. It removes almost all lower age restrictions for hormones and surgeries and expands medical treatment to “eunuchs” and “nonbinary” identities

2023- Genspect Calls for Repathologization▼
Genspect’s repsychopathologization campaign recognizes that a trans-identified person’s compulsive pursuit of hormonal and surgical body modification reflects a pathological condition driven by an extreme overvalued belief—an all-consuming, culturally reinforced conviction that compels harmful behavior. This new framing recognizes that cultural and social reinforcement mechanisms are central to how this belief develops and spreads

Here is an expert discussion panel on this report.

In this episode of The Director’s Desk, NIH Director Dr. Jay Bhattacharya hosts a roundtable with the primary authors of the newly released HHS peer-reviewed report, “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.” This landmark review evaluates the scientific evidence behind pediatric gender dysphoria treatments — including puberty blockers, cross-sex hormones, and surgical interventions — and concludes that these “sex-rejecting procedures” carry substantial and long-term risks for children and adolescents.

Featured Authors / Contributors:

• Evgenia Abbruzzese, Society for Evidence-Based Gender Medicine
• Alex Byre, PhD, Massachusetts Institute of Technology
• Farr Curlin, MD, Duke University
• Moti Gorin, PhD, MBE, Colorado State University
• Kristopher Kaliebe, MD, DFAACAP, University of South Florida
• Michael K. Laidlaw, MD, Michael K. Laidlaw MD, Inc.
• Kathleen McDeavitt, MD, Baylor College of Medicine
• Leor Sapir, PhD, Manhattan Institute for Policy Research

Together, they break down the report’s major findings, discuss long-term outcomes, examine the strength and limitations of current evidence, and outline implications for clinical best practices, research, and policy.

SOME BACKGROUND OF THE HORMONAL TREATMENT OF CHILDREN

This is Michael Biggs speech from a Medico Legal Society meeting on the 13 October 2025.

History of and evidence for puberty suppression as intervention for children experiencing gender dysphoria

Published 9th December 2025

https://journals.sagepub.com/doi/10.1177/00258172251392357?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

This is the final two paragraphs of an extensive recounting of the history of children’s treatment. There is a lot in the speech to take in.

“One final speculative reflection. It’s true that only a small number of adolescents who are going through a transition or identify as transgender undergo early puberty suppression. Even if you look at the ones who go for medical intervention, the typical patient would be a 17-year-old girl who thinks she’s non-binary or thinks she’s a boy, and of course puberty suppression is irrelevant in that case. However, even though only a small number of children have undergone early puberty suppression, they dominate media portrayals and they help to construct the image of the transgender child. It’s very telling that all the media-friendly trans kids have had early puberty suppression: Jazz Jennings in America and Jackie Green in the UK; there was also a trans boy called Leo who was featured on BBC Children’s television; and Valentijn de Hingh, a very famous transgender woman in the Netherlands. So actually they have an outsized role in constructing this idea of a transgender child. Moreover, the availability of puberty blockers becomes a kind of self-fulfilling prophecy because it makes social transition feasible. Before puberty blockers, it was not really possible to socially transition in school because, obviously, your emerging sex characteristics would become visible to everyone. But the availability of puberty blockers makes social transition in school possible; consequently, social transition becomes a self-fulfilling prophecy because it locks in the transgender identity.

I think the final broader cultural ramification of puberty suppression is that you begin to conceive puberty not as a crucial life stage that we all have to go through in order to become adults – but as literally a disease or almost like a disease. As de Vries, the most published Dutch gender clinician, says, ‘Disallowing puberty suppression, resulting in irreversible development of secondary sex characteristics, may be considered unethical’.This is why she said we can never have a randomised control trial because it’s actually unethical not to stop puberty. So the broader social and cultural implications of puberty suppression are very wide.

