Signs and symptoms of fraud

Plus: Medicaid tap turns off; ROGD birthday; WPATH fesses up; Trans safetyism in Oz; Germany's outlier guideline; reviving Watchful Waiting; Canada's data hole; Cass inconsistency; Singapore update

GCN global briefs

By any other name

America | US hospitals and clinics have been referred to the Trump Administration’s Department of Justice for possible breaches of federal law following a report on potentially fraudulent insurance claims for paediatric medical transition. The Wolves in White Coats report, commissioned by the Department of Health and Human Services (HHS), identifies US$50 million in insurance claims for puberty blockers billed with the misleading diagnosis of “endocrine disorder, unspecified”. The HHS report says that using this code instead of a gender-related diagnosis violates the Centers for Medicare & Medicaid Services guidelines “for the simple reason that gender dysphoria is not an endocrine disorder, since it exhibits no hormonal abnormalities. In fact, the only endocrine disorders these patients have are the ones created by their doctors through the use of sex-rejecting interventions”.

The HHS report also highlights nearly US$11 million in claims using the diagnosis of precocious puberty in the suspect age bracket of 13-17. That diagnosis applies when children commence puberty prematurely, under 8 for girls and under 9 for boys. Data from the Pennsylvania Department of Human Services shows an increase of 2,100 per cent in reimbursement for puberty blocker claims wrongly using the code for precocious puberty between 2013 and 2017, the report says.

“[T]here is reason to believe that some (perhaps many) providers of sex-rejecting procedures systemically diagnose minors with physical conditions they did not have in order to secure insurance coverage for ‘treatments’ (like breast removal or hormonal treatment) that insurers (including Medicaid and Medicare) might not otherwise have covered, had they been provided with full and accurate information. If true, the entities that took these steps face potentially serious criminal and civil liability.” (In Australia, clinicians use the diagnosis of “androgen deficiency/testicular disorder” to access taxpayer-funded testosterone for teenage females who identify as male or non-binary.)

America | The US Centers for Medicare & Medicaid Services (CMS) has announced a new rule intended to cease federal funding of paediatric medical transition through Medicaid and the Children’s Health Insurance Program from October 13. “Children deserve our protection, not experimental interventions that pose serious risks and convey no proven benefits,” CMS Administrator Dr Mehmet Oz said. “By cutting off federal funds for these sex-rejecting procedures, we’re following the science, saving taxpayer dollars, and, most importantly, protecting children from potentially irreversible harm so they can truly flourish.”

Texas surgeon Dr Eithan Haim, a whistleblower, said the change was “a big deal”. “Before the rule, if a gender doc wanted to sterilize a child with blockers, 50 per cent of the cost would be covered by federal Medicaid dollars. Now that’s gone. States will pay 100 per cent of the cost.”

Financial appetite: The “wolves in white coats” got revenue, while harm accrued for detransitioners.

ROGD milestone

International | Dr Stella O’Malley, founder of Genspect, and Mia Hughes, director of Genspect Canada, have hosted a webinar on the importance of Dr Lisa Littman’s 2018 research paper in which she coined the term “rapid-onset gender dysphoria”. The occasion for the webinar was ROGD Awareness Day, marked on August 16, eight years on from the Littman paper.

Visibility

International | From October, people who desist or detransition will be recognised in the ICD diagnostic system with updated categories including “gender dysphoria, in remission (desistance)”. The new diagnoses are meant to generate better data, identify treatment and secure insurance coverage. This will correct “a lamentable official blindness to the very existence of detransitioners,” according to the medical watchdog group Do No Harm.

Big as Texas

America | The first US detransition clinic is to open by October under a US$10 million settlement between the Texas Children’s Hospital and the state’s Attorney General Ken Paxton. The hospital, accused of Medicaid fraud in pursuit of gender medicine, has issued a statement declaring it has “permanently and irrevocably” stopped providing “sex-rejecting procedures”. Whistleblower nurse Vanessa Sivadge said she had witnessed doctors who “allegedly falsified medical records, used vague diagnosis codes to conceal sex-rejecting hormones, and misdiagnosed patients so Medicaid would reimburse treatments it otherwise shouldn’t”.

These alleged practices stretched back to 2010, according to Burke Law Group, which was involved in the settlement. The firm said the detransition clinic “will provide free multidisciplinary services, including endocrinology, surgery, primary care, fertility counseling, psychiatry, psychotherapy, social work/case management, and speech pathology”.

