Speak, Hippocrates!
American lawfare; UK blocker trial on trial; Yalie paper debunked, again; hormones without check ups; retrofitting the Dutch protocol; Germany's guideline; top surgery on the NHS; research censorship
GCN in brief
Drugs of desire
France | The centre-right French newspaper, Figaro, has devoted a full page to a new book, The Sermon of Hippocrates: Medicine in the Grip of Identity Ideologies. Its authors, clinical psychologist Dr Cรฉline Masson and child psychiatrist Dr Caroline Eliacheff, are co-founders of the gender medicine watchdog group the Little Mermaid.
Their book is described by Figaro as โprecise and gripping,โ an interrogation of โa form of medicine that, under the guise of benevolence, no longer treats, but validates desires, at the risk of causing irreversible damage.โ
The book extract published on February 18 includes a pot shot at the โirresponsible role of the progressive pressโโ
โThe mediaโs communication strategy consists of highlighting only studies that show improvements in mental health, even though they have been shown to be of poor scientific quality. The side-effects of hormone treatments are played down or even ignored, and the main argumentโthe mantra of trans-affirmative doctors and militant associationsโis that puberty blockers are reversible, as if they were a simple โpause button.โ
โThe progressive, pro-transition press trivialises, even discredits, the argument that itโs better to wait than regret later on, which happens more often than people think.
โWaiting is seen as mistreatment, since puberty โdoesnโt waitโ and does violence to the adolescent, who risks suicide. However, there is no proven correlation between medical transition and a reduced risk of suicide.
โProfessionals calling for caution are systematically branded with negative labels: โtransphobicโ, โabusersโ, โreactionariesโ, โcharlatansโ andโthe ultimate insultโโextreme right-wing.โ The recommendation of psychological exploration is immediately met with another deterrent: the practice of โconversion therapyโ, a veritable weapon of intimidation which, like transphobia, is liable to prosecution.โ
Lawfare
America | In the US state of Kansas, Republican legislators voted on February 18 to override Democrat governor Laura Kellyโs veto of a bill prohibiting gender medicalisation of minors. The bill also creates a civil cause of action exposing a gender clinician to liability for any iatrogenic harm up to 10 years from the date of the patientโs 18th birthday.
In Texas, Republican state senator Bryan Hughes this week introduced a bill to require insurance companies that cover medical transition also to cover โall possible adverse consequencesโ of these interventions.
Last month, a Biden-era federal prosecution of Texas whistleblower Dr Eithan Haim was abandoned. Dr Haim, a surgeon, had gone public because Texas Childrenโs Hospital was continuing to practise gender medicalisation of minors, despite a statement that it would pause these interventions.
In California, Democrat Attorney-General Rob Bonta urged Childrenโs Hospital Los Angelesโhome to the gender clinic of Dr Johanna Olson-Kennedyโto ignore threats to its federal funding from President Trumpโs January 28 executive order seeking to restrict paediatric gender medicine. Mr Bonta cited a federal judgeโs restraining order freezing any such funding cuts.
The Trump order has come under legal attack not only from Mr Bonta and other Democrat state attorneys-general but also from the ACLU and Lambda Legal representing parentsโ group PFLAG and transgender-identifying minors.
The plaintiffs include Cameron, a 12-year-old โnon-binaryโ boy, who was receiving the โmedically necessary careโ that the White House order would prohibit. The claim is that from the age of four โCameron communicated to their parents that they were neither a boy nor a girl.โ
Rapid-onset censorship
America | The reception of the Trump order is by no means all hostile. It has been welcomed as a necessary corrective by a psychology professor, J Michael Bailey, who is well known as the author of the book The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism.
In Newsweek earlier this month, Professor Bailey deplored โthe trend of activists distorting the scientific pictureโ by making attacks on important figures such as Dr Ken Zucker and Dr Lisa Littman.
Professor Bailey wroteโ
โIn 2023, it was my turn. I have been a professor of psychology at Northwestern University for 35 years and a researcher for over 40. Iโve studied many controversial topics, including sexual orientation and gender identity. Activists of all stripes have attacked my work, but Iโd never been censored until 2023.
