Detrans horizon

Norwegian regret; US school secrecy; South Africa under analysis; Trump's systematic review; NHS alert; no-clue Kiwi health chiefs; Joyce choice; Strum Down Under; retracting an Oz suicide scare

GCN in brief

Unexplained deaths

Norway | Almost 40 per cent of the female patients who were under age 18 when referred to Norway’s national gender clinic from 2000 to 2020 went on to have mastectomies as adults (338/861 or 39.3 per cent), according to an analysis of “treatment trajectories.”

Of the 1,258 patients of both sexes referred over that period, 11 (0.9 per cent) were registered as dead by the end of 2023; the registry did not record the cause of death.

Of 783 patients who began cross-sex hormones as minors at the Oslo University Hospital-located clinic, 18 females (2.3 per cent) detransitioned, stopping testosterone. The paper acknowledges uncertainty about detransition rates in the scientific literature, with estimates ranging from less than one per cent to almost 30 per cent “depending on definitions.”

“Our detransitioning numbers [at Norway’s specialist national clinic] could potentially be the beginning of an increase in persons transitioning back to their birth-assigned gender,” the analysis says.

“Indeed, among [females] started on [testosterone] in 2018, one in ten have stopped gender-affirming medical treatment and are followed by the adult gender team supporting them in coping with the irreversible changes resulting from testosterone treatment.

“It is worth noting that even with close collaboration and a follow-up programme at the adult team, persons discontinuing medical treatment might be lost to follow-up. A recently published Finnish study using national health registers found a 7.9 per cent discontinuation rate of [cross-sex hormones], underscoring the possibility of our detransition numbers being an underestimate.”

Age of initiation for puberty blockers over the 20-year period ranged from 10 to 16 years old (with a mean of 12.6). Mean age at referral for all 1,258 patients was 14.4 years old, with a much higher proportion starting cross-sex hormones (62.2 per cent) than blockers (10.7 per cent).

“We found a reduction in the use of GnRHa [puberty blockers] in recent years. Reduction in treatment could be the result of a more restrained clinical practice in Norway following increased concern regarding the risk/benefit within part of the medical community.” In 2023, the Norwegian Healthcare Investigation Board declared gender medicalisation of minors to be “experimental.”

No secrets

America | The Trump administration’s Department of Education has launched an investigation of California’s Department of Education for alleged breaches of the federal Family Educational Rights and Privacy Act (FERPA), which gives parents the right to access their children’s education data.

The target of the probe is a California law that prohibits school personnel from disclosing a child’s “gender identity” to that child’s parent.

US Secretary of Education Linda McMahon said: “Teachers and school counsellors should not be in the business of advising minors entrusted to their care on consequential decisions about their sexual identity and mental health. That responsibility and privilege lies with a parent or trusted loved one.”

Thomas More Society, a law firm representing teachers and parents opposed to California policies mandating secrecy on gender identity, welcomed last month’s federal intervention.

Also last month, chief state school officers and superintendents across the country were sent a letter from the US Department of Education warning them against breaches of FERPA arising from gender identity secrecy provisions.

The letter is critical of the practice of local school authorities whereby “gender plans” are created for a child, kept in a separate file and deemed not part of the official student record in order to frustrate the parental right to inspect their children’s education data.

Do better

South Africa | The endorsement of gender-affirming care by the South African Society of Psychiatrists (SASOP) ignores England’s Cass review and other recent international evidence leading to more cautious treatment policy in various jurisdictions, according to a scientific letter published in the South African Journal of Psychiatry and urging a rigorous review of the SASOP position statement.

The letter from general practitioner Dr Allan Donkin and two medical colleagues says the SASOP statement uses the device of circular referencing criticised by Dr Hilary Cass. The statement was devised by a “special interest group” within SASOP and failed to use a best-practice development tool such as the Appraisal of Guidelines for Research & Evaluation (AGREE) Instrument.

The letter from the three doctors affiliated with the group First Do No Harm Southern Africa says the SASOP position makes no mention of alternative treatment such as “neutral exploratory psychotherapy” and is silent on “a child’s right to an open future.”

“This ethical principle states that children have the right to have their future life choices kept open until they reach adulthood, so they can exercise them in the future as autonomous adults.”

Gambling with reproduction

International | A new Frontiers in Endocrinology paper scrutinises the ethics and the unknowns of offering fertility preservation options to transgender-identifying children given early puberty blockers to be followed by cross-sex hormones.

Endocrinologist Dr Michael Laidlaw and co-authors note that even parents of children who are receiving necessary but “gonadotoxic” treatment for cancer may struggle to understand the information given during fertility preservation counselling.

“Therefore, it would seem even more concerning in [fertility counselling] for trans-identifying children and adolescents, given the relatively unknown repercussions of combining GnRHa [puberty blockers], cross-sex hormones, and potential surgeries,” the authors say.