Meanwhile, Connecticut Children’s Medical Center has become the third hospital to reach a settlement with the Trump Administration’s Department of Justice. The Center has agreed to end sex-rejecting procedures for minors and will pay a US$500,000 penalty towards treatment for patients harmed by those procedures.

Not rare enough to ignore

America | The need for protocols to help detransitioners has been admitted in member-only forums of the World Professional Association for Transgender Health. WPATH’s standards of care claim that “the decision to detransition appears to be rare”.

Forum threads from 2024 obtained by Daily Wire reveal clinicians concerned about the lack of guidance for patients detransitioning. “We really need the clinical pathways,” one psychologist said. “People will ask how to go off testosterone or how to restart testosterone and I’ve asked various MDs and gotten different responses. Often, folks who are choosing to detransition feel like they have to do this all on their own.”

No informed consent

America | Sinead Haupt, a male with a mental health history who identified as a woman and had his testicles removed at age 24, has filed a claim in the Superior Court of New Jersey alleging that practitioners were negligent in allowing him to go ahead with the surgery, The Sunday Times reports. Mr Haupt, now a detransitioner, says his mental health was not adequately evaluated, and the severe side-effects of the surgery were not properly explained, meaning he was unable to give informed consent.

Just an opinion

International | The WPATH standards of care—promoted as the gold standard, settled science, and the north star of trans health—are in fact one-sided opinions in an “intense public debate,” WPATH has argued in a US court case. “WPATH is on one side of that debate and provides guidelines on how to best provide transgender healthcare. Others, such as Dr Hilary Cass, fall on the other side of the debate and disagree with how to, or if one should, provide transgender healthcare to adolescents.”

WPATH’s perhaps surprising position is offered as a defence to the Federal Trade Commission’s allegations of misleading and deceptive conduct. WPATH claims constitutional protection for its right to express its scientific opinions. “That transgender healthcare is an area of intense medical debate does not entitle [the Commission] to prevent individuals and organizations like WPATH from speech aimed at contributing to that debate. To the contrary, participation in such a debate is exactly the type of speech the First Amendment is intended to protect.”

Safe from debate

Australia | “Trans-denial” will not be tolerated in a new special interest group within the Australian Association of Psychologists Inc. The minutes of the August 7 meeting of the Diverse Sexes, Sexualities and Genders—Allies Welcome Group recorded that it was “Not explicitly stated during the meeting but it seemed clear through the discussion that trans-denial and other discourse widely accepted within the queer community as problematic will not be acceptable within this group. The unanimous preference is for affirming practice.”

Across four pages of minutes and a charter, the words “safety”, “safe” or “safer” are used 17 times without clear definition.

In the code of conduct for psychologists, issued last year by the Australian Health Practitioner Regulation Agency, “safe” or “safety” appears 74 times. “Cultural safety” is said to require “respect” for diverse “gender identities”. What respect means in this domain is not explained.

It seems that dissent from the gender-affirming model is deemed unsafe, as if it inflicts a psychological injury.

Resource rich

International | Tavistock clinic whistleblowers Marcus and Susan Evans have launched a website “bringing together our books, articles, lectures and interviews on gender distress, identity and psychological development”. Resources include information and support for parents, and a Family Consultation Service, which “offers parents and families an opportunity to think together about a child’s or young person’s distress, the wider emotional and developmental context in which it has emerged, and the different ways of understanding and responding to it”.

Double standards

America | Dr Karla Solheim, an obstetrician who had performed gender-affirming hysterectomies at an LGBTQ+ clinic in Iowa has recounted for The Free Press her disillusionment with the model promoted by WPATH. “I was floored to discover the research basis into gender medicine both for adolescents and adults was not just poor; it was fraudulent,” she said.

Dr Solheim’s attitude to gender-affirming hysterectomy changed when a woman in her 20s requested the procedure. The would-be patient identified as non-binary but presented like a conventional woman and was not seeking transition with testosterone. “Why was it that for a healthy young [non-trans] person it would be nearly impossible to get their uterus removed without an underlying medical issue, but if one were simply to identify as a man with no other plans to transition—or even just say they are non-binary—the surgery is freely available?”

Her public criticism of the WPATH gender-affirming model led to her being forced out as chair of the Iowa section of the American College of Obstetricians and Gynecologists (ACOG), which had endorsed WPATH. “Rather than hear my concerns and take them seriously, my national medical association chose to silence me. They chose to be complicit in a campaign to promote ideology in medicine over evidence-backed science.”

