False promise

When gender medicine is life-ending; the patient who can’t grow a penis; 1000s of mastectomies; NZ doctors on notice; more US whistleblowers; blockers on trial; a Biden judge upholds trans existence

Photo by Alex Shih Mendez on Unsplash

GCN in brief

Another review

Belgium | The use of puberty blocker drugs with gender-distressed minors will be reviewed by Belgium’s Federal Health Care Knowledge Centre (KCE), according to the newspaper De Standaard. The coalition agreement for the country’s new government under Prime Minister Bart de Wever stipulates that the scientific evidence for transgender puberty suppression be examined.

“There is a broad debate taking place in our society, but also among doctors, about the use of hormone inhibitors,” a spokesman for the social democratic Health Minister Frank Vandenbroucke told De Standaard last month. “When do you start [puberty blockers]? What is the impact on the human body? We are therefore asking the KCE to collect all the international scientific evidence.”

However, Dr Patrik Vankrunkelsven, director of Belgium’s Centre for Evidence-based Medicine, said the lack of sound scientific support for this use of hormone suppression was already well established. “Additional research by the KCE would therefore be a waste of time,” Dr Vankrunkelsven said.

“It should be forbidden to give puberty inhibitors to adolescents. We do need to commit to counselling these adolescents. For example, in the teenage girls who now present with gender dysphoria, we often see other problem areas, such as ADHD or autism spectrum disorder.”

In a 2007-23 review of treatment at Ghent University Hospital’s gender clinic, published in January, five suicides were reported; these were young women with a median age of 18.6.

“Four of these individuals had started medical transition during late puberty with [hormone suppression] followed by [testosterone]; they had also undergone mastectomy and [genital surgery] at the time of suicide,” the authors said.

“One individual had started medical transition with [testosterone] without previous [hormone suppression], and had undergone [genital surgery].” With 431 patients starting cross-sex hormone treatment at the clinic from 2007 to 2023, this translates to a high suicide rate of 1,160 per 100,000 people.

Such a rate gives the lie to the “transition or suicide” narrative used to persuade parents to go along with the gender medicalisation of their children, family physician Dr Luc Vandecasteele told GCN. He also highlighted the landmark Finnish study concluding that psychiatric co-morbidity, not gender distress itself, drives suicide risk.

Second thoughts

International | Five months after a politicised study reported low regret among minors given hormonal treatment, the journal JAMA Pediatrics has published a letter scrutinising the results. The October 2024 paper from Princeton University’s Professor Kristina Olson was widely covered in the media, with The Washington Post headline declaring, “Survey of trans youths reports high satisfaction with gender-affirming care.”

Dr Olson and her colleagues framed the reassuring outcome as an argument against laws restricting gender medicalisation of minors in US Republican states.

In a March 3 letter published by JAMA Pediatrics, under the heading “Levels of Satisfaction and Regret Are Far From Settled,” Canadian researchers raise a series of objections, starting with the young average age (16) of those taking the survey: “Do children this age have capacity to understand satisfaction and regret, especially as it relates to possible sequelae of interventions (like infertility and anorgasmia)?” The youngest patients were aged 12.

The letter continues: “Patients were socially transitioned prior to enrolment [in the online survey]; most were monitored by endocrinology pre-puberty. Did the authors consider that this could have impacted patient or parent expectations regarding the necessity of the intervention? Did the authors consider cognitive mechanisms such as the placebo effect and cognitive dissonance in interpreting satisfaction and regret findings?”

The letter also challenges the generalisability of the results. “In the study, 60 per cent of patients were recorded as male at birth, and the cohort had normative mental health. Do the authors believe their results can be generalised to the broader population presenting for intervention, which is predominantly female with high rates of psychiatric co-morbidities?”

“What limitations do the authors see in generalising from this non-random sample chosen from environments supporting youth transition?”

The Canadian researchers note a disconnect between some subjective responses to the survey—“can’t grow penis,” “can’t conceive own children,” “no sex drive” and “strong suicidal ideation”—and the measures of satisfaction and regret used in the study.

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Video: Psychotherapists Stella O’Malley and Sasha Ayad talk to 20-year-old detransitioner Clementine Breen, who is suing the high-profile gender clinician Dr Johanna Olson-Kennedy and others following her medical transition

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A harvest of mastectomies

United Kingdom | The vast majority of 3,490 gender-distressed patients referred for mastectomy from 2021 to 2023 by the NHS are young women aged 17-25, The Daily Mail has reported.

“These figures are thought to be just the tip of the iceberg, with many patients having transgender surgery privately to avoid the lengthy NHS waiting lists, which can be up to two years,” the newspaper says. “Two years after her daughter was given a double mastectomy at the age of 24 by the NHS to remove her healthy breasts—in order to ‘change gender’—Jane is still absolutely ‘livid.’

“‘I foolishly believed that the NHS was there to protect my daughter—to do no harm,’ the mother of two tells The Mail.

