The consensus on gender medicine for kids is crumbling

The hottest issue in bioethics at the moment is paediatric gender medicine. Is it ethical for doctors to help children affirm their chosen gender identity? Is it ethical for doctors to suppress puberty in gender dysphoric children? Is it ethical for doctors to sterilize young males with estrogen and females with testosterone so that they can physically mimic the opposite sex? Is it ethical for doctors to surgically remove the breasts of girls under 18?

Gender-affirming doctors answer Yes, Yes, Yes, and Yes to these questions. Dr Jack Turban, of the University of California, San Francisco, one of the leading defenders of trans medicine for children, has this to say:

“pubertal suppression can be reversed”

“access to pubertal suppression, when indicated for gender dysphoria, [is linked] to improved mental health outcomes”

“there may be instances in which providers may consider starting [gender-affirming hormones] as early as age 13”

“gender-affirming hormones … improve mental health for adolescents with gender dysphoria”

“The vast majority of gender-affirming surgeries are not considered until adulthood. The most notable exception to this is masculinizing top surgery for trans masculine and nonbinary adolescents (i.e., mastectomies).”

Furthermore, Dr Turban says that attempting to dissuade a child from “going trans” is wrong.

“ … ‘desistance’ of a young person’s transgender identity is generally not considered an ethical goal and that gender identity conversion efforts (that is, attempts to force transgender people to be cisgender) have been labeled unethical by the American Academy of Child & Adolescent Psychiatry. “

The opinions of Dr Turban and his colleagues have been codified in a document called the World Professional Association for Transgender Health Standards of Care. This has become the Bible for trans medicine. President Joe Biden effectively endorses its conclusions every year in his proclamation on the Transgender Day of Visibility.

For the layman, and even for many doctors, trans stuff is deeply confusing. No one wants to see a troubled child suffer, or even, God forbid, commit suicide. So despite their misgivings, many people have simply believed the experts.

However, in the past few years, the WPATH consensus cobbled together by experts like Dr Turban is being dismantled. Around the world, governments and professional associations are questioning the evidence base for transgender medicine. Again and again, reviews undermine smug assurances that the treatment is harmless and ethical and that its beneficiaries are happy as Larry.

The most important of these is the Cass Report, published in England in April. It was based on a thorough review of the reliability of academic articles supporting the WPATH consensus – and it was damning. But for several years, health authorities in other countries had been examining the reliability of trans research. In fact, gender medicine specialists in the US and Australia are beginning to look less like physicians and more like alternative medicine practitioners prescribing ginseng tea for breast cancer. 


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Without wading through the tall grass, here are some of the major developments in chronological order.

June 2024 | Chile. Health Minister Ximena Aguilera instructed the public health system to stop giving children puberty suppressing and gender-affirming hormones because of the weak evidence base for this treatment. The scandal of gender medicine has become big news in Chile’s media.

May 2024 | Italy. The Ministers of Health and Family set up a 29-member commission to revise existing guidelines for treating gender dysphoria in children, especially puberty blockers. The president of the Italian Drug Agency, Robert Giovanni Nisticò, says that “the scientific data [on puberty blockers] is thus far inconclusive on the cost-benefit ratio for adolescents”.

May 2024 | Germany. Although German doctors are far from unanimous on this issue,  the 128th German Medical Assembly recently passed a resolution which stated that doctors should reserve puberty blockers, cross-sex hormones, and surgeries for gender-dysphoric youth under 18 for use in controlled clinical trials.

This follows a major review of the evidence published in February in the Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (Journal of Child and Adolescent Psychiatry and Psychotherapy) which found that “The available evidence on the use of [puberty blockers] and [cross-sex hormones] in minors with [gender dysphoria] is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies.”

May 2024 | UK. The Association of Clinical Psychologists (ACP-UK) has endorsed the Cass review as a “truly impressive and comprehensive body of work, conducted and completed in the most hostile, fractious and challenging of circumstances.”

April 2024 | EU. The European Society for Child & Adolescent Psychiatry (ESCAP) has advised “healthcare providers not to promote experimental and unnecessarily invasive treatments with unproven psycho-social effects and, therefore, to adhere to the ‘primum-nil-nocere’ (first, do no harm) principle.” It says that recent reviews of trans medicine “highlighted that research on treatment benefits and harms of gonadal suppression and cross-sex hormones for children and adolescents with gender dysphoria has significant conceptual and methodological flaws, that the evidence for the benefits of these treatments is very limited, and that adequate and meaningful long-term studies are lacking.”

April 2024 | Switzerland. The Swiss Society for Child and Adolescent Psychiatry and Psychotherapy, announced that it supported the ESCAP’s recommendations.

April 2024 | England. The most influential of all reviews of paediatric gender medicine has been the Independent Review of Gender Identity Services for Children and Young People, headed by Professor Hilary Cass. Professor Cass found that the evidence base was remarkably weak. "You must have the same standards of care as everyone else in the NHS, and that means basing treatments on good evidence," she told gender dysphoric children. "I have been disappointed by the lack of evidence on the long-term impact of taking hormones from an early age; research has let us all down, most importantly you."