FOI ESTABLISHED CHILD SELF MEDICATION RATES FOR SEX HORMONES - HANNAH BARNES

https://www.newstatesman.com/investigation/2025/12/one-in-ten-children-receiving-nhs-gender-care-are-self-medicating-with-sex-hormones

archive.is/KTMVl

16th December 2025

One in ten children receiving NHS gender care are self-medicating with sex hormones

Almost one in ten children currently being seen by NHS Children and Young People’s Gender Services have disclosed that they self-medicate with masculinising or feminising hormones. The figures, exclusively seen by the New Statesman and revealed through freedom of information requests, come from all three regional gender clinics currently open to young people, serving London, the south-west and north-west England.

In total, 84 children (all under 18 years old) have told staff they are taking either testosterone (for females wishing to masculinise) or oestrogen (for males wishing to feminise), out of a total open caseload of 891. These hormones cause irreversible changes to the body, helping someone who wants to transition to develop characteristics associated with their preferred gender. For example, testosterone use in a biological female can stimulate growth of facial hair (and other body hair), a drop in the pitch of their voice, and other typically male characteristics such as pattern baldness.

The south-west, Bristol-based children’s gender service has the highest proportion of its caseload self-medicating – at 13 per cent – though these numbers may be an underestimate. In its FOI response, the London-based service (where 11.8 per cent of patients are taking hormones from non-NHS suppliers) acknowledged that the totals provided “may not be a true reflection of the number in receipt of hormone therapy without an NHS prescription as some patients under our care may not have disclosed this information to us”.

All of the NHS Children and Young People’s Gender Service clinics said that they were recording the source of the hormones in patients’ medical notes, for example, whether it has been obtained from an online pharmacy, overseas supplier, or elsewhere. The Bristol and London-based services said that whenever a child disclosed they are self-medicating with hormones, they and their parents or carers would be advised “about the known and unknown risks of this, as well as informing the patient’s GP in writing”.

The service for the north-west region, which had the lowest proportion of its caseload self-medicating (5.2 per cent), said that when staff become aware of patients self-medicating, they followed their own guidelines developed to deal with the issue of children accessing hormones from non-NHS sources. Further advice is given to clinicians in the service specification which underpins the operation of all the youth gender clinics.These NHS services will not work alongside unregulated providers who are supplying hormones, and in some circumstances might suggest that a GP or local health professional consider whether safeguarding measures are necessary to protect the child in question.

The article goes on...

https://www.dailywire.com/news/florida-brings-down-the-hammer-on-medical-groups-that-pushed-trans-procedures-on-children

Florida Brings Down The Hammer On Medical Groups That Pushed Trans Procedures On Children

Leif Le Mahieu. Dec 9, 2025

Florida took legal action on Tuesday against a trio of medical organizations that promote transgender procedures on children, The Daily Wire has learned.

Republican Attorney General James Uthmeier filed a suit against the World Professional Association for Transgender Health (WPATH), the Endocrine Society, and the American Academy of Pediatrics over their support of transgender procedures on kids. The suit accuses the organizations of pushing irreversible medical procedures on gender-confused children for financial benefit.

“For years, these groups insisted the recommendations were settled science, but behind closed doors, they knew the evidence was weak,” Uthmeier said in a video shared with The Daily Wire. “They knew the outcomes [were] uncertain, and the risks very real. Parents were not told the full story. In fact, some parents were told that if they didn’t put their kids through permanent, life-altering, sick procedures, like double mastectomies and castration, their child would commit suicide. Not only is that unethical and dangerous medicine, but it is against the law.”

and

The suit was filed in the 19th Judicial Circuit Court in Saint Lucie County, Florida. It accuses the organizations of violating Florida’s Deceptive and Unfair Trade Practices Act and engaging in racketeering by misleading “patients, parents, insurers, regulators, and courts about the reversibility and efficacy of pediatric sex interventions.”

and

“Defendants have a problem: there is no credible evidence that sex interventions alleviate pediatric gender dysphoria. To convince patients, insurance companies, regulators, and judges otherwise, Defendants initiated a coordinated campaign to develop ‘clinical guidelines’ recommending sex intervention for pediatric gender dysphoria,” the suit reads.

