Surgical self-harm

Voices against trans mastectomy in Austria, Switzerland; Chilean prosecutor on the case; another Children's Crusade; New Hampshire joins US state bans; Oz whistleblower petition; Italy's expert fail

Photo by César Badilla Miranda on Unsplash

GCN in brief

Austria | Psychiatrist Bettina Reiter has urged Austria’s government to impose a minimum age of 25 for trans surgery, the same age threshold that applies for sterilisation or gun ownership, the newspaper Kurier has reported. Once unheard of, mastectomies among Austrian females under the age of 20 with the diagnosis of “gender identity disorder” rose from 5 in 2013 to 49 in 2023. “Looking at the even larger group of under-25s, there have been more than 740 hospital discharges with [the same diagnosis] in Austria since 2013; 90 per cent of the healthy body parts removed were female breasts,” the Kurier said.

“Parents of affected young people are now organising themselves into self-help groups. And they are calling on politicians and the medical community to do something that should actually be a matter of course: provide evidence-based treatment.” But recommendations issued by the Ministry of Health state that trans mastectomy for minors is permissible if they have lived “for a reasonable period of time in the desired gender role.”

Dr Reiter said a “climate of fear” had suppressed critical discussion within Austria’s medical profession, and families were making the mistake of reinforcing the unprecedented trend of trans-identification among teenagers. “Adults have a responsibility to say no in important situations.” She questioned medical interventions, noting that many of these young patients “also suffer from illnesses such as depression or anorexia, and it must be clarified where the assumed dysphoria comes from.”

Also in the Kurier, Faika El-Nagashi, a former MP and diversity spokeswoman for Austria’s Green Party, said other countries were waking up to the risks of social, legal and medical transition of youth. “Professional diagnosis and therapy should clarify the circumstances and provide open-ended support to young people instead of putting them on the path to transition,” she said. “Many of them grow out of it as they get older and mature physically, or simply turn out to be lesbian or gay as adults.”

She also stressed the duty of political parties to reflect critically on the demands of the trans lobby before embracing them as policy, but said the Greens had become afflicted by “intellectual and political laziness” and had “adopted a dogmatic stance that does not allow for any deviation.”

Scotland | Surgeon Dr Joseph Chrysostom has issued an open letter appealing to anaesthetists not to co-operate with “gender-affirming” surgery, which he says is a biology-denying response to a mental health issue.

Aberrant therapy

Australia | The affirmative response to gender dysphoria is unlike the treatment of any other mental health disorder in the DSM, the diagnostic manual, according to Australian psychologist Clare Rowe. In a podcast with educator Phil Dye, Ms Rowe says gender dysphoria “is the only disorder where, at the moment, the treatment of it is to encourage and lean into the disorder … this would be like leaning into someone presenting with an eating disorder and encouraging them to go further with it.”

“For any other condition in the DSM, we treat it by cognitively challenging the patient. We try to help them think with more rational thinking. We try and give examples of how their thinking may be distorted in some way. We give them tools to emotionally regulate, to tolerate their distress.”

And yet, Ms Rowe says, the affirmative approach to gender dysphoria is still promoted as “the gold standard” by the main professional body, the Australian Psychological Society. In 2022, following disquiet about this unevidenced, activist position, the society launched a review. GCN emailed the society to ask about the outcome of this review, but there was no reply.

They deserve better

International | Reem Alsalem, the UN Special Rapporteur on violence against women and girls, has raised concerns about the gender medicalisation of young females, saying they are “particularly vulnerable to the socially contagious stereotyped roles as a coping strategy, placing them at risk of erroneously adopting stereotypes as their core identity while experiencing dissociation from their sexed bodies.”

In a report to the Human Rights Council, Ms Alsalem says: “The long-lasting and harmful consequences of social and medical transitioning of children, including girls, are being increasingly documented ... Allowing children access to such procedures not only violates their right to safety, security and freedom from violence, but also disregards their human right to the highest standards of health and goes against their best interests.”

High time

Switzerland | A ban on transgender surgery for minors has been put on the national agenda by the populist-right Swiss People’s Party, the largest party in the country. In July, Natalie Rickli, the party’s state councillor for health in Zurich, said the federal government should establish national legal rules because the options for a canton-level ban were limited, the newspaper 24 heures reported.

Nina Fehr Düsel, a national councillor for the party, said it was “high time that we addressed this issue in [federal] politics.” She planned to table a motion for a national ban on trans surgery in the upcoming autumn session of Switzerland’s federal assembly. “For Nina Fehr Düsel, the main priority is to protect young people,” the newspaper reported. “During puberty, it is normal for teenagers to experience periods of doubt about their bodies and lack self-confidence.”

