Put down the knife

French revolt; America's Cass report; Brazil's drugs of dignity; trans chatbots; Crenshaw's chainsaw; Trans Europe Express; antsy gender docs in NZ; Trump's whistleblower zone; FGM and gender clinics

Photo by Aedrian Salazar on Unsplash

GCN in brief

Harm cloaked in euphemism

France | “You don’t cut off young women’s breasts based on feelings!” is the title of a petition to the French National Authority for Health, whose leaked draft treatment guideline would allow gender-distressed girls to undergo double mastectomies from the age of 16.

“It is young girls and young women who identify as transgender who are directly exposed to this surgery, which has been trivialised by some surgeons working in so-called ‘gender medicine’ services and euphemised as ‘torsoplasty’ to make it sound like a cosmetic operation, thus obscuring the fact that it is an irreversible mutilation of healthy individuals,” the petition says.

“By claiming to adapt a torso to a feeling, we are obscuring the fundamental fact that these young girls were born with a functional body, which they often reject in a context of suffering or fragility, and which no one can predict what it will be like in a few years’ time.

“This practice, which denies anatomy in the name of subjective experience and claims to solve a psychological problem by modifying the body, raises questions about medical responsibility: can we seriously talk about care when we mutilate healthy organs to respond to a perception based on feelings steeped in ideology?

“These mastectomies are a new form of violence against women who, throughout history, have suffered other mutilations, including hysterectomies, due to behaviour deemed ‘non-conforming’ and labelled as hysteria or nymphomania. Here again, it was believed that treating the psyche could be achieved by harming the body.”

The petition linked to the watchdog group The Little Mermaid has garnered more than 6,000 signatures including more than 250 doctors, psychologists, lawyers, teachers, researchers and feminists.

Nice surprise

America | While deploring the hyperbolic language of President Trump, The Washington Post has welcomed the 400-page Gender Dysphoria Report issued by his Department of Health and Human Services (HHS).

The editorial board of the newspaper describes the HHS report as “a careful, thorough and definitely skeptical tour through the subject, including the history of gender medicine, the evolution of pediatric interventions, the evidence for pediatric medical transition, and the ethical conundrums that researchers and practitioners face. Critics have been scathing about what they see as the report’s bias and shortcomings. But it makes a legitimate case for caution that policymakers need to wrestle with.”

In a letter to The Wall Street Journal, Canadian endocrinologist Roy Eappen highlights the HHS report’s recognition “that transgender ideology has a particular kind of victim: children who are gay or lesbian.”

“As a gay physician, I can attest to two things. First, gay boys and lesbian girls usually don’t conform to gender roles. Second, the medical establishment now assumes that gender nonconformity means a child is transgender. This isn’t merely an insult to many kids’ identity—it leads to a medical assault on their bodies and minds, in the form of hormones that have irreversible effects and invasive surgeries that lead to permanent scars.”

The Economist magazine quotes Oregon paediatrician Julia Mason, a founding board member of the Society for Evidence-based Gender Medicine, to the effect that the HHS report is “a lot like [England’s] Cass review.”

The magazine notes that many US medical organisations follow the “gender-affirming” approach of the World Professional Association for Transgender Health, “even though [WPATH] does not require members to be medical professionals.”

“The HHS report traces how this impression of medical consensus came about, through blind delegation of authority to WPATH and its members, a chain of trust that was broken, the report says, when WPATH chose to suppress evidence.”

More analysis of the HHS report from biologist Colin Wright and retired lawyer Peter Sim.

Check first

United Kingdom | Under new guidance, England’s NHS is to assess all gender-distressed minors for autism and ADHD, mental health, cognitive and physical development, school experience, same-sex attraction and family problems. Such issues raise questions about the cause of gender distress and the appropriate or priority treatment.

The new guidance for the NHS Children and Young People’s Gender Service has been reviewed by Baroness Cass and is expected to be issued for public consultation soon, The Daily Telegraph has reported. Dr Louise Irvine, of the Clinical Advisory Network on Sex and Gender has welcomed the “proposed holistic approach and prioritisation of psychological interventions,” but says it is a “serious flaw” for the guidance to leave open the option of referring minors for cross-sex hormones.

The Telegraph has also recounted the story of a mother whose autistic son eventually abandoned an online-influenced trans identity. “If these tests [screening for autism] had been available to us on the NHS years before, we would have possibly saved our family thousands of pounds that we paid for private tests and therapy—and years of agonising heartache,” the mother said.

Meanwhile, activist pressure has reportedly led to the NHS abandoning draft guidance that children under age 7 were simply too early in development to be seen by gender clinics, The Telegraph has reported under the headline “Trans toddlers’ allowed gender treatment on NHS.” There was no suggestion of any medical treatment, and commentators disagreed whether such early intervention was consistent with England’s Cass review or a gender-affirming subversion of it.

