UK dismantles the Dutch protocol

Plus: US judges veto secret gender change; in defence of Dr Amos; American medical consensus undone; hypocrisy on UK trial oversight; Australia's trans-activist broadcaster; Fox Varian aftershocks

Photo by Gaurav Jain on Unsplash

GCN global briefs

Teen hormones on hold

United Kingdom | The National Health Service (NHS) has announced it will pause new prescriptions of cross-sex hormones for minors, the BBC has reported. A small number of teenagers would be affected, according to the NHS. Activist group TransLucent said it would consider litigation against the decision.

After the 2024 Cass review highlighted the very weak evidence base, the NHS was told to take “extreme caution” before giving 16 and 17-year-olds hormones; under-16 prescribing was not allowed. On March 9, the BBC reported, a 90-day consultation would begin, ahead of longer-term NHS policy on cross-sex hormone treatment for teenagers.

If 16- and 17-year-olds can no longer access NHS hormones, it would mark the end of the “Dutch protocol” for gender reassignment of minors within the public system, where routine supply of puberty blockers has already stopped. It would also undermine the rationale for the puberty blocker trial, since most patients are expected to progress to hormones. (Teens already on NHS hormones can continue, subject to clinical review.)

Professor James Palmer, national medical director for specialised services at NHS England, said that following the Cass review, there had been “an in-depth review of all available clinical evidence for using oestrogen or testosterone either alone or with other medications to treat gender incongruence and dysphoria. This review has established that the available evidence does not support the continued use of masculinising or feminising hormones to treat gender incongruence or dysphoria for young people under 18.”

The Sunday Mail newspaper cited an internal NHS document “which acknowledges that injecting oestrogen and testosterone [as cross-sex hormones] can cause blood clots, breast cancer, heart disease, stroke and ‘impaired sexual function’.” Hormones are still available through UK private health and unregulated online suppliers.

Meanwhile, doctors have called for urgent investigation of trans activist groups advising young people how to use hormones obtained on the black market, The Times said. “To have organisations that facilitate self-medicalisation with no clinical oversight is dangerous,” one Scottish GP told the paper. “The greatest harm is in the prescribing of cross-sex hormones. These are used off-licence and there is mounting evidence of the increased risk of irreversible harms, which include stroke, ischaemic heart disease and early mortality.”

No more secrecy

America | State policies requiring teachers to keep parents in the dark about their child’s gender transition at school are likely to be unconstitutional. In the Mirabelli case, a majority of judges on the US Supreme Court have held that the plaintiff parents may well succeed in their constitutional challenge to California’s “gender secrecy” policy. The rights cited by parents included the free exercise of religion under the First Amendment and the due process clause of the Fourteenth Amendment. The court reinstated an injunction stopping enforcement of the California State policy pending a lower court appeal.

One set of parents in the case only discovered their daughter had transitioned at school after a suicide attempt. “The State [of California] argues that its policies advance a compelling interest in student safety and privacy,” the March 2 per curiam decision of the Supreme Court said. “But those policies cut out the primary protectors of children’s best interests: their parents.”

“Everyone agrees that children’s safety is the overriding equity. And the injunction here promotes child safety by guaranteeing fit parents a role in some of the most consequential decisions in their children’s lives. The injunction also permits the State to shield children from unfit parents by enforcing child-abuse laws and removing children from parental custody in appropriate cases,” the court said.

Law firm Thomas More Society—representing plaintiffs including Elizabeth Mirabelli and another teacher, Lori West, who did not wish to lie to parents—said the 6-3 ruling was “the most significant parental rights ruling in a generation”. The firm’s special counsel Paula M Jonna said: “The Supreme Court has told California and every State in the nation in no uncertain terms: you cannot secretly transition a child behind a parent’s back”. For more commentary, see National Review, US government officials responsible for health and families, City Journal and Fox News.

Silenced

Australia | A petition has been launched in protest against the silencing of a psychiatrist, Andrew Amos, who has been a prominent critic of the gender-affirming medicalisation of children. The Australian Health Practitioner Regulation Agency (Ahpra) has ordered him to cease social media commentary “in relation to gender medicine, gender identity and/or expression, and transgender persons”. Trans activists had complained about Dr Amos.

