Unfettering talk therapy

Teen-brain denial in South Africa; NZ's untold detransition stories; anti-Cass bias in Australia; German docs reject hate smears; judicial activism thwarted in Brazil; pressure for answers in Norway

Photo by Priscilla Du Preez 🇨🇦 on Unsplash

GCN in brief

Talk therapy

America | A majority of the US Supreme Court bench appears likely to strike down Colorado’s anti-conversion law therapy as viewpoint discrimination contrary to the Constitution’s free-speech guarantee. In Chiles v Salazar, a licensed counsellor, who is a Christian open to helping minors accept their biological sex or reduce unwanted same-sex attraction, argues that her purely voluntary talk therapy cannot be prohibited by Colorado’s law.

That statute, in keeping with an international activist template, conflates sexual orientation with the unstable and contradictory concept of gender identity. In oral argument, the counsellor’s lawyer, James Campbell, said it was a clear case of viewpoint discrimination because Colorado’s law “would allow a 12-year-old without their parents’ consent to enter into counseling that would go the opposite [“affirmative”] way on these issues of gender identity and sexual orientation.”

“This law harms gender-dysphoric kids because the statistics that we’ve cited …indicate that 90 per cent of young people who are struggling with gender dysphoria before puberty work their way through it and realign their identity with their sex, but if one of those children goes to a counsellor and they specifically say, that is the help I want—realigning my identity with their sex—they cannot receive that help from someone like my client.” If locked into social transition at odds with their sex, Mr Campbell said, these children would be led down the “route of medicalized transition” with its harms.

False advertising

International | “Gender-affirming care” is a misnomer, according to a new analysis published by Voices in Bioethics. “The bundled expression often obscures more than it clarifies: ‘affirmation’ is treated as will-realization rather than truth-recognition; ‘medical’ is invoked where interventions compromise rather than restore bodily function; and ‘care’ is reduced to consent-compliance rather than fiduciary beneficence.”

Teenage savants

South Africa | A neuropsychiatrist has played down the risks of cognitive immaturity in adolescents seeking puberty blockers. In a University of Cape Town webinar last month, Professor Jackie Hoare suggested the vast majority of adolescents were competent to consent to puberty blockers.

“There are some studies in cisgendered youths that have shown that adolescents may be particularly prone to rash decision-making,” she said. “However, these concerns are context dependent and likely to be significantly reduced when decisions are made in a calm environment with support from parents and clinicians, which is generally the case in gender-affirming care.”

South Africa’s 2021 Gender-Affirming Healthcare Guideline (GAHG) cites a claim, as if it is research, that “Transgender youth are invariably significantly/profoundly advanced in understanding gender identity as compared to their cisgender peers, as they are faced with prejudice and their gender dysphoria on a daily basis and usually constantly think and reflect critically and deeply about all the potential issues, including taking hormones and outcomes, on a daily basis”. This was an advocacy statement by the Professional Association for Transgender Health South Africa (PATHSA), a gender-affirming lobby, in response to a UK court ruling that children under 16 years of age lacked the capacity to grasp the consequences of puberty blockers.

Also on the University of Cape Town webinar, Dr Anastacia Tomson, a trans doctor and lead author of the South African GAHG document, made a parallel between medical transition and treatment of tuberculosis, a deadly disease in a country struggling with an overstrained health system. Dr Tomson acknowledged “there isn’t always grade-A evidence that we can draw on” in gender medicine and suggested there were lessons from earlier work on TB drug trials.

“In testing new agents or existing drugs that have never been applied to TB before, we don’t compare them to a placebo or to non-intervention, because we know it’s unethical. We know that we can’t withhold treatment in the name of building a body of evidence.”

The Tomson-led GAHG document was rated 17/100 for rigour of development in international research commissioned by England’s Cass review.