“How could an eleven-year-old natal female child understand the ramifications of a uterus exposed to [puberty blockers], followed by supraphysiologic doses of testosterone, and the risks that this could have to gestation in adulthood? We currently have no information regarding pregnancy outcomes in patients exposed to this regimen.”

As for boys, “Testicular tissue cryopreservation for the prepubertal and early pubertal stage male remains experimental.”

The paper notes that the doses of cross-sex hormones given to trans-identifying patients “are very high, on the order of 6-100 times above the normal reference range.”

Wig and gown

The UK Supreme Court has ruled that under the 2010 Equality Act, the term woman means a biological woman, not a male with a certificate that “recognises” him as a woman, and that sex is binary. The biologist Richard Dawkins welcomed the decision, saying—“Yes, the science was settled in the Precambrian. Nice that the law has finally caught up.”

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Video: Appearing before the US House Judiciary on April 9, Texas whistleblower surgeon Eithan Haim tells his story (from 51:25m). He refers to HIPAA, a federal privacy law; TCH, the Texas Children’s Hospital; and Baylor, the college of medicine affiliated with the hospital

More bad news for WPATH

America | A systematic review of the evidence for treating gender dysphoric minors is expected to be published by the US Secretary of Health and Human Services (HHS) by April 28, according to the group Genspect.

President Trump’s January 28 executive order instructed the HHS secretary to “publish a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria” within 90 days.

Genspect’s Stella O’Malley and Amanda Miller argue that this systematic review might prove a mortal blow to the World Professional Association for Transgender Health (WPATH), which promotes paediatric gender medicalisation.

“While funding restrictions may shift with each administration, this systematic review represents something far more enduring: a rigorous, government-led scientific assessment,” they write.

“It will expose the hollow core of WPATH’s recommendations—already criticised by many analysts of the gender-affirming care approach, but this time the critique will carry the authority of the HHS.”

Gay parallel doesn’t play

Australia | Dr Philip Morris, president of Australia’s National Association of Practising Psychiatrists (NAPP), has highlighted an ethical dilemma in the idea that medicalised trans identity is on a path of depathologisation akin to the history of homosexuality, which was once a psychiatric diagnosis.

In a seminar last month at NSW Parliament House in Sydney, Dr Morris said—

“Homosexual orientation does not require medical intervention. A pressing question now emerges: if transgender identity is to be regarded as a normal variant, does it necessitate medical intervention, particularly when such interventions carry significant risks? Yet transgender advocates demand medical interventions to make trans individuals feel more comfortable with their chosen gender.

“The ethical framework guiding medical decision-making emphasises non-maleficence—First, do no harm—and beneficence, whereby doctors act in the best interests of the patient. In the context of youth gender medicine, this requires meticulous assessment to avoid unnecessary or harmful interventions.

“Legal precedent underscores the importance of proportionate and appropriate treatment. [The courts] have articulated that diagnoses must result from proper assessment, and legitimate treatments must be directed at established pathology or psychiatric disorder and must be both therapeutic and proportionate to their intended purpose.

“Applying these principles to gender medicine demands a clear diagnosis, consideration of differential diagnoses, and a careful weighing of anticipated benefits against potential adverse effects.”

The NAPP has elaborated a guide to managing gender distress in minors, hosted a webinar with Dr Cass, and is offering free access to the proceedings of last month’s Parliament House seminar on the Future of Youth Gender Medicine featuring psychiatric, psychological, medical and legal commentary.

Doctors beware

United Kingdom | General practitioners (GPs) have been warned not to become entangled with unregulated medical providers of puberty blockers or cross-sex hormones for gender-distressed minors.

In guidance this month, NHS England said GPs must refuse to support such private prescribing and advised doctors against shared care arrangements with unregulated providers, naming two such entities, GenderGP and Anne Transgender Healthcare, both associated with the British doctor Helen Webberley.

“Unregulated healthcare services pose a risk to patient safety as they are not subject to the same level of scrutiny as registered services,” the NHS guidance says.

It notes that the NHS has accepted the advice of the Cass review that cross-sex hormones not be prescribed for gender-distressed children under age 16.

The NHS says these may be given to minors aged 16-17 “where the clinician making the prescribing recommendation can demonstrate extreme caution in clinical decision making, such as to justify not waiting until the young person turns 18 years,” and where the treatment is approved by a national multi-disciplinary team.

“It is within this context that GPs and other prescribing professionals are cautioned against a shared care approach with unregulated providers who continue to offer access to—or facilitate access to—hormone interventions to children and young people under 18 years of age.”

The barrister and trans activist Jolyon Maugham represented the NHS advice to his 410.2K followers on Twitter/X as a ban on GPs doing blood tests for children and as proof that UK Health Secretary Wes Streeting was “continuing his war on trans people.” This in turn prompted social media posts from Mr Streeting and his department correcting “misinformation.”