Drugs of dignity

Brazil | New rules from Brazil’s Federal Council of Medicine restricting hormonal and surgical treatment of young people have been challenged as an affront to a constitutional right to “dignity.” LGBTQ lobbies filed an action with the country’s Supreme Federal Court last month, the newspaper Folha de São Paulo has reported.

The council’s April 8 resolution prohibits doctors from prescribing puberty blockers for gender distress, while exempting the use of hormone suppression for conditions such as precocious puberty, where, by contrast, puberty blockers are “scientifically indicated.” Cross-sex hormones for gender distress are banned before age 18. The new rules do not apply to young people already taking blockers or hormones.

“In cases of regret or detransitioning, the doctor must offer care and support, assessing the physical and mental impact and, when necessary, referring the patient to appropriate specialists,” the council resolution says. Gender surgery with “a potential sterilising effect” cannot be performed before the age of 21.

The constitutional challenge to the restrictions was brought by the National Association of Transvestites and Transsexuals and the Brazilian Institute of Transmasculinities, which, according to Folha de São Paulo, have “legal support from lawyer Paulo Iotti, one of those responsible for the criminalisation of homophobia in Brazil.”

“The lawsuit calls for the revocation of the [council’s April 8] rule because, according to the plaintiffs, it violates articles of the Constitution, such as the right to dignity, which prohibits the creation of rules that cause suffering and place human beings in conditions that are degrading to their honour, spirituality and integrity,” the newspaper reported.

Sorry, busy right now

International | “Hi there! I’d love to chat with you about transgender rights.” That’s a chatbot, an attempt to use artificial intelligence to scale up persuasive trans activism. The project is explained in a new paper published by SSRN. What these North American researchers call “Personalised Moral Reframing” uses the standard vague and emotive claims. Here’s an example—

Bot: Hi there! I’d love to chat with you about transgender rights. Where do you stand on issues related to transgender people’s rights?

Human: I don’t care either way.

I appreciate your response. Many transgender individuals experience significant emotional distress due to discrimination. When we consider the suffering they often endure—including higher rates of depression, anxiety, and suicidal thoughts—how do you feel about protections that could reduce this suffering?

It’s a mental health issue.

You’ve touched on an important point about mental health. Research shows that supportive environments dramatically improve transgender people’s well-being. When they receive acceptance and appropriate healthcare, their mental health outcomes improve significantly. Does the potential to reduce suffering through compassionate support influence your perspective?

Power of the dollar

America | A bill before the US Congress would ban federal funding for paediatric medical transition under the programs Medicaid, the Affordable Care Act and the Children’s Health Insurance Program, according to its sponsor, Texas Republican Dan Crenshaw. Once enacted, it would enforce key elements of President Trump’s January 28 executive order seeking to restrict gender medicalisation of minors.

Mr Crenshaw noted that during 26 hours of debate, Democrats sought amendments on many other provisions in this multi-subject bill, but not the provision cutting funds for hormonal and surgical transition of minors. “And I thought that was interesting,” Mr Crenshaw told Daily Wire.

“They know it’s a losing issue. They know we’ve won this issue. They know to stay away from it. Stay away from kids. Stop doing pseudoscience—scientific experiments on children who would be better off on therapy.”

“Gender transition procedures are the lobotomy of our generation,” Mr Crenshaw said. “People will look back on this period, I think, with disbelief. Gender-affirming care? It’s not healthcare, it’s fringe science with no proven benefit and enormous risks.

“Truth is, many of these kids are wrestling with issues that kids wrestle with—their co-morbid psychiatric diagnoses. They have fleeting ideations, peer pressure, online echo chambers. It’s not a condition that demands a prescription and a scalpel. When science is this weak, the only ethical answer for us is, First, do no harm. We’re supposed to protect the kids, full stop.

“I don’t think this debate is about compassion versus cruelty. I think it’s just about medical ethics, safeguarding children and demanding that real science and not activism guides our public health.”

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Video: Fast-track hormones at Planned Parenthood, which has morphed into one of America’s biggest providers of gender medicalisation of teenagers and young adults

Each-way coverage

America | A bill in Texas to provide health insurance cover for detransitioners has passed the state legislature and awaits the governor’s signature. If an insurance plan covered medical transition, then it would be required to cover the adverse effects of transition, as well as treatment to “manage, reverse, reconstruct from, or recover from” transition. The group Genspect welcomed “this landmark bill.”

Litigation Down Under

Australia | The decision of the Australian state of Queensland to suspend new treatment of gender-distressed minors with puberty blockers and cross-sex hormones relied heavily on England’s 2024 Cass report, ABC News has reported. (Queensland is the first Australian jurisdiction to impose such restrictions.)