Uthmeier wants the court to rule that the organizations’ promotion of transgender procedures constitutes unfair trade practices, impose a civil penalty of $1 million against each defendant, block the organizations from advertising the procedures as safe and reversible, and impose a $10,000 penalty for each time a false claim about the safety of transgender procedures was made.

(Here is some background in this video from earlier 2025:

Guys. Could we please keep this as just for the stashing of links so they are easy to find. ( I am going to work through the FP stuff tomorrow). ☺️

HANNAH BARNES’ ARTICLE ON THE PUBERTY BLOCKER TRIAL

archive.is/C4YbN

Will the new puberty blocker trial put children at risk?

Hannah Barnes
6th December 2025

It has this quote from Dr Cass

“Asked whether she understood why there was concern about the trial and whether it would answer the questions she herself highlighted, Cass said: “Nobody is wrong on this. It’s a finely-honed decision, and, with justification, you could come down on either side of it.” She drew comparisons with the assisted dying debate taking place in the House of Lords: “Whether you are in support or against it, it’s an ethical decision about what you know, how many people you think you’re going to do something positive for against how many people might be harmed… and everyone makes their decision.” Cass explained that she had recommended a group of people should explore a trial, but that “I didn’t even necessarily anticipate whether or not such a trial would get through an ethics committee, or whether a group of academics would be able to even design a trial, given the circumstances that we’re in now. So, I didn’t prejudge whether it would happen… And if the ethics committee had said, despite everything, we don’t think this is an ethical approach, then I would have been content with that too.”

IQ IMPACT OF PUBERTY BLOCKERS

Just adding this Sally Baxendale paper from February 2024 on neuropsychological function that may be of interest.

https://onlinelibrary.wiley.com/doi/10.1111/apa.17150

The impact of suppressing puberty on neuropsychological function: A review

Aim
Concerns have been raised regarding the impact of medications that interrupt puberty, given the magnitude and complexity of changes that occur in brain function and structure during this sensitive window of neurodevelopment. This review examines the literature on the impact of pubertal suppression on cognitive and behavioural function in animals and humans.

Methods
All studies reporting cognitive impacts of treatment with GnRH agonists/antagonists for pubertal suppression in animals or humans were sought via a systematic search strategy across the PubMed, Embase, Web of Science and PsycINFO databases.

Results
Sixteen studies were identified. In mammals, the neuropsychological impacts of puberty blockers are complex and often sex specific (n = 11 studies). There is no evidence that cognitive effects are fully reversible following discontinuation of treatment. No human studies have systematically explored the impact of these treatments on neuropsychological function with an adequate baseline and follow-up. There is some evidence of a detrimental impact of pubertal suppression on IQ in children.

Conclusion
Critical questions remain unanswered regarding the nature, extent and permanence of any arrested development of cognitive function associated with puberty blockers. The impact of puberal suppression on measures of neuropsychological function is an urgent research priority.

Relating to the claim that there is ‘some evidence’ of a detrimental impact on IQ of children, she says this about puberty blockers with precocious puberty.

In the only human study that established a baseline prior to treatment, Mul et al.43 examined the response to treatment with puberty blockers on a number of psychosocial outcomes including the Child Behaviour Checklist and performance on the shortened version of the Wechsler Intelligence Scales for Children in a group of 25 girls treated for early puberty. Three years after treatment commenced, the group as a whole had experienced a loss in both performance IQ and full scale IQ, with a decline of 7 points in the latter. While statistically significant at p < 0.01, the authors state that the decrease in IQ was not ‘clinically relevant’, a conclusion repeated in a later citation of the study.44 While the average loss of IQ points was 7, it is noteworthy that at least one patient in this study experienced a significant loss of 15 points or more, since the highest IQ score in the group was 138 at baseline and this dropped to 123 following treatment.