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Video: “I’d been asked more questions in that one appointment where I said I was detransitioning than in my whole two years of transitioning appointments”—the story of New Zealand detransitioner Zara; more here

Dissing Cass

Australia | In an article for the Medical Journal of Australia, a bevy of gender-affirmationists, including staff of children’s hospital gender clinics, have criticised the Cass review as “lacking expertise and compromised by implicit stigma and misinformation”. They argue that the “gender-affirming model of care is highly acceptable to young people and families,” and they deplore the UK restrictions on puberty blockers that followed Dr Hilary Cass’s report in April 2024.

Faced with her finding that gender dysphoria treatment “is an area of remarkably weak evidence”, the MJA authors claim that “much healthcare in other areas of medicine is guided by evidence of similar or lesser strength”. Dr Cass has contradicted this, stating that the evidence for puberty blockers and cross-sex hormones is weak even by comparison with the field of paediatrics where the gold standard of randomised clinical trials is less common.

The MJA authors fault Dr Cass for focusing on the poor evidence for mental health benefits of puberty suppression, claiming the primary goal of blockers is simply physiological—“to prevent progressive irreversible incongruent pubertal changes”. Yet the treatment guideline followed by paediatric gender clinics in Australia—issued in 2018 by the Royal Children’s Hospital (RCH) Melbourne—promotes puberty suppression on the basis that it “typically relives distress” by freezing normal sexual development.

That guideline’s lead author, Dr Michelle Telfer, has explained that the very first proposal to treat a child with puberty blockers at RCH Melbourne—the 2003 case of a female who identified as Alex—was driven by the concern of her treating doctors “to help Alex’s mental state”. As the weakness of the evidence base has been exposed internationally since 2018, gender clinicians have shifted the rationale for medical intervention from improved mental health and reduced gender dysphoria to enabling patient “autonomy” and merely physical changes characterised as personal “embodiment goals”.

In a similar tactical retreat, the unqualified, reassuring claim of the RCH guideline that puberty blockers are “reversible” has morphed into the assertion by the MJA authors this month that they are “largely reversible”, without any explanation why this change has been made or in what way puberty suppression is now acknowledged to have irreversible effects.

The authors claim that Dr Cass found that “detransition and regret appear uncommon” when her report notes that the true level of this phenomenon is difficult to determine because of flaws in the dated regret studies relied upon by affirmationists and the likelihood that detransitioners do not return to their former clinics and therefore disappear from the regret data.

The MJA authors also argue that the Cass report is compromised by undisclosed conflicts of interest on the part of those involved. Competing interests declared by the MJA authors themselves include membership of the World Professional Association for Transgender Health and the Australian Professional Association for Trans Health, both bodies that include activists with no medical qualifications.

The MJA article makes no mention of the fact that research commissioned by Dr Cass found the RCH guideline—the blueprint for Australia’s treatment model—to be of low quality, scoring 19/100 for the rigour of its development. The MJA authors include Dr Ken Pang, one of the guideline authors, while the principal author of the MJA article, Dr Julia Moore, is among those acknowledged for consultation and feedback on the guideline.

Switcheroo

America | The alleged practice of falsifying medical records, prescriptions and insurance billing should be a prime target for US federal and state governments seeking to shut down paediatric gender clinics, according to whistleblower surgeon Dr Eithan Haim, who revealed in 2023 that, contrary to its public assurances, the Texas Children’s Hospital had continued its gender medicalisation of minors.

At Genspect’s conference in Albuquerque last month, Dr Haim detailed alleged practices to conceal the transgender nature of treatments banned by a state or unlikely to be covered by insurers. For example, a trans-identified female would appear in the medical records as male, the diagnosis would be stated as testosterone deficiency and the treatment would be given as testosterone supplementation.

Or puberty blockers for a child would be disguised with the diagnosis “endocrine disorder, unspecified”, despite that diagnosis requiring the “presence of clinical signs or symptoms suggestive of an endocrine disorder” and “laboratory or imaging studies indicating endocrine dysfunction”. There is no suggestion that trans-identified minors have any endocrine disorder before their natural sex hormones are suppressed with blockers or they start on opposite-sex hormones.

