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

Photo by Melpo Tsiliaki on Unsplash

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 Céline 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 “precise and gripping,” an interrogation of “a form of medicine that, under the guise of benevolence, no longer treats, but validates desires, at the risk of causing irreversible damage.”

The book extract published on February 18 includes a pot shot at the “irresponsible role of the progressive press”—

“The media’s 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 argument—the mantra of trans-affirmative doctors and militant associations—is that puberty blockers are reversible, as if they were a simple ‘pause button.’

“The progressive, pro-transition press trivialises, even discredits, the argument that it’s better to wait than regret later on, which happens more often than people think.

“Waiting is seen as mistreatment, since puberty ‘doesn’t wait’ and does violence to the adolescent, who risks suicide. However, there is no proven correlation between medical transition and a reduced risk of suicide.

“Professionals calling for caution are systematically branded with negative labels: ‘transphobic’, ‘abusers’, ‘reactionaries’, ‘charlatans’ and—the ultimate insult—‘extreme right-wing.’ The recommendation of psychological exploration is immediately met with another deterrent: the practice of ‘conversion therapy’, a veritable weapon of intimidation which, like transphobia, is liable to prosecution.”

Lawfare

America | In the US state of Kansas, Republican legislators voted on February 18 to override Democrat governor Laura Kelly’s 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 patient’s 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 “all possible adverse consequences” 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 Children’s 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 Children’s Hospital Los Angeles—home to the gender clinic of Dr Johanna Olson-Kennedy—to ignore threats to its federal funding from President Trump’s January 28 executive order seeking to restrict paediatric gender medicine. Mr Bonta cited a federal judge’s 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 parents’ group PFLAG and transgender-identifying minors.

The plaintiffs include Cameron, a 12-year-old “non-binary” boy, who was receiving the “medically necessary care” that the White House order would prohibit. The claim is that from the age of four “Cameron communicated to their parents that they were neither a boy nor a girl.”

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 “the trend of activists distorting the scientific picture” by making attacks on important figures such as Dr Ken Zucker and Dr Lisa Littman.

Professor Bailey wrote—

“In 2023, it was my turn. I have been a professor of psychology at Northwestern University for 35 years and a researcher for over 40. I’ve studied many controversial topics, including sexual orientation and gender identity. Activists of all stripes have attacked my work, but I’d never been censored until 2023.

“That year, I published an article titled ‘Rapid-Onset Gender Dysphoria: Parent Reports on 1,655 Possible Cases’ in the prestigious Archives of Sexual Behavior. The article confirmed Dr Littman’s basic findings [on a potential new pathway to gender dysphoria] with a much larger sample and also contributed some novel, disturbing findings.

“For 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.

“Among 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.”

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Video: UK psychiatrist Dr Az Hakeem on the myths and realities of ‘trans’

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 “any decision to approve such a trial would invariably be unlawful and in breach of ethical, regulatory and legislative requirements.”

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 infertility—if minors recruited for the trial follow the familiar trajectory to cross-sex hormones.

“Giving life-changing, damaging drugs to confused children in mental distress is an obvious recipe for disaster,” Ms Bell, a former patient at the now closed Tavistock gender clinic, told The Daily Telegraph.

“It 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.”

As a clinical trial, the puberty blocker project application would go through a “combined review” with “a co-ordinated assessment and review of the medicinal product’s safety, quality and efficacy” 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 government’s 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: “The 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.”

After Dr Cass’s final report, England’s National Health Service (NHS) instructed gender clinics to take “extreme caution” when prescribing cross-sex hormones for minors.

Ms Bell said she had been given testosterone at age 17 when she was—

“… in a vulnerable state, struggling with a multitude of issues including my sexuality and repressed trauma. Many others have already—and will continue to—have similar revelations as we mature and gain insight.

“These 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.”

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 Germany’s 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 “a milestone,” involving more than seven years’ work by 26 medical, psychotherapeutic and other organisations.

She added some pre-emptive spin: “This 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.”

In its draft form, the guideline promoted the medicalised “gender-affirming” 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 “non-binary” females to consider their breasts “embarrassing,” Swiss media has reported.

In 2023, 556 people in Switzerland had “sex-reassignment” 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 Canada’s McMaster University—known for its expertise in evidence-based medicine—have 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 said—

“Since the current best evidence—including our systematic review and meta-analysis—is predominantly very low certainty, clinicians must clearly communicate this evidence to patients and caregivers.