And this about the use for Gender dysphoria.

Three studies were identified that examined the neuropsychological impact of GnRH analogue treatments in transgender and gender diverse young people. In a single case study, Schneider et al. (2017) examined the impact of pubertal suppression on brain white matter and (white matter fractional anisotropy) and cognitive function (Wechsler Intelligence Scale for Children-IV) in an 11-year-old treated for gender dysphoria (male to -female). On admission, at the age of 11 years and 10 months, the patient was assessed to have a global IQ of 80. Treatment with GnRHa was instigated at age 11 years, 11 months. The patient was reassessed age 13 and 3 months, at which time, a loss of 9 IQ points had occurred, and the IQ had dropped to 71. A loss of 15 points was evident in working memory. At 14 years and 2 months, a loss of 10 global IQ points and 9 points in working memory remained apparent. The verbal comprehension index (a measure which depends on the expansion of vocabulary and conceptual thinking in adolescence, for the standardised score to remain stable) deteriorated progressively over the follow-up, falling from the initial baseline of 101, to 91 (age 13) and 86 (age 14), a loss of 15 points over 3 years.

Her discussing her work at the SEGM conference :

GENDER DYSPHORIA REPORT (DEPT OF HEALTH & HUMAN SERVICES) FINAL VERSION PUBLISHED 19 NOVEMBER 2025

The peer reviewed version is now published.
https://opa.hhs.gov/gender-dysphoria-report

And this is the ‘Peer review supplement’ which is worth reading.
https://opa.hhs.gov/gender-dysphoria-report-peer-reviews

Below is the foreward:

" Over the past decade, the number of children and adolescents who question their sex and identify as transgender or nonbinary has grown significantly. Many have been diagnosed with a condition known as “gender dysphoria” and offered a treatment approach known as “gender-affirming care.” This approach emphasizes social affirmation of a child’s self-reported identity; puberty suppressing drugs to prevent the onset of puberty; cross-sex hormones to spur the secondary sex characteristics of the opposite sex; and surgeries including mastectomy and (in rare cases) vaginoplasty. Thousands of American children and adolescents have received these interventions.

While sex-role nonconformity itself is not pathological and does not require treatment, the use of pharmacological and surgical interventions as treatments for pediatric gender dysphoria has been called “medically necessary” and even “lifesaving.” Motivated by a desire to ensure their children’s health and well-being, parents of transgender-identified children and adolescents often struggle with how best to support them. Many of these children and adolescents have co-occurring psychiatric or neurodevelopmental conditions, rendering them especially vulnerable. When they seek professional help, they and their families should receive compassionate, evidence-based care tailored to their specific needs.

Society has a special responsibility to safeguard the well-being of children. Given that the challenges faced by these patients intersect with deeply contested issues of moral and social significance—including social identity, sex and reproduction, bodily integrity, and sex-based norms of expression and behavior—the medical practices that have recently emerged to address their needs have become a focus of significant controversy.

This Review is published against the backdrop of growing international concern about pediatric medical transition. Having recognized the experimental nature of these medical interventions and their potential for harm (which has been inadequately studied, especially with respect to long-term outcomes), health authorities in a number of countries have imposed restrictions. For example, the U.K. has banned the routine use of puberty blockers as an intervention for pediatric gender dysphoria.

Health authorities have also recognized the exceptional nature of this area of medicine. That exceptionalism is due to a convergence of factors. One is that the diagnosis of gender dysphoria is based entirely on subjective self-reports and behavioral observations, without any objective physical, imaging, or laboratory markers. The diagnosis centers on attitudes, feelings, and behaviors that are known to fluctuate during adolescence.

Additionally, the natural history of pediatric gender dysphoria is poorly understood, though existing research suggests it will remit without intervention in most cases. Medical professionals have no way to know which patients may continue to experience gender dysphoria and which will come to terms with their bodies.

