#segm

Samantha Riedel at Them:

Dr. Mehmet Oz pressed members of major U.S. medical societies to change their policies on gender-affirming pediatric care during a meeting this past winter, according to a New York Times report this week. Oz, the current administrator of the Centers for Medicare and Medicaid Services (CMS), held the meeting at some point in the last few months, although the Times did not report its exact date. The former daytime talk show host reportedly claimed that gender-affirming care for trans youth — which the Trump administration has lately dubbed “sex-rejecting procedures” — was not supported by medical literature, accused medical organizations of not “engaging with the evidence,” and spoke approvingly of rollbacks to care in countries like the U.K. In attendance were representatives for the American Medical Association (AMA), the American Psychiatric Association (APA), the American Society of Plastic Surgeons (ASPS), and the American Academy of Family Physicians. Zhenya Abbruzzese, co-founder of the Society for Evidence-Based Gender Medicine (SEGM) — an anti-trans lobbying group now closely allied with the Trump administration — also attended the meeting, per the Times.

An ASPS representative said during the meeting that their organization would update its policies to oppose surgeries for trans people under 19 years old, which the group did in February. But the Times article also claimed that the AMA “announced a shift in its position” on pediatric gender-affirming surgeries after the meeting, which was untrue. Although the AMA did affirm in February that “surgical interventions in minors should be generally deferred to adulthood,” no AMA policies have changed, and the organization still considers gender-affirming care — including surgeries, which are most frequently performed on cisgender boys — to be medically appropriate based on existing evidence.

Dr. Mehmet Oz tried to get medical societies such as the AMA to oppose gender-affirming care for trans youths. Thankfully, most of those medical societies noped him and the Trump Regime.

See Also:

https://onlinelibrary.wiley.com/doi/10.1111/apa.70533

Abstract

Aim To examine the prevalence of severe psychiatric morbidity among gender-referred adolescents, focusing on gender differences and outcomes related to medical gender reassignment.

Methods Finnish nationwide cohort of all under-23-year-old gender-referred individuals between 1996 and 2019 (n = 2 083) and 16 643 matched controls. Cross-tabulations with X2 statistics and Cox regression were used to analyse the data.

Results Gender-referred adolescents showed significantly higher psychiatric morbidity than controls both before (45.7% vs. 15.0%) and ≥ 2 years after referral (61.7% vs. 14.6%). Those referred after 2010 had greater psychiatric needs than earlier cohorts, both before (47.9% vs. 15.3%) and ≥ 2 years after (61.3% vs. 14.2%) referral. Among adolescents who underwent medical gender reassignment, psychiatric morbidity increased markedly during follow-up—rising from 9.8% to 60.7% in feminising gender reassignment and from 21.6% to 54.5% in masculinising gender reassignment. After adjusting for prior psychiatric treatment, all gender-referred adolescents had similarly elevated risks of psychiatric morbidity, with hazard ratios approximately three times higher than female controls and five times higher than male controls.

Conclusion Severe psychiatric morbidity is common among gender-referred adolescents and appears to be more prevalent in those referred after the recent surge in referrals. Psychiatric needs do not subside after medical gender reassignment.

Summary

Gender-referred adolescents show high psychiatric morbidity, yet gender differences and mental health trajectories after medical gender reassignment remain poorly understood.

These adolescents had markedly higher psychiatric morbidity than controls before and after referral, with treatment needs often persisting and even intensifying after medical interventions—on some, they might even have a negative impact.

Findings emphasise the need for thorough psychiatric assessment and ongoing treatment throughout medical gender reassignment.

==

The year 2020 has been pivotal in the field of gender medicine. Earlier this month, in a landmark decision, the UK High Court ruled that children under 16 are unlikely to be able to consent to the use of puberty blockers, which the Court deemed to be an experimental treatment. Rather than a “pause button,” the court recognized puberty blockers as the first step in a largely irreversible pathway of medical transition. After a thorough evaluation of expert evidence, the judges cautioned clinicians that even 17-year-olds may not be able to fully comprehend the lifelong consequences of these interventions. The implications of the UK High Court judgement are poised to reverberate worldwide, according to the article published by the Economist last week. […]

Several other recent developments were also instrumental in shifting the tone and tenor of the debate, with increasing acknowledgement of the weak evidence basis for the “affirmation” treatment model for young people:

Following a 2019 review by Professor Carl Heneghan, which concluded that there is no quality evidence base to support the use of hormonal and surgical interventions in young people, two systematic reviews (one from Finland and another from Sweden) came to similar conclusions. Consequently, Finland became the first country in 2020 to issue new guidelines for treatment of gender dysphoria for young people; the new guidelines prioritize psychological treatment over treatment with hormones or surgeries.  

