SEGM
@segm_ebm
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Society for Evidence-Based Gender Medicine. Promoting ethical and evidence-informed healthcare for children, adolescents & young adults. (Formerly SEGMtweets)
United States
Joined October 2019
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We've completed our preliminary analysis of the Cass Report. The "gender-affirming" model of care is over in England, as is the era of the gender-clinic model of care, which exists to deliver youth transitions. This will have world-wide implications./1
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The Norwegian Healthcare Investigation Board, (NHIB/UKOM) has deemed puberty blockers, cross-sex-hormones & surgery for children & young people experimental, determining that the current “gender-affirmative” guidelines are not evidence-based and must be revised. /1
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The President of the American Academy of Pediatrics has announced that gender-affirming hormones & surgery are NOT recommended for the "vast majority" of gender dysphoric youth. This realigns the AAP with Sweden, Finland & the UK's new cautious stance. /1
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Last week, England shut down the world’s largest pediatric gender clinic at the Tavistock (GIDS). Investigative journalist Hannah Barnes shares 7 lessons for the rest of the world at
@segm_ebm
NYC conference.
Lesson 1: When new evidence emerges, be prepared to change direction.…
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The Director of the Belgian Center for Evidence-Based Medicine (CEBAM) Dr. Patrik Vankrunkelsven has joined a growing list of experts who are criticizing the highly medicalized "gender-affirming" treatment approach for minors with gender dysphoria as not evidence-based. /1
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A new peer-reviewed open-access study exposes deep flaws in the Dutch studies that formed the foundation for youth gender transition. These studies should have never been used to launch the practice into mainstream medicine, conclude the authors./1
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The Karolinska Hospital in Sweden has issued a policy statement regarding treatment of gender dysphoric minors at its pediatric gender services division. This policy ends the practice of prescribing puberty blockers and cross-sex hormones to minors <16. /1
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Yesterday, Sweden released its long-awaited guidelines for the care of gender-dysphoric youth. These guidelines represent a major departure from the WPATH "Standards of Care," and are a vital step towards safeguarding vulnerable youth from medical harm./1
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The UKOM report asserts that future guidelines must rely on a systematic review of evidence rather than cherry-picking studies, and that all hormonal and surgical interventions must be restricted to research settings to ensure clear protocols, safeguarding & adequate follow-up./2
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The NHS has ended "gender-affirming care" in England for <18s, according to the newly-released draft guidance. Psychotherapy will be the first & usually only line of treatment. Puberty blockers will be confined to research settings.
SEGM's analysis below:
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The journal of the Danish Medical Association Ugeskrift for Læger has confirmed that Denmark is restricting medical transition of gender-dysphoric minors. Only 6% of the gender clinic referrals were approved for transition in 2022, down from 65% in 2018./1
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The
@NHSEngland
landmark decision to stop using puberty blockers for gender dysphoric youth raises a key question: what do we know about the effects of puberty blockers on adolescent development?
Prof. Sallie Baxendale explored this question at
@segm_ebm
2023 conference./1🧵
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A systematic evidence review by the Swedish health authority has just been published in an English-language peer-reviewed journal. It concluded that puberty blockers & cross-sex hormones in <18s are not a medical treatment but experimental procedures./1
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In summary, Sweden has changed direction because of a lack of evidence to support medical interventions for gender-dysphoric minors. A new emphasis has been placed on psychiatric care and psychosocial support. Hormonal interventions for minors will be highly restricted. /10
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Do puberty blockers improve mental health? The original Dutch studies claimed so, but a replication attempt in the UK failed, finding no impact. A new peer-reviewed reanalysis of the UK data shows that up to 34% of youth actually "reliably deteriorated"./1
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The Norwegian Healthcare Investigation Board noted several worrying trends: the rapid rise of gender dysphoria in adolescents (esp. females), the high burden of mental illness (75%) & a high prevalence of neurocognitive conditions (ADHD/autism, Tourette) in the affected youth. /6
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The National Academy of Health in France has just issued a press release regarding the care of gender-dysphoric youth. The Academy is advising psychological exploration, and cautions about the risks of pursuing hormones & surgery in youth /1.