Nevertheless, the “gender-affirming” model of care includes irreversible endocrine and surgical interventions on minors with no physical pathology. These interventions carry risk of significant harms including infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret, and there has been inadequate research into the frequency and severity of these harms. Meanwhile, systematic reviews of the evidence have revealed deep uncertainty about the purported benefits of these interventions "

(my bold)

AN ARTICLE THAT TRACES THE EAST GERMAN FEMALE ATHLETES AND THE IMPACT OF TESTOSTERONE ON THEIR BODIES

This article has a link to a summary (in German) about the impact of testosterone on those athletes. However, Paul Steger does a summary in this substack article. He makes a point that many of those women started testosterone around 12 to 14 not long before the average recommended age of girls taking testosterone of over 16- 17.

Doped then, transitioned now.
Paul Steger
May 26, 2025

https://genderstats.substack.com/p/doped-then-transitioned-now?r=2b1evv&utm_campaign=post&utm_medium=web&triedRedirect=true

This is part of the article:

The Eastern German doping scandal

" Doping often began between ages 12 and 14.

Oral-Turinabol was designed to maximize muscle-building (anabolic) effects while minimizing masculinization (androgenic) traits. The intent was to boost strength—especially in female athletes—without making them look “too male.” In the end, it is estimated that at least 10,000 athletes received androgen doping with the majority of them being female.

A blueprint for the mass-medicalization of gender distressed girls

To assess whether this doping scandal offers a meaningful precedent for understanding the long-term health consequences of testosterone in trans-identified females, two criteria must be met:

1. The substances involved must be comparable in effect and dosage.
2. The age profiles of the affected individuals must be similar.

• Disruption of the menstrual cycle, including a complete absence of the period (amenorrhea)
• Increased cyst formation
• Uterine and vaginal atrophy
• Irreversible deepening of the voice, increased hair growth
• Excessive increases in libido
• Increased aggression and impulsive behavior "

and then

"Testimonies affected women: Chronic illness, birth defects and trans-identification

Consider the case of Birgit Pabst, a former shot-putter. Told she was receiving vitamin supplements, she soon experienced classic signs of masculinization: a deepened voice, excess hair, and rapid muscle growth. When she later failed to conceive, her doctor discovered her uterus was developmentally equivalent to that of an 11-year-old. Only after prolonged treatment with female hormones was she able to have a child. Today, she suffers debilitating joint pain and requires morphine daily.

Katja Hofmann, a former discus thrower, lives with severe liver damage, hypertension, cysts, joint pain so intense she vomits from the pain, and underdeveloped reproductive organs. In a 2018 Die Zeit interview she stated that while she “loves life,” she doubts it will be a long one.

In a disturbing parallel to the testimonies of detransitioners today, many athletes today say that there is a strong sense of shame and guilt. Many endured years of guilt and shame before speaking out, describing the experience as "liberating" and crucial to healing—eerily similar to the testimonies of detransitioners today.

In some cases, the next generation was also affected. Nicole S., a rower doped from age 12 developed severe heart and liver cancer in her early 20s. Her son was born with epilepsy, ADHD, asthma, and fine motor impairments. This does not seem to be an isolated incident: The advocacy group for doping victims DOH (“Doping-Opfer Hilfe”) is aware of at least 300 such cases involving birth defects—ranging from hydrocephalus to malformed limbs. The German sport historian Giselher Spitzer noticed early on that among affected women, unusually many suffered from miscarriages and stillbirths. And if their children made it to the world alive, an unusually large proportion continues to suffer from chronic illnesses.

The effects across generations is maybe not surprising when you consider what testosterone (and to that extent also anabolic steroids) do to the female reproductive system. Testosterone and its derivatives cause uterine atrophy, increasing the risk of infections and impairing fertility. Just watch this interview with the Venus Envy on the Gender - A Wider Lens Podcast for a more detailed explanation. "

and

" What the research says

There have been a variety of attempts to measure the health effects of the East German doping scandal. Most studies, however, rely on self-selected samples because the people studied came forward by themselves. For instance, people who have stronger health complications might be more eager to speak out than those with only mild impacts on their well-being. The findings of these studies should therefore always be taken with a grain of salt in that they might overestimate the negative health effects.