In Sweden, broad coverage of the controversy, including the documentary The Trans Train produced by Sweden’s national public television broadcaster, appears to have decreased demand for gender reassignment among teens, which began to decline significantly in late 2019.

In the US, the issue of adolescent-onset gender dysphoria was brought to the attention of a general audience by Abigail Shirer’s “Irreversible Damage,” chosen by The Economist as one of its Books of the Year. [my note: Shirer is right-wing, this is half a win at best, I would not promote this book].

The UK NHS initiated a review of evidence, with the goal of reassessing treatment approaches for gender dysphoria in persons under age 18. The UK NHS also commissioned a wide-ranging independent review of gender identity healthcare for the under 18s, to include an exploration of why there has been a marked increase in the number of females seeking gender reassignment.

The analyses and conclusions of several widely quoted studies that misrepresented the success of “affirmative care” have been challenged and refuted. A major study that originally proclaimed to be the first to provide evidence of long-term mental health benefits of biomedical treatment for adults was critiqued and subsequently corrected, ultimately concluding that neither hormones nor surgery show any benefit in terms of long-term mental health or suicidality. Two other widely-quoted studies purporting benefits of puberty blockers and suggesting harms of psychological approaches to gender dysphoria were also found to have errors and misrepresentations that invalidated the papers’ conclusions.

One of the principal authors of the “Dutch Protocol,” the basis for the “affirmative” model of treating teens with hormones and surgeries, published a commentary in the journal Pediatrics, alerting clinicians that biomedical transition is currently being applied to young people for whom it was not designed and who might not benefit from it. The author emphasized the need to identify those people who need enhanced mental health support, rather than gender reassignment.

As the evidence for biomedical interventions underwent much-needed scrutiny, a number of small but promising case reviews of psychological approaches to gender dysphoria treatment in young people have been published. Much research is needed into the role of psychotherapy for young people with a novel, adolescent-onset variant of gender dysphoria, especially in light of the significant mental health and neurodevelopmental comorbidities found in this group. 

At the same time, 2020 was marked by increased politicization of healthcare for gender-dysphoric young people. In particular, there has been a wave of proposed legislation that misrepresents ethical psychotherapy for gender dysphoria as a form of conversion therapy. A recent Economist editorial concluded that such conflation “could criminalise counselling that raises the distinct possibility that a particular trans-identifying child or adolescent might one day desist. So such laws are a bad idea.” SEGM maintains that although well-meaning, the legislation that fetters the clinical freedom of ethical clinicians attempting to help young people understand factors that contribute to their gender distress and to resolve it non-invasively, ultimately hurts the individuals it aims to protect.

Since SEGM formed in early 2020, more than 120 clinicians and researchers have joined us in our mission to promote safe, compassionate, ethical and evidence-informed healthcare for children, adolescents, and young adults with gender dysphoria. We have established a thriving online collaboration space, with a number of researchers evaluating the current evidence basis, writing research papers, and engaging with medical societies.

Our work has already begun to impact the quality of scientific discourse regarding treatments for gender-dysphoric young people. For example, the work conducted by SEGM-affiliated clinicians led to the official correction of a key study that mistakenly claimed that “gender-affirmative” surgeries improve mental health outcomes. At SEGM’s request, Medscape withdrew its inaccurate coverage of the study, and is currently in the process of notifying over 6,000 clinicians who took its Continued Medical Education (CME) class that the original conclusions of the study were incorrect.

Madison Pauly at Mother Jones:

On December 18, Health and Human Services Secretary Robert F. Kennedy Jr. issued a declaration that rebranded transgender medical care as “sex-rejecting procedures” and claimed, erroneously, that the treatments “fail to meet professional recognized standards of health care” when given to minor patients. That same day, his agency proposed a pair of regulations that would curtail access nationwide. The first would forbid federal insurance programs that cover kids in low-income families from paying for puberty blockers, hormone therapy, and the surgery used in rare cases to treat gender dysphoria. The other would deliver an ultimatum to hospitals: Stop providing the treatments to trans kids or get kicked out of the federal Medicaid and Medicare programs.