She said she had always thought that medical associations confronted with the truth would change their guidance. “The reality is that these medical associations have now become overrun by a small, loud group of activists. The leaders who we expect to guide us and hold us to the highest standards have succumbed to [the activists] out of cowardice, or even ignorance ... They’re now more interested in silencing critics than they are in standing up for what is best for our patients. I know this because it’s exactly what I witnessed at ACOG.”

“Ordinary people can see quite clearly that this medicine is dangerous. When our greatest medical authorities insist otherwise, it undermines doctors’ credibility and makes people less likely to trust us for their care.”

Wait and see

International | Jason Watson, the New Zealand mental health nurse whose debunking paper on the trans suicide narrative was removed from an Australian journal after activist complaints, has published a new paper on the cautious “watchful waiting” approach to gender distress. In the journal Nurse Education in Practice, he notes the “lack of a robust evidence base” for gender-affirming treatment and the questionable capacity of patients to give informed consent. He suggests instead “a cautious, developmentally informed approach such as watchful waiting may offer a patient-centred framework while the evidence base continues to develop”.

“[Watchful waiting] is defined as a deliberate, evidence-informed approach that considers the individual’s unique needs and circumstances while avoiding unnecessary interventions that may result in long-term or irreversible consequences.

“[It] emphasises allowing sufficient time before planning and implementation to facilitate comprehensive assessment, observation, and, where appropriate, further investigation. This process enables nurses to identify co-existing conditions and associated risks, including psychosocial challenges, co-occurring mental health disorders, neurodevelopmental conditions, and the influence of peer relationships or social contagion.”

Data vacuum

Canada | The influential Globe and Mail newspaper has weighed into the debate over puberty blockers, arguing that treatment “must be based on the best medical advice available, not ideology”. The paper’s editorial board notes the shift away from routine puberty blocking in countries including Finland, Sweden and the UK. “There has been no such re-examination in Canada,” the editorial says.

While opposing legal restrictions in the province of Alberta, the Globe and Mail says Canada is not engaged in the necessary debate about best practices.

“There is a data vacuum in this country on the long-term effects of puberty blockers, one that deprives physicians, patients and their families of the best possible science in treating cases of possible gender incongruence and dysphoria. So far, the medical establishment has not been willing to fill that vacuum. It’s past time for clinicians and researchers to do so: this country cannot shy away and hope to outsource this research to other countries.”

Meanwhile, Canadian writer Peter Gajdics, a gay man who suffered conversion therapy, has thought better of his past advocacy for the deceptive new generation of conversion bans focused on transgender identity. He says he did not understand at the time that such bans would lead to the medicalisation of gender non-conforming minors. Now, on a Genspect podcast, he says: “Gender affirmative care is the new euphemism for conversion therapy.”

Thumb on the scale

Australia | In the state of Tasmania, the Greens party has released an exposure draft of a law against “conversion practices” involving not only sexual orientation but the ill-defined concept of “gender identity”. The accused could face civil or criminal proceedings, with a maximum prison term of 21 years. In a submission, Emeritus Professor of Law Patrick Parkinson argues that the bill, like its counterparts in other jurisdictions, is “deeply flawed”.

He writes: “There has never been a well-documented issue about therapy concerning ‘gender identity’ that has caused significant harm. The only issue has been debate about the role of psychotherapy in treating gender dysphoria or incongruence. On this issue, medical practitioners differ. That [psychotherapy] treatment, which some call ‘conversion therapy’, is now the mainstream option for gender dysphoric minors in Scandinavia, Britain and elsewhere, following expert medical reviews of the evidence for the efficacy of hormonal treatments in addressing gender dysphoria.

“The Parliament of Tasmania should not put its thumb on the scale on what is an intense debate in the medical and mental health professions internationally.”

Benefit-harm ratio

International | Dr Yuan Zhang, of the Toronto-based Evidence Bridge organisation, has challenged the assumption that the low quality of evidence of benefit for paediatric medical transition entails an equivalent uncertainty about the risk of harm. In a paper based on his July 2026 talk at the recent London conference of the Clinical Advisory Network on Sex and Gender and the Society for Evidence-based Gender Medicine, Dr Zhang argues that “many physiological harms [of medical transition] can be reasonably inferred from established mechanistic evidence in physiology, developmental biology, and pharmacology”.

