Medical Treatment for gender identity evidence archive thread

[Helleofabore]

Hi everyone

I am creating this thread as an archive thread just for statistics and polling links and information that we can all access and refer to. With the option for saving threads so we can find them easily, I figure it is a good way to gather specific types of information into one place.

Please post studies, papers, media articles that pull together references, or informative articles, tweets, videos, and interviews. Just on statistics and polling about the topic of Sex & Gender. Please post with a summary of the article, study, papers, etc so people can also use Advanced Search to locate the information and it will make it easier to read through to find the information again too.

I don't want to be the thread police, but ask that we keep this free of discussion. Getting into discussion on this thread will mean it will fill up quickly and not serve the purpose of being simply an archive.

Can I ask that if you want to discuss something you see here, you start a thread to do so and link and refer to a post on this thread? If a post has been presented with commentary that people disagree with, can that be discussed on a new thread please..

Keep this thread free just for the information.

Here is the link to the previous Break it down for me thread and the new General Break it Down archive thread.

The specific archive threads (including this one) are:

Save female sports evidence thread
Statistics & poll evidence archive thread
Medical treatment archive thread
It will never happen - resource thread
Court cases/Judicial Reviews/ET/ETAs

Thank you.

THE FIRST WPATH FILE LEAK

Here is one link to the WPATH pdf

https://static1.squarespace.com/static/56a45d683b0be33df885def6/t/65e64b9e5cbd756da9fbbdfa/1709591479160/Final+WPATH+Report.pdf

and another

https://environmentalprogress.org/big-news/wpath-files

Here are some of the reactions:

https://www.dailymail.co.uk/news/article-13156695/Trans-healthcare-doctors-exposed-admitting-patients-young-mentally-ill-understand-consequences-treatment.html

https://www.telegraph.co.uk/news/2024/03/05/wpath-tansgender-hormone-therapy-cancer-links-leaked-emails/

https://sex-matters.org/posts/updates/wpath-the-truth-about-gender-affirming-healthcare/

https://genspect.org/the-wpath-files-revealed/

Here is a summary from Michael Shellenberger.

https://x.com/shellenberger/status/1764800595473686865?s=20

And the first part. Much more of it requires images.

Here is the threadreader version:

https://threadreaderapp.com/thread/1764799914918490287.html

THE WPATH FILES

Advocates of gender-affirming care say it’s evidence-based.

But now, newly released internal files from the World Professional Association for Transgender Health (WPATH) prove that the practice of transgender medicine is neither scientific nor medical.

American Medical Association, The Endocrine Society, the American Academy of Pediatrics, and thousands of doctors worldwide rely on WPATH. It is considered the leading global authority on gender medicine.

And yet WPATH’s internal files, which include written discussions and a video, reveal that its members know they are creating victims and not getting “informed consent.”

Victims include a 10-year-old girl, a 13-year-old developmentally delayed adolescent, and individuals suffering from schizophrenia and other serious mental illnesses.

The injuries described in the WPATH Files include sterilization, loss of sexual function, liver tumors, and death.

WPATH members indicate repeatedly that they know that many children and their parents don’t understand the effects that puberty blockers, hormones, and surgeries will have on their bodies. And yet, they continue to perform and advocate for gender medicine.

The WPATH Files prove that gender medicine is comprised of unregulated and pseudoscientific experiments on children, adolescents, and vulnerable adults. It will go down as one of the worst medical scandals in history.

Why I Am Publishing WPATH Files And How I Got Them

The written WPATH Files come from WPATH’s member discussion forum, which runs on software provided by DocMatter.

Ninety seconds of the 82-minute video was made public last year. We are making the full video available for the first time.

One or more people gave me the WPATH Files, and my colleagues and I attempted to summarize them as a series of articles. We quickly realized the topic was too sensitive, complex, and large to be dealt with as a work of journalism, and we moved the project to the research institute I founded seven years ago, Environmental Progress (EP).

The Files are authentic. We redacted most names and left only those individuals who are leading gender medicine practitioners to whom we sent “right-of-reply” emails. We know WPATH members discussed our emails internally. No WPATH leader or member has denied that the Files are anything other than what they appear to be.

EP is publishing a 70-page report to provide context for the 170 pages of WPATH Files. Mia Hughes is the author of the report. It and accompanying summary materials can be downloaded at the link below. That link also provides a link to the full WPATH video.

THE FINAL CASS REPORT - APRIL 2024

The page with the link - sorry it is a messy link....

webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/cass.independent-review.uk/home/publications/final-report/

This link should download the pdf

Overview of key findings

-There is no simple explanation for the increase in the numbers of predominantly young people and young adults who have a trans or gender-diverse identity, but there is broad agreement that it is a result of a complex interplay between biological, psychological and social factors. This balance of factors will be different in each individual.