The January 28 “health service directive” issued by Queensland Health director-general David Rosengren applies to public health services. The lawfulness of his decision has been challenged in the Supreme Court by the mother of a trans-identifying teenager.

In a statement of reasons for the treatment pause, given to the mother at the court’s order, Dr Rosengren cited irregularities in gender treatment of 17 young people in the regional city of Cairns, as well as “recent restrictions introduced overseas,” ABC News said.

Dr Rosengren said he had considered a draft human rights assessment, which acknowledged the claim that denial of hormonal treatment “may cause emotional distress and an increased risk of suicide,” but this assessment acknowledged the Cass report finding “that the evidence does not support a conclusion that hormone treatment reduced the elevated risk of suicide.”

Before a change of government from a centre-left to a centre-right administration last October, Queensland Health was a staunch advocate for the gender-affirming treatment model.

The argument run on the mother’s behalf by the LGBTI Legal Service is that Dr Rosengren failed to meet a statutory requirement to consult health chiefs. In an answer to an April 1 question in parliament, Health Minister Tim Nicholls said that chief executives of public health services across the state were consulted, prior to the directive, during a 21-minute meeting on January 28, the day of the announcement.

There was “nothing meaningful” about such a brief consultation, the mother told AAP. Also on January 28, Mr Nicholls declared there would be an independent review of the evidence for blockers and hormones.

In March, shortly after the appointment of psychiatrist Ruth Vine to lead that review, Dr Rosengren defended the treatment pause before a parliamentary committee. He noted there was “a substantial amount of evidence being considered nationally and internationally that raises questions around the validity of the role of puberty blockers and hormonal therapies.”

“The decision to pause the treatment is for the purposes of us undertaking a very detailed evidence analysis of, firstly, the typical assessment of evidence of a clinical treatment or therapy, in the same way as if we were introducing a new drug or a new machine technology [Emphasis added].

“The review [led by Professor Vine] will look at the evidence base to support these things: does the treatment work, first and foremost; is the treatment safe; and then what are the ethical considerations that need to be taken into consideration in the context of the treatment?”

Always, maybe

America | Researchers linked to multiple US paediatric gender clinics are seeking children as young as age 8 to undergo MRI brain scans while on puberty blockers, the Washington Examiner has reported. The researchers, some linked to the World Professional Association for Transgender Health, admitted that the long-term effects of blockers on the developing adolescent brain are “largely unknown,” calling into question their own claim in the funding application that puberty suppression is “typically” considered “fully reversible.”

With testing sites at Nationwide Children’s Hospital in Columbus, Ohio; Lurie Children’s Hospital in Chicago, Illinois; and Children’s National Hospital in Washington, DC, the study will compare the puberty blocked children with a control group on measures from brain scans, behavioural tasks and questionnaires over a two-year period.

The study—“The Impact of Pubertal Suppression on Adolescent Neural and Mental Health Trajectories”—was launched in 2021 with funding from the National Institutes of Health (NIH). It is unclear whether the researchers are still getting NIH funds, and they had signed up only 85 of the projected 132 children at the latest progress report last year, the Examiner reports.

Time travel

New Zealand | The gender-affirming lobby has sought to pressure Health NZ, a government agency, to release treatment guidelines updated by the Professional Association for Transgender Health Aotearoa (PATHA). The letter and petition circulated by Dr Rona Carroll, a PATHA executive member, claim that “political interference” has delayed the issue of the new guidelines. Genspect NZ, which urges a pause in the use of puberty blockers, said it was understandable that the Ministry of Health was “taking time to review their position”.

In 2023, Health NZ made a contract with PATHA, a gender-affirming lobby, to update that lobby’s 2018 guideline. In April 2024, the 2018 PATHA guideline scored 12/100 for rigour of development during an evaluation of international treatment guidelines undertaken as part of England’s Cass review.

In November last year, an evidence brief from the NZ health ministry found a lack of sufficient evidence to support the use of puberty blockers. The ministry took no effective steps to restrict these drugs, but did flag the possibility that its political masters might intervene to do so.

Where to blow the whistle

America | Consistent with President Trump’s January 28 executive order seeking to restrict medical transition of young people under 19, the US Department of Health and Human Services has published guidance for whistleblowers. It has also set up a webpage for tips and complaints.

Texas surgeon and whistleblower Eithan Haim has drawn attention to the use of “Insurance Coding Alternatives for Trans Healthcare,” whereby clinicians use false or misleading diagnoses—such as “Endocrine disorder, unspecified” for puberty blockers—to secure coverage for gender medical interventions that do not attract subsidy or rebates.