The rules were designed to be a “nuclear weapon” against trans youth health care, a former domestic policy assistant to President Donald Trump explained at a recent event. Medicaid and Medicare reimbursements cover nearly half of all hospital care spending. “Hospitals just are not in a position to say, ‘You know what? It’s really important to us that we continue to provide this care, and we’re going to forgo payments from the federal government,’” says Lindsey Dawson, director of LGBTQ program at the health policy research firm KFF. The rules are not yet final, but they’ve already sent shock waves through the health care system. Since the start of the year, at least nine hospital systems stopped providing puberty blockers and hormone therapy, including Lurie Children’s Hospital in Chicago and Rady Children’s Health in San Diego, according to a Stat analysis. For a teenager struggling with gender dysphoria, a break in treatment could mean their body proceeds with the puberty of their birth sex, with potentially severe mental health consequences. Blair’s mom worried about her son losing not just his medication, but also the counseling, regular blood tests, and side-effect monitoring he received from his team at the MetroHealth clinic. So after taking some time to think, she wrote a comment on Regulations.gov, beseeching the government to stay out of her family’s personal business.

“I have learned that my original vision of what my child’s life would look like is very different from reality—and yet, this version is just as beautiful, if not more so,” she wrote. “That is why I find it so hard to understand why the government would try to interfere in such personal and medically complex matters.” She’s not the only parent pleading with the Department of Health and Human Services not to cut off their child’s treatment. “Every decision I have made as a parent is to keep my kid healthy and safe,” wrote one of the 30,000-some public commenters on the proposed regulation. “In an emerging culture where parents’ choice is so important to school and child development policies, why is my choice to consult with my child’s medical team and make informed decisions being taken away and infringed on?”

The answer is bound up in a Trump-era political crusade against transgender people, one that has the backing of a small cadre of academics and clinicians who disagree with the position held by virtually all leading US medical groups that gender-affirming treatments are medically necessary for some kids. In its latest attempt to wipe trans health care off the map, the administration drew on a report written by these opponents—none of whom have direct experience providing hormone treatments to trans children and some of whom have a background in anti-trans activism.

Right-wingers began drafting the earliest bans against transgender health care around 2019. Since then, following a coordinated campaign, 27 states now forbid doctors from following mainstream medical standards that regard puberty blockers and hormone therapy as reasonable treatments for teens with gender dysphoria. Such treatments are rare even among the tiny fraction of minors whose doctors have coded them as trans; about 5 percent of them take puberty blockers and 11 percent take cross-sex hormones, per one study of insurance data. Gender-affirming surgeries, also forbidden under the state bans, are even more uncommon. These treatments remain available mostly in Democratic-led states, 14 of which have passed “shield laws” protecting providers from other states’ crackdowns.

The Trump administration’s latest rules would reach past those shield laws by cutting off insurance coverage and threatening hospital balance sheets, creating yet another “significant barrier” to care, according to KFF’s Dawson. Families like Blair’s would need to find new doctors unaffiliated with hospitals—a daunting prospect—and pay out of pocket or with private insurance. “The people who are going to have the hardest time accessing care moving forward are the people with the fewest resources,” Dawson says. Trump’s administration has been laying the foundation for this specific attack since his first day back in the White House. That’s when he issued an executive order instructing federal agencies to “take all necessary steps, as permitted by law, to end the Federal funding of gender ideology.” A few days later came another order that characterized gender-affirming treatments for minors as “blatant harm [that] cloaks itself in medical necessity” and told HHS to do everything in its power to shut down treatments.

But to so dramatically change the way the federal government viewed trans health care would require expertise. So Trump’s order also instructed the agency to produce a report examining evidence and best practices for treating children who present with gender dysphoria or, in its words, “identity-based confusion.” That May, HHS published a several-hundred-page document by anonymous authors whom the White House described as “distinguished scholars.” The report, which HHS said was “informed by an evidence-based medicine approach,” scrutinized the decade-plus of research previously used to support transgender health care for minors and ultimately declared most of the treatments unethical. It suggested that kids with gender dysphoria be treated only with psychotherapy rather than a mix of therapy and hormone treatments medical providers sometimes prescribe. (The report specifically defended the use of so-called “exploratory” psychotherapy, an approach embraced by modern-day conversion therapists that seeks to identify the supposed cause of a client’s transgender identity.) The report didn’t stop there; it also went so far as to question whether the concept of gender—as opposed to sex—was even real.