-There are conflicting views about the clinical approach, with expectations of care at times being far from usual clinical practice. This has made some clinicians fearful of working with gender-questioning young people, despite their presentation being similar to many children and young people presenting to other NHS services.

-An appraisal of international guidelines for care and treatment of children and young people with gender incongruence found that that no single guideline could be applied in its entirety to the NHS in England.

-While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.

-The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate.

-The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services.

-The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.

-The use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

-Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.

-For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.

-Innovation is important if medicine is to move forward, but there must be a proportionate level of monitoring, oversight and regulation that does not stifle progress, while preventing creep of unproven approaches into clinical practice. Innovation must draw from and contribute to the evidence base.

Collated data on "gender affirming care" in the US, including genital surgeries for children.

www.ncbi.nlm.nih.gov/pmc/articles/PMC10448302

Puberty Blocker and Aging Impact on Testicular Cell States and Function

Varshini Murugesh, Megan Ritting, Salem Salem, Syed Mohammed Musheer Aalam, Joaquin Garcia, Asma J Chattha, Yulian Zhao, David JHF Knapp, Guruprasad Kalthur, Candace F Granberg, Nagarajan Kannan

March 27, 2024.

https://www.biorxiv.org/content/10.1101/2024.03.23.586441v1.full

Abstract

"Spermatogonial stem cell (SSC) acquisition of meiotogenetic state during puberty to produce genetically diverse gametes is blocked by drugs collectively referred as ‘puberty blocker’ (PB). Investigating the impact of PB on juvenile SSC state and function is challenging due to limited tissue access and clinical data. Herein, we report largest clinically annotated juvenile testicular biorepository with all children with gender dysphoria on chronic PB treatment highlighting shift in pediatric patient demography in US. At the tissue level, we report mild-to-severe sex gland atrophy in PB treated children. We developed most extensive integrated single-cell RNA dataset to date (>100K single cells; 25 patients), merging both public and novel (52 month PB-treated) datasets, alongside innovative computational approach tailed for germ cells and evaluated the impact of PB and aging on SSC. We report novel constitutional ranges for each testicular cell type across the entire age spectrum, distinct effects of treatments on prepubertal vs adult SSC, presence of spermatogenic epithelial cells exhibiting post-meiotic-state, irrespective of age, puberty status, or PB treatment. Further, we defined distinct effects of PB and aging on testicular cell lineage composition, and SSC meiotogenetic state and function. Using single cell data from prepubertal and young adult, we were able to accurately predict sexual maturity based both on overall cell type proportions, as well as on gene expression patterns within each major cell type. Applying these models to a PB-treated patient that they appeared pre-pubertal across the entire tissue. This combined with the noted gland atrophy and abnormalities from the histology data raise a potential concern regarding the complete ’reversibility’ and reproductive fitness of SSC. The biorepository, data, and research approach presented in this study provide unique opportunity to explore the impact of PB on testicular reproductive health."

And an article

https://www.dailymail.co.uk/health/article-13276501/Mayo-Clinic-puberty-blockers-trans-kids-fertility-cancer-medicine.html

The long awaited Johanna Olson-Kennedy study

https://www.medrxiv.org/content/10.1101/2025.05.14.25327614v1

Mental and Emotional Health of Youth after 24 months of Gender-Affirming Medical Care Initiated with Pubertal Suppression

Johanna Olson-Kennedy, Ramon Durazo-Arvizu, Liyuan Wang, Carolyn F. Wong, Diane Chen, Diane Ehrensaft, Marco A. Hidalgo, Yee-Ming Chan, Robert Garofalo, Asa E. Radix, Stephen M. Rosenthal

May 16, 2025

Abstract

Background and Objectives Medical interventions for youth with gender dysphoria can include the use of gonadotropin releasing hormone analogs (GnRHas) for suppression of endogenous puberty. This analysis aimed to understand the impact of medical intervention initiated with GnRHas on psychological well-being among youth with gender dysphoria over 24 months.

Methods Participants were enrolled as part of the Trans Youth Care United States Study. Eligibility criteria for youth included a diagnosis of Gender Dysphoria and pubertal initiation. Youth with precocious puberty or pre-existing osteoporosis were ineligible. Youth reported on depressive symptoms, emotional health and suicidality at baseline, 6, 12, 18 and 24 months after initiation of GnRHas. Parent/caretaker completed the Child Behavior Checklist at baseline, 12 and 24 months after initiation of GnRHas. Latent Growth-Curve Models analyzed trajectories of change over the 24-month period.

Results Ninety-four youth aged 8-16 years (mean=11.2 y) were predominately Non-Hispanic White (56%), early pubertal (86%) and assigned male at birth (52%). Depression symptoms, emotional health and CBCL constructs did not change significantly over 24 months. At no time points were the means of depression, emotional health or CBCL constructs in a clinically concerning range.

