Berlin | In the field of gender medicine, marked by open questions and misinformation, doctors must be conscious of their responsibility to tailor treatment to the scientific evidence, not to ideology, according to the president of the German Medical Association.
Dr Klaus Reinhardt, whose association plays a role in the country’s health and social policy debates, was giving the opening address earlier today at the Berlin conference on youth gender distress hosted by the Society for Evidence-based Gender Medicine (SEGM).
“Our responsibility as physicians is to promote scientific progress and to shape treatment pathways, not through ideology, but through a reflective dialogue and with considerations of the best possible evidence in the interest of our patients,” Dr Reinhardt said.
“We know that the number of young people experiencing conflicts or insecurities regarding their gender identity has significantly increased in recent years. At the same time, public and social attention to this issue has intensified. This has led to high expectations of medicine and medical research, expectations to provide clear answers, offer guidance and to propose solutions.
“But that’s not so simple, as our medical knowledge has not yet progressed that far, and I deliberately say ‘not yet.’ Gender incongruence is a multi-faceted condition, yet scientific research on this subject remains insufficient.
“This field is defined by insecurities, open questions, misinformation and controversial debates. Where evidence is lacking, speculations take hold.
“This can be observed in the often emotionalised and polarised debates. For this reason, it is of the utmost importance that physicians take their responsibilities seriously. This involves providing medical care based on scientific evidence that considers the benefits and risks while prioritising the wellbeing of the individual.”
In May 2024, the 128th German Medical Assembly, which brought together delegates from medical associations across the country, called on the federal government to restrict puberty blockers, cross-sex hormones and transgender surgery for minors to ethically controlled clinical trials with at least ten years’ follow-up.
This cautious proposal is in stark conflict with the new “affirmation-only” German-language treatment guideline for gender distress in childhood and adolescence, which was issued in March 2025.
In Berlin on Thursday, Dr Reinhardt said: “Medical practice may never be guided solely by the social zeitgeist or political expectations.”
“Medicine is an applied science that is based on a shared foundation of scientific knowledge. Rapid changes in medicine, in medical knowledge, require critical thinking.”
He stressed the need for international scientific exchange of the kind enabled by SEGM’s three-day Berlin conference.
Video: In dissociating himself from SEGM, Gordon Guyatt, the pioneer of evidence-based medicine (EBM), put his name to a statement suggesting that ‘gender-affirming’ care is ‘medically necessary’. That term, often used to secure insurance cover, is not an EBM concept. Asked about this, Professor Guyatt confessed he had failed to read the statement carefully. The full interview with him is here
Hatred of evidence?
In his opening remarks at today’s Berlin conference, SEGM president Dr Roberto D’Angelo reasserted the public policy rationale of the society, noting that in the domain of gender medicine there was sometimes “hostility toward those who prioritise rigorous evidence over ideological certainty.”
He rejected the characterisation of SEGM as a “hate group” by trans-rights activists.
This smearing of the society was implicit in an August 14 statement signed by Professor Gordon Guyatt, the pioneer of evidence-based medicine, denouncing the alleged misuse of systematic reviews of the (weak) evidence for paediatric gender medicine. Those reviews, independently undertaken by Professor Guyatt and colleagues at Canada’s McMaster University, had been commissioned by SEGM, and targeted by trans-rights activists.
Dr D’Angelo told today’s conference attendees—who included current and former leaders of gender clinics as well as researchers and practitioners from around the world—that the labelling of SEGM as a “hate group” was “a deliberate and damaging misrepresentation of our work.”
“Our focus on evidence-based care is not an act of hate—it is an act of advocacy for safe, effective healthcare for all sexual- and gender-minority individuals,” he said.
“These false labels are not just an attack on our credibility; they are an attempt to silence critical inquiry, which ultimately harms the LGBT community by blocking needed dialogue.”
“The Society for Evidence-based Gender Medicine formed in 2019 in response to concerns that a rapidly growing group of vulnerable youth with increasingly diverse presentations of gender dysphoria were being subjected to a highly medicalised treatment protocol never designed for them and never shown to be safe or effective.”—statement on the “hate group” claim, SEGM, 10 September 2025
Certainty’s peril
“The greatest danger to young people, I would argue, is not the questions we ask but the assumption that we already have all the answers. As a member of the LGBTQ community, I am only too aware of how certainty has led to harm in the past,” Dr D’Angelo told the SEGM conference.
“We reject the false narrative that questioning medical interventions equates to denying identities or causing harm. On the contrary, our commitment to evidence is about safeguarding the health and futures of those who are still growing into themselves.
“We believe that access to safe, effective and compassionate care is a fundamental human right—a principle that guides every aspect of our work.
“When it comes to children and young people, our approach is both compassionate and cautious. We take their experiences of gender distress seriously, acknowledging the profound suffering many endure. At the same time, we recognize their developmental stage—their still-evolving capacities for critical thinking, self-reflection and decision-making in the context of complex social and cultural influences.
“Our mission is to ensure that the care provided to young people respects their humanity, supports their unique developmental journey and minimises the risk of irreversible harm.”
Dr D’Angelo said that SEGM—“a global network of licensed clinicians and researchers from over 20 countries”—advocated for “non-invasive approaches [in response to gender distress], such as exploratory psychotherapy, particularly for youth with complex psychological or psychiatric needs.”
“The field of gender medicine is at a crossroads. Over the past decade, referrals to gender clinics have surged, particularly among adolescent females with no prior history of childhood dysphoria. This shift has raised important questions about the suitability of the ‘gender-affirming’ model for this new cohort.”
He said SEGM respected “the choices that mature adults make, whether within or outside cultural gender norms” and condemned any “vilification, discrimination or violence directed towards any individual or group, regardless of their sex, gender identity, sexual orientation or other minority status.”
He urged the society’s critics to “engage with us in good faith. Challenge our ideas, scrutinise our evidence, and join us in dialogue rather than resorting to disparagement or false labels.”
Thank you Bernard for this reporting. I was previously scheduled to attend but made the decision not to.
It is extremely disappointing that Professor Guyatt signed the statement saying Gender Affirmation was medically necessary treatment.
And then to see him try to weasel out of his mistake.
I think the only thing he can do to resurrect his reputation is make a public statement that makes clear his position which was previously that the evidence was too weak to support Gender Affirmation treatment.