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The European Society of Child and Adolescent Psychiatry (ESCAP) published a policy statement on child and adolescent gender dysphoria, calling on healthcare providers to "not to promote experimental and unnecessarily invasive treatments with unproven psycho-social effects and,…
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Under the current Norwegian guidelines, youth may receive puberty blockers at tanner stage 2, cross-sex-hormones at 16, and surgeries at 18. The report noted that these widely available interventions are irreversible, carry many risks, and rest on insufficient evidence. /4
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However, unlike Sweden, Finland and England, Norway explicitly calls out the group of young adults whose development is still ongoing and who are at risk for erroneously undertaking gender transitions. The report notes that the age of consent for sterilization in Norway is 25./8
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The report criticized Norway’s current "gender-affirmative" guidelines as inadequate, noting a lack of specificity regarding assessment & determination of medical necessity of risky and irreversible interventions provided to youth whose identities are still forming. /5
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The existing Norwegian treatment guidelines for gender-dysphoric youth, based on a 2015 report ”The Right to the Right Sex,” closely mirror WPATH SOC7 “gender-affirming” model. Medical gender affirmation is widely available to youth, with no psychological assessments required. /3
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Sweden becomes the first country to stop the use of the "Dutch protocol" for treating gender dysphoric minors over concerns of medical harm and low certainty of benefit. Other countries (UK, Finland) are also moving away from medicalizing minors. /2
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NHIB/UKOM notes that the right to medical care does not include the right to experimental treatments. As an experimental intervention, gender transitions will be subject to heightened scrutiny around informed consent, eligibility criteria, and outcomes evaluation./9
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The recommendations by the Norwegian Healthcare Investigation Board (NHIB/UKOM) align Norway with the changes among the growing number of European countries (Sweden, Finland, England) which aim to safeguard youth from harm by sharply restricting youth gender transitions. /7
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Norway's proposed model appears to resemble the model of care outlined in the Cass review. Gender dysphoric youth will receive care for their distress in local primary care settings with multidisciplinary support. Youth gender transitions will be an exception, not the rule. /10
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A new German publication compares two conditions in adolescent females: gender dysphoria and anorexia. It posits that most cases of GD represent temporary struggles, and clinicians should not “hastily collude" in applying a "trans-identification template."
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Dr. Kaltiala just won Finland's most prestigious medical award for her work in adolescent psychiatry. Dr. Kaltiala was a speaker at
@segm_ebm
's NYC conference, where she described how the Finnish youth gender services moved away from the "gender-affirmative" model of care. 🎉/1…
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The Board also comments on the highly polarized & unbalanced nature of the discussions surrounding care for gender-dysphoric youth, which stifles scientific debate. The Board calls on all parties to treat each other with professionalism, empathy and respect. /11
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Sweden’s new guidelines emphasize that gender-dysphoric youth will continue to receive care. However, health care for gender dysphoria is no longer reduced to “hormones and surgeries.” The recommendations now call out a key role for psychiatric and psychosocial services. /3
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As international awareness of the low quality of evidence behind "gender-affirming" hormonal interventions grows, the focus is expected to shift to non-invasive options for ameliorating the distress of gender-dysphoric minors, including psychological treatment and support. /3
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The Royal Australian and New Zealand College of Psychiatrists (RANZCP) released a position statement in which it no longer presents "gender-affirming" hormonal and surgical interventions as the preferred treatment for gender dysphoria in youth. /1
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The guidelines assert that based on current evidence, the risks of hormonal interventions outweigh the possible benefits. Thus, these interventions (often referred to as "gender-affirming care") will not be available outside of research settings, except as "last-resort." /4
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Research previewed at SEGM's 2023 conference, examining the relationship between youth gender dysphoria (GD) & suicide, has now been published. It concludes that the GD diagnosis doesn't predict suicide when co-occurring mental illness is accounted for. /1
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The largest Norwegian daily newspaper, Aftenposten, interviewed the UKOM project leader, Stine Marit Moen. The links to the interview, the executive summary, and the full report are are provided below. /13
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The guidelines highlight the unexplained rapid rise in trans identification in youth, especially teenage girls. They also note the worrying rise of detransitioners & regretters, which contradicts prior estimates of "low regret." They cite Littman 2021. /6
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@WHO
responded to public concern by extending comment deadline to Feb 2. WHO also clarified that it won't make any recommendations for children & adolescents due to limited evidence regarding long-term outcomes of affirmative care for youth.