However, the long-term health complications are shocking. Here is a selection of studies. Whenever possible, I will restrict findings to female athletes. However, when it comes to cardiovascular and oncological side effects, I could not find any reasonable argument why the effect should be dependent on whether the athlete was male or female.

-A 2023 case-control study (comparing doping victims to the general population) finds that relative to people of similar age who have not undergone doping, athletes who were given androgens exhibit statistically and clinically significant elevated rates of depression, chronic stress and a severe reduction in physical well-being. The effects are similar for both sexes.

-Together with the doping victim advocacy group “Doping Opfer Hilfe e.V.”, the German psychologist Harald Freyberger analyzed health records of former athletes that came forward and found that previously doped athletes died on average 10-12 years earlier than the general population and were 2.7 times more likely to be physically ill.

-A 2018 study found that 25 % of doped athletes suffered from cardiovascular disease, 27 % had tumors and 27 % of female athletes suffered from gynecological problems

-A 2024 study found that 21 of 56 female athletes suffered from miscarriages, 50 out of 56 suffered from gynecological problems.

The athletes today are on average 55 years. Overall, 25 of 107 athletes had cancers in various forms, 35 out of 107 heart issues, 10 out of 107 were epileptic, 13 out of 107 had lung issues and 94 of them were suffering from joint pain.

The German collection of side effects is on this link below

DDR-Leistungssportler:innen und Staatsdoping

https://www.nomos-elibrary.de/10.30820/9783837962017-53.pdf

The 2023 case-control study is on this link below:

Psychopathology of Former GDR Competitive Athletes in Comparison to The General Population
Simon-Friedrich Buhrmann, Thomas Klauer, Jochen-Friedrich Buhrmann, Hans Jörgen Grabe
May 2023

https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2093-3122

The 2018 study referred to is on this link below:

Traumatische Folgen des DDR-Staatsdopings
May 2018
Freyberger, Harald J.; Netzker, Jens; Buhrmann, Simon; Drescher, Anne; Geipel, Ines; Gallistl, Adrian; Buhrmann, Jochen

https://elibrary.klett-cotta.de/article/10.21706/tg-12-2-116

The 2024 study referred to is on this link below:

Damage to doping victims of the GDR
10 December 2024
Christoph Raschka & Horst J Koch

https://link.springer.com/article/10.1007/s15006-024-4236-1

NZ Bans prescribing puberty blockers to new patients with gender dysphoria

Announced 19 November 2025

https://www.beehive.govt.nz/release/new-safeguards-puberty-blocker-prescribing

New safeguards for puberty blocker prescribing

Cabinet has agreed to introduce new safeguards on the prescribing of gonadotropin-releasing hormone analogues, while ensuring patients with medical needs can continue to access appropriate care, Health Minister Simeon Brown says.

"We are putting in place stronger safeguards so families can have confidence that any treatment is clinically sound and in the best interests of the young person or child.

"Gonadotropin-releasing hormone analogues play an important role in treating a range of medical conditions. We are ensuring they remain available for patients who need them for conditions such as early-onset puberty, endometriosis, or prostate cancer, where there is strong clinical evidence of benefit."

The Ministry of Health’s evidence brief found that there is a lack of high-quality evidence that demonstrates the benefits or risks of the use of gonadotropin-releasing hormone analogues for the treatment of gender dysphoria or incongruence. While this uncertainty persists, the Government is taking a precautionary approach.

Following public consultation, Cabinet has agreed to introduce new regulations under the Medicines Act to align New Zealand's approach with the United Kingdom:

-New patients seeking treatment for gender dysphoria or incongruence can no longer be prescribed gonadotropin-releasing hormone analogues, pending the completion of the United Kingdom's clinical trial on their use in this context.