Conclusion Participants initiating medical interventions for gender dysphoria with GnRHas have self- and parent-reported psychological and emotional health comparable with the population of adolescents at large, which remains relatively stable over 24 months. Given that the mental health of youth with gender dysphoria who are older is often poor, it is likely that puberty blockers prevent the deterioration of mental health.

Prevalence of Personality Disorder Diagnoses in People Referred to Specialized Gender Identity Clinics in Finland

Marja Kaila-Vanhatalo, Tommi Tolmunen, Aino Mattila and Riittakerttu Kaltiala
Published Online: 28 Apr 2025

https://doi.org/10.1521/pedi.2025.39.2.95

Abstract

A higher prevalence of personality disorder diagnoses has been found among individuals with gender dysphoria. However, previous studies on this topic have been limited and methodologically inconsistent. The object of this research was to determine the prevalence of personality disorder diagnoses in individuals requesting medical gender reassignment. A registerbased follow-up study tracked individuals who contacted the nationally centralized gender identity services in Finland in 1996-2019 (n = 3,665) and 8:1 age- and sex-matched population controls (n = 29,292). All their specialist-level psychiatric treatment contacts in 1994-2022 were identified in the National Care Register for Health Care. ICD-10diagnoses and dates of the contacts were extracted.

Among the gender dysphoria group, 15.0% (551 out of 3,665) had received a diagnosis in the personality disorder group (F60-69 excluding F64.x), while among the control subjects, 2.1% (625 out of 29,292) had received such a diagnosis.

SEGM has a page with links to studies. This is a great archive.

It covers treatment, and side effects, mental health, suicide, even social transitioning.

https://segm.org/studies

WPATH SOC versions that I can find

V5 https://www.genderpsychology.org/transsexual/hbsoc_1998.html

V6 https://share.google/QNHgweg9XIXFLVVBg

V7 https://www.gendergp.com/wpath-standards-of-care-version-7/

V8 https://wpath.org/publications/soc8/

NEUROPSYCHOLOGICAL FUNCTION AND PUBERTY BLOCKERS

The Impact of Suppressing Puberty on Neuropsychological Function
UCL, Queen Square, Institute of Neurology
Sallie Baxendale 2023

https://www.authorea.com/users/713322/articles/697715-the-impact-of-suppressing-puberty-on-neuropsychological-function

ABSTRACT
Concerns have been raised regarding the neuropsychological 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. In mammals the effects are complex and often sex specific. 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. However there is some evidence of a detrimental impact of pubertal suppression on IQ, concordant with findings in the wider literature on gonadotropin-hormone-releasing-hormone expression in relevant brain structures. Critical questions remain unanswered regarding the nature, extent and permanence of any arrested development of cognitive function that may be associated with pharmacological blocking of puberty in humans. The impact of puberal suppression on measures of neuropsychological functions should be an urgent priority for future research. Neuropsychologists should be an integral member of the multidisciplinary team caring for people treated with puberty blockers to monitor the impact of these treatments.

Key Points

1. Adolescence is a critical window of neurodevelopment and puberty plays a critical role in these neurodevelopmental processes.
2. The suppression of puberty impacts brain structure and the development of social and cognitive functions in mammals, the effects are complex and often sex specific.
3. No human studies have systematically explored the neuropsychological impact of pubertal suppression in transgender adolescents with an adequate baseline and follow up.
4. Animal studies, single case reports and studies of the impact of puberty blockers in children with precocious puberty indicate that these treatments may be associated with reductions in IQ.
5. The impact of pubertal suppression on measures of neuropsychological function should be an urgent priority for future research.

DISCUSSION ON HOW FAR SHOULD PEOPLE EXPECT THEIR IDENTITY TO BE SUPPORTED

“Should a psychological idea take precedence over a physical fact?” — Dr. Paul McHugh, Distinguished Services Professor, Johns Hopkins University School of Medical

https://x.com/stellaomalley3/status/1945881924389806122?s=46

Full interview

PUBERTY BLOCKERS AND BONE DENSITY FROM THE CASE OF LEO

www.svtplay.se/video/33358590/uppdrag-granskning/mission-investigate-trans-children-avsnitt-1

The video from Sweden on the effects of puberty blockers on Leo and others.

As the poster who posted this initially states:

A trans child, Leo was treated for puberty blockers for 4 years. Leo ended up with osteoporosis (significantly below any normal bone density interval), fractures in the back, constant pain and worse mental state.

The journalist also found an additional 12 cases in Stockholm only where children had serious side effects (bone fractures, deep regret from voice changes, injuries, deteriorating mental health and significant weight gains). Leo’s case was not reported and not one of these.

STUDY: Finland’s detransition numbers

Discontinuing hormonal gender reassignment: a nationwide register study.