More below:
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SEGM will be analyzing the report in more detail. Currently, our assessment is that the UKOM report is akin to UK's Cass Review in that it makes recommendations for restructuring youth gender services. How Norway's NHS will implement these recommendations remains to be seen. /12
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Yesterday, the Swedish Board of Health and Welfare published new treatment guidelines for youth with gender dysphoria. The guidelines explicitly instruct medical providers that psychosocial support should be the first line of treatment. /1
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Yesterday, the UK shut down the world's biggest pediatric clinic, GIDS. The reasons for the shut-down were not mere operational failures. The entire model of care provided by GIDS, "gender-affirming care," was deemed unsafe for gender dysphoric youth. /1
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A new peer-reviewed commentary argues that the medical community has a professional responsibility to recognize detransitioners as survivors of iatrogenic harm and provide them with the comprehensive medical and supportive care that they deserve. /1
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The claim that youth whose breasts are removed "can always get them later" contributes to the U.S. gender medicine establishment's promotion of mastectomies for minors 12-13+. However, the surgical technique in masculinizing mastectomy makes reversals unfeasible in most cases. /1
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The
@AAPPres
states that the vast majority of gender dysphoric youth need "just the opposite" of hormones & surgery. We call on the
@AmerAcadPeds
to update its guidelines accordingly & articulate the alternative treatment paths including the role of exploratory psychotherapy. /2
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Our recent Spotlight highlights a study from Finland, which convincingly demonstrates that suicides are uncommon in gender-dysphoric youth. The study demonstrates why youth gender transitions can’t be justified by the “suicide-prevention” argument./1
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The BBC investigated the source of the myth that the Cass Report "ignored 98% of the evidence".
Dr. Cass is clear: "Adults who deliberately spread misinformation about this topic are putting young people at risk, and in my view, that is unforgivable."
…
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Sweden is centralizing its gender care for minors to a few centers for highly specialized care. Individual clinics and private providers will not be allowed to provide "gender-affirming" services. /8
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The wave of teens seeking gender transition in the UK continues to grow. According to the most recent data released by
#GIDS
and its new referral service, after a COVID dip, referrals doubled 2021-22, for a total of 5,000+ referrals. Teen girls continue to dominate this trend. /1
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Sweden is realigning with the classic “Dutch Protocol” model, where only early childhood-onset gender dysphoria cases will be considered for hormones and surgeries. Those with post-puberty onset of trans identity will not be candidates for hormones/surgeries as minors. /5
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Florida's Boards of Medicine & Osteopathic Medicine voted to no longer allow new medical gender transitions in <18 in general medical settings (but allowed minors already in treatment to proceed with hormones). Poor quality of evidence was the stated basis for the new ban. /1
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The World Health Organization has announced the complete panel developing transgender health guidelines in 2024. The panel's unmanaged conflicts of interest will undermine the guidelines' credibility. Public comment deadline (hiv-aids
@who
.int) is Jan 8. /1
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A recent large-sample study (n=237) of detransitioners highlights their experiences and unmet mental and physical healthcare needs. On average, detransition occurred at age 23 (30 for males), about 5 years after the transition was initiated. /1
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By 2016, the UK gender clinic had enough outcome data to observe two problematic results. Contrary to the expectation, the kids were NOT doing better psychologically on puberty blockers, and some even got worse. These data remained unpublished for 5 years, as more and more…
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Suppressing puberty in gender-dysphoric children by administering puberty blockers entails several known risks including decreased bone density. A new study found that after 2 years on GnRHas, up to 1/3 of the children have abnormally low bone density. /1
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The guidelines also note the lack of knowledge about how to treat "non-binary" youth (the predominant presentation today). They assert that access to medical interventions should be based on the presence of gender dysphoria, rather than the presense of a transgender identity. /7
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A new publication concludes that puberty blockers for gender dysphoria undermine a child’s right to an open future, a bioethics principle stating that children must be protected from exercising certain rights to exercise these rights as autonomous adults./1…
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The rapidly rising rates of gender dysphoria complicated by mental illness are ubiquitous in the Western world. We call on the
@AmerAcadPeds
to work with UK, Finland & Sweden to impartially review the evidence and articulate treatment approaches that safeguard youth from harm./3
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A new article by The Economist explains England's move away from the affirmative care model, "which accepts patients’ self-diagnosis as the starting-point for treatment." As England is "tiptoeing away from a medical scandal," the U.S. is doubling-down. /1
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Gender dysphoria sufferers need sound evidence to guide life-changing decisions. So a study that "lends support to the decision to provide gender-affirming surgeries" could have big clinical implications. But now, a review of it has "demonstrated no advantage of surgery”.
>>
This first total population study of
#transgender
individuals diagnosed with gender dysphoria lends support to the decision to provide gender-affirming surgeries to those who seek them.