-Ensure existing youth gender services are maintained for young people experiencing gender dysphoria or incongruence and bringing these services together through a central, accessible online resource.

"These changes will ensure a more consistent and carefully monitored approach. This mirrors steps taken in other countries, such as the United Kingdom, Finland, Norway, and Sweden, where additional safeguards have recently been implemented to ensure decisions are made in line with the best available evidence," Mr Brown says.

The new approach will not impact patients currently receiving gonadotropin-releasing hormone analogues for the treatment of gender dysphoria or incongruence, with changes applying only to new cases going forward.

“The Government expects existing youth gender services to continue supporting young people and their families, connecting them with healthcare professionals who have specialised expertise and can provide evidence-based guidance.
"These changes are about ensuring treatments are safe and carefully managed, while maintaining access to care for those who need it."

MORE ON THE DUTCH PROTOCOL

A Legal Assessment of the Dutch Protocol for Transgender Care to children: Evidence, Ethics and Procedure

Smeehuijzen, L., Smids, J., Hoekstra, C

March 2025

https://www.boomportaal.nl/tijdschrift/FenR/FENR-D-24-00001

Abstract: A Legal Assessment of the Dutch Protocol for Transgender Care to Children: Evidence, Ethics and Procedure In the Netherlands, healthcare for children with gender dysphoria is provided based on the Dutch Protocol . Typically, medical protocols are guiding in the interpretation of the medical-professional standard. For a protocol to be guiding, it (i) must be evidence-based, (ii) should carry limited medical-ethical weight, and (iii) have been developed through an adequate process. This article disputes the first criterion as highly debatable and maintains that the second and third criteria fail to be satisfied. Consequently, the Dutch Protocol cannot be regarded as a legitimate guiding standard.

SEGM Summary

In this article, two Dutch legal experts (Smeehuijzen and Hoekstra) and a medical ethicist (Smids) evaluate whether the Dutch Protocol as laid out in the 2018 Dutch guideline for somatic gender care (i.e., medical and surgical interventions) meets the necessary requirements for it to have authority in legal settings be recognized as the standard of care. Of note, the 2018 Dutch Protocol substantively departed from the original Dutch Protocol by reducing lower age limits for puberty blockers, cross-sex hormones, and mastectomy, and by dropping the requirement of pre-existing childhood gender dysphoria as a condition for obtaining medical and surgical interventions in adolescence.

The authors outline the three key criteria required in the Netherlands for a standard of care to be considered legally authoritative, namely: (1) the standard is evidence-based, (2) it is not of an ethical nature, and (3) it was established through a properly designed process. They find that the 2018 Dutch Protocol fails to meet these criteria and thus conclude that courts should not rely on it.

SEGM comment: Although this article focuses on the Dutch medical and legal situation, it is likely to have considerable cross-over relevance to other countries. The 2018 Dutch protocol's criteria and development bear significant resemblance to the 2017 Endocrine Society guideline and the WPATH Standards of Care, both of which have been identified as the source of all other "affirmative" guidelines. Practitioners relying on such guidelines may find that poorly evidenced and/or inadequate medical treatment protocols and clinical practice guidelines might not be accepted as the medical standard of care in adversarial legal settings.

THE DUTCH PROTOCOL IS FALLING APART & OTHERS

The Dutch Protocol is falling apart By Stella O'Malley / 2 January 2023

First, Stella O’Malley writes about an article in Nederlands that is throwing a great deal of light on the Dutch Protocol. It also seems that there will be a review of the patients that the Dutch team had not previously included in their papers.

