Change of guard

US pivots to trans regret; ethical doubts in Oz; embodiment blues; overlooked eunuchs; Lionel Shriver's advice; testosterone's untold damage; Dutch point the finger; charity drive for puberty blockers

Photo by Roberto Catarinicchia on Unsplash

GCN in brief

Standard uncertainty

America | The Trump administration has directed the National Institutes of Health (NIH) to focus on studies of regret after gender transition, according to a news report in the journal Nature. An email from then acting NIH director Matthew Memoli described the new priority as “regret and detransition following social transition as well as chemical and surgical mutilation of children and adults” and “outcomes from children who have undergone social transition and/or chemical and surgical mutilation.”

Asked about this, the US Department of Health and Human Services said: “NIH is prioritising research that serves the best interests of public health, not ideological agendas, and will continue to support studies that provide clear, objective data—particularly regarding the long-term effects of gender transitions.”

Some existing NIH grants relevant to paediatric gender medicine have been terminated—for example, a Boston Children’s Hospital study on “the effects of gender-affirming sex steroids on brain development in adolescents.”

Physician-scientist and health economist Jay Bhattacharya, the new NIH director, has said studies by his agency should report negative results, not just sought-after positive findings. In a Senate confirmation hearing last month Dr Bhattacharya was asked about a report in The New York Times that gender clinician Dr Johanna Olson-Kennedy had not published results of an NIH-funded study showing no improvement in children given puberty blockers because she was worried this result would embolden critics of “gender-affirming care.”

Dr Bhattacharya’s answer, reported by journalist Benjamin Ryan, was: “So, if the NIH funds a study that shows that the gender transition doesn’t reduce suicide rate among adolescents, there is an obligation to report, even though [Dr Olson-Kennedy] may think it’s politically inconvenient. So, I want to make sure that NIH research is required to report even negative results.”

Skip the trials

Australia | Brisbane psychiatrist Catherine Llewellyn has raised questions about the ethical foundation for the public youth gender clinic at the Queensland Children’s Hospital. In an interview with journalist Des Houghton in The Courier-Mail, Dr Llewellyn said: “I have not found any evidence the [hospital] ethics committee was involved in the establishment of the clinical pathway. The usual processes of medicine have not been followed.”

On Twitter/X, emeritus professor of law Patrick Parkinson said Queensland’s was “not the only state gender clinic [in Australia] to have developed a program of gender-affirming care without any proper ethics approval. Various state health departments could be exposed to massive legal liability.”

Dr Llewellyn said she had “significant worries” about the irreversible effects of puberty blockers and cross-sex hormones and the insufficient evidence to justify their use. “If you are going to give a treatment to a child with irreversible effects, the usual process is that you first examine that within clinical trials.”

Dr Llewellyn has published a 50-page analysis of the ethics, risks and unknowns arising from the gender medicalisation of minors, with a particular focus on the state of Queensland, where the use of blockers and hormones is under review. She has also called for the reinstatement of whistleblower psychiatrist Jillian Spencer, who went public with her concerns about the gender-affirming treatment model in Queensland in 2023.

Gender taboo

International | Social media use is associated with “specific mentalistic disorders characterised by symptoms of perturbed embodiment,” such as eating disorders and body dysmorphia, according to a new systematic review.

“Considering modern technological advances, the reflecting power of another person’s eyes is being replaced by the glow of smartphone screens displaying virtual faces and bodies,” the authors say. “For the first time in human evolutionary history, social interactions can thus be completely disembodied and dissociated from its physical, temporal, and tactile cues.” The paper does not mention gender distress.

Shifts in the concept of “gender identity” and the exponential increase in the atypical patient profile of teenage females call into question the relevance of gender dysphoria as a diagnosis, according to a recent paper from Belgian and French researchers including Céline Masson, a co-founder of the watchdog group The Little Mermaid.

“Could the recent increase in reports of ‘trans-identity’ be better understood as a cultural idiom of distress, perhaps reflecting a collective way of expressing the challenges associated with puberty and adolescence?” the paper says.

“[I]dentification with the signifier ‘trans’ appears to be more a process than a fixed identity in response to the distress these young people experience in the face of pubertal challenges.” Instead of the term gender dysphoria, clinicians of The Little Mermaid propose the clinical concept of Pubertal Sexuation Anxiety (Angoisse de Sexuation Pubertaire).

Eunuchs?

America | The former president of the World Professional Association for Transgender Health (WPATH), Dr Marci Bowers, who is a surgeon and a transwoman, has claimed in a court document not to have read the contentious “eunuch” chapter of the current standards of care (SOC-8) issued by WPATH, which recommends “castration to better align [male eunuchs’] bodies with their gender identity.”

WPATH, whose standards are reportedly followed by hospitals and clinicians around the globe, cited a “lack of research” as the reason for not offering treatment advice for “children who may identify as eunuchs.”