@SBS_Yale
@YaleSPH
@karolinskainst
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Dr. Bradley, a child psychiatrist & founder of Canada's first youth gender clinic, has published a commentary raising grave concerns regarding the practice of "gender-affirmation" for young females with high functioning autism-spectrum disorders (ASD). /1
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The British Medical Journal
@bmj_latest
released a vitally-important analysis of the state of pediatric gender medicine, concluding that the practice of youth gender transitions cannot be considered "evidence-based." Our analysis will be posted shortly.
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The guidelines express concern that little advance in quality knowledge has occurred since "gender-affirming" interventions were first recommended in Sweden in 2015, and that generally, little is known about how to best care for gender-dysphoric youth. /9
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According to the NHS England's final interim specifications for treating gender dysphoric (GD) youth, published earlier today, the primary intervention for GD children & young people <18 will be psychosocial & psychological support and intervention. /1
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The Dutch studies reported only the best-case scenario outcomes while ignoring the serious risks that emerged; wrongly concluded that gender dysphoria "disappeared" post-treatment; and failed to separate the effects of psychotherapy from those of blockers, hormones &surgery. /2
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The Cass Review, tasked with evaluating England's pediatric gender identity services, has issued its interim report. The Review expresses the concern that puberty blockers and hormones may not be the best approach for all desiring these interventions. /1
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The debate over the practice of youth gender reassignment has reached the Netherlands, the birthplace of the Dutch Protocol. Our spotlight profiles the latest medical, legal & cultural Dutch debates. The significance of this debate cannot be overstated./1
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A new peer-reviewed publication questions to what extent the small and highly uncertain benefits of "gender-affirming" hormones and surgeries, reported by some recent research from pediatric gender clinics, are further weakened by the "placebo effect."/1
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Earlier this week, two new systematic reviews of puberty blockers and cross-sex hormones were published. They were commissioned by NHS England, as part of a review of gender dysphoria healthcare led by Dr Hilary Cass. These reviews make sober reading. /1
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The statement notes that the rise in trans identity in youth may be in part due to excessive reliance on social media and "the questioning of an overly dichotomous view of gender identity by some young people." /2
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In Sweden, Part IV of the ground-breaking "Trans Train" movie has just aired. This segment focuses on the negative effect of puberty suppression on bone health, profiling an 11-year-old Leo, who developed pain and was diagnosed with osteopenia. /1
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"Extraordinary claims demand extraordinary evidence" wrote Prof. Baxendale in a piece describing her research. "The only extraordinary evidence here is the gaping chasm of knowledge, or even apparent curiosity, of the clinicians who continue to chant 'safe and completely…
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SEGM will be undertaking an analysis of Sweden's new guidelines, which we will share at a later date. Below is a summary of our initial take-aways and observations. /2
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The press release states,"great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological," and points to risks for bone health, sterility, emotional and intellectual consequences and, for females, menopause-like symptoms./3
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The National Academy of Medicine of France cautions parents of gender-dysphoric youth to "remain vigilant" regarding the addictive role of social media and its negative influence on psychological development in general, and on the onset of gender-related distress in particular./5
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At the same time as youth gender transitions became widely available, the numbers of referred gender distressed youth began to rapidly grow. Unexpectedly, the profile shifted from mostly young boys, to mostly adolescent females with serious mental health problems.
It was clear…
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Last week, child & adolescent physician Dr. McNamara pledged in front of Florida’s Medical Board to provide a “truthful account" of pediatric gender medicine. She then falsely claimed that a key evidence report the Board relied on was invalid, as it was written by a "dentist.” /1
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We are disappointed by AAP's decision to disallow our booth at the upcoming AAP conference in October 2021. Our appeal was also rejected with no explanation. The politicization of gender medicine is jeopardizing the long-term health of gender diverse youth.
A worldwide debate on pediatric gender medicine isn't happening in U.S. medical institutions.
American medical organizations are too busy muzzling it.
My piece in the
@WSJopinion
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By design, the study’s outcomes were reported only for those who had good outcomes. Those who had less-positive outcomes or developed serious problems during treatment were either not included or reclassified as “nonparticipants” (such as 3 cases of obesity/diabetes & 1 death)./3
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Gender dysphoric youth have high rates of psychiatric comorbidity. Discrimination and prejudice have been posited as the primary explanations for this link.
The results of a new study challenge this theory, suggesting a much more complex relationship. /1
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Also, nearly all treated with puberty blockers proceeded to cross-sex hormones. Rather than providing “time to think,” they were cementing a desire to transition. As Dr. Hutchinson put it, “What are the chances if 100% of people offered time to think, thinking the same thing”?…
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The Journal for Infant, Child, and Adolescent Psychotherapy has published a paper by Dr. David Schwartz. Dr. Schwartz, a psychologist, argues that psychotherapy, rather than hormones and surgery, should be first-line treatment for gender dysphoric youth./1
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"For me it began with a graph. In 2017, I was shown a chart of children referred to GIDS..."
