Published: Feb 2024, 2026
American advocates for youth gender medicine have insisted for years that overwhelming evidence favors providing gender dysphoric youth with puberty blockers, hormones and, in the case of biological females, surgery to remove their breasts.
It didnât matter that the number of kids showing up at gender clinics had soared and were more likely to have complex mental health conditions than those who had come to clinics in years earlier, complicating diagnosis. Advocates and health care organizations just dug in. As a billboard truck used by the L.G.B.T.Q. advocacy group GLAAD proclaimed in 2023, âThe science is settled.â The Human Rights Campaign says on its website that âthe safety and efficacy of gender-affirming care for transgender and nonbinary youth and adults is clear.â Elsewhere, these and other groups, like the American Civil Liberties Union, referred to these treatments as âmedically necessary,â âlifesavingâ and âevidence-based.â
The reason these advocates were able to make such strong statements is that for years, the most important professional medical and mental health organizations in the country had been singing a similar tune: âThe scienceâ was supposedly codified in documents published by these organizations. As GLAAD puts it on its website, âEvery major medical association supports health care for transgender people and youth as safe and lifesaving.â
But something confounding has happened in the last few weeks: Cracks have appeared in the supposed wall of consensus.
After expressing concerns about the evidence base in 2024, on Feb. 3, the American Society of Plastic Surgeons became the first major American medical group to publicly question youth gender medicine since its widespread adoption. The organization published a nine-page âposition statementâ advising its members against any gender-related surgeries before age 19 and noting that âthere are currently no validated methodsâ for determining whether youth gender dysphoria will resolve without medical treatment. (The document also acknowledged a similar level of uncertainty surrounding blockers and hormones, though thatâs less directly relevant to the practice of plastic surgeons.)
The next day, the American Medical Association â which has long approved of such procedures â announced that âin the absence of clear evidence, the A.M.A. agrees with A.S.P.S. that surgical interventions in minors should be generally deferred to adulthood.â
These statements were released days after a woman named Fox Varian became the first person to win a malpractice case after undergoing gender transition care and later regretting it. Ms. Varian and her lawyer argued that her psychologist and plastic surgeon in suburban New York, despite her serious mental health problems and apparent ambivalence over her transgender identity, failed to safeguard her by going forward with a double mastectomy when she was 16. (Many gender medicine practitioners and advocates believe that to carefully scrutinize or even explore claims of a transgender identity is to engage in de facto conversion therapy.) The juryâs $2 million award will most likely give pause to hospitals and clinics that continue to provide these treatments without substantial guardrails.
The science doesnât seem so settled after all, and itâs important to understand what happened here. The approach of left-of-center Americans and our institutions â to assume that when a scientific organization releases a âpolicy statementâ on a hot-button issue, that the policy statement must be accurate â is a deeply naĂŻve understanding of science, human nature and politics, and how they intersect.
At a time when more and more Americans are turning away from expert authority in favor of YouTube quacks and their ilk â and when our own government is pushing scientifically baseless policies on childhood vaccination and climate change â itâs vital that the organizations that represent mainstream science be open, honest and transparent about politically charged issues. If they arenât, thereâs simply no good reason to trust them.
The most striking finding of the Cass review, a 2024 British inquiry that found âremarkably weakâ evidence to back up the practice of youth gender medicine, was the shoddy quality of the professional guidelines for this treatment.
Researchers at the University of York, who provided underlying work for the Cass review, found that rather than being linked to careful, independent evaluations of the evidence, these guidelines relied heavily on other organizationsâ guidelines. The authors wrote that this âmay explain why there has until recently been an apparent consensus on key areas of practice for which evidence remains lacking.â
A 2018 policy statement by the American Academy of Pediatrics provides a useful example of how these documents can go wrong. At one point, it argues that children who say they are trans âknow their gender as clearly and as consistently as their developmentally equivalent peers,â an extreme exaggeration of what we know about this population. (A single study is cited.) The document also criticizes the âoutdated approach in which a childâs gender-diverse assertions are held as âpossibly trueâ until an arbitrary ageâ â the A.A.P. was instructing clinicians to take 4- and 5-year-oldsâ claims about their gender identities as certainly true. Itâs understandable why the Cass reviewers scored this policy statement so abysmally, giving it 12 out of 100 possible points on ârigor of developmentâ and six out of 100 on âapplicability.â
Policy statements like this one can reflect the complex and opaque internal politics of an organization, rather than dispassionate scientific analysis. The journalist Aaron Sibariumâs reporting strongly suggests that a small group of A.A.P. members, many of whom were themselves youth gender medicine providers, played a disproportionate role in developing these guidelines.