“However, responding to this form of ‘identity crisis’ with permanent surgery is not an appropriate solution, according to the politician,” 24 heures said. “She believes that young people find it difficult to understand all the implications of such an important decision.”

---

Video: The story of Claire, a Texas detransitioner

On the case

Chile | Ángel Valencia, the National Prosecutor of the Chilean Public Prosecutor’s Office, has been handed an investigative report from the country’s Congress with the aim that he determine whether the medical transition of minors has involved criminal offences.

In May, a special investigative commission of the Chamber of Deputies, the lower house of Chile’s Congress, made findings highly critical of the Ministry of Health and the government’s Gender Identity Support Program (PAIG), which has enabled referral of children for hormonal treatment. The lawfulness of this medicalisation has been challenged. A group of deputies from the investigative commission delivered their final report to Mr Valencia in June, the media outlet BíoBíoChile reported.

Arguing that PAIG had been misused to refer minors for puberty blockers and cross-sex hormones, opposition deputy Diego Schalper said: “Our conviction is that what has been happening in Chile for quite some time is that a law that was not intended for this purpose has been used to systematically carry out a practice in the public health system that is harmful to minors.”

Drug abuse

Turkey | Citing the rights of families and children, the Turkish Health Ministry has banned hormonal gender transition for anyone under the age of 21, the LGBT group KAOS GL has reported. On June 25, the ministry’s Medicines and Medical Devices Agency issued a nationwide directive prohibiting the under-21 use of puberty blockers, testosterone and oestrogen “for the purpose of gender transition.”

The letter, titled “Abuse of sex-hormone medications,” cited as justification Turkey’s 2025 Year of the Family. Invoking Article 41 of the country’s Constitution on the “Protection of the Family and Children’s Rights,” the ministry characterised under-21 access to hormonal transition as a “threat to cultural and moral values.”

Still very young

America | Puerto Rico has enacted a law prohibiting medical transition of minors defined as anyone under the age of 21. The governor of the US territory, Jenniffer González Colón, signed the bill in July. The stated purpose of the law is to protect “the physical and emotional integrity of children and adolescents, prohibiting medical practices that may have irreversible consequences on their natural development…”

Similar bans in more than a score of Republican states restrict under-18 treatment, but President Trump’s January 28 executive order seeks to protect those under 19. The LGB Courage Coalition has produced a map giving details of US state restrictions. New Hampshire has just adopted the first ban in the liberal region of New England. North Carolina has enacted a 10-year retroactive statute of limitations so that otherwise time-barred detransitioners can bring medical injury claims to court. (An earlier version of this article reported a 25-year extension, but this term applies to injuries inflicted after the new law takes effect.—BL). Meanwhile, a group of Democratic-run states led by New York has filed a lawsuit claiming the Trump administration has no basis in law to issue threats “chilling providers from [offering] gender-affirming care to individuals under 19 years old.”

Unholy contagion

International | In an X/Twitter thread with 1.3 million views British philosopher Jimmy Doyle, who had left Harvard University for unrelated reasons, unburdened himself after some five years of being unable “to speak frankly” as he witnessed “this nation’s ‘intellectual élite’ enforcing moral auto-lobotomy as a condition of entry to polite society.”

He was speaking of higher education and wider society in the grip of gender ideology. “This is easily the most extraordinary outbreak of mass irrationality I have encountered in my life, & it has permanently & profoundly altered my conception of human beings. Among young people it has provoked the most obvious social contagion since the Children’s Crusade [of the 13th century].”

A profile in The Times followed, with Dr Doyle saying the treatment of Harvard evolutionary biologist Carole Hooven, assailed for stating the importance of recognising the human sex binary, was “as stark a cautionary tale as there could be of the dangers”. He said that “over the last ten years or so universities have done a terrible job of creating safe spaces of intellectual inquiry. And they’ve done a terrible job of ensuring that what’s supposed to be education doesn’t slide into indoctrination.”

The gambits used by activist or evasive thinkers in the academy have been analysed and found wanting in an article by Daniel Kodsi and John Maier for The Philosophers’ Magazine. They write: “Some of the most macho, straight-shooting, take-no-prisoners analytic philosophers out there are easily left tongue-tied if asked to venture an opinion as to whether there are any male women. Biologists who have just spent half an hour explaining their research on sex-differences in plants respond with blank stares.”

“Though it may be painful to admit it, even many people smart enough to become academic philosophers seem to lack the kind of intellectual-cum-aesthetic judgment that consists in finding the right things obvious. It is obvious that there are no male women. It is obvious that you shouldn’t do things that will harm mentally unwell children, even when they are asking you to. It is obvious that creating an environment in which those truths cannot openly be expressed is a sinister and destructive thing to do.”