‘For her to get a mastectomy paid for by the NHS, removing healthy tissue that is there to help feed your offspring, when my sister and my stepsister have had breast cancer and mastectomies, makes me beyond angry’.”

Settled science

America | In City Journal last month, commentator Leor Sapir argued that the New England Journal of Medicine (NEJM) is afflicted by a heavy bias in favour of the “gender-affirming” treatment approach. His focus is the journal’s Perspectives section, supposed to invite informed debate on controversial topics.

“Since 2015, by my count, Perspectives has published 26 articles supportive of ‘gender-affirming’ medicine,” Dr Sapir writes. “As far as I can tell, Perspectives has not published a single article that is critical, or even sceptical, of the controversial practice. I asked NEJM if they could cite a single article offering a different perspective but did not receive a response.”

Dear Doctor

New Zealand | Medical practitioners prescribing puberty blockers and cross-sex hormones for minors in New Zealand have been sent a lawyer’s letter suggesting they may expose themselves to future liability, NZ Doctor has reported.

The letters, sent by the Wellington law firm Franks Ogilvie on behalf of pressure group Inflection Point NZ, were sent to doctors in general practice as well as those in the employ of the government agency Health NZ.

Public broadcaster RNZ reported that the letters had generated complaints to the NZ Law Society and police. The chief medical officer of Health NZ, Professor Dame Helen Stokes-Lampard, has reassured those in receipt of the letters that her agency would come to their defence.

Lawyer Stephen Franks, a former MP, has dismissed “hysteria” about the letters sent by his firm. He says the letters drew on the NZ Ministry of Health’s evidence brief last November acknowledging the scarcity and poor quality of the research data for puberty blockers. At that time, the NZ Government did not impose any restrictions on the use of blockers but launched public consultation which might lead to tighter regulation of these drugs.

“Our client asked us to research the liability that might accrue from the odd delay in changing practice [away from gender medicalisation] in New Zealand,” Mr Franks says.

“We were then asked to write to practitioners in the area because our client believes that some of them have their heads in the sand, refusing to acknowledge the now well-established absence of the normally required evidence of net benefit to justify the use of harmful drugs.”

He concedes that plaintiffs in NZ, which has a compensation scheme, face a high threshold for civil action against doctors.

To experiment or not?

United Kingdom | News of a £10.7m grant enabling a clinical trial of puberty blockers in the UK—as recommended by gender care reviewer Dr Hilary Cass—has encountered some strong opposition. In an editorial The Times newspaper declared that, “Puberty is not an optional extra in a healthy human being’s biological life plan.”

“The notion that an ethical trial should be undertaken to establish the possible downsides of chemically sterilising children is as macabre as it is irrational,” the newspaper opines.

Arguing that the dramatic surge in diagnosis of gender dysphoria “bears all the hallmarks of a social contagion,” The Times says that “adults, not least doctors, have a responsibility to prevent, rather than collude in, the mistaken choices children are liable to make about their own best interest.”

On X/Twitter, Tavistock clinic whistleblower and psychotherapist Marcus Evans said, “When adults sanction the delay of secondary sex characteristics, they risk undermining a young person’s capacity to cope.”

“The implicit message is: You’re afraid you can’t handle puberty, we agree—you don’t have the resources to manage the identity confusion and uncertainty that accompany the transition from childhood to adulthood.”

Dr Cass has welcomed news of the trial, telling The Times it “aims to fill some of the gaps in our knowledge about the outcomes of different interventions and address some of the uncertainty about the impacts and efficacy of puberty-suppressing hormones”.

However, journalist Hannah Barnes, who covered the Tavistock scandal, said it was difficult to see how a trial limited to a two-year follow-up would clarify the key unknowns of puberty blockers. She said that England’s NHS lacked the permission even to request from adult gender clinics data potentially showing longer-term outcomes of the 2,000-odd children given blockers at the Tavistock.

The protocol providing essential detail on the trial is yet to be released. Hurdles ahead include ethical approval and potential litigation.

In an open letter to UK Health Secretary Wes Streeting, the LGB Alliance, which believes most of the young people in gender clinics are same-sex attracted, suggests the study of existing data from past patients would avoid the “unnecessary harm” of a puberty blocker trial with a new group of children.

The alliance highlights the refusal of most NHS adult clinics to enable a data linkage project as part of the Cass review. “It must be a consideration that a likely reason behind their refusal to cooperate is that the medical interventions for children have led to poor outcomes and that clinicians have ideological reasons for seeking to suppress the information,” the alliance says.

US surgeon Eithan Haim, who blew the whistle on covert gender medicine at Texas Children’s Hospital, has argued that a puberty blocker trial is impermissible as a matter of logic.

“An experiment loses its value when the central question (hypothesis) can be answered through logical reasoning. Example: What happens if you drop an egg from the top of a 10-storey building? It will crack; no experiment needed,” he posted on X/Twitter.

“When the [puberty blocker] intervention in question also is associated with well-known, predictable harms and has no biological relationship to the desired outcome, it becomes highly unethical and should not be permitted.”