A petition calling on Ahpra to “uncensor” him has been started by West Australian politician Maryka Groenewald of the Australian Christians party. “As a medical professional, Dr Amos has every right to speak out on the critical risks of puberty blockers and so‑called ‘gender-affirming care’ for children,” the petition says.

The Australian newspaper reported that Ahpra’s Medical Board used its “immediate action” power to move against Dr Amos; that power requires the board to have “a reasonable belief there may be a serious risk to people and it is necessary to take action … to protect the public”. The Board placed restrictions on him seeing patients, despite his focus being academic.

The Medical Board code of conduct for doctors prescribes a vague “cultural safety” and “respect” for “gender identities”. Its material defines “gender fluid” people as those who “can be one gender, multiple genders or no gender”. Ahpra as an institution shows the influence of gender ideology.

Category error: Psychiatrist Andrew Amos discusses his view that gender-affirming care is at its core a political strategy rather than a medical model

About that consensus

America | Marking an important shift, The New York Times has published an opinion article concluding that the science is not “so settled” in favour of paediatric gender medicine after all. The article by journalist Jesse Singal cites the shift to caution on gender surgery for minors by the American Society of Plastic Surgeons (ASPS) and the American Medical Association (AMA). No longer could the weakness of the evidence base be countered with the seemingly reassuring line that every major medical association in the US endorsed gender-affirming care. Singal also suggested that the apparent medical consensus, while it lasted, relied on activist capture of policymaking and low-quality treatment guidelines engaging in deceptive, circular referencing.

In The Atlantic, writer Helen Lewis had a similar message. “As the shaky evidence base for youth gender medicine has become better known, activists have retreated to an argument from authority,” she wrote. Lobby groups such as the American Civil Liberties Union and GLAAD, as well as the Democratic Party, have cried “medical consensus” when confronted with proof after proof that puberty blockers and cross-sex hormones rest on very poor scientific evidence. The Lewis article was headlined “The Tide Goes Out on Youth Gender Medicine”. The Free Press hosted a panel discussion, with Singal included, on the vibe shift.

In a letter to the AMA, 20 state attorneys-general, led by Alabama Republican Steve Marshall, pointed up the tension between the association’s new concession of the weak evidence for under-age gender surgery and its continued advocacy for hormonal treatment. “Our concern is that the evidence base is similarly lacking when it comes to the provision of puberty blockers and cross-sex hormones to treat gender dysphoria in minors,” the letter says.

In a video interview with journalist Lisa Selin Davis, surgeon Scott Glasberg, a past president of the ASPS, explained the background to the new cautious position of the society; a key driver was the fact that the evidence for paediatric gender surgery was of low quality and low certainty.

Dr Glasberg recalled claims that “these were lifesaving procedures” improving mental health. “The data hasn’t panned that out yet,” he said, citing a number of systematic evidence reviews. These included the McMaster University review of surgery for patients under age 26—commissioned by the Society for Evidence-based Gender Medicine—as well as the Cass review of the hormonal treatments that may lead to surgery. Gender surgeons have pressured the ASPS to abandon its new cautious policy. The society is standing by its position, according to Brian Christine, assistant secretary with the US Department of Health and Human Services.

Cancel corner

United Kingdom | A doctor who played a key role in the decision to pause the UK clinical trial of children on puberty blockers has been recused by the Medicines and Healthcare products Regulatory Agency (MHRA) from further oversight of the research. This followed a media report on past social media posts by Professor Jacob George expressing views that are gender critical and biologically realist. None of the posts concerned the clinical trial. Professor George took up his role as chief medical and scientific officer at the MHRA in January, one month before the MHRA’s letter raising concerns about the trial.

However, reporting by journalist Hannah Barnes reveals that the MHRA had serious concerns about the trial before last November when it gave approval for it to go ahead. “Most significantly, the MHRA argued that the study’s follow-up period for the children taking part was ‘inadequate to assess the long-term benefits and risks’ of suppressing puberty in this group of children and young people,” Barnes wrote. The MHRA accepted reassurances from the research team running the trial at King’s College London.