Dr. Julia Mason, a 30-year member of the organization, wrote in The Wall Street Journal, with the Manhattan Instituteâs Leor Sapir, that the A.A.P. deferred to activist-clinicians and stonewalled the criticsâ demands for a more rigorous approach. Dr. Sarah Palmer, an Indiana-based pediatrician, told me she recently left the A.A.P. after nearly 30 years because of this issue. âIâve tried to engage and be a member and pay that huge fee every year,â she said. âThey just stopped answering any questions.â This is unfortunate given that, as critics have noted, in many cases the A.A.P. documentâs footnotes donât even support the claims being made in the text.
The shakiness of the guidelines didnât matter, though â they were cited numerous times in news accounts and court documents as evidence that the most important pediatric association in the country supported youth medical transition.
In 2020, Republican-led states began pushing in earnest to tightly restrict or ban youth gender medicine. In response, the professional organizations â including the A.M.A., the A.A.P. and the American Psychological Association â wrote a flurry of letters to legislators, amicus briefs and sciencey-sounding documents opposing the bans. These documents routinely exaggerated the evidence base for the treatments in question. There was more talk of consensus: âEvery major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people,â explained the A.M.A. in a letter from 2021.
During this same period, a sea change occurred in Europe. Finland, Sweden and Britain conducted systematic evidence reviews of youth gender medicine â a much more transparent and regimented process designed to attenuate the influence of human bias. Every such review revealed deep uncertainty about the evidence base, and as a result the countries that conducted the reviews began more tightly regulating youth gender medicine. (Denmark has since followed suit, and there are some signs France and Norway may as well.) Which science, then, should be trusted? The confident American professional organizations or the skeptical European health care systems? What about when even the professional organizations start to schism?
Iâve been covering this controversy for about a decade from a left-of-center perspective, and Iâve found that anyone who questions these treatments, even mildly, is invariably accused of bigotry. It would be shocking if the professional organizations chiming in on these issues â which, like all such organizations, exist in part to increase the esteem of their members and to enhance their own influence â were immune from such influences. And now that the political winds have shifted radically, with the Trump administration launching an all-out assault on both the practice of and research into youth gender medicine, it seems some of them are realizing they would benefit from appearing a bit more moderate.
Perhaps Iâm being unfair. But itâs impossible to know, because these organizations are quite opaque about the processes that give rise to their public statements. Theyâve tried to have it both ways: Theyâve presented themselves as representing âthe scienceâ while sometimes violating scienceâs traditional norms of transparency and open debate. (Neither the A.A.P. nor the A.M.A. would grant me an interview. The American Psychological Association responded to some of the questions I sent the organization via email.)
The A.P.A. presents a particularly striking case of why transparency is important. In 2024, it published what it touted as a âgroundbreaking policy supporting transgender, gender diverse, nonbinary individualsâ that was specifically geared at fighting âmisinformationâ on that subject. But when I reached out to the group this month, it pointed me to a different document, a letter written by the groupâs chief advocacy officer, Katherine McGuire, in September in response to a Federal Trade Commission request for comment on youth gender medicine.
The documents, separated by about a year and a half (and, perhaps as significantly, one presidential election), straightforwardly contradict each other. The A.P.A. in 2024 argued that there is a âcomprehensive body of psychological and medical research supporting the positive impact of gender-affirming treatmentsâ for individuals âacross the life span.â But in 2025, the group argued that âpsychologists do not make broad claims about treatment effectiveness.â
In 2024, the A.P.A. criticized those âmischaracterizing gender dysphoria as a manifestation of traumatic stress or neurodivergence.â In 2025, it cautioned that gender dysphoria diagnoses could be the result of âtrauma-related presentationsâ rather than a trans identity, and noted that âco-occurring mental health or neurodevelopmental conditions (e.g., depression, anxiety, autism spectrum disorder) ⌠may complicate or be mistaken for gender dysphoria.â It seems undeniable that the 2025 A.P.A. published what the 2024 A.P. A considered to be âmisinformation.â (âThe 2024 policy statement and the 2025 F.T.C. letter are consistent,â said Ms. McGuire in an email, and âboth documents reflect A.P.A.âs consistent commitment to evidence-based psychological care.â)
Along those same lines, how did the American Medical Association go from arguing that âforgoing gender-affirming care can have tragic consequencesâ for âpediatric patientsâ in its 2021 letter to its present stance that one such treatment, surgery, should be delayed â potentially for many years â as a general matter of course?
If, as I suspect, political forces are the culprit, that would lead to an inescapable conclusion: You cannot automatically trust what these organizations say at a given moment. Not unless they provide a lot more information about their decision-making processes.
Should we âtrust the scienceâ? Sure, in theory â but only when the science in question has earned our trust through transparency and rigor.
[ Via: https://archive.is/Jysf8 ]
It wasn't "belief over science" so much as "faith over science." It was always a faith-based belief, no different from any religious belief.