“Consequently, the current balance of the best available evidence [for paediatric medical transition] suggests that the potential harms may outweigh the anticipated benefits.” Dr Zhang says this has implications for clinical decision-making and equipoise, the ethical principle in research “that requires genuine uncertainty about the relative benefits and harms of competing interventions before a study can be ethically conducted”.

“For example, as for the [UK] PATHWAYS trial, uncertainty may remain regarding the incremental benefits and harms of adding puberty blockers before subsequent cross-sex hormone therapy, compared with initiating cross-sex hormone therapy alone. However, such uncertainty does not imply that either treatment strategy has a favourable benefit–harm profile. “Based on the current best available evidence, both strategies may reasonably be expected to result in net harm. In the absence of evidence demonstrating an overall net clinical benefit, the principle of non-maleficence requires that patients not be exposed to avoidable harm.”

United Kingdom | Writing for Genspect, scientist Dr Zoe Hollowood argues that Dr Hilary Cass’s recent parliamentary briefing on the puberty blocker trial lacks the “intellectual discipline and restraint” of her 2024 final report. The briefing, Dr Hollowood says, “adopts a very different tone, presenting a much stronger and at times unevidenced case for why the trial should proceed (e.g. buying time, harm reduction) whilst minimising potential arguments against the trial (e.g. risks, completion of the data linkage study)”.

“Cass increasingly argues that the trial must go ahead on the basis that children are self-medicating using unregulated providers and that long waiting lists have left children vulnerable to online misinformation.

“Yet [the trial] is not designed to answer whether offering puberty blockers reduces those harms. The primary endpoint is a self-reported quality-of-life questionnaire. There appears to be a mismatch between the rationale being advanced by Cass in the briefing and the questions the study is actually designed to answer.”

International | A 26-country Ipsos survey has tracked a decline in support for teenage “access to gender-affirming care” where parents agree. In 2023, 59 per cent of those polled agreed with such access. That fell to 55 per cent in 2024, then stabilised at 50 per cent in 2025 and 2026.

Singapore | Hormonal treatment of gender dysphoria will continue while health authorities in the Southeast Asian republic of Singapore roll out treatment review panels to make case-by-case decisions. Under recently issued guidelines, puberty blockers are to be banned, while cross-sex hormones will be denied to the 18-21 age group, apart from “exceptional circumstances”. (The age of majority is 21.)

In an August 5 answer to questions from MPs, the Health Minister Ong Ye Kung confirmed the new, psychology-first approach to gender distress. This approach, he said, “gives us greater assurance that each patient receives an appropriate diagnosis and treatment pathway. It enables us to better support young people with [gender dysphoria], while avoiding putting those without [this condition] on a painful and irreversible path.

Mr Ong also appeared to explain the disappearance of the new guidelines from health ministry webpages soon after they were uploaded in early May. He said the guidelines were “not intended for a wider audience” than medical practitioners, who were sent the documents directly.

America | In a Substack post, psychiatrist Kristopher Kaliebe has criticised the lowering of standards in the American Journal of Psychiatry (AJP) when the subject matter is paediatric medical transition. He cites the highly charged language of a January 2026 paper which characterises puberty blockers, cross-sex hormones and surgery as “essential, evidence-based, and lifesaving” and calls for “ethical resistance” to age-limit laws in US states and “medical disobedience”, which “entails deliberate lawbreaking”.

Professor Kaliebe and fellow psychiatrist Dr Kathleen McDeavitt managed to get a letter to the editor published, eliciting a reply from the authors of the paper. “To my knowledge, this exchange is the first time AJP has permitted scholarly exchange on this topic,” Professor Kaliebe says in his post. “It is good that the journal is finally acknowledging the many systematic reviews, the European policy shifts, and the costs of raising concerns inside the field. Most importantly, the gap between inaccurate advocacy language (‘essential, evidence-based, and lifesaving’) and the actual state of the evidence is now on record.”

The Kaliebe-McDeavitt letter to the editor notes the effects of paediatric medical transition as a politicised domain, stating that:

“In this culture, continuing medical education courses that criticize prevailing narratives [on paediatric medical transition] are summarily delisted upon complaints from activists, physicians lose their jobs for voicing criticism, psychology graduate students are disciplined for merely discussing systematic reviews with classmates, psychologists are prohibited from mentioning the UK’s practice changes on official listservs and researchers are harassed and intimidated into withdrawing papers. These conditions are antithetical to the pursuit of scientific knowledge and, consequently, pose a risk to patients.”