Last month, Texas dropped its case against one of three doctors accused of falsifying records and breaching the state prohibition on medical transition of minors. Paediatric endocrinologist Dr Hector Granados was found not to have broken the law; the cases against the two other doctors continue.

Meanwhile, the Trump Administration’s Department of Justice is reportedly investigating children’s hospitals in Philadelphia and Pittsburgh to determine whether or not their gender doctors are using incorrect diagnoses and billing codes in order to secure insurance coverage for puberty blockers and cross-sex hormones, which are given off-label without regulatory approval to treat gender dysphoria.

Brickbats and bouquets

Australia | Clinicians in Australia are invited to sign a letter of support for whistleblower psychiatrist Dr Jillian Spencer, who has been issued with a termination notice after she raised concerns about the risks of the gender-affirming treatment model at the Queensland Children’s Hospital. The letter to Queensland Health Minister Tim Nicholls is co-ordinated by the Australian Doctors Federation.

Meanwhile, the country’s most influential gender clinician, Dr Michelle Telfer, has been listed as a finalist for Australia’s Human Rights Medal “for her advocacy for trans and gender-diverse young people and shifting national conversation towards inclusion, compassion and evidence-based care”. Dr Telfer was heavily criticised for giving misleading evidence as an advocate, rather than an objective witness, in a Family Court dispute over whether a 12-year-old gender non-conforming boy should be medicalised.

Debasing the currency of hate

Germany | The president of the German Medical Association, Klaus Reinhardt, has condemned the “public defamation of participants in a scientific conference”. He was referring to online “Know your enemy posters” showing photos of presenters at the recent meeting of the Society of Evidence-based Gender Medicine (SEGM) held in a secret, secure location in Berlin as trans activists sought to locate and disrupt the event. “Such methods cross every line of objective debate and promote intimidation and, in some cases, even actual real threats,” he told the newspaper Die Welt. “We must be seriously concerned about scientific freedom in our country as well.”

Two of the prominent German clinicians targeted by trans activists are Professor Tobias Banaschewski, medical director of the Clinic for Child and Adolescent Psychiatry and Psychotherapy in Mannheim, and Professor Florian Zepf, head of the Clinic for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy in Jena. Professor Banaschewski attributed this hostility to the fact that he and 15 other German professors had been critical of new, poorly evidenced treatment guidelines for use in German-speaking jurisdictions.

In a commentary for the newspaper Frankfurter Allgemeine Zeitung, journalist Thomas Thiel said these guidelines—designated as “S2k” level, signifying low quality—“focus on puberty blockers and hormones.”

“Psychotherapy as a tool for getting to the root causes of dissatisfaction, for example, is dismissed as unethical. Before the guidelines were published, Banaschewski and Zepf, together with other scientists, pointed out that there was insufficient scientific evidence that the administration of hormones or the use of surgery prevented the perceived suffering of children and adolescents,” Mr Thiel said.

The Medical Association of the German State of Mecklenburg-Vorpommern has sent a letter of support for SEGM—and its contribution to the debate—to the three child and adolescent psychiatric societies in Germany.

Trans activists internationally have exploited the smearing of SEGM as an “Anti-LGBTQ+ Hate Group” by the US Southern Poverty Law Centre, a former civil rights organisation that has pivoted to radical identitarian politics. On October 3, FBI director Kash Patel announced his agency had cut all ties with the centre, saying their “so-called ‘hate map’ has been used to defame mainstream Americans and even inspired violence”.

Fessing up

America | Lawyer Josh Payne, co-founding partner of Campbell Miller Payne, which specialises in cases of harm inflicted by “gender-affirming care”, has revealed that depositions of doctors, surgeons and therapists show that even the sub-standard recommendations of the World Professional Association for Transgender Health are not being followed. “Instead, vulnerable adolescents and young adults are being experimented on without informed consent,” Mr Payne told last month’s Genspect conference.