This article in the Nederlands points out the dangers on only using a nation’s own sources with no international input or even wide review.

genspect.org/the-dutch-model-is-falling-apart/

Then there was this documentary later in 2023

A documentary on the Dutch Protocol

"There are currently almost 3,000 young people on the waiting list for gender care in the Netherlands. They are vulnerable adolescents who are frequently subjected to discrimination. Many of them suffer severe mental distress. Doctors at the gender clinic in Amsterdam are pioneers in care for transgender young people. The treatment developed here years ago is now used worldwide. Now, criticism is growing. International experts are questioning the scientific evidence put forward by the clinicians in Amsterdam. Zembla investigates the Dutch transgender protocol."

What this covers is that no gender clinic has been able to replicate the results of the Dutch paper. One patient of the group died due to the surgery complications of gender surgery and even de Vries questioned why no one seemed interested in that patient while accepting the study. Dr Riittakerttu Kaltiala (Professor of Pschyiatry, Tampere and who set up gender clinics) and Mikael Landen (Professor of Pscyhiatry, Gotenberg) and Dr Angela Samfjord (Head of Child and Adolescent Psychiatry at the University of Gotenberg ) all are interviewed about the quality of the study behind the protocol and its flaws that became apparent later. Ie. The 55 patients is so small and de Vries acknowledges that they are not really similar to todays cohort of adolescent transitioners. That only 32 filled in the survey with positive results. The others were not chased up and one died.

Gerard van Breukelen, a professor of Methodology at Maastricht university goes on record to say that the methodology of that initial study was weak. There was no control group so the conclusions should not have been considered as strong as the gender clinicians claimed. Other academics declined to be interviewed due to fear for their employment as it is such a contentious issue. When talking to de Vries, she mentions that many more studies have been done by other countries now. And the doco makers mention that all those studies de Vries refer to have stated that the evidence is low quality. A Swedish team led by Landen was asked to do a full review by the Swedish government and he confirms that the evidence was just not there. Hence the Swedish government withdrew treatment.

The mention the Cass review and discussion ‘locking in’ of identities contradicts the ‘time to think’ narrative. They interview three transitioners. One detransitionered before surgery and one is happy with transition but not with the process the team followed. The one who detransitioned was put on hormones despite not even socially transitioning as he felt wearing a dress was ‘a man wearing a dress’. But was put on hormones but didn’t go through surgery after all. It also wraps up with Lucy who was stuck on the waiting list and who believes that if she was given PBs, she would not have ended up transitioning. She has obviously detransitioned now after double mastectomy and testosterone, then ovaries and uterus removal.

Followed by the reanalysis

The newly released peer reviewed reanalysis of the UK study. McPherson & Freedman both worked on the initial analysis of the patient clinical data.

https://www.tandfonline.com/doi/full/10.1080/0092623X.2023.2281986

Psychological Outcomes of 12–15-Year-Olds with Gender Dysphoria Receiving Pubertal Suppression in the UK: Assessing Reliable and Clinically Significant Change

Susan McPherson & David E. P. Freedman

Published online: 29 Nov 2023

Abstract

The evidence base for psychological benefits of GnRHA for adolescents with gender dysphoria (GD) was deemed “low quality” by the UK National Institute of Health and Care Excellence. Limitations identified include inattention to clinical importance of findings. This secondary analysis of UK clinical study data uses Reliable and Clinically Significant Change approaches to address this gap. The original uncontrolled study collected data within a specialist GD service. Participants were 44 12–15-year-olds with GD. Puberty was suppressed using “triptorelin”; participants were followed-up for 36 months. Secondary analysis used data from parent-report Child Behavior Checklists and Youth Self-Report forms. Reliable change results: 15–34% of participants reliably deteriorated depending on the subscale, time point and parent versus child report. Clinically significant change results: 27–58% were in the borderline (subclinical) or clinical range at baseline (depending on subscale and parent or child report). Rates of clinically significant change ranged from 0 to 35%, decreasing over time toward zero on both self-report and parent-report. The approach offers an established complementary method to analyze individual level change and to examine who might benefit or otherwise from treatment in a field where research designs have been challenged by lack of control groups and low sample sizes.