[...] The HHS report served as the foundation for the new, pending Medicaid rulings that threaten to end pediatric transgender care at hospitals. Who were the “distinguished scholars” who wrote the document, and what experiences informed their analysis? In recent months, more details have come to light, giving more weight to Baker’s and other critics’ charge that the project was political from the start. In November, HHS announced the names of the report’s nine authors. The ringleader was Leor Sapir, a senior fellow at the Manhattan Institute, a conservative think tank perhaps best known in recent years for stoking a right-wing panic around critical race theory in schools. Sapir has long made clear his stance opposing trans rights; in his 2020 political science PhD dissertation from Boston College, he argued that the federal ban on sex discrimination in schools should not be interpreted to also ban anti-trans discrimination. Since joining the Manhattan Institute in 2022, he’s written essay after essay criticizing pediatric transgender health care and its supporters. Then he got the call to spearhead the creation of the new HHS report and recruit its team of authors, as he explained on a recent episode of the City Journal podcast. The idea was to produce a US version of the Cass Review—the controversial 2024 report commissioned by England’s National Health Service that found a lack of methodologically rigorous evidence around medical treatments and social and psychological interventions for kids with gender dysphoria. But the Cass Review took four years; Trump wanted a report within months. “We basically had about eight weeks, nine weeks,” Sapir says on the podcast. The Trump administration “wanted to be able to cite it in their regulatory action,” he goes on to explain. “It’s obviously going to be central justification in the administration’s various actions on this issue.”

[...] Another of the HHS report’s authors was Dr. Michael Laidlaw, a private practice endocrinologist who has been publicly speaking against transgender health care since at least 2018. He’s called gender identity “a fantasy or superstitious belief” and said providers of transgender health care were “deluded by their gender identity phantoms.” At various points, he’s been a member of the American College of Pediatricians (ACPeds), a small but influential group of religious-right doctors originally formed to oppose gay and lesbian couples adopting children, and the Kelsey Coalition, a now-defunct activist group of parents who argued against accepting trans children’s gender identities.

Laidlaw also consulted on one of the earliest bills to ban gender treatments for minors in South Dakota. “These are not physician-patient relationships at all, they are criminal-victim relationships,” he argued in a 2020 email to the bill author. Doctors who provide such care “must be prosecuted by the law,” he insisted. Laidlaw, with his ties to ACPeds, represents the old guard of religious-right doctors who can be counted on by think tanks like the Heritage Foundation and legal groups like the Alliance Defending Freedom to produce research backing conservative social policy on matters like LGBTQ rights and abortion.

But among opponents of transgender health care, there’s also a new guard, neither overtly religious nor partisan. Helping lead it is the Society for Evidence-Based Gender Medicine, or SEGM, a controversial advocacy group of clinicians who are highly critical of gender-affirming treatments for minors. Several of the HHS report’s authors have ties to SEGM. Founded in 2019, the group “frames itself as a secular alternative to the major medical, mental health professional associations’ line on gender-affirming care,” says Joanna Wuest, a scholar researching the anti-trans movement at Stony Brook University. SEGM argues that gender-affirming treatments for youth have an unfavorable risk-benefit ratio: The benefits of treatment are “uncertain,” while the harms, such as the loss of fertility in some cases, are “more certain.” Mainstream medical associations have long taken the opposite stance, citing the evidence that gender-affirming treatments improve mental health and wellbeing for youth with gender dysphoria, as documented in a 2024 review by the University of Utah.

On its website, SEGM says it “opposes all politicization of transgender care” and does not take a position on bans. Yet the Southern Poverty Law Center has classified SEGM as a hate group and describes it as the “hub” of an anti-LGBTQ “pseudoscience network” (characterizations that SEGM rejects). According to an analysis by the watchdog group Documented, a trio of therapists who advised SEGM for years have collectively been affiliated with at least six other organizations whose main purpose is to criticize transgender medical care for minors or to promote non-affirming alternatives.

The suppression of video courses I was featured in is yet another blow to open and honest debate about pediatric transgender medicine.

By: Kristopher Kaliebe

Published: Nov 18, 2025

Who’s afraid of medical evidence? Unfortunately, the “experts” who oversee continuing medical education. They’re so terrified of transgender activists, they won’t even let physicians listen to skeptical conversations about invasive and irreversible sex-change treatments for children.