Do better

International | Expatriate American writer Lionel Shriver thinks an “underplayed” argument against the idea of identifying as the opposite sex is that it is “a terrible waste of time and resources and energy.” Speaking on the Beyond Gender podcast Ms Shriver says medicalised gender change “doesn’t work, it’s expensive, it’s painful, it’s destructive … all those doctors’ appointments, all those drugs, all that medicalisation of your life from this time forward, it’s a waste—and you could be doing something interesting.”

Damage incoming

United Kingdom | A GP (primary care doctor) working for the National Health Service (NHS) in the UK has written an anonymous letter explaining their decision not to take part in prescribing hormones and monitoring for trans-identified patients referred by activist-driven adult gender clinics. The letter, published by Nick Wallis’s Gender Blog, predicts that many more women will emerge in the next 5-10 years with adverse effects of testosterone, given to masculinise their bodies. “A female patient in her twenties on testosterone presented at my surgery with urinary incontinence and vaginal atrophy,” the GP writes.

“Vaginal atrophy occurs when the tissue in the wall of the vagina becomes thin and fragile, which can lead to pain and bleeding. The incontinence was caused by the effects of testosterone on the bladder and urethra—it was unable to function properly … The patient had not been told that hormone therapy could result in incontinence and vaginal atrophy. This made me question whether patients are giving informed consent. The patient had been lost to follow-up by her gender identity clinic, so I referred her back.”

In an updated position statement on the role of family doctors in “transgender care,” the UK’s Royal College of GPs welcomes the Cass review and advises its members to refer “children and young people” to specialist secondary services and not to prescribe cross-sex hormones to minors with gender issues. The college notes restrictions on puberty blockers in public and private health.

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Video: Zhenya Abbruzzese, of the Society for Evidence-based Gender Medicine, discusses the curious history of “sex changes”

Body of law

America | The US Supreme Court has agreed to hear a constitutional challenge to a state law in Colorado prohibiting “conversion therapy” for minors. The case involves a Christian counsellor Kaley Chiles who “believes clients can accept the bodies that God has given them and find peace.” She argues that the Colorado law against conversion of someone’s gender identity breaches her constitutional rights to free speech and free exercise of religion.

Her law firm Alliance Defending Freedom says Colorado’s statute “sends a clear message: the only option for children struggling with these issues is to give them dangerous and experimental drugs and surgery that will make them lifelong patients.”

In a friend-of-the-court brief, the Ethics and Public Policy Center (EPPC) argues that the Colorado law, which exempts gender transition from the ban on conversion, cannot be understood without analysis of its animating “gender-affirming” viewpoint.

The EPPC brief says: “Gender identity ‘conversion therapy’ laws effectively impose the gender-affirmative viewpoint—and the novel and faulty anthropology on which it is based—on all counsellors and their clients.” The EPPC says that because “gender identity, unlike sex, can change, counsellors should consider and respond to a client’s goals, including a client’s desire to explore change.” But Colorado’s “counselling restrictions exert a chilling effect on therapists, discouraging the careful psychological assessments and counselling that minors need.”

A new law in Kentucky allows counselling of a kind elsewhere prohibited as conversion therapy. The law defines a “protected counselling service” as “counselling, talk therapy, or other speech-based mental health service performed with the goal or purpose to relieve discomfort or distress caused by an individual’s sex or romantic or sexual attraction,” as long as it does not involve aversive treatment. The bill had been vetoed by Kentucky governor Andy Beshear, but the Republican-controlled legislature last month overrode his veto.

A Biden-era rule that made federal funding conditional on “gender affirmation” of children in state foster care has been set aside following court action by Texas Attorney-General Ken Paxton.

Not our fault

The Netherlands | The media outlet NRC has published a 10,000-word profile of the Amsterdam gender clinic famous for the puberty blocker-driven “Dutch protocol” of medical transition for minors. Under certain conditions, the journalists were allowed to interview clinicians, including key figures such as psychiatrist Annelou de Vries and psychologist Thomas Steensma.

The journalists were also able to sit in during appointments with young patients. Clinicians are portrayed as probing beneath gender distress for psychiatric issues requiring treatment before any gender transition.

Contradictory claims about puberty blockers emerge in the coverage. At one point, NRC’s readers are told blockers are meant to be a “pause button” affording the child “time to think about their desire to transition.” Then, it emerges that in 93 per cent of cases, this “thinking” leads to cross-sex hormones meant to be taken lifelong. A little further on, there is the stark admission that, “Not much is known about the effects of [blockers] on transgender young people … doctors do not know what the long-term effect will be on the bones or the brain.”