โThat year, I published an article titled โRapid-Onset Gender Dysphoria: Parent Reports on 1,655 Possible Casesโ in the prestigious Archives of Sexual Behavior. The article confirmed Dr Littmanโs basic findings [on a potential new pathway to gender dysphoria] with a much larger sample and also contributed some novel, disturbing findings.
โFor example, my article concluded that the strongest predictor of whether a child had undergone social or medical transition was having a gender specialist. Parents with that experience believed the specialist pressured them towards transitioning their child.
โAmong the adolescent and young adult children, those with the most pre-existing mental health problems were most likely to have transitioned. Activists erupted yet again, attacking both the article and the editor who accepted it. Under this pressure, the journal retracted the article.โ
Video: UK psychiatrist Dr Az Hakeem on the myths and realities of โtransโ
Trial on trial
United Kingdom | Lawyers for detransitioner Keira Bell and psychotherapist James Esses have threatened court action if a UK clinical trial of puberty blockers goes ahead as recommended by gender medicine reviewer Dr Hilary Cass.
A February 12 letter from Sinclairs Law to the UK Health Research Authority (HRA) claimed that โany decision to approve such a trial would invariably be unlawful and in breach of ethical, regulatory and legislative requirements.โ
The letter argued that the potential benefits of blockers could not outweigh the risks, including early-onset osteoporosis, brain swelling, interference with a critical window for development of the brain, and infertilityโif minors recruited for the trial follow the familiar trajectory to cross-sex hormones.
โGiving life-changing, damaging drugs to confused children in mental distress is an obvious recipe for disaster,โ Ms Bell, a former patient at the now closed Tavistock gender clinic, told The Daily Telegraph.
โIt is completely unethical and unjustifiable to proceed with a trial for these drugs that have not indicated any benefit, only detriment, and facilitate no return.โ
As a clinical trial, the puberty blocker project application would go through a โcombined reviewโ with โa co-ordinated assessment and review of the medicinal productโs safety, quality and efficacyโ involving the HRA, a research ethics committee and the Medicines and Healthcare products Regulatory Agency, a spokesman for the HRA told GCN. In most cases, he said, this would take less time than the stipulated 60 days from receipt of the application.
Ms Bell, together with claimant parents of the Bayswater Support Group, have also foreshadowed a potential judicial review case arguing that the UK governmentโs indefinite ban on private prescribing of puberty blockers for gender-distressed minors should also have restricted the risky use of cross-sex hormones to give effect to the findings of the 2020-24 Cass review.
In a letter to government, Sinclairs Law said: โThe claimants are concerned generally about the prescription of cross-sex hormones and particularly about the risk posed by one prescriber, GenderGP which is registered in Singapore and operates out of Spain.โ
After Dr Cassโs final report, Englandโs National Health Service (NHS) instructed gender clinics to take โextreme cautionโ when prescribing cross-sex hormones for minors.
Ms Bell said she had been given testosterone at age 17 when she wasโ
โโฆ in a vulnerable state, struggling with a multitude of issues including my sexuality and repressed trauma. Many others have alreadyโand will continue toโhave similar revelations as we mature and gain insight.
โThese drugs warp your being and (particularly for women) they cause irreversible effects, changing your physical and social state forever. Once realising the harm caused, you are trapped in a nightmare with no way out.โ
Little data, much confidence
Germany | A contentious German-language guideline for treatment of gender dysphoria in children and adolescents will be published in its final form just after Germanyโs February 23 election, if the rumour mill is right. On social media, psychotherapist Sabine Maur, a member of the guideline development group, declared the document would be out at the end of this month.
She said it would be โa milestone,โ involving more than seven yearsโ work by 26 medical, psychotherapeutic and other organisations.
She added some pre-emptive spin: โThis guideline is also important in order to be able to counter political instrumentalisation and the massive spread of misinformation and transphobic narratives with a scientifically based expert consensus.โ
In its draft form, the guideline promoted the medicalised โgender-affirmingโ approach despite the lack of good evidence for puberty blockers and cross-sex hormones, according to child and adolescent psychiatrist Dr Alexander Korte, a dissenting member of the guideline group.
Last year, German researchers conducted a systematic review of the evidence for blockers and hormones, which they found to be very limited and flawed; they recommended psychotherapy as the main response to gender distress.