On October 29, the Accreditation Council for Continuing Medical Education pressured Washington State University to stop offering seven video courses that review a range of topics concerning pediatric transgender medicine. I spoke in one of the videos, and while I’m well aware of the medical establishment’s bias, I’m still shocked at how quickly the ACCME caved to activists.

The campaign against these continuing medical education courses — which any physician in the U.S. could take to maintain his or her license — went from zero to a hundred in less than a day. On the morning of the 29th, a transgender activist posted a blog article criticizing the courses. The blog attacked their creator, the Society for Evidence-Based Gender Medicine, for being a “hate group”; it also attacked Washington State University for hosting the courses for nationwide use. The blog then provided a link for readers to complain to the ACCME, which has the ultimate authority to decide what constitutes legitimate continuing medical education for physicians.

The ACCME’s president, Dr. Graham McMahon, told the blog that his organization couldn’t comment “on an activity we have not (yet) reviewed.” Yet before the day was over, the ACCME had launched an investigation of the courses, and the university stopped offering them for credit. Physicians can no longer watch them through the school’s continuing medical education portal. As far as I can tell, the ACCME has never before launched an investigation immediately after receiving complaints. While there’s no telling how the ACCME will rule or when, its near-instantaneous decision to pressure Washington State University — the only university to offer the courses for continuing education — speaks volumes. There wasn’t even enough time for a single person to view all seven videos, which can still be viewed on the SEGM website but not for credit.

But what, exactly, is in these courses? Two things that ought to be utterly unobjectionable in the context of medicine. First, a focus on scientific evidence. Second, earnest discussion about what that evidence means for patient care.

The seven courses were all drawn from SEGM’s 2023 conference on “International Perspectives on Evidence-Based Treatment for Gender-Dysphoric Youth.” The conference featured medical experts and researchers from more than 30 countries, specializing in everything from psychology and psychiatry to endocrinology and bioethics. Many international presenters had played a pivotal role in systematic evidence reviews that led their respective countries to limit or prohibit children’s access to transgender treatments such as puberty blockers and cross-sex hormones. In the U.S., meanwhile, professional medical organizations have uniformly suppressed discussion of this same research, as it doesn’t align with their advocacy of child sex changes.

The course that featured me focused on “the role of social and cultural context” in the rapid rise of child transgender identification in recent years. For just over 30 minutes, my fellow panelists and I discussed the data showing that a large percentage of children who identify as transgender struggle with other physiological and mental health issues, including autism or depression. We also discussed the evidence pointing to the role of social media in convincing children that they were “born in the wrong body.” All of us want to help these children, including through therapeutic approaches instead of rushing toward chemical interventions and genital surgeries. All the countries that have commissioned systematic reviews, including Finland, Sweden, and the U.K., now recommend therapy as the first line of treatment.

It is inconceivable that these courses violate the ACCME’s standards for continuing medical education. SEGM designed them with those standards in mind, and Washington State University spent nine months reviewing the courses before approving them. And while these courses are now unavailable for credit, physicians still have access to a slew of continuing medical education offerings that promote sex changes for children. I have viewed many of these presentations from the professional medical associations, and I can safely say that they place advocacy over science. Yet there’s little chance that the ACCME will launch an inquiry against them, much less pressure the professional medical associations to take down their courses.

Physicians depend on continuing medical education to provide the best care, and for the sake of their patients, they deserve to hear an honest discussion of the science. But the people who oversee this critical part of the medical profession are mainly concerned with appeasing activists and appearing virtuous within their academic and bureaucratic bubbles. I wonder if all of ACCME’s leadership — including a medical director at UnitedHealthcare and a deputy undersecretary of Veterans Affairs — know what this organization is really doing.

Trudy Ring at The Advocate:

A scientist who’s coauthored several reviews of gender-affirming care says his work has been misused to justify bans on the care. Gordon Guyatt, an epidemiologist and a professor of health research methods, evidence, and impact at McMaster University in Canada, joined in three reviews of this care for children and young adults — one of puberty blockers, one of hormone therapy, and one of top surgery. A Ph.D. student led the reviews, and Guyatt’s task was to assure they were “as objective as possible,” Stat10 reports. The reviews found the evidence for these treatments had “either low or very low certainty,” the site notes. But Guyatt said that’s not a reason to ban them.

“Low-quality evidence doesn’t mean it doesn’t work. It means we don’t know. And so we try,” he told Stat10. “There is, I would say, quite good evidence from the accounts of the individuals who’ve undergone the therapy that they were really benefited by the therapy.” There is actually low-quality evidence for most medical care, he said, such as the exercises he was advised to do after hurting his neck in a mountain biking accident.