The Barnes article for The New Statesman also identifies shortcomings in the process leading up to the trial’s approval from the Research Ethics Committee. All this predated the controversy over Professor George’s social media history. The MHRA said there was “no evidence to suggest that decisions taken [by Professor Barnes on the trial] were not impartial”, but he was being recused “as a precaution”.

Journalist Sonia Sodha criticised Professor George’s removal for mainstream beliefs based on science and evidence—for example, that men should not be able to self-identify into women’s sport—with “no direct connection” to his responsibilities at the MHRA. “Citizen detectives on X have already uncovered social media posts from others involved in signing off clinical trials expressing sentiments aligned with a belief in gender ideology—will they be recused from anything to do with puberty blocker trials too? Where does this stop?” Sadha wrote.

The group Sex Matters, which advocates for biological reality, said Professor George should be reinstated. In a letter to the MHRA, the group said he was the victim “of a media witch-hunt against him for expressing [legally protected] ‘gender-critical’ beliefs”. One of Professor George’s posts, predating his MHRA appointment, bemoaned the “well-meaning idiocy” of those in the NHS denying the “basic biological fact” that sex is fixed at birth.

The Committee for Academic Freedom said public officials were “not required to be opinion-free” and noted there was no finding of wrongdoing against Professor George. “Academic careers—particularly in medicine and the life sciences—are built not only on publications, but on participation in regulatory panels, advisory committees and clinical trial leadership,” the committee said. “If lawful views expressed on live public controversies can later trigger removal from such roles absent any proven partiality, researchers will draw rational conclusions about the career risks of speaking plainly.”

Australia | A gender service in the regional city of Cairns has been the subject of a damning inquiry. “Children as young as 12 were prescribed puberty blockers without adequate assessment, documentation or monitoring [at the Cairns service]; staff feared ­reprisal when speaking up about patient safety concerns; and parents who objected to the treatment were alienated,” The Australian newspaper reported.

The inquiry’s findings were covered with unusual accuracy by Australia’s public broadcaster, the ABC, which for years has uncritically promoted paediatric gender medicine. The taxpayer-funded ABC has disseminated gender identity ideology in its search for success in the “workplace equality” competition run by ACON, a former gay rights body turned trans lobby.

“Newly released documents show how the ABC won platinum status last year with trans lobby group ACON after pledging to use its unique position to push the advocacy group’s agenda in its on-air journalism and programming,” The Australian reported on March 9.

“But the ABC has refused to reveal key documents submitted to ACON in its chase for gold and platinum over the last two years, despite a promise by managing director Hugh Marks to review links with the lobby group after The Australian exposed repeated breaches of the broadcaster’s editorial standards.”

Lawsuits

America | The landmark $2m damages award to US detransitioner Fox Varian continues to generate commentary. The Economist said doctors should take seriously the threat of “a flood of medical-malpractice claims”. To support its view the magazine cited Varian’s victory in court, as well as the new policy of the American Society of Plastic Surgeons (ASPS) opposing gender surgery for anyone under age 19. On its editorial page The Wall Street Journal welcomed the surgeons’ cautious policy as “Good Sense on Transgender Children”.

However, retired lawyer Peter Sim, who follows the gender medicine debate, said the New York jury’s verdict for Varian might not herald a wave of successful detransition lawsuits. The obstacles noted by Sim include short statutes of limitations blocking claims, capped damages awards in many US states, and the new more defendant-friendly standards of care, SOC-8, issued by the World Professional Association for Transgender Health (WPATH).

The Fox Varian litigation was fought on SOC-7, a standard of care that the defendants did not meet. WPATH president-elect Loren Schechter testified in the case that that in his opinion the WPATH recommendations did not represent the standard of care in the legal sense, meaning the benchmark for judging in litigation what a reasonable doctor ought to do with a given patient.

The Fox Varian verdict, and the ASPS-AMA shift away from paediatric gender surgery, were picked up in France by the newspaper Le Figaro. The Australian Society of Plastic Surgeons, asked for its reaction by The Australian, refused to state a position on gender surgery for minors; it is seeking universal public funding for these procedures for anyone 18 or above who has “gender incongruence”, a depathologised condition involving no need for any psychological distress. The Canadian Society of Plastic Surgeons did not respond to a request for public comment on the issue of under-18 gender surgery.