Cases of gender dysphoria appear to be rising sharply worldwide. The profile of patients has changed, such that adolescent females are now in a majority. Trauma, mental health difficulties and neuro-developmental diagnoses are very common associations. What's causing these changes is unknown, and the lack of robust evidence for current 'gender-affirmative' interventions concerns us.

The history of healthcare shows many well-intentioned and initially promising interventions that led to unintended harms, such as opioid overuse. To ensure the best outcomes for patients, clinicians and researchers must engage in a sober, independent, rigorous and high quality review of the science. We must be faithful to the core principle of medicine: first do no harm.

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