The reviews were funded by the Society for Evidence-Based Gender Medicine, which “doesn’t explicitly advocate for restrictive policies” but “consistently emphasizes the weakness of the evidence base for gender-affirming care, emboldening those who do call for bans,” Stat10 reports. It submitted a friend-of-the-court-brief in the U.S. Supreme Court case on Tennessee’s law banning this care for transgender youth, and it “was in support of neither party, but called gender-affirming care ‘experimental,’ highlighting its ‘remarkably weak scientific foundation,’” the outlet explains. The court upheld the law and said other states can enact or enforce similar laws.

[...] When he realized the reviews were being used to justify bans, he decided to speak out. “It just became extremely evident to me that our work was being used in what I thought was egregious and unconscionable ways,” he said. He wrote a letter to the editor about this to a right-wing Canadian newspaper, which didn’t publish it, but he’s glad now that McMaster has issued its statement. He said gender-affirming care should be done with caution and allowed that there’s some appeal for using certain interventions, such as hormone therapy, only in research, but “if you say ‘in research only’ and the potential for being involved in the research can accommodate 1 percent of the individuals seeking care, then that’s not acceptable.”

By: SEGM

Published: Aug 13, 2023

Near-zero regret” findings among adults suffer from a critical risk of bias and have low applicability to youth

Recent research published in JAMA Surgery evaluated satisfaction and regret among individuals who had undergone chest masculinizing mastectomy at the University of Michigan hospital. The average patient age at the time of mastectomy was 27 years; no patients who were under age 18 were allowed to participate in the study.

The participants reported high levels of satisfaction and low levels of regret at an average of 3.6 years following mastectomy. The study authors lauded the “overwhelmingly low levels of regret following gender-affirming surgery,” and framed their findings as in conflict with the “increasing legislative interest in regulating gender-affirming surgery,” referring to current legislative attempts to restrict or ban “gender-affirming” procedures for minors. Another group of authors provided an invited commentary on the paper, reinforcing the view held by the study authors, and asserting the presence of a “double standard:” “gender-affirming” mastectomies have come under undue scrutiny by states’ legislators, while other surgical procedures with higher regret rates do not appear to concern legislative bodies.

The study suffers from serious methodological limitations, which render the findings of high levels of long-term satisfaction with mastectomy among adults at a "critical risk of bias"—the lowest rating according to the Risk of Bias (ROBINS-I) analysis. ROBINS-I is used to assess non-randomized studies for methodological bias. The "critical risk of bias" rating signals that the results reported by the study may substantially deviate from the truth. The results also suffer from low applicability to the central issue the study and the invited commentary sought to address, which was whether legislative attempts to regulate “gender-affirming” surgeries are warranted in minors. Unfortunately, these highly questionable findings are misrepresented as certain and highly positive by both the study authors and the invited commentators, several of whom have significant conflicts of interest.

Below, we provide a detailed explanation of the key methodological issues in the study which render its claims untrustworthy and not applicable to the patient population at the center of the debate: youth undergoing gender reassignment. We also comment on the alarming trend: several prestigious scientific journals appear to have deviated from their previously high standards for scholarly work and instead have become vehicles for promoting poor-quality research, seemingly to influence judicial policy decisions rather than advance scientific understanding. We conclude with recommendations about how journal editors can restore the integrity of scientific debate and raise the bar on the quality of published studies in the field of gender medicine.

[ For in-depth analysis, see: https://segm.org/long-term-regret-satisfaction-mastectomy-critical-appraisal ]

SEGM Take-Aways

Although this study reports extremely high rates of satisfaction and low regret, the timeframe in which these outcomes were assessed is insufficient—just 3.6 years post-mastectomy on average. The sample is also highly skewed: 50% of the participants had mastectomies in the last 3.6 of the 30 years. This skewing of the length of time since surgery is expected, given the sharp rise in the number of people (especially adolescents and young adults) identifying as transgender and undergoing chest masculinization mastectomy. It is also a short time in which to assess regret, particularly since one quarter of study participants were younger than age 23 at time of surgery and the median age of first birth in the US is 30 years.

The conclusion of high satisfaction/low regret suffers from a critical risk of bias due to the high non-participation rate, important differences between participants and non-participants, and lack of control group. Problematically, the authors misuse the (critically-biased) results from adults to argue against regulations for irreversible body alternations for minors and do so with a decidedly politicized spin.