Breaking cover

America | Since the Trump Administration took office, leading to the abandonment of the Biden-era prosecution of Dr Haim, other whistleblower doctors have made contact to discuss possible breaches under the False Claims Act at their hospitals and “false billing” for gender procedures, according to Dr Haim’s lawyer, Marcella Burke of the Texas firm Burke Law Group PLLC.

“Seeing that fallout after his case was dropped [by the US Department of Justice], and the increase in calls that we’re getting, just goes to show that the prosecution was actively trying to suppress whistleblowers,” she said.

Scandalous surgery

International | A Turkish surgeon and urologist has declared that gender-affirming surgery violates the ethical rule, First, do no harm. In a research letter published by the Italian Archives of Urology and Andrology, the Istanbul-based Dr Zeki Bayraktar argues that the literature fails to show benefits for gender surgery. Instead, he says, this surgery worsens psychological health as well as harming urinary, reproductive and sexual function.

“In my opinion, [gender-affirming surgery] is the greatest systematic iatrogenic harm in the history of medicine,” Dr Bayraktar says.

“Transgender individuals have serious mental health issues and need psychosocial support because of these problems … As surgeons, we are not improving the mental health issues of transgender individuals with [this surgery]; instead, we are collaborating with their mental health issues and, by engaging in consent engineering, mutilating them urogenitally.” The group ROGD Boys has documented the risks of gender surgery for males.

Unacceptable impost

America | The requirement that gender-reassignment surgery be publicly funded was one reason for Iowa’s governor, Kim Reynolds, to sign a bill last month removing “gender identity” as a protected class from her state’s Civil Rights Act. Governor Reynolds said the bill was necessary to recognise biological differences between male and female, and to protect female sport and female-only spaces such as bathrooms and locker rooms.

“But unfortunately, these common sense protections were at risk because, before I signed this bill, the Civil Rights Code blurred the biological line between the sexes,” she said. “It has also forced Iowa taxpayers to pay for gender-reassignment surgeries. That is unacceptable to me, and it is unacceptable to most Iowans.”

In the US last month, a Pew Research Center poll reported that most American adults (56 per cent) agreed that health practitioners should be prohibited “from providing care related to gender transitions for minors.” And most respondents (53 per cent) were opposed to requiring health insurance firms to cover “medical care for gender transitions.”

Opportunity Cost 101

United Kingdom | The NHS spent £250 million over the last five years on surgical and other interventions for people who identify as trans or non-binary, The Daily Mail reports. Now running at more than £100 million a year, this cost was reportedly greater than the amount spent on penicillin or the recruitment of 2,500 nurses.

It was also “close to what it would cost to supply all 1,000 women in England and Wales who would benefit from Enhertu, a drug that would give women with advanced breast cancer an extra six months of life. Because it costs about £118,000 per patient, it was turned down by the NHS last year for being too expensive.”

At least £69 million over five years was spent on transgender treatment of children and young people, with a 50 per cent increase from £17.5 million in 2023-24 to £26.5 million in 2024/25 up to January.

Stephanie Davies-Arai, of Transgender Trend, told The Mail: “NHS England’s job is to treat medical problems, yet they are creating medical problems where none previously existed. To spend so much on damaging people’s bodies for no evidenced reason is unacceptable and in the case of children unconscionable.”

Existence affirmed

America | A US District Court judge in Seattle has extended an order stopping the Trump administration denying federal funding to providers of medicalised gender change in four Democratic-run states.

Judge Lauren King, a Biden-era appointee, held that two Trump executive orders were an unconstitutional intrusion upon the funding power of Congress. She also discerned a violation of the equal protection guarantee of the US Constitution’s Fifth Amendment.

In her opinion, the Trump order confirming human sexual dimorphism “denies the very existence of transgender people and instead seeks to erase them from the federal vocabulary altogether and eliminate medical care for gender dysphoria at federally funded medical institutions.”

The group Do No Harm, which opposes identity politics in medicine, had filed an amicus brief in the case, defending President Trump’s January 28 order, which seeks to restrict gender medicalisation of young people.

Citing multiple systematic reviews, the group says “the use of puberty blockers, cross-sex hormones, and surgeries to treat gender dysphoria carries a host of known harms and risks and has no reliable evidence of benefit.”

Meanwhile, in Arizona, Phoenix Children’s Hospital has announced an indefinite cessation of hormonal treatment of young people, as a result of the January 28 order. Children’s Hospital Los Angeles, home to gender clinician Dr Olson-Kennedy, ended its treatment pause, citing interventions by federal judges and California’s Attorney-General Rob Bonta.

Also last month, the US Court of Appeals for the First Circuit upheld a Massachusetts school policy allowing concealment of a child’s social transition from parents. That policy was challenged as breaching a constitutional guarantee of the parental right to guide and bring up children, including the “medical/mental health treatment” that is social transition.

However, the court was not persuaded that what it characterised as mere “use of gender-affirming pronouns or a gender-affirming name” amounted to medical or even clinical treatment.