These are the opening lines of UK’s The Times Magazine Special Report, “What went wrong at the Tavistock clinic for trans teenagers?”available on our site. /1
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Due to growing numbers of gender-dysphoric youth, the National Academy of Medicine in France recommends extensive psychological evaluations, a multi-disciplinary approach to the decision to treat medically, and calls for studies of both medical as well as ethical implications./4
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Another key lesson from the UK is about powerful special interest groups exerting influence on clinical practice. In the UK, one of such groups which strongly pushed for wide availability of youth transitions is
@Mermaids_Gender
. Similar activist groups are currently exerting…
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The UK High Court rules that
#PubertyBlockers
for normally-timed puberty are experimental and that young gender-dysphoric people (under 16) are unlikely to be able to provide meaningful informed consent.
Read SEGM's full statement below:
#KeiraBell
/1
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Have hormones been proven safe & effective for gender dysphoric (GD) youth? Is transition regret so rare that it is negligible? When a recent editorial by
@TheLancet
made these claims, scientific debate ensued, revealing that the science is not settled./1
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Dr. Vankrunkelsven said that despite some "good elements" in the WPATH guidelines, its recommendation for puberty blockers is not evidence-based. He added, "if we had to review [the WPATH guidelines] at CEBAM, we would actually toss them in the bin." /2
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WPATH now admits that "gender affirmation" of youth has been rejected by England. Medical societies must ask: Who is guided by evidence? WPATH, which insists a systematic review of evidence (SR) is not possible? Or public health authorities who completed SRs & reversed course? /6
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A new peer-reviewed article, “Transition Regret and Detransition: Meaning and Uncertainties" reviews clinical and research issues related to transition regret and detransition.
SEGM's spotlight of the article is at the link below:
The author notes that…
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The year 2020 has been a pivotal one in the field of gender medicine. It highlighted the risks, uncertainties, and experimental nature of current approaches to treating gender dysphoria in young people. Please read SEGM's overview of these key events.
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The studies' only clinically significant outcome was resolution of gender dysphoria (GD), but it's invalid. It came from switching the scale version from "female" to "male" (& vice versa) posttreatment, mathematically guaranteeing a "drop" in GD independent of any treatment. /4
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Activist pressures in the UK also prevented clinicians from documenting negative outcomes of puberty blockers. The fact that puberty blockers were not working as a pause button (but rather, a gas pedal for transition), and the fact that 80% of boys would have insufficient penile…
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A new German study adds to the growing international consensus that medical gender transition of youth has "conceptual and methodological" problems, should be restricted to research settings, and that therapy is beneficial. The supplement is in English.
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Canada's public broadcaster aired a new documentary, Trans Express, underscoring the growing international concern with the practice of youth gender transitions. SEGM's NYC 2023 conference was profiled. /1
Full documentary (in French):
Synopsis (in…
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Once the data were finally published in 2021 (with an additional re-analysis in 2023), the findings were troubling. Overall the youth did not get better (and ⅓ got worse). Of note, the same 2021 study showed a negative impact on bone development, which was dismissed as merely an…
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A new commentary from Sweden raises serious concerns about the effects of puberty blockers on a child's brain. Dr. Landén, Sweden's gender medicine expert, calls for research "using the same rigorous criteria as other medical treatments" to avoid harm.
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This week, England prepares for the release of the final Cass review, with the rest of the world watching. The final details of the Cass recommendations are not yet known. Nor is it known whether and how NHS England will follow these recommendations. But one thing is clear.…
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The Gender Medicine establishment, led by U.S.-based WPATH, has finally acknowledged the roll-back of "gender-affirmative" approach to gender dysphoric youth in England. This follows months of first ignoring, and then denying the extent of the changes. /1
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This story on puberty blockers by the
@nytimes
is yet another sign that a rational debate about "gender-affirming care" for gender dysphoric minors has begun. SEGM was among the first to voice concerns, which are now being platformed by mainstream media./1
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What’s without doubt is that the world of pediatric gender medicine is currently engaged in one of the most problematic practices of our times: the near-certain sterilization of mentally troubled minors, performed under the banner of civil rights. /19
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Last month, the final draft of the German "Gender Incongruence and Gender Dysphoria in Childhood and Adolescence” guideline drew attention for the highly medicalization-focused nature of its recommendations.
In response, 15 professors from the German Society for Child and…
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