Mr Maugham also posted, “Are Wes Streeting and NHS England covering up trans suicide data?” Mr Streeting’s department cited on social media the July 2024 report of suicide prevention expert Professor Louis Appleby, who debunked the last round of trans suicide mongering.

Suggesting suicide

America | A 20-year-old detransitioner, Simon Amaya Price, gave powerful testimony last month in favour of a New Hampshire bill to prohibit gender medicalisation of minors; the bill has passed the state house and is now before the senate.

Mr Amaya Price said: “I remember being 14; I was sitting in my paediatrician’s office explaining to him that I was transgender and that my father wasn’t affirming my new identity. So, my paediatrician asked my father, would you like a dead son or living daughter? I was in the room when he asked this question.

“There is no other situation when a doctor is allowed to suggest suicide like this to a patient, and quite frankly, it’s medical malpractice…

“Despite being referred to my local gender clinic three times by three separate doctors, [despite] the emotional blackmail and my gender dysphoria diagnosis, my father refused to take me to be medicalised, and I hated him for it at the time, but now I am deeply grateful…

“My girlfriend is a detransitioner, and I can’t do much more than pray that if and when we decide to have kids, that—despite the double mastectomy, which precludes her from ever breastfeeding, and the four years of cross-sex hormones she was given, starting from when she was a minor—she is able to carry a pregnancy to term.”

Conversion’s spectre

International | A new paper in Archives of Disease in Childhood warns of medicine entering “dangerous territory” as gender clinicians, unable to prove claims of better mental health outcomes, shift the rationale for puberty blockers and cross-sex hormones to patient “autonomy” and “embodiment goals.”

The paper, written by Australian psychiatrist Dr Alison Clayton, illustrates her concern with a hypothetical case—

“A young person, identifying as non-binary, requests ongoing [puberty blockers] … It later emerges that this young person has unwanted homosexual (same-sex) desires and fantasies.

“They report a strong and persistent preference to have no or diminished sexual desire—to be an asexual non-binary person rather than be a same-sex attracted sexual person. In effect, they are asking for [blockers] as chemical castration…

“[T]hose arguing for [blockers] and [hormones] to be made available according to personal desire and an individual’s life goals would appear to be required, if they are going to be consistent, to give in-principle agreement to such requests.

“In doing so, although unwittingly, they resurrect the spectre of medical conversion practices for homosexual people—indeed, there are clinician and detransitioner accounts indicating this is already occurring.”

Litigation

Ireland | Endocrinologist Professor Donal O’Shea and psychiatrist Dr Paul Moran have filed papers in Ireland’s High Court seeking judicial review of public health care for gender-distressed children, the Irish Times has reported.

“Professor O’Shea and Dr Moran—two of the leading experts in the area of transgender healthcare in Ireland—have stressed they are not against the ‘gender-affirming’ model that is typically found overseas but have concerns over its link to an early readiness to begin what could be inappropriate and irreversible medical treatment for patients presenting with gender identity issues,” The Times said.

“They have advocated for more holistic models of care when it comes to children who are questioning their gender rather than focusing on measures and treatments that are irreversible.”

Although the Ireland’s public provider, the Health Service Executive, is developing a new clinical program for such children, it is expected they will still be referred abroad for assessment until 2026. More than 230 Irish children and adolescents were sent to the now closed UK Tavistock gender clinic.

Not legit medicine

America | The state medical board of Alaska has recommended a ban on gender medicalisation of minors and advises psychological methods “as safer alternatives.” In a letter to legislators last month, the board says it “opposes hormonal and surgical treatments for gender dysphoria in minors due to insufficient evidence of long-term benefits and risks of irreversible harm.

“We view these interventions as lacking legitimacy as standard medical practice for those under the age of 18 years old. This reflects our duty to protect patients and uphold evidence-based care.”

No idea

New Zealand | In a group of 63 patients aged 15 and receiving puberty blockers in 2018 in New Zealand, 84 per cent went on to cross-sex hormones, according to data released under the Official Information Act.

Average time on puberty blockers was just under three years. In 2023, there were 127 patients aged between 12 and 17 started on blockers.

The government agency Health NZ, which was responding to an information request from the Ministry of Health, said provision of gender-affirming care “via a distributed model” meant it had no idea what proportion of minors presenting at primary and community providers ended up on puberty blockers.

Joyce’s choice

Ireland | The Irish Independent newspaper has given the “very obviously Irish” Helen Joyce her “first Irish interview” since she published the best-selling 2021 book Trans: When Ideology Meets Reality.