“Doctors that we have spoken to have admitted to continuing prescriptions of cross-sex hormones, even when the patient’s mental health is getting demonstrably worse, or when the patient expresses doubts about whether the hormones are the right course of treatment. Surgeons in these cases have testified that they relied on recommendations from mental health professionals they did not know and never spoke to. In some cases, the surgeons proceeded with the surgery without a recommendation from a mental health professional at all.

“Therapists have testified that they engaged in affirmation only. They did not explore underlying sexual trauma as a potential cause of a female patient’s discomfort with her body. They did not discuss the concept of detransitioning with the patient prior to clearing the patient for permanent and irreversible surgery.”

He said short statutes of limitations were an obstacle to seeking remedies, although North Carolina’s recent extension of time to bring actions could provide a national model. The application of that legislation, which sets a 10-year retroactive window for claims, is being disputed on appeal in the case of detransitioner Prisha Mosley. Mr Payne said an “under-the-radar” effect of the filing of claims on behalf of detransitioners—or family members of young people who had died—was a reported increase in malpractice insurance premiums for gender clinics.

Parental oversight

America | Florida and 22 other states have filed an amicus brief with the US Supreme Court in support of litigation by Floridian mother January Littlejohn, who says her constitutional right to raise and guide her children was violated when school staff allegedly kept secret the social transition of her 13-year-old daughter.

The brief says: “The Littlejohns’ story is troubling but increasingly common. Across the country, government officials are fundamentally altering the upbringing of children and keeping parents in the dark. Dizzying numbers of school districts and a growing number of states have passed similar ‘secret transition’ laws and ordinances without any concerns for parental rights”. These policies imply that parents who might not go along with social transition are abusive and potential harmful to their own children.

The brief argues that parental rights are “among the oldest and most established rights” in US legal tradition. The need for parental guidance of a minor affected by gender dysphoria is emphasised. “Recent reports reveal that social transitioning can concretize gender dysphoria and may not improve mental health status in the short term.”

Child protection

Brazil | A resolution of Brazil’s Federal Council of Medicine (O Conselho Federal de Medicina, CFM) banning new treatment of minors with puberty blockers and cross-sex hormones has been reinstated following a legal ruling. On October 2, an injunction suspending the resolution by a lower-court judge was set aside to preserve the exclusive jurisdiction of the country’s Supreme Federal Court, in which an earlier challenge to the resolution is yet to be decided. Legal objections to the April 2025 resolution rest chiefly on constitutional rights grounds.

In its successful petition to have the injunction overturned, the CFM argued that the injuncting judge had disregarded the “scientific robustness” of the resolution. “With regard to hormonal and surgical therapies in adolescents, the resolution was based on the precautionary principle, already recognised by the [Supreme Court] in health matters.”

On October 1, Dr Raphael Câmara Medeiros Parente and colleagues associated with the CFM resolution defended its rationale in the journal nature medicine. Their article cites international acknowledgement of the weak evidence base for hormonal interventions with minors, the shift to more cautious treatment policy in several overseas jurisdictions, and the rise in detransition and regret linked to an unexplained surge in cases of youth gender dysphoria.

“The main rationale for [the CFM resolution] is the low quality of current scientific evidence regarding the efficacy and safety of puberty blockers and cross-sex hormone therapy in adolescents with gender dysphoria,” they write. “Recent independent systematic reviews, including the Cass review, indicate that the certainty of evidence is very low across all clinical outcomes evaluated (such as the impacts on gender dysphoria and mental and psychosocial health).

“Under these circumstances, adopting irreversible treatments in minors without robust scientific support is inconsistent with the principles of good medical practice. The precautionary principle, in this context, is not an instrument of ideological restriction, but a norm of prudence widely applied in public health policy when future risks are uncertain, as in the case of gene therapies or neuropsychiatric interventions.

