INFORMATION FOR PHYSICIANS
Since 2010 clinicians have witnessed an exponential increase in adolescent females expressing distress over their sexed bodies and seeking medical interventions to masculinize their bodies. The number of adolescent male patients has also dramatically increased. This rise was common across Western countries and remains poorly researched and poorly understood. The vast majority from this new cohort have co-occurring mental health issues, with an over-representation of those with neurodevelopmental conditions, like ASD and ADHD.​
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Sex ratio in children and adolescents referred to GIDS in the UK (2009-16)
*Indicates p< .05 which shows a significant increase of referrals compared to previous year
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Source: Figure adapted from de Graaf, N. M., Giovanardi, G., Zitz, C., & Carmichael, P. (2018).
The SEGM CME courses have been suspended pending investigation as a response to activist demands. For more information, read their statement and Ben Ryan's article in the NY Sun.
Free CME Courses
International Perspectives on Evidence-Based Treatment for Gender Dysphoric Youth. Earn up to 5.5 hours of AMA PRA Category 1 credits with this CME series led by prominent clinical experts and researchers in pediatric gender medicine and related fields. Courses cover the significant shifts in international consensus on the benefits, risks, and ethical considerations of medical interventions for gender-dysphoric and gender-questioning youth. The series aims to support informed clinical decision-making that prioritizes patient safety and informed consent.
Despite obvious ethical concerns—the inability for patients to consent to interventions; introduction of illness in otherwise healthy bodies; a lack of quality supporting evidence; and no coherent assessment protocol—clinics in Europe and the U.S. moved rapidly to provide puberty blockers, opposite-sex hormones, and “gender affirming” surgeries to youth. A corresponding rise in regret and detransition was easily predictable.
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Our understanding of transition regret is limited:
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Clinics are not tracking long-term patient outcomes.
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There has been insufficient time to assess the impacts on the new cohort receiving these interventions.
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Many patients do not inform their clinicians if they detransition or experience regret.
However, increasing numbers of public accounts and lawsuits from the growing population of detransitioners indicate that early claims of low regret were inaccurate. With some states extending the statute of limitations on these interventions, physicians may be held legally responsible for the harm.
Children Cannot Consent to Irreversible Medical Interventions
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Children cannot consent to halting their puberty.
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Children cannot consent to sterilization or loss of fertility.
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Children cannot consent to surgical removal of healthy body parts.
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Reality by the Numbers
In the U.S., between 2019 and 2023, 13,994 minors underwent sex trait modification treatments, 5,747 minors had related surgeries, and 8,579 minors received opposite-sex hormones and/or puberty blockers. 62,682 “gender” related prescriptions were written for minors.
In a second investigation into pediatric patient numbers, Reuters found an increase from 15,172 new diagnoses in 2017 to 42,167 in 2021 in youth ages 6-17. (Neither analysis includes patient data from Kaiser Permanente—one of the most aggressive hospital systems in terms of medicalizing “gender distress” in minors.)
Doing No Harm?
Blockers, opposite-sex hormones, and surgeries strip children of developmentally appropriate identity exploration. Instead, they are physically locked into conforming to outdated sex stereotypes of masculinity and femininity.
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Presented with a false ultimatum—pursue “gender-affirming care” or risk suicide—families are coerced into consenting to these interventions. The suicide risk claim is unsupported by credible data. Furthermore, recent evidence suggests that individuals face a high suicide risk after gender-affirming interventions.
The “Gender-Affirming Care” Model is Not Evidence-Based
Despite claims from the American Academy of Pediatrics, no consensus exists on the safety or efficacy of this model of care, and multiple systematic evidence reviews validate concerns about the low and very low quality basis for these interventions.
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In 2024, the World Health Organization acknowledged insufficient evidence to support “gender-affirming care” for minors and excluded it from future guidance.
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The European Society for Child and Adolescent Psychiatry, an umbrella association of child and adolescent psychiatry societies from over 30 countries, issued an urgent call for safeguards and a re-evaluation of these experimental treatments due to potential harms.
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The American Society of Plastic Surgeons “has not endorsed any organization's practice recommendations for the treatment of adolescents with gender dysphoria.”
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The United Kingdom, Sweden, Denmark, Finland, and other countries have restricted, gender-affirming" interventions for minors, prioritizing evidence-based medicine.
An Ethical Crisis
Why do prominent US medical organizations like the AAP and the Endocrine Society lag behind?
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Are our medical institutions influenced by ideological bias?
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Have resources been diverted to prioritize unproven practices over objective science?
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An affirmative answer to either question signals an ethical crisis in pediatric medicine. Physicians must demand rigorous, evidence-based standards to protect children from irreversible harm.