Meanwhile, data points of medicalisation continue to emerge. In Switzerland in 2023, 32 girls younger than age 18 underwent trans mastectomy, with a gender clinician saying it was increasingly common for โnon-binaryโ females to consider their breasts โembarrassing,โ Swiss media has reported.
In 2023, 556 people in Switzerland had โsex-reassignmentโ surgery, a 14.4 per cent increase on the year before. The most common procedure was mastectomy; female patients had an average age of 27.
So meta
International | Two new systematic reviews from Canadaโs McMaster Universityโknown for its expertise in evidence-based medicineโhave confirmed the very uncertain state of the data for the use of puberty blockers and cross-sex hormones to treat youth gender dysphoria.
For extra rigour, this project commissioned by the Society for Evidence-based Gender Medicine (SEGM) also involved the first meta-analysis of blocker data. The findings are in line with previous systematic reviews. The McMaster researchers saidโ
โSince the current best evidenceโincluding our systematic review and meta-analysisโis predominantly very low certainty, clinicians must clearly communicate this evidence to patients and caregivers.
โWhile [blockers were] originally considered fully reversible, concerns have emerged about potential long-term effects and partial irreversibility.โ
The systematic review and meta analysis of data on cross-sex hormone use included patients aged 25 and younger, reflecting concern about the still developing brains of young adults.
โThe overarching theme from this and other [systematic reviews on cross-sex hormones] is the lack of high-quality evidence for individuals with [gender dysphoria],โ the researchers said. โProspective studies giving higher certainty evidence are needed to understand the short- and long-term effects of [these hormones].โ
UK author JK Rowling highlighted the new McMaster reviews on X/Twitter, saying: โExactly like Cass, [these Canadian researchers] found โvery low confirmatory evidence of any substantive change in gender dysphoria, depression or overall healthโโ with blockers or hormones.
Ms Rowling said: โThis scandal will be studied to death in years to come. An ideology spawned in academia met greedy, unethical medics, while a tidal wave of activists, politicians, corporations and self-serving celebs glamourised and normalised irreparable harm to minors.โ
The following week, biologist Dr Richard Dawkins hailed Ms Rowling as โa heroโ for her stand against gender medicalisation of minors.
On X/Twitter, Dr Dawkins, an emeritus fellow of New College, Oxford, said: โI look forward to successful lawsuits against surgeons who cut off the breasts of girls below the age of consent. What does โage of consentโ mean if not too young to make irrevocable, life-changing decisions. โFirst do no harmโ.โ
Checking the check ups
United Kingdom | A study of young adult patients in English primary care has found โconspicuous deficiencies in the routine monitoring of gender interventions.โ
In a group of patients identifying as trans or non-binary at two general practices, โa substantial proportion of relevant patients had not had the most basic monitoring of oestrogen (27 per cent) or testosterone levels (11 per cent) and less than one in five transgender patients had had optimal annual blood monitoring,โ the researchers reported earlier this month in the journal Healthcare.
Females in the group had first presented at a younger age (median=17) than the males (20).
โFor masculinisation therapy, there is wide agreement that testosterone levels and full blood count require regular monitoring, in order to ensure haematocrit (HCT) remains within safe levels. There is no consensus on a safe upper limit of HCT [which poses a risk of thromboembolism].โ
Body, not mind
The Netherlands | Psychiatrist Dr Annelou de Vries, a central figure in the development of the puberty blocker-driven โDutch protocol,โ has given an interview in the newspaper NRC, in which she muses about what is meant by a successful gender transition. Consistent with a recent journal article retreating from mental health measures, Dr de Vries conceded that the outcome on such measures may disappointโ
โBut I think we need to question: is that really what we are looking for? That you feel better about your gender experience, that will be a more likely goal, I think.โ
In this revisionist mode, she suggested that hormonal treatment be judged by its physical effect and consumer desire, not by its familiar promise of psychological improvement.