Meanwhile, The Free Press has reported that child psychiatrist Allan Josephson has achieved a $1.6 million settlement from the University of Louisville, “which fired him in 2019 for criticizing the rush to use hormone therapy and gender reassignment surgery to treat gender dysphoria in children.”

About two thirds of Americans in a recent poll opposed the use of government insurance programs such as Medicare and Medicaid for hormonal or surgical treatment of patients under 19. The White House has published an update on progress in implementing the January 28 executive order.

US Attorney General Pam Bondi has issued a memo warning that the federal Department of Justice will investigate the medical transition of girls under laws carrying a ten-year prison sentence for female genital mutilation (FGM) NBC News has reported.

The memo cites data from the medical watchdog group Do No Harm, which analysed insurance claims to conclude that between 2019 and 2023, roughly 14,000 minors were given gender transition treatment, with more than 5,700 minors undergoing surgeries.

The data for surgery did not distinguish between, say, mastectomy and genital surgery, the latter presumably the FGM target of Ms Bondi. A 2022 Reuters investigation, also using insurance data, found 56 genital surgeries among gender dysphoric patients aged 13 to 17.

In her memo issued last month, Ms Bondi said: “The practitioners who provided this so-called ‘care’ profited while their patients were left permanently disfigured, scarred, and sterilized. Those children will struggle for the rest of their lives to overcome regret, and their parents will struggle equally to overcome the guilt of ruining their children’s lives on the false and misleading advice of medical providers who told them that surgery or hormone replacement was the best solution to their problems.”

The Bondi memo also lines up paediatric medical transition for investigation under consumer protection law (misleading claims about side effects) and fraud provisions (when, for example, clinicians bill gender treatment as something else in order to secure insurance cover).

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Video: Scoping lawsuits against gender clinicians, a panel talk from Genspect’s Detrans Awareness Day conference at Capitol Hill, 12 March 2025

Blockers unblocked

Argentina | An emergency decree by Argentina’s libertarian President Javier Milei to prohibit paediatric medical transition has been declared unconstitutional by a court, La Pampa 24 has reported.

The February 6 executive decree invoked the UN Convention on the Rights of the Child and sought to amend the country’s 2012 Gender Identity Law so that only adults would be able to access hormonal and surgical interventions.

On April 16, the Federal Court No 2 of Paraná held that the executive branch had trespassed on legislative territory by seeking to limit the statutory right of “free development of a person in accordance with their gender identity”. The ruling was made in a case brought by a trans-identifying 17-year-old female whose treatment was interrupted by a health insurance provider following the Milei decree. The court ordered a resumption of access to treatment, including a future mastectomy.

“This is a reconquest of rights,” said activist and lawyer Ariel Villanueva from the LGBTQ lobby Equal, which was involved in the litigation. In 2015, former Left-peronist president Cristina Fernández de Kirchner issued a decree to enumerate the trans surgeries available under the Gender Identity Law, which was one of the world’s first statutes to enshrine the concept of self-declared gender.

Trans Europe Express

Germany | The embrace of the “affirmation-only” model in Germany—marked by the new S2k German-language treatment guideline—has Europe-wide implications, according to commentator Paul Steger.

“At a time when many European countries are scaling back pediatric transition, German-speaking countries are moving in the opposite direction. This creates a powerful trans-affirmative bloc in the heart of Europe, with a combined population of roughly 100 million people, a total GDP of nearly 6 trillion USD (almost twice that of the UK), and healthcare systems among the largest in Europe (measured by healthcare expenditure as a percentage of GDP),” Mr Steger argues.

“Through EU cross-border health insurance, this development may enable children and adolescents from across Europe to access pediatric transition services.”

Weimar days

America | Psychiatry online, a publication of the American Psychiatric Association (APA), has published a rare critique of the gender-affirming treatment approach. In a letter Kurt Miceli, medical director of Do No Harm, highlights the fact that in the US, “opinions supporting an ‘affirming’ approach are given outsized weight.”

“Why are systematic reviews from Finland and Sweden that highlight the experimental nature of gender reassignment in minors seemingly ignored? Why do we dismiss the Cass review, which, using peer-reviewed systematic evidence, underscores the ‘remarkably weak evidence’ these experts regard as authoritative?”

Dr Miceli calls on the APA to revise its own pro-affirmative position statement “and ground it in fact, not supposition. We’re doing no service to our patients or our profession as our medical society blindly advances an unscientific agenda that is harming many children.”

His letter was a response to an article on President Trump’s “trans” executive orders. One luminary of gender medicine, Columbia University’s Dr Jack Drescher, was quoted as saying: “I feel like I’m in Weimar, Germany, in the 1930s.”