Breach of trust

United Kingdom | WellBN, a GP practice in Brighton, is being investigated by the National Health Service (NHS) after it emerged that more than 100 minors may have been given puberty blockers or cross-sex hormones potentially in breach of post-Cass review restrictions, GB News has reported.

The media outlet quoted a senior NHS source who said: “This is a huge breach of trust. These were vulnerable children, many may have had underlying mental health conditions, neurodiversity, or trauma—and they were given powerful drugs outside any regulated NHS service.”

The Daily Telegraph reported that private prescription of puberty blockers, contrary to a national ban absent a proposed clinical trial, could be a criminal offence. Dr Alice Hodkinson, co-founder of Biology in Medicine, told the newspaper that the WellBN consent form “indicates that young patients are not being properly informed of the risks and complications of cross-sex hormones, which can cause infertility, loss of sexual function and other health damage.”

“While much of the debate has rightly been focused on safeguarding under-18s, we want to see a ban on cross-sex hormones for all young adults, as there is no evidence of psychological benefit and plenty of evidence of physical and psychological harm.”

Define dissent

Australia | A petition seeking the reinstatement of whistleblower psychiatrist Jillian Spencer has more than 6,700 signatures, with its closing date falling on August 24. Dr Spencer was stood down from clinical duties at the Queensland Children’s Hospital after she questioned the safety of the gender-affirming treatment model. One point of friction with her employers was Dr Spencer’s adoption of the dictionary definition “Woman: adult human female” in her email signature, which she was told might seem “transphobic.”

Meanwhile, a co-founder of Australia’s Greens Party, Drew Hutton, has been expelled from the party for refusing to censor discussion of trans issues by others on his personal Facebook page. This event, and Mr Hutton’s account of how he became alerted to the dangers of paediatric medical transition, were covered in multiple media outlets, led by The Australian newspaper. “I mean, we don’t allow children to drink alcohol or buy tobacco or to drive or vote, and here we are—here’s the Greens—saying children should be able to go to a doctor and have these incredibly radical transformations to their bodies wrought around them with puberty blockers and other treatments,” Mr Hutton said. The newspaper has also published two major articles on the plight of families who feel they have fought to protect children from trans medicalisation.

In the state of Victoria, Liberal MP Moira Deeming has argued that people harmed by gender ideology are perfectly entitled to make submissions to a parliamentary inquiry into cults. And a federal expert committee has blocked, for the moment, an activist proposal for universal public funding of trans surgery for Australians aged 18 and older, citing inadequate evidence, unexplained changes in the patient profile, and the lack of specific diagnostic criteria for “gender incongruence.”

Catch-up research

United Kingdom | The benefits or harms of social transitioning, along with all key aspects of health and wellbeing, are to be investigated in an observational study with a five-year follow up of some 3,000 children and teenagers referred to NHS gender clinics, The Times has reported. The study, to be run in parallel with a yet-to-be approved clinical trial of puberty blockers, is part of the attempt to improve the very weak evidence base for youth gender clinics.

Meanwhile, a court challenge to the “irrational” registration of England’s first private gender clinic offering cross-sex hormones to 16- and 17-year-olds has failed. After her review of gender dysphoria care, Dr Hilary Cass had urged “extreme caution” before any under-18 prescribing of hormones.

Don’t box kids in

America | Laura Edwards-Leeper, a clinical psychologist who helped establish the gender clinic at the Boston Children’s Hospital almost 20 years ago, has warned that the term “trans kids” is not neutral and puts children “on a more likely path toward medicalization, a path that can be very hard for some to get off.”

In a City Journal interview, Dr Edwards-Leeper says: “I used to use ‘trans kid,’ but try not to do so anymore, partly because it could skew clinical reasoning and partly because I’ve seen too many kids (and adults in their lives) assume that if the child identifies as trans at one point in time, they will always be trans. I feel strongly that we should do everything we can to prevent kids from feeling boxed into a particular identity or trajectory.”

Trans mask

New Zealand | A teenage girl with anorexia, Vanessa, starved to death alone in emergency accommodation, with her parents kept away because they did not accept her trans identification, New Zealand’s public broadcaster RNZ has reported. “The psychiatrist advised us that Vanessa was using the transgender identity as a mask for her continuing anorexia, that Vanessa was saying the reason she didn’t want a curvy, female body was not because she was suffering from anorexia, but because she was really a boy,” her mother, Catherine, said.

“Vanessa, and everyone [in the health, education and welfare agencies] who was supposed to help her, accepted the belief that we her parents, in not agreeing that she had become a boy, were uncaring bigots who deserved to be cut off.”

In a Substack post, journalist Yvonne Van Dongen has reflected on New Zealand’s status as a country slow to realise the dangers of paediatric gender medicine and with links to key figures on both sides of the international debate.