The only intellectually honest commentary is that we do not have good knowledge of the likely rates of detransition and regret following chest masculinization mastectomy, nor do we know how many people experience regret but remain transitioned. There is an urgent need for quality research in this area. Previously, detransition and regret rates were considered to be low: they may have indeed been low due to the much more rigorous screenings, or the results may have been biased by the notoriously high dropout rates that plague “regret” research. Regardless, there is now growing evidence of much higher rates of medical detransition.

A recent study from a comprehensive U.S. dataset with no loss to follow-up revealed a 36% medical detransition rate among females within just 4 years of starting hormonal transition. At least two recent studies suggest that average time to regret among recently-transitioned females is about 3-5 years, but there is a wide range. Much less is known about detransition among those who undergo surgery. A growing number of detransitioners now express regret associated with the loss of breastfeeding ability, with one case study detailing breastfeeding grief experienced some 15 years post-mastectomy.

The study and invited commentary exemplify three problematic trends that plague studies emerging from the gender clinics: problematic conflicts of interest of the authors; leveraging scientific journals to disguise politically-motivated pieces as quality research; and a conflicted stance by the gender medicine establishment on surgery for minors. We expand on each briefly below.

Conflicts of interest of study authors and commentators 

The significant conflicts of interest of the gender clinicians who study and report on the outcomes of “gender-affirming” interventions cannot be overlooked. These clinicians are conflicted financially, since their practices specialize in “gender-affirming” interventions, as well as intellectually. While conflicts of interest among experts are common, such experts should still attempt to be balanced in their discussions and should acknowledge and reflect on their conflicts of interest.

The interpretations of the data in the study is neither rigorous nor balanced, and both the study and the invited commentary have a decidedly political spin. Further, the invited politicized commentary does not disclose that at least one of the authors is a key expert witness opposing states’ efforts to regulate “gender-affirming” surgeries for minors. This role alone precludes the ability to provide a balanced commentary.

There is a fundamental problem with research emerging from gender clinic settings. The same clinicians provide gender-transitioning treatments to individual patients in their practice; serve as primary investigators and custodians of data used in research informing population health policies; and increasingly, provide paid expert witness testimony in courts defending the unrestricted availability of hormonal and surgical interventions for minors.

As a result, such clinicians cannot express nuanced perspectives. Since any balanced statements may be used against them in a court of law when they serve as expert witnesses, they must resort to the lowest common denominator of the "winner-takes-all" adversarial approach. Such an approach does not tolerate nuance. Unfortunately, this approach contributes to the erosion of the quality of the published work in the arena of gender medicine and accelerates loss of trust about the integrity of the scientific process.

Misuse of scientific publications to promote politically-motivated articles disguised as scientific research

That prestigious medical journals now serve as platforms for promoting misleading, politically motivated research that aims to apply a veneer of misplaced confidence in  highly invasive, irreversible treatment should worry everyone committed to evidence-based medicine and the integrity of science. Moreover, it impairs our ability to accurately assess and improve the long-term health outcomes of the rapidly growing numbers of gender-diverse and gender-distressed youths.

This is not the first time that a JAMA has been used as a platform for positioning advocacy for “gender-affirming” care as scientific research. In 2022, JAMA Pediatrics published a study that assessed bodily happiness in a group of subjects aged 14-24 three months after chest masculinization mastectomy. Despite the very short follow up and dropout rate of 13%, the authors argued that their findings supported the premise that there was no evidence to suggest that young age should delay surgery. They also asserted that their research would help dispel the misconception that such surgeries are experimental. The editorial commissioned to bolster the authors claims was descriptively titled, “Top surgery in adolescents and young adults-effective and medically necessary.”

Another troubling trend is the misuse of statistical tools to reframe research findings that contradict the author's own position. For example, a well-known study that claimed that access to puberty blockers reduce the risk of suicide disregarded the fact that individuals reporting use of puberty blockers use had twice as many recent serious suicide attempts as their peers who did not use puberty blockers. Like the finding cited above, the doubling of suicide attempts was not statistically significant due to a small underpowered sample—but the magnitude of the effect was striking and should have tempered the authors’ enthusiastic conclusion that puberty blockers prevent suicides. Another recent gender clinic study, widely and positively covered by major media outlets, claimed that puberty blockers and cross-sex hormones led to plummeting rate of depression—even though the rate of depression among youth taking those medications remained demonstrably unchanged. More information about problems with research originating from gender clinics is detailed in this recent analysis.

