The “Gender-Affirming Care” Model Is Not Evidence-Based

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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.

• In 2024, 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.

• In February 2026, The American Society of Plastic Surgeons became the first major U.S. medical association to decisively break ranks, issuing a position statement recommending that "surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old,.” and stating, “ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.”  

• The United Kingdom, Sweden, Denmark, Finland, and other countries have restricted gender-affirming" interventions for minors, prioritizing evidence-based medicine.

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Doing No Harm?

 

Blockers, opposite-sex hormones, and surgeries strip children of developmentally appropriate identity exploration. Instead, such interventions  physically lock these children into conforming to outdated sex stereotypes of masculinity and femininity.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.

 

​Reality by the Numbers

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In the U.S., between 2019 and 2023, of procedures covered by insurance, 13,994 minors were provided with “gender-affirming care” interventions: 5,747 minors had related surgeries, and 8,579 minors received opposite-sex hormones and/or puberty blockers. 62,682 prescriptions for feminizing or masculinizing hormones were written for minors. This is a conservative estimate.

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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 medicalizing “gender distress/incongruence” in minors.)

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A May 2026 study, which analyzed data for about 80% of all insured Oregon residents aged 8 to 17 between 2016 and 2023, found that about 1 in 100 youth were diagnosed with gender dysphoria. Data showed a nearly 10-fold increase in females using testosterone—about 1 in 240 by age 17, and a 14-fold increase in boys using estrogen—about 1 in 630.

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Rising Regret

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Given the reckless approach to addressing what was clearly a social phenomenon, without curiosity or further examination, a corresponding rise in regret and detransition was easily predictable. Currently, very limited psychological or medical support is available for those struggling with regret. Patients encounter physicians who provide “gender-affirming” interventions but are unprepared for, and/or dismissive of, the needs of detransitioners. There are plans for a small handful of clinics specifically to provide this care, but as with the “gender-affirming” pathway, credible, long-term data for detransition interventions is lacking.

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The severe lack of data means our understanding of transition regret is extremely limited:

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• Clinics are not tracking long-term patient outcomes.

• There has been insufficient time to adequately assess the impacts on the new cohort receiving these interventions—regret and, to the degree possible, action to reverse the effects of the medical interventions can take decades to manifest. 

• Of patients surveyed, the vast majority did not inform their clinicians that they detransitioned or experienced regret.

• The detransition interventions patients receive cannot be tracked; although there are many ICD-10 codes for “gender-affirming care,” there are no ICD-10 codes for “detransition.”

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Increasing numbers of public accounts and lawsuits from the growing population of detransitioners indicate that early claims of low regret were inaccurate. The time from receiving interventions to experiencing regret can be a decade or more, limiting legal options for those harmed. However, with some states extending the statute of limitations for these interventions, more physicians may be held legally responsible for harm.

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An Ethical Crisis

 

Why do prominent U.S. medical organizations like the AAP, Endocrine Society, and the AMA continue to promote this unevidenced medical pathway?

 

• Are our medical institutions influenced by ideological bias?

• 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

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Reports and Evidence Reviews

 

Quality of the World Professional Association for Transgender Health Guideline Standards of Care 8: An Appraisal Using the AGREE II Instrument, Yuan Zhang et al., Archives of Sexual Behavior, February 2026.

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Treatment for Pediatric Gender Dysphoria Review of Evidence and Best Practices, Department of Health and Human Services, November 2025. 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. Read DIAG’s summary of the HHS Review.

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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 set 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 commented 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. Read DIAG’s summary of the Cass Review.

 

Related:

• “Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine,” New York Times, May 13, 2024

• The Evidence Was Disappointingly Poor, WBUR, video interview with Dr Hilary Cass, May 8, 2024

• ​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​​

 

A systematic review of hormone treatment for children with gender dysphoria and recommendations for research, Swedish National Board of Health and Welfare, February 2022

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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

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Position Statement on Gender Surgery for Children and Adolescents, American Society of Plastic Surgeons, February 2026

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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.

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“A Consensus-No-Longer," Leor Sapir, City Journal, 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," Jennifer Block, British Medical Journal, 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.

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“Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It,” Dr. Riittakerttu Kaltiala, The Free Press, October 30, 2023

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“Gender dysphoria in young people is rising—and so is professional disagreement," Jennifer Block, British Medical Journal, February 2023.

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​“The Cass Review Won't Fade Away,"Jesse Signal, The Dispatch, April 2024. How youth gender medicine broke almost every liberal institution it touched.

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​“Adolescent Onset Gender Dysphoria, Our Perspective,” Kristopher Kaliebe, MD and David Atkinson, MD, American Academy of Child and Adolescent Psychiatry News, (p. 16), November/December 2023.

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“Why is the U.S. still pretending we know gender-affirming care works?," Pamela Paul, New York Times, July 2024.

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“The mental health establishment is failing trans kids,” Laura Edwards-Leeper and Erica Anderson, Washington Post, November 2021.

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“A Reuters Special Report: Youth in Transition," Reuters, October 2022. An unflinching look at “gender-affirming” medical care for youth, concluding 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.

issues involved in “gender-affirming care” in minors.

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Videos

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We Were Told Transition Would Help - It Didn’t, Genspect panel with detransitioners, June 2026

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Testimony to the House Committee on Energy and Commerce, Dr. Miriam Grossman, June 2023

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Gender Clinics Are Harming Children, Jamie Reed, Genspect Bigger Picture Conference, Denver, December 2023

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Podcasts

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​Gender: A Wider Lens

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Beyond Gender

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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.

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The WPATH Files: Pseudoscientific Surgical and Hormonal Experiments on Children, Adolescents, and Vulnerable Adults, Mia Hughes, March 2024, documents that the purported world leaders in the field of “gender-affirming care” were (and are) aware of the risks and consent issues involved with “gender-affirming care.”

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