“The resolution aligns with Article 227 of the Brazilian Constitution, which places upon the state, the family and society the duty to ensure, as a matter of absolute priority, children’s and adolescents’ rights to health, physical and mental development, and protection against all forms of negligence or exposure to risk. The suspension of puberty blocker and cross-sex hormone therapy in minors, established by the resolution, is a protective measure for reproductive, bone, cardiovascular and neuropsychiatric health.”

Risk:benefit ratio

International | An news feature in The New Atlantis magazine by science writer Jennifer Block brings a sharper focus to psychotherapy as an alternative to medicalised gender-affirming care. An excerpt:“ ‘Based on the current state of knowledge and evidence in the field of pediatric gender medicine, we’ve basically got no idea what type of effect hormonal interventions are going to have on these kids’ mental health and psychosocial functioning,’ says Dr Kathleen McDeavitt, assistant professor of psychiatry at Baylor College of Medicine, who recently presented on the topic at the annual conference of the American Psychiatric Association …

“While the evidence is inconclusive, says McDeavitt, ‘we do understand as physicians that these interventions pose significant risks—to fertility, bone density, sexual function. On the other hand, we have evidence-based psychotherapeutic tools that we can use to help kids manage distress.’

“Though there may not be a strong evidence base for using those tools specifically to treat gender-related distress, because they have not been studied, techniques like dialectical behavioral therapy have far fewer risks than medication or a mastectomy, McDeavitt argues. ‘Why wouldn’t that be our standard recommended approach?’ Furthermore, she points out, history has not looked kindly on medical practices that disproportionately affected vulnerable populations’ sexual functioning and fertility.”

Please explain

Norway | In an open letter to the country’s Directorate of Health, the professional and parents group GENID Norway has sought an update on the status of a possible review of the country’s 2020 gender-affirming treatment guidelines. The group also sought clarification on a 2024 assurance that gender-affirming treatment would not be available from private providers, municipalities or general practitioners.

The national specialist gender clinic at Oslo University Hospital had reportedly adopted a more cautious treatment approach with minors, especially with teenage girls fitting the profile of rapid-onset gender dysphoria. However, GENID questioned whether youth dysphoria treatment had in fact been concentrated in this more cautious clinic.

“Through our work, we observe that individuals can access gender-affirming hormones (oestrogen, testosterone) and surgery through private psychologists/doctors in Norway, who, after a few consultations (including online), refer patients to private endocrinologists and surgeons. We are also aware of self-medication through online hormone purchases without healthcare professional involvement.”

Detrans input

Australia | The process for developing new national guidelines for youth gender dysphoria in Australia will have input from detransitioners, according to the National Health and Medical Research Council (NHMRC), which is overseeing the project. A stakeholder reference panel would include “people who have discontinued treatment and/or re-identified with their sex recorded at birth,” NHMRC chief executive Professor Steve Wesselingh said last month.

He was replying to a letter from NSW Upper House politician Greg Donnelly, who had asked whether or not the expert advisory committee leading the guideline development would include “any desister or detransitioner”. That committee, which was to have been established by July 2025, would include “lived experience representations,” Professor Wesselingh said. “For privacy reasons, and noting that appointments are not complete, NHMRC is unable to provide the specific backgrounds of lived experience members.”

Membership would be announced “in due course”. The NHMRC maintains that the original deadline for interim advice on puberty blockers in mid-2026 will be met.

Unserious

America | A secretly recorded web conversation shows the American Medical Association’s president, Dr Bobby Mukkamala, dismissing with a talking-hand gesture the prospect of children being rendered infertile by puberty blockers. On the call, whistleblower surgeon Dr Eithan Haim refers to the common gender-affirming practice of suppressing a child’s natural sex hormones at Tanner Stage 2, the outset of puberty, with the consequence of infertility. At this point, Dr Mukkamala makes the gesture. His association is regularly invoked as one of the many mainstream US medical organisations in favour of gender-affirming care. GCN sought comment from the AMA.

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