Gender medicine’s stance on pediatric surgery

More generally, the gender medicine establishment is in a curious state of internal conflict about its stance on “gender-affirming” surgeries for minors.  On the one hand, it has become common for advocates of “gender-affirmation” of minors to insist that surgeries for minors are not performed and anyone who suggests otherwise is spreading “scientific misinformation” and “science denialism.”  On the other hand, gender clinicians publish mastectomy outcomes for minors in major medical journals, and laud surgeries for minors as “effective and medically necessary.” It is not uncommon for these opposing claims to be made by the same group of researchers and clinicians, as they test various arguments, searching for the "angle" that is most likely to convince judges and juries--and public at large--that scrutiny of the practice of pediatric transitions, which is increasingly occurring in European countries, is not warranted in the United States.

Notably, none of the European countries that are enacting severe restrictions on the use of puberty blockers or cross-sex hormones for minors have ever allowed surgeries for youth under 18. That the U.S. gender affirmation professionals continue to fight regulation of these problematic procedures speaks volumes about how far the U.S. healthcare has drifted when it comes to "gender affirmation" of minors.

Final thoughts

While it is challenging to determine how best to reduce the temperature of the highly politicized nature of the debate in gender medicine, the editors of scientific journals can begin to restore balance by recognizing how far the field has drifted from the standards of quality scientific research, and begin to expand their circle of peer-reviewers to those with diverse views. Inviting those concerned with the state of gender medicine (and not just the practices’ advocates) into the peer-review and commentary process is the first essential step to improve the quality of research published in the field of gender medicine.

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The activists are predictably - and consistent with the superficiality of their own ideology - upset that anyone should look below the surface. It seems to be more troubling that anyone would notice the shoddiness of the research, than that the research is shoddy.

If this is supposed to be "healthcare," you would think that they would want the best healthcare, and be more alarmed at the misrepresentations of the study, than by people finding those misrepresentations.

Could it be that this is ideological rather than medical? 🤔

S. Baum at Erin In The Morning:

Clariece, a 23-year-old trans woman in Mesa, Arizona, said she got the phone call late on Friday from her Planned Parenthood doctor’s office. It was in regards to her routine appointment that Monday—the office was cancelling her visit, and all upcoming visits for trans patients seeking gender affirming care in the coming week. “We are hoping that this is a temporary pause for the next week,” a representative said, as per a voicemail left to Clariece. The office said they would reach out when they knew they could reschedule. Clareice was able to find another provider—missing even a week of hormone replacement therapy can be destabilizing, and it can be a major setback due to the stringent regulations on hormones for trans patients—but since getting the call, she says she’s felt "the sword of Damocles” hanging over her head. “Even a little bump can push back when you go and see somebody, which pushes back when you get your lab work, which pushes back when you can get a new prescription written, and that all means there will probably be a gap,” she told Erin in the Morning. (She spoke on the condition that her last name be omitted from publication due to privacy concerns.) By Saturday, April 12, Erin in the Morning reported that the Planned Parenthood of Arizona had added a new banner on its website. “At this time, Planned Parenthood Arizona is pausing Gender Affirming Care services,” the header reads. “We are committed to keeping our patients updated about the services we provide and will communicate further once we can provide more information.” It says the catalyst for the stoppage was an April 11 letter from the Centers for Medicare and Medicaid Services (CMS) which ordered Medicaid agencies to halt funding for any clinics that provide gender affirming care for trans people. The CMS is a government agency led by Mehmet Oz—a doctor-turned-media-mogul-turned-politician whose claim to fame is promoting dangerous “miracle” (pseudoscientific) weight loss drugs and cancer cures to a live studio audience via The Dr. Oz Show.

“Initiated with an underdeveloped body of evidence, [gender affirming] interventions lack reliable evidence of long-term benefits for minors,” the CMS letter reads. Put simply, this is not true. Every major medical association supports affirming health care for transgender youth. Meanwhile, the CMS letter cites Southern Poverty Law Center-designated hate groups known for dubious, anti-LGBT “science,” such as Do No Harm, which was founded to stop “woke” health care, and the Society for Evidence-Based Gender Medicine, which pushes conversion therapy for trans kids. But the Planned Parenthood of Arizona’s pause on care is not just about kids; adults are also barred from gender affirming care.