Riittakerttu Kaltiala, Mika Helminen, Timo Holttinen & Katinka Tuisku

19 August 2024

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-06005-6

Background

With increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition and the risk factors for discontinuation.

Methods

A nationwide register-based follow-up was conducted. Data were analysed via cross-tabulations with chi-square statistics and t tests/ANOVAs. Multivariate analyses were performed via Cox regression, which accounts for differences in follow-up times.

Results

Of the 1,359 subjects who had undergone hormonal GR in Finland from 1996 to 2019, 7.9% discontinued their established hormonal treatment during an average follow-up of 8.5 years. The risk for discontinuing hormonal GR was greater among later cohorts. The hazard ratio was 2.7 (95% confidence interval 1.1–6.1) among those who had accessed gender identity services from 2013 to 2019 compared with those who had come to contact from 1996 to 2005. Discontinuing also appeared to be emerging earlier among those who had entered the process in later years.

Conclusions

The risk of discontinuing established medical GR has increased alongside the increase in the number of patients seeking and proceeding to medical GR. The threshold to initiate medical GR may have lowered, resulting in a greater risk of unbalanced treatment decisions.

And

”It has long been assumed that very few patients embarking on medical GR regret their choice and seek to reverse it. From the 1970s to the 2010s, estimates of those regretting their initiated GR were only in the region of 2% [5, 6]. However, more recent research suggests that alongside the increase in the number of people accessing medical gender reassignment, reversing the initiated transition seems to be increasing [7]. In recent samples, 20–30% of those who initiated hormonal GR discontinued hormonal treatment in four to five years [8, 9]. It is possible that some patients discontinue hormonal treatment because they have reached their transition goals.”

And

“More importantly, those who have detransitioned have repeatedly reported that before their embarking on medical GR, insufficient attention was given to their mental health and psychosocial problems, which, in retrospect, they believed played a major role in their desire to transition. They have expressed concerns that assessments for medical gender reassignment were too superficial, with no search for explanations for their distress beyond an assumed stable sex-discordant identity requiring transition.”

Just a reminder though....

Please look back on the Break it down for me? original thread for many more links to studies and papers....

https://www.mumsnet.com/talk/womens_rights/3145470-Break-it-down-for-me?page=1

And some will inevitably pop up on the 2nd Break it down thread too.

https://www.mumsnet.com/talk/womens_rights/5445899-break-it-down-for-me-2-general-break-it-down-archive-thread?reply=148603352

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.

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.

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."

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.

On the first count, the overlap is striking. Anabolic steroids like Oral-Turinabol are testosterone derivatives and produce similar virilizing effects in women. A 2024 summary of the East German doping scandal listed common side effects reported by female athletes — many of which closely resemble those described by female detransitioners today:

• 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

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)

https://statsforgender.org/topics/
Is another good resource that has collected together several scientific studies on medical treatment of gender identity. I will try to link a few of the most important ones, but I have little time at the moment!

The link for the Cass Review doesn't work for me, so I'm trying again:
<a class="break-all" href="https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/cass.independent-review.uk/home/publications/final-report" rel="nofollow" target="_blank">https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/cass.independent-review.uk/home/publications/final-report/
Hopefully it works. The review can be downloaded from a link on yhatvpage.

I think it's important to have the link to the sistematica review commissioned by Dr. Cass and conducted by researchers at the University of York. The link in the Cass review page doesn't work, but they are here
https://adc.bmj.com/pages/gender-identity-service-series

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 :

Lots of lniks to studies etc here:

https://www.transgendertrend.com/#

A market share report on sex reassignment surgery.
The language is very straightforward, exactly as you would expect of any other market share report. Which makes it all the more horrifying.

https://www.polarismarketresearch.com/industry-analysis/sex-reassignment-surgery-market

The title is: "Sex Reassignment Surgery Market Share, Size, Trends, Industry Analysis Report, By Gender Transition (Female to Male, Male to Female); By End-Use; By Region; Segment Forecast 2024-2032". Link contains the abstract, you have to pay $4250 for the full report. The abstract is revealing enough; even if I had $4250 to splash around, I don't think I could take reading any more. It's just all about making money and techno surgery.

Some select quotes from the abstract:
"The global sex reassignment surgery market was valued at USD 701.67 million in 2023 and is expected to grow at a CAGR of 12.00% during the forecast period."

"This market has seen substantial growth due to technological advancements and increasing acceptance of transgender individuals. Improved surgical techniques and heightened awareness have made SRS more accessible. Factors like enhanced quality of life and reduction in gender dysphoria drive the demand. However, cost and societal stigma remain significant barriers. The market's future lies in continued innovation, expanded accessibility, and comprehensive support for transgender individuals seeking gender-affirming healthcare solutions."

"However, cost and affordability, as well as stigma and discrimination, are the factors hampering the growth of this market. "

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.”