The UK-based journalist recalled the impact of meeting detransitioners at a radical feminist event. “I hadn’t realised the extent to which gay kids were being mutilated—and I will use the word ‘mutilated’, because that’s what they used at that event—by a very passing, transitory idea in their teens that they wanted to be boys,” Ms Joyce told The Independent.

“There were six girls at this event, between, I think, 18 and 23—and some of them had gone right up to having their wombs removed. And the thing is that gay kids go through extra identity and personality confusion compared to straight kids—and lesbians are late [coming out], compared to gay boys.”

Testicular disorder

Australia | Eighty per cent of patients aged 16 to 25 given taxpayer-subsidised testosterone in 2021-22 were female and probably trans-identified, according to a study promoted in the latest annual report of the Trans Health Research Group at the University of Melbourne.

This represented 3,795 female patients out of a total of 4,726 patients.

Testosterone subsidised under Australia’s Pharmaceutical Benefits Scheme (PBS) is given to males with the condition “androgen deficiency/testicular disorder.”

But that condition is also invoked to prescribe PBS testosterone to trans-identifying females, as the Melbourne researchers explain. A powerful hormone, testosterone requires an “authority prescription,” which is not available for the condition of gender dysphoria.

Watch the insurers

America | In a new article for City Journal, commentator Leor Sapir recounts a series of body blows sustained by the movement for gender medicalisation of minors. He notes there are now almost two dozen detransitioners in the US suing doctors and clinics—

“Though these lawsuits are tough to win, even a single multimillion-dollar verdict or out-of-court settlement could send malpractice insurance premiums soaring and create a chilling effect in states where ‘gender-affirming care’ remains legal.”

Why so quiet?

Australia | A prominent psychologist has criticised the silence of the Australian Psychological Society (APS) in the debate about the treatment of youth gender distress.

The psychologist, Clare Rowe, wrote an article welcoming the recent Family Court decision by Justice Andrew Strum in the case of Devin—a 12-year-old boy protected by order from administration of puberty blockers. On her Substack, Ms Rowe says the court ruling “should send shockwaves through every children’s gender clinic in the country. Not because of politics. Not because of ideology. But because, finally, someone in authority stood up and said: ‘Where is the science?’”

She says proper psychological care involves treating distress, not identity. “If a child presents with body hatred, anxiety, or confusion, we explore it. If a child wants to change their name and clothes, we may support them—but we also ask why? Not because we’re doubting them. Because we respect them enough to be curious.”

And yet, Ms Rowe says, the APS, the largest professional body for psychologists, is absent from the debate. “While international peak bodies are revisiting their guidelines in light of emerging evidence, ours remains silent, afraid, it seems, to offend the loudest voices. That silence speaks volumes.”

In 2022, the APS began a review of its uncritical position in favour of the gender-affirming worldview.

In The Australian newspaper, emeritus professor of law Patrick Parkinson argues that Justice Strum’s decision in re Devin has delivered “another hammer blow” to paediatric gender medicalisation.

“Is this the beginning of the end in Australia for the experiment of using puberty blockers for gender-incongruent children?” Professor Parkinson writes. “The gender clinics and clinicians in private practice are fighting hard, with powerful political support from LGBTQ+ advocacy organisations. The professional medical colleges have been reluctant to take a stand; but if no one else will act, the courts will.”

The national newspaper also published an editorial on the Family Court case, saying, “One of the most important aspects of Justice Strum’s decision is his insistence on the fluid realities of human development and the need to keep the options of children and teens open as they grow, experiment and change. This truth has been obscured in our culture by a dogmatic and coercive form of identity politics.”

Talking therapy

America | Laws banning so-called “conversion” of gender identity breach the free speech rights of therapists and muzzle them in the debate over how best to help gender-distressed minors, according to a court brief filed by 11 Republican-run states asking the US Court of Appeals for the Sixth Circuit to overturn a judge’s decision upholding Michigan’s anti-conversion statute.

Furtive caution

Australia | Belatedly and quietly, the Queensland Children’s Gender Service (QCGS) has taken down from their website an “information” leaflet for parents, complete with a state government logo, that prominently displayed a comment from the father of a “10-year-old trans boy”—

“The real concern was the statistics on suicide… I didn’t want my son to be one so I supported him in the decisions ahead and informed him as best as possible.”

The “transition or suicide” narrative has been criticised as baseless and irresponsible.

The leaflet “strongly implied that treatment for gender-related concerns at QCGS may specifically reduce a child’s risk of suicide,” according to child and adolescent psychiatrist Dr Catherine Llewellyn.

She raised her concerns with Queensland health authorities in August 2023 and again in July 2024. By end-January 2025, it had been removed, without explanation.

Meanwhile, the Star Observer has reported that the mother of a trans-identified child has secured a Queensland Supreme Court order requiring the state’s top health official to justify his January 28 directive pausing new treatment involving puberty blockers or cross-sex hormones in the public system pending an independent review of the evidence.

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