โPuberty inhibitors work, sex development stops,โ Dr de Vries said. โOestrogen works, feminisation begins. Testosterone also works. If we take that as an outcome measure, they are heartily effective treatments. And thatโs what people come for.โ
Act now
International | It is time for health authorities โto get seriousโ about remedying the lack of good research evidence on youth gender dysphoria, according to a new opinion article in the journal JAMA by philosophers Moti Gorin and Jilles Smids with consultant John Lantos MD. They saidโ
โThere are widely used models for collaborative evaluation of innovative therapies for children. In paediatric oncology and other fields, clinicians work together to maintain national collaborative efforts in which data collection and analyses are standardised.
โA similar approach should be attempted for paediatric gender medicine, one that will allow the development of research protocols to address fundamental questions about diagnosis, safety, efficacy, and long-term outcomes.
โThis may be more complicated than in other fields, especially in the current political climate. But that is no reason not to try. After all, the problems will not go away or get any easier.
โAs US physicians and medical societies have learned over the past several years, if the medical profession does not have a closer look at this field of medicine, lawmakers and judges will continue to determine policy on their own.โ
Gender scalpel
United Kingdom | The National Health Service referred 3,490 UK women for โmasculinising chest surgeryโโmastectomyโbetween 2021 and 2023, according to data obtained under Freedom of Information law by The Daily Telegraph.
โAs many as 80 per cent of people using those services are females between the ages of 17 and 25,โ the newspaper reported. โThe 1,000-plus referrals could be the tip of the iceberg, because many people have transgender surgery privately to bypass long NHS waiting lists.โ
Zhenya Abbruzzese, co-founder of SEGM, said: โWe are concerned that young people are being told that these procedures will relieve their distress when the research cannot find the benefits, but the harms of losing a functioning body part are certain.
โDoctors need an urgent memo about the actual state of the evidence. But this is a question primarily for health authorities to decideโshould the treatment be available given the risk-benefit ratio and the evident risk of harm?โ
Sterility as a human wrong
America | The 2018 affirmation-only gender dysphoria policy of the American Academy of Pediatrics (AAP), subjected to a withering fact-check in 2020 by researcher Dr James Cantor, has come under further scrutiny in a letter to the Archives of Sexual Behavior from Dr Kathleen McDeavitt of Baylor College of Medicine in Texas.
Her letter said: โOut of the seven citations provided in [the AAPโs] narrative review [of the scientific literature], only one (de Vries et al, 2011) was actually a clinical outcomes research study that found improvement in mental health outcomes. In that study, clinical significance of improvement was unclear.โ
Dr McDeavitt noted that the AAP had reaffirmed its 2018 policy in August 2023 without acknowledging that multiple systematic reviews since 2018 had found the evidence for puberty blockers and hormones to be very weak. She wroteโ
โMedical organisations in the US have functioned, in this ongoing saga, mostly as trade union representatives for their paediatric gender specialist members and lobbyists for the rights of those specialists to practise unencumbered by legislation.
โIt is likely that an altruistic drive has also underlaid these efforts; commitment to human rights and defence of marginalised, vulnerable groups are laudable qualities.
โHowever, the AAP should consider another perspective, which is that the organisation continues to recommend, in the setting of weak evidence, that a vulnerable minority group be treated with interventions that may cause (among other problems) infertility and lifelong sexual dysfunction.โ
More corrections
America | Another peer-reviewed critique of the so-called โYale white paperโ on the Cass review has been published, with psychiatrist Professor Stephen B Levine among its authors. The critique challenges, among other points, the Yale paperโs suggestion that the Cass reviewโs own audit of patient data revealed the detransition rate to be very low.
โActually, the review explicitly noted that the percentage who detransition remains unknown. Its audit could not identify all patients who detransitioned โฆ because adult gender clinics refused to share data with the review,โ the new critique said.
โThe audit was affected by truncated follow-up time, as existing literature suggests average time to detransition โฆ of several years. The reviewโs (limited) audit showed an average time to detransition of seven years. Thus, the reviewโs emphasis was on the existing inadequacy of follow-up data, rather than the rate of detransition being โvery lowโ.โ
WPATH on the nose
Ireland | The 2025 Programme for Government in Ireland has abandoned a plan to implement US-style โgender-affirmingโ treatment for adults and minors. The 2020 programme had promised a model of care based on the advice of the World Professional Association for Transgender Health (WPATH).
News of the more cautious Irish government approach was welcomed by Dr Paul Moran, a consultant psychiatrist at the National Gender Service for adults.