May 2023 | Denmark. The journal of the Danish Medical Association "Ugeskrift for Læger" says that Danish doctors are being urged to be much more cautious in prescribing hormonal treatment for gender dysphoric children. The Minister of Health Sophie Løhd, praised the shift in emphasis, saying that “it is a positive thing that there is a response to research and experience... both in Denmark, but also abroad, which we must follow closely.”

March 2023 | Norway. In a lengthy statement the Norwegian Healthcare Investigation Board, (NHIB/UKOM) has described puberty blockers, cross-sex-hormones and surgery for children and young people as experimental. It says that the current Norwegian “gender-affirmative” guidelines are not truly evidence-based and must be revised.

January 2023 | Italy. In an open letter to Prime Minister Giorgia Meloni, the Italian Psychoanalytic Society said that it was very concerned about the use of puberty blockers with children and insisted on “rigorous scientific discussion” of youth gender problems. “The contraindications to this treatment must be seriously considered.”

June 2022. Florida, USA. Health officials in the American state of Florida that “ found that several services for the treatment of gender dysphoria – i.e., sex reassignment surgery, cross-sex hormones, and puberty blockers – are not consistent with widely accepted professional medical standards and are experimental and investigational with the potential for harmful long term affects [sic].” (Ed: for some reason, these reports have been removed from the internet, but they are still available in web archives.)

February 2022 | France: The French National Academy of Medicine issued a statement calling for extreme caution in paediatric gender medicine. “If France allows the use of puberty blockers or cross-sex hormones with parental authorization and no age limitations, the greatest caution is needed in their use, taking into account the side-effects such as the impact on growth, bone weakening, risk of sterility, emotional and intellectual consequences and, for girls, menopause-like symptoms. As for surgical treatments, specifically mastectomy, which is allowed in France at the age of 14, and surgeries relating to the external genitalia (vulva, penis), it must be emphasized that these procedures are irreversible.”

February 2022 | Sweden. Swedish health authorities made a U-turn in gender medicine. According to its 2015 guidelines, puberty blockers and cross-sex hormones were readily prescribed. A 2022 report said that a literature review showed that the evidence base was so weak that they should only be used in exceptional cases.   

August 2021 | United States. A section within the US Department of Health and Human Services, the Agency for Healthcare Research and Quality, was sceptical. One of its briefing notes admitted that: “There is a lack of current evidence-based guidance for the care of children and adolescents who identify as transgender, particularly regarding the benefits and harms of pubertal suppression, medical affirmation with hormone therapy, and surgical affirmation.” It seems that this was ignored. 

June 2020 | Finland. Finland was the first country to officially break with the WPATH consensus. The Council for Choices in Health Care in Finland (COHERE Finland) revised its guidelines and recommended that gender dysphoria should be normally be treated with psychological therapies rather than with hormones and surgeries.  

Note. There are a number of reputable sites which report the latest developments in paediatric gender medicine. Some of the above information was gleaned from Bernard Lane’s excellent Substack, Gender Clinic News, and from SEGM, the Society for Evidence Based Gender Medicine.  

Michael Cook is the editor of Mercator.

Image credit: Bigstock 


Showing 7 reactions

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  • Peter Faehrmann
    commented 2024-06-25 11:27:22 +1000
    They can’t drive, they can’t drink, they can’t enter the military, they are mandated to attend school, but…children can decide at a young age that they are not what they seem to be, and demand treatment for non biological conditions, which may be permanently life altering. The parents and doctors who countenance this should be slapped.
  • Keith Wilson
    commented 2024-06-18 00:05:54 +1000
    I’m finding, in my online perusals of the accounts of “transgender” youth come adult, that many of them ultimately fatigue of the onerous maintenance involved in keeping their natural bodies in check against natural developments. Many of these settle on a “non-binary identity” when the disappoint from the promised “transition” doesn’t really occur, just a sad mutilation.
  • Michael Cook
    commented 2024-06-16 15:51:41 +1000
    You’re welcome. The Cass Report deserves more coverage, as the literature review was deep and extensive.
  • Carolyn Moynihan
    commented 2024-06-16 11:31:59 +1000
    Thanks for this very useful summary Michael
  • David Page
    commented 2024-06-15 09:42:54 +1000
    Nothing irreversible should be done to anyone who has not yet reached their majority. Some of this is a fad, not dissimilar to the idea that you can make a gay child into a heterosexual.
  • mrscracker
    When amputations of healthy young tissue and organs are dumbed down as “top” or "bottom " surgeries by medical professionals it’s to obscure the reality and anesthetize our conscience.
    Back in the eugenics era the same sort of surgeries went on but at least they used proper medical terminology. If we’re okay with castrating boys and mutilating and sterilizing girls then we should call it what it is. Not use nursery
    school language.
  • Michael Cook
    published this page in The Latest 2024-06-14 17:50:14 +1000