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RESOURCES
Reports and Evidence Reviews
The Cass Review. Published on April 10, 2024, this independent review, commissioned by England’s National Health Service describes the fate of young people seeking support for gender distress from 2015 to 2020. It sets out a recommended clinical approach to the care they should expect, the interventions that should be available, and how services should be organized. It also comments on quality improvement and research infrastructure required to ensure evidence-based care. Dr. Hillary Cass is a leading U.K. pediatrician, and the report has been widely praised for its impartiality and thoroughness.
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Related:
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“Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine,” New York Times, May 13, 2024
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The Evidence Was Disappointingly Poor, WBUR. Full Video Interview with Dr Hilary Cass, May 8, 2024
This review of evidence and best practices was commissioned pursuant to Executive Order 14187, signed on January 28, 2025. It is not a clinical practice guideline, and it does not issue legislative or policy recommendations. Rather, it seeks to provide the most accurate and current information available regarding the evidence base for the treatment of gender dysphoria in this population, the state of the relevant medical field in the United States, and the ethical considerations associated with the treatments offered.
Evidence review: Gonadotrophin releasing hormone analogues for children and adolescents with gender dysphoria, U.K. National Institute for Health and Care Excellence, 2020.
Evidence review: Gender-affirming hormones for children and adolescents with gender dysphoria, U.K. National Institute for Health and Care Excellence, 2020.
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A systematic review of hormone treatment for children with gender dysphoria and recommendations for research, Swedish National Board of Health and Welfare, February 2022.
Recommendation of the Council for Choices in Health Care in Finland, PALKO / COHERE Finland, 2020
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Mastectomy for individuals with gender dysphoria below 26 years of age: A systematic review and meta-analysis, Plastic and Reconstructive Surgery, June 2025
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Pediatric Gender Affirming Care is Not Evidence-based, Current Sexual Health Reports, Kathleen McDeavitt et al., May 2025. This paper reviews outcomes for risks and benefits of puberty blockers and gender-affirming hormones for pediatric gender dysphoria or gender-related distress.
Articles
“The Chen 2023 Paper Raises Serious Concerns About Pediatric Gender Medicine Outcomes," discussion of Psychosocial Functioning in Transgender Youth after 2 Years of Hormones, New England Journal of Medicine, Chen et al., January 2023.
“A Consensus-No-Longer," City Journal, Leor Sapir, August 2024. The American Society of Plastic Surgeons becomes the first major medical association to challenge the consensus of “gender-affirming care” for minors.
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“Dispute arises over World Professional Association for Transgender Health’s involvement in WHO’s trans health guideline," British Medical Journal, Jennifer Block, October 2024.
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“Research Into Trans Medicine Has Been Manipulated,"The Economist, June 2024. Court documents from a case in Alabama reveal that WPATH exerted undue influence over the independent systematic reviews it commissioned from Johns Hopkins University, potentially undermining the credibility of its findings.
“Gender dysphoria in young people is rising—and so is professional disagreement," British Medical Journal, Jennifer Block, February 2023.
“Gender-Affirming Care is Dangerous. I know Because I Pioneered It." The Free Press, Riittakerttu Kaltiala, October 2023.
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“The Cass Review Won't Fade Away,"The Dispatch, Jesse Signal, April 2024. How youth gender medicine broke almost every liberal institution it touched.
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“Adolescent Onset Gender Dysphoria, Our Perspective,” American Academy of Child and Adolescent Psychiatry News, Kristopher Kaliebe, MD and David Atkinson, MD (p. 16), November/December 2023.
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The WPATH Files show that leaders are aware of the risks and consent issues involved in “gender-affirming care” in minors.
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“Why is the U.S. still pretending we know gender-affirming care works?," New York Times, July 2024, Pamela Paul.
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“The mental health establishment is failing trans kids,” Washington Post, 2021, Laura Edwards-Leeper and Erica Anderson.
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“A Reuters Special Report: Youth in Transition," Reuters, October 2022. Reuters takes an unflinching look at the newly emerging—and controversial—field of gender-affirming medical care for youths, and it finds that the soaring number of patients has added urgency to questions about the safety and long-term success of treatment and whether it's appropriate for all the children now receiving it.
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Videos
Genspect’s Detrans Awareness Days. Webinars in which detransitioners speak about what led to their transitions, what they’ve learned about the gender healthcare industry, and about what they believe doctors, therapists, and everyone else needs to know.
Dr. Miriam Grossman's Testimony House Committee on Energy and Commerce, June 2023.
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Gender Clinics Are Harming Children, Jamie Reed, Genspect Bigger Picture Conference, Denver 2023
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Podcasts
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Miscellaneous
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R/Detrans - Detransition Subreddit. A members-only Subreddit for detransitioners, desisters, and self-questioners with some medical or legal professionals allowed and over 55,000 members.