โThe WPATH model of care was not evidenced based and that has been shown by the Hilary Cass report,โ Dr Moran told the Irish Independent newspaper.
โWPATH has come under scrutiny for suppressing evidence in America and has been significantly discredited. As an advisory body, a lot of medical people have stepped away from it and it was increasingly controlled by lay people or activists. It promoted gender care that went against the best evidence such as giving puberty blockers to children.โ
Irelandโs government has also dropped a proposal to consider allowing children under 16 to change their legal gender.
Gender Minus
United Kingdom | A legal challenge to the licensing of Gender Plus, a new private clinic in the UK, has been set down for hearing in the High Court on June 24-25. Gender Plus was approved to give hormonal treatment to minors aged 16-17.
In Glasgow, Scotland, there are reportedly 30 minors aged five to ten years old on the waiting list for the Sandyford gender clinic, which has restricted hormonal treatment since the Cass review. Meanwhile, polling in the UK by YouGov shows 78 per cent opposition to cross-sex hormones for minors under age 16, and 87 per cent against breast or genital surgery on those under 16.
Drugging the healthy
Belgium | In 2022 in Belgium, 684 children aged nine to 17 were prescribed puberty blockers for gender distress, representing a 60 per cent increase on 2019, according to Joren Vermeersch, a lawyer and columnist for the newspaper De Standaard.
โIn Belgium, girls with gender dysphoria can have their breasts amputated from the age of 16,โ he wrote. โWe donโt realise how exceptional that is in a European context. Outside Belgium, only the Netherlands allows it.
โIn Belgium, there is also no legal age limit on administering testosterone or oestrogen to children with gender dysphoria. This is done as early as 16 years old, sometimes even earlier. And at an even much younger age, such children can obtain puberty blockers in Belgium.โ
Mr Vermeersch pointed out that blockers (GnRH analogues) were developed for other purposes; โto cure real and dangerous physical conditions.โ
โToday, Belgian gender clinics prescribe them for long periods to children who are in perfect physical health. This is done off label: in violation of the information leaflet.โ
Regarding the Californian law suits;
โThe plaintiffs include Cameron, a 12-year-old โnon-binaryโ boy, who was receiving the โmedically necessary careโ that the White House order would prohibit. The claim is that from the age of four โCameron communicated to their parents that they were neither a boy nor a girl.โ
So this seems a simple problem. If Cameron does not know he is a boy or a girl why not leave him as a boy. Surely this would be better than starting him on a lifelong regime of puberty blockers then oestrogen and finally castration and penectomy only for him to find at the end of that that maybe he was a boy after all.
THE MYTH THAT GENDER TRANSITION SAVES LIVES;
An ABC News article commended Dr. Michelle Telfer for โsaving the lives of hundreds, even thousands of children without ever picking up a scalpel or treating a disease.โ
This is nonsense. LONG-TERM outcome following gender transition demonstrates a miserable outcome for those poor souls thus 'treated'.
I cite a brief summary of four notable studies (all readily accessible on the internet) that shed light on the outcomes associated with gender transition:
1. Amsterdam Cohort of Gender Dysphoria Study (1972โ2017)
โข Key Finding: While suicide risk in transgender individuals is higher than in the general population, this risk remains consistent across all stages of transition. The study noted no significant increase in suicide risk over time, and in some cases, a decrease in trans women.
2. Long-Term Follow-Up of Transsexual Persons in Sweden (1973โ2023)
โข Key Finding: Individuals who underwent sex reassignment surgery (SRS) exhibited substantially higher risks of mortality, suicidal behaviour, and psychiatric conditions compared to the general population.
3. Suicide Mortality Among Adolescents in Finland (1996โ2019)
โข Key Finding: Gender dysphoria alone did not predict mortality or suicide among adolescents referred to gender identity clinics. Psychiatric comorbidities were the primary predictors of mortality, and medical gender reassignment did not mitigate suicide risk.
4. Somatic Morbidity and Cause of Death in Denmark (1978โ2010)
โข Key Finding: Among individuals who underwent SRS, somatic morbidity increased from 19.1% pre-surgery to 23.2% post-surgery, with a mortality rate of 9.6%. The average age at death was 53.5 years.