Good in theory

Germany | The new German language S2k guideline for youth gender dysphoria has been scrutinised in a new book chapter by psychiatrists Professor Florian Zepf of Jena University Hospital and Dr Werner Königschulte from Marien Hospital Papenburg Aschendorf. “One of the key innovations of the guideline is the attempt to distinguish between supposedly ‘stable’ gender incongruence and ‘temporary dissatisfaction with one’s own gender’,” they write. “Whilst this approach sounds plausible at first glance, it fails in practice: the guideline does not specify any verifiable criteria by which these two groups could be reliably distinguished from one another in advance. It also remains unclear to what extent such a distinction would even be valid. Without reliable diagnostic markers, this differentiation remains merely a theoretical construct with no immediate practical relevance.

“Whilst the guideline acknowledges that the evidence is limited, particularly regarding puberty blockers and cross-sex hormones, it draws hardly any practical conclusions from this.

“International analyses—including the systematic reviews by the UK’s [National Institute for Health and Care Excellence] and the Cass Review—unanimously conclude that there is a lack of robust evidence of efficacy. The new German-language S2k guideline … deviates significantly from international developments on this issue and is thus adopting an increasingly isolated position.”

No to surgery

Australia | The state of South Australia (SA) has decided not to revive transgender surgery in public health, The Advertiser newspaper reports. Flinders Medical Centre had offered such surgery until 1988. A 2023 SA Statewide Gender-Diversity Model of Care, reportedly co-designed with trans lobby groups, includes taxpayer-funded surgery. In one draft, this model of care proposed trans surgery for minors in the adult services of public health, which would be the most radical step yet in Australia.

Now, however, SA Health says: “Currently, with increasing service demand for elective procedures already available within the SA public system, it is not feasible to implement the gender-diversity surgical model and there is no proposed date for its introduction.”

Meanwhile, an SA Health review into how 22 minors in 2023-24 were given gender-affirming medical treatment without the mandated psychiatric assessment will not be made public. SA politician Sarah Game, of the Family First party, said a Freedom of Information request lodged last November had resulted in a 27-page, “fully redacted” document, despite the request not seeking any names or private medical records. “We wanted to know what the review identified about how this happened, what recommendations were made, and what changes have been implemented to prevent it happening again,” she said. Ms Game called on the government to release a de-identified copy of the review’s findings. Adelaide, the SA state capital, is hosting a Gender Healthcare Summit on October 9-10.

Money ill-spent

Australia | A grant of AU$10 million to a La Trobe University centre and two trans medicine lobbies, ACON and Thorne Harbour Health, “will exacerbate health and wellbeing risks for young Australians with gender incongruence or dysphoria and channel them towards unproven medical interventions with irreversible effects,” according to Genspect, which advocates for non-invasive responses to youth gender distress. The grant is to enable a voluntary training and accreditation scheme to deliver “safe, inclusive and affirming care for LGBTIQA+ people”. Genspect board member and paediatrician Dr Gary Geelhoed, a former Chief Medical Officer of Western Australia, said that “‘affirming care’ when applied to gender-confused young people is not a synonym for safe care”. He said this treatment model encourages “the use of puberty blockers, cross-sex hormones and surgery, including for minors”.

School to clinic pipeline

America | A new report from the group Do No Harm has documented little-known state funding for transgender ideology. “Taxpayers are not only paying for irreversible and dangerous treatments for children through Medicaid. They are also funding the state-run programs that encourage children down the gender-ideology path in the first place,” James Eller, the group’s director of government accountability, wrote in The Wall Street Journal.

“Through public funding for state education and healthcare programs, taxpayers are unwittingly complicit in physically harming vulnerable children.” His report focuses on the state of Colorado’s “gender-affirming pipeline”. The “I Matter” program delivers “gender-affirming care” therapy sessions to children as young as ages 6-9. “Colorado children currently have access to taxpayer-backed therapy aimed at affirming a ‘gender identity’ that doesn’t match their sex,” Mr Eller said.

“Meantime, at the University of Colorado School of Medicine, taxpayer funding supported the indoctrination of future physicians. Documents show that the ‘LGBTQ+ Health’ curriculum—a mandatory course for all first-year medical students in the 2024-25 class—was heavily influenced by external advocacy groups that support child transgenderism.”