“While [blockers were] originally considered fully reversible, concerns have emerged about potential long-term effects and partial irreversibility.”

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.

“The overarching theme from this and other [systematic reviews on cross-sex hormones] is the lack of high-quality evidence for individuals with [gender dysphoria],” the researchers said. “Prospective studies giving higher certainty evidence are needed to understand the short- and long-term effects of [these hormones].”

UK author JK Rowling highlighted the new McMaster reviews on X/Twitter, saying: “Exactly like Cass, [these Canadian researchers] found ‘very low confirmatory evidence of any substantive change in gender dysphoria, depression or overall health’” with blockers or hormones.

Ms Rowling said: “This 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.”

The following week, biologist Dr Richard Dawkins hailed Ms Rowling as “a hero” for her stand against gender medicalisation of minors.

On X/Twitter, Dr Dawkins, an emeritus fellow of New College, Oxford, said: “I look forward to successful lawsuits against surgeons who cut off the breasts of girls below the age of consent. What does ‘age of consent’ mean if not too young to make irrevocable, life-changing decisions. ‘First do no harm’.”

Checking the check ups

United Kingdom | A study of young adult patients in English primary care has found “conspicuous deficiencies in the routine monitoring of gender interventions.”

In a group of patients identifying as trans or non-binary at two general practices, “a 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,” 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).

“For 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].”

Body, not mind

The Netherlands | Psychiatrist Dr Annelou de Vries, a central figure in the development of the puberty blocker-driven “Dutch protocol,” 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 disappoint—

“But 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.”

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.

“Puberty inhibitors work, sex development stops,” Dr de Vries said. “Oestrogen works, feminisation begins. Testosterone also works. If we take that as an outcome measure, they are heartily effective treatments. And that’s what people come for.”

Act now

International | It is time for health authorities “to get serious” 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 said—

“There 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.

“A 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.

“This 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.

“As 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.”

Gender scalpel

United Kingdom | The National Health Service referred 3,490 UK women for “masculinising chest surgery”—mastectomy—between 2021 and 2023, according to data obtained under Freedom of Information law by The Daily Telegraph.

“As many as 80 per cent of people using those services are females between the ages of 17 and 25,” the newspaper reported. “The 1,000-plus referrals could be the tip of the iceberg, because many people have transgender surgery privately to bypass long NHS waiting lists.”

Zhenya Abbruzzese, co-founder of SEGM, said: “We 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.

“Doctors need an urgent memo about the actual state of the evidence. But this is a question primarily for health authorities to decide—should the treatment be available given the risk-benefit ratio and the evident risk of harm?”

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: “Out of the seven citations provided in [the AAP’s] 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.”

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 wrote—

“Medical 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.

“It is likely that an altruistic drive has also underlaid these efforts; commitment to human rights and defence of marginalised, vulnerable groups are laudable qualities.

“However, 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.”

More corrections

America | Another peer-reviewed critique of the so-called “Yale white paper” on the Cass review has been published, with psychiatrist Professor Stephen B Levine among its authors. The critique challenges, among other points, the Yale paper’s suggestion that the Cass review’s own audit of patient data revealed the detransition rate to be very low.

“Actually, the review explicitly noted that the percentage who detransition remains unknown. Its audit could not identify all patients who detransitioned … because adult gender clinics refused to share data with the review,” the new critique said.

“The audit was affected by truncated follow-up time, as existing literature suggests average time to detransition … of several years. The review’s (limited) audit showed an average time to detransition of seven years. Thus, the review’s emphasis was on the existing inadequacy of follow-up data, rather than the rate of detransition being ‘very low’.”

WPATH on the nose

Ireland | The 2025 Programme for Government in Ireland has abandoned a plan to implement US-style “gender-affirming” 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.

“The WPATH model of care was not evidenced based and that has been shown by the Hilary Cass report,” Dr Moran told the Irish Independent newspaper.

“WPATH 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.”

Ireland’s 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.

“In Belgium, girls with gender dysphoria can have their breasts amputated from the age of 16,” he wrote. “We don’t realise how exceptional that is in a European context. Outside Belgium, only the Netherlands allows it.

“In 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.”

Mr Vermeersch pointed out that blockers (GnRH analogues) were developed for other purposes; “to cure real and dangerous physical conditions.”

“Today, 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.”