RESOURCES
Popular Media
Even the New York Times has published op-eds titled:
1. Hilary Cass Says U.S. Doctors Are ‘Out of Date’ on Youth Gender Medicine
2. Why Is the U.S. Still Pretending We Know Gender-Affirming Care Works?
Systematic reviews (The highest level of evidence available)
We all know there’s a study to prove anything. However, in evidence-based medicine, data is systematically collected, evaluated and reviewed. Researchers perform systematic reviews to weigh the evidence. 14 English-speaking systematic reviews have been performed. These are the highest level of evidence we have.
#1-6 published in the respected BMJ (British Medical Journal), included:
- Hall et al, 2024: there’s no good evidence supporting social transition: not that it helps or that it’s safe.
- Taylor et al., 2024: there’s no good evidence supporting puberty blockers: not that it helps (even with gender dysphoria, much less suicide). It may harm bone health.
- Taylor et al., 2024b: there isn’t good evidence to support that cross-sex hormones help long-term or objectively or are safe.
- Taylor et al., 2024c: “Most clinical guidance for managing children/adolescents experiencing gender dysphoria/incongruence lacks an independent and evidence-based approach.” In fact, Figure 3 shows a concerning web of organizations citing each others’ guidelines, instead of evidence—something Dr. Cass called “circularity of evidence.”
#7 published by Johns Hopkins University.
- Baker et al., 2021: Found no effect of hormone therapy on suicide, and said studies were highly biased in their design.
#8-12 were completed by Johns Hopkins, but, WPATH (World Professional Association for Transgender Health) blocked Hopkins from publishing as reported in the Economist: [Research into trans medicine has been manipulated.] We don’t know what those other five reviews showed. WPATH didn’t want anyone to see the results.
#13 and 14 were published in Canada, at the prestigious McMaster University, with Dr Gordon Guyatt, a “father” of evidence-based medicine.
- Miroshnychenko et al, 2025: No evidence that puberty blockers helped depression, global function, or even gender dysphoria.
- Miroshnychenko et al, 2025: Evidence not clear whether hormones for kids helps or harms.
American Medical Organizations
It is true that at one time every major US medical society that had issued a statement on pediatric GAC has been in favor. This is no longer true. The prestigious American Society of Plastic Surgery issued a statement saying there is “considerable uncertainty as to the long-term efficacy” of pediatric GAC surgery and “the existing evidence base is viewed as low quality/low certainty.” Recall that Colorado surgeons advertise this at age 15, and Denver Health does at age 16. Also, HCPF guidelines appear to allow other surgeries for <18 if a doctor argues for it.
The ASPS President publicly doubled down multiple times, saying, “Currently, ASPS doesn’t think that gender-affirming care for adolescents is appropriate.”
Guidelines from medical organizations are opinions, not evidence. It is very concerning that guidelines were not found to be credible by the Arch Dis Child BMJ systematic review of international guidelines, “despite the majority being published in the last 5 years.” Figure 3 in their paper shows how guideline organizations mostly cited each other as evidence—like asking your friends to vouch for you--instead of citing actual evidence as proof.
Regret/detransition:
Consider the U.S. insurance data that shows that “most adolescents with a G[ender] D[ysphoria] diagnosis will not have this diagnosis within as few as seven years.” Or the similar German insurance data showing that “only 36.4%” of young people retained their diagnosis after just five years.
How many of those who change their minds will have lifelong regrets from medicalization?
Do we really think children 8 to 13 can consent/assent to puberty blockers (as Colorado Medicaid covers at the first hint of puberty, in that age group)?
Are we sure that puberty blockers are a safe pause? If 98% of kids on puberty blockers go on to hormones, how many will have lasting effects by the time they reach the age of detransition?
The Cass Review Final Report
Most of us would be interested in the multi-year Cass Review Final Report, which recommended GAC be restricted to experimental studies with 10-15 year follow-up, recognizing that many kids “detransition” in half that time. This led to a nationwide ban (public and private) of puberty blockers, as the UK finds that 8-to-13-year-olds (the age for puberty blockers) can’t consent to them. This ban remains throughout Scotland, England, Northern Ireland and Wales, although kids may be able to get puberty blockers within studies being considered. Unlike in 27 U.S. States, the ban in the UK was bipartisan.
- Queensland, Australia also banned blockers and hormones in under-18’s in January 2025.
We all care for these affected children and adolescents. I suggest our empathy is on safest ground when standing on evidence. We should pay attention to physicians in Norway, Sweden, the Netherlands, England and Denmark, who originally led the U.S. into pediatric GAC, and are now leading in the opposite direction.
Health authorities have issued concerns in:
- Finland, 2020, Finland’s Council for Choices in Healthcare (COHERE): restricted hormones
- Sweden, May 2021, Karolinska Hospital: Stopped blockers/hormones <18 outside of experiments
- Sweden, February 2022 (National Policy): Same
- France, February 2022 (French National Academy of Medicine recommended “the greatest caution” with blockers/hormones, due to lack of evidence.
- Norway, March 2023 (Norwegian Healthcare Investigation Board (NHIB): recommended blockers/hormones experimental only
- Denmark, August 2023 (reported in Danish Medical Association’s journal): Denmark’s gender clinic shifted from blockers/hormones to predominately therapy
- Alberta, Canada, January 2024: banning blockers and hormones (starting January 2025) under 16; surgeries under 19.
- Chile, June 2024 (Health Minister), gender clinic (CETPEG): No more blockers/hormones/surgeries <18. In November 2024 (Senate) banned public funds for these uses.
- England, Scotland, Wales, Northern Ireland, April 2024, restricted blockers outside of experiments due to Cass Review; Hormones restricted to over 16 (their age of consent).
The 36-member European Society of Child and Adolescent Psychiatry (ESCAP) issued a formal report in April 2024, saying "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." ESCAP based this partly on the "poor reliability and instability of a gender dysphoria diagnosis in a specific child over time" and the "possible effects of the decisions to block puberty or preventing medical transitioning on a child's psychosocial development."
Some major U.S. medical societies have NOT issued statements at all, presumably either uncertain of the evidence or trying to wait out the storms. If we are not personally very confident in the evidence, we should take care what we publicly support.