Caution’s opponent

Brazil | The Federal Council of Medicine says it is surprised at news that a lower-court judge has suspended its cautious new rule on paediatric medicine at a time when that rule is already under challenge in Brazil’s highest court. On July 25, a regional federal court in the state of Acre ordered the suspension of the rule which, among other restrictions, prohibits puberty blockers for minors. Prosecutor Lucas Costa Almeida Dias claimed the April 8 rule “constitutes a social and legal setback, in flagrant violation of established scientific evidence,” CNN Brasil reported.

The council, which regulates medical practitioners, said it was “strange that a unilateral decision, handed down by a judge of first instance, attempts to override the jurisdiction of the Federal Supreme Court,” where LGBTQ lobbies are arguing that the rule restricting medical transition of young people is an affront to constitutional “dignity”.

The sex-realist women’s group MATRIA attributed the injunction to “trans activism” by Mr Dias and said his application to the regional court was “based purely on ideological arguments and fake data.”

“According to the lawyers we consulted, the injunction by a judge from Acre has no standing, considering the matter is being judged by the Supreme Court, but it’s of course a piece of publicity in the trans narrative that wants to paint the prohibition of transition for minors as some sort of human rights violation,” Clarice, a MATRIA director, told GCN.

Expert fail

Italy | In an article for the journal Psicologia clinica dello sviluppo Marco Del Giudice, a psychology scholar from the University of Trieste who has worked in US academia, ponders the lessons as the health professions and institutions negotiate “a difficult return to reason after years of ideological intoxication on the subject of gender dysphoria and transgender identities.” He began work in the US just as the trans phenomenon “exploded onto the media, political and cultural scene,” and he “experienced first-hand the climate of intimidation that descended on academia.”

“The result has been a widespread regime of (self-)censorship, in which the ideas and practices of the so-called ‘affirmative’ model have been able to spread and take hold unchallenged, sheltered from the continuous critical examination that is the essence of the scientific method. I too was complicit in this silence: for example, when I published a 2018 book on psychopathology from an evolutionary perspective, I decided not to write a chapter on gender dysphoria because the topic had become so toxic that I feared it would sink the entire project.”

Although the trans issue was less “polarised and suffocating” in his home country than in the US, Dr Del Giudice cites the example of 12 Italian medical and scientific societies issuing a January 2024 manifesto in defence of “lifesaving” puberty blockers, following public concern about the wellbeing of minors put on these drugs at the Careggi hospital in Florence.

He said this expert statement contained “questionable claims, unreliable data, and even a statistical error that massively exaggerated the alleged efficacy of [the puberty blocker] triptorelin. In the weeks that followed, what was the reaction of Italian scientists? A great and embarrassing silence, broken only by isolated voices such as that of psychoanalyst Sarantis Thanopulos. Where were the epidemiologists, statisticians and methodologists? Where were the suicidologists? Where were the doctors who were aware of the various systematic reviews conducted even before the Cass review?”

“While the scientific community looked the other way, the anonymous parents of GenerAzioneD took it upon themselves to raise crucial questions, write open letters to the companies involved, and compile scientific evidence on the actual risk of suicide among transgender young people and on the (dubious) effectiveness of puberty blockers and other affirmative interventions …”

More experiments

International | In a paper for Nature Reviews: Endocrinology researchers warn against “endocisnormative misinformation,” which they say is “of growing concern in the field of gender healthcare.” They define endocisnormativity as “assumptions or biases that only people who are both cisgender and of either male or female sex are ‘normal’,” and they give examples of misinformation, which include—

stating that gender-affirming medical interventions are “unsafe or unsupported by evidence”

claiming that trans and non-binary youth are unable to make decisions about these medical interventions

promoting “a false idea that non-binary genders are a new phenomenon”

The researchers proceed to argue for “novel therapies”—such as experimental use of oestrogen receptor modulators, 5α-reductase inhibitors, aromatase inhibitors and non-steroidal antiandrogens—where the existing, orthodox forms of gender medicalisation cannot achieve the “embodiment goals” of minors. The paper makes reference to “embodiment” 36 times; the researchers have nothing to say about “gender dysphoria” or “gender incongruence”.

In this way, the rationale for medical intervention becomes personalised, mix-and-match modification of the body, rather than the pursuit of recognisable opposite-sex features or measurable benefits to mental health. This shift in the marketing of identity medicine follows a rash of systematic reviews exposing the very weak and uncertain evidence base for the claimed psychological outcomes of old-school hormonal interventions.

The North American and Australian authors of the paper acknowledge funding from Australia’s taxpayer-funded National Health and Medical Research Council and the DT Williamson Foundation, whose namesake Hugh DT Williamson was an Australian banker and philanthropist known for “hard work, common sense [and] dislike of waste of any kind.”