The coverage sketches in the background of intensifying scrutiny of the Dutch protocol both domestically and abroad. Dr de Vries defends her pivotal research as “not bad,” and puts the onus on overseas clinics adopting the Dutch protocol to validate the treatment approach with their own studies. “I mean, one positive [Dutch] study is not proof that the same approach works all over the world; I understand why [Dr Hilary] Cass is critical of that,” she says.

Dr Steensma also suggests that harsher scrutiny of the Dutch protocol reflects trends overseas, not the reality of practice in Amsterdam. “In America, thousands of young people have been treated, but hardly any follow-up studies have been published,” he says. “They were real cowboys.”

A study involving both Drs Steensma and de Vries, covering the first 20 years of the Dutch protocol (1997-2018), reported that 63 per cent of children potentially eligible for puberty blockers had started them by 2018.

No more experiments

United Kingdom | Conservative MP Saqib Bhatti has urged the UK Labour government to complete the “data linkage study” proposed by Dr Cass in her review, rather than go ahead with a clinical trial of puberty blockers. The linkage study was to check the adult gender clinic outcomes of former patients of the Tavistock paediatric clinic, including an estimated 2,000 children given blockers. Most of the NHS adult clinics refused access to the data.

In his letter to Women and Equalities Minister Bridget Phillipson, Mr Bhatti says: “The idea that the NHS now conducts a medical experiment on a further cohort of vulnerable children is reprehensible, and ethically and medically unjustifiable, when there is an existing large cohort of children who used puberty blockers, and a better available pathway [via the linkage study] to understanding their full impact on vulnerable young people.”

The British Medical Journal reported last month that the NHS still hoped the data linkage study would go ahead; “refreshed research approval” was being sought. The BMJ also quoted clinical psychologist Dr Anna Hutchinson, who was a Tavistock clinic whistleblower, as saying she would not want to be involved in a clinical trial of blockers.

“The Cass review made it clear that there is no predictive validity to a diagnosis of trans identity,” she says. “It’s a gamble and one I’m not prepared to take. There’s a difference between putting a child on CBT [cognitive behavioural therapy] or not and putting them on an experimental medical pathway that is likely to lead to major surgery.”

Another ex-clinician from the Tavistock gender clinic, Anastassis Spiliadis, says: “NHS England should be encouraging research into different psychotherapeutic interventions, including psychoanalysis, family therapy, and CBT, and be working to support the desperate need for more trained clinicians.”

In an interview with The Times, philosopher Kathleen Stock has also expressed opposition to the proposed clinical trial of puberty blockers, saying, “It’s like asking whether there should be controlled research on trepanning [drilling a hole in the skull to expose the brain]. There’s animal trials you can do that don’t involve experiments on live adolescents.”

Bad reaction

America | Clinical psychologist Erica Anderson, a gender clinician and transwoman, says she is “appalled” by the way in which some progressive states in the US are “doubling down” on paediatric gender medicine and dismissing the more cautious treatment approach of some European countries inspired by systematic reviews of the (weak and uncertain) evidence base.

In an interview with NPR Boston, Dr Anderson says: “The hallmark of clinical psychology is evaluation prior to treatment, and that’s been something of a battle cry for me in the USA, where it seems to me that too many providers are ignoring the time-honoured practice of doing a thorough, comprehensive, individualised evaluation. And when we do [such evaluation], what we find is that many of these young people have other issues [such as mental health problems] going on with them, some of which should, in my opinion, take priority [over gender transition], and in my practice, they do.”

Real data only, please

International | A new method for excluding fraudulent, bot-driven or scam responses to detransition surveys has been trialled, resulting in almost 70 per cent of 1,377 responses being deemed eligible. Trans activist sabotage of detransition research is a problem.

Crowd-funded blockers

Australia | Gender medicine lobby the Australian Professional Association for Trans Health (AusPATH), which has reportedly raised almost $100,000 to pay for private hormonal treatment of gender-distressed minors during a pause in public treatment in the state of Queensland, has issued an application form for parents seeking this financial assistance with a doctor’s support.

The pause in new treatment with puberty blockers and cross-sex hormones in public health is a safety measure, pending an independent review to report by November 30. Puberty blockers cost about $3,000 a year with a private prescription; they have been subsidised in public health.

The AusPATH financial assistance form seeks the date of the child’s last appointment (if any) with the public Queensland Children’s Gender Service and whether the child is judged competent to give informed consent to treatment. The doctor is to sign below the statement, “I confirm that the young person named above is in need of gender-affirming healthcare and that due to financial hardship [is] not able to seek treatment without assistance.”

The AusPATH fund-raising campaign is called “Project 491,” reflecting the number of children reportedly on the waiting list for the public gender service at the Queensland Children’s Hospital.

In 2024, the service accepted 334 new referrals, started 23 patients on blockers and 85 on cross-sex hormones, according to new data obtained under Right to Information law. In 2023, 172 patients were begun on blockers. The service was under government-commissioned evaluation in 2024.