December 30, 2024

Looking Back on 2024 and Ahead to 2025

The arc of history has bent toward protecting gender-questioning youth from medical harm

As we reach the end of 2024, we wanted to look back at this year's major developments in the field of gender medicine and look ahead to the challenges and opportunities 2025 presents. 

 

What has SEGM been up to in 2024?

Our 2024 work includes too many projects to cover in a brief update, but we wanted to share a few highlights:

 

  • Commissioning systematic reviews of evidence. SEGM commissioned an expert team from a world-renowned research university to conduct several systematic reviews of evidence. The first systematic review, evaluating the effects of mastectomy for individuals with gender dysphoria under age 26, was just published in the official journal of the American Society of Plastic Surgery. Four more systematic reviews, currently underway, will address social transitioning (including a review of binding and tucking), puberty blockers, and cross-sex hormones for individuals under age 26.
  • Hosting international scientific conferences. In October, we hosted an international conference in Athens, Greece, under the auspices of the Medical School of Athens. The three-day conference was attended by over 100 researchers and clinicians from 18 countries. The conference addressed the evolution of gender identity and gender distress, critiques of gender-affirming care, psychotherapeutic approaches, developmental perspectives, and challenges such as co-occurring disorders, family dynamics, and detransition. We also co-sponsored a conference in Paris with the Observatoire La Petite Sirene at the end of June titled The Child at the Center of Anthropological Changes: Can the Child Still Grow Up? You can read a write-up of the conference proceedings in English or French here.
  • Holding guideline development groups accountable for following evidence-based practices. We challenged the World Health Organization (WHO) about serious irregularities in its guideline development process for transgender health. Following our challenge, WHO acknowledged that “the evidence base for children and adolescents is limited and variable regarding the longer-term outcomes of gender affirming care for children and adolescents” and postponed the publication of the guidelines pending additional evidence evaluation. We also challenged the German guideline development process due to its undue reliance on WPATH and a failure to properly evaluate the evidence. The German-language guideline did not receive approval in its original form and is currently undergoing revisions.
  • Informing decision-makers about the state of the evidence. SEGM has provided information to policymakers evaluating approaches to regulating the practice of youth gender transitions. A notable U.S. Supreme Court case, which was heard on December 4, evaluates the question of whether state laws that restrict gender transitions for youth violate the equal protection clause. SEGM was the only organization to submit a neutral amicus brief to the Supreme Court. While we did not take a position on the state laws, we did inform the Court about the key issues to enable it to arrive at a just decision. This underscores our commitment to an evidence-based, balanced approach that prioritizes reason and scientific inquiry.
  • Curating key international developments. From its inception, SEGM has been bringing to light international news about treatments for gender-dysphoric youth, so that clinicians and researchers are aware of efforts underway in other countries. Among the many international developments in 2024, we focused on curating the results of the Cass Review in England, the registry study of suicide from Finland, and the emerging debates in Germany. We discussed the importance of the European Society of Child and Adolescent Psychiatry (ESCAP) Policy Statement on Youth Gender Dysphoria, which urged child and adolescent psychiatry associations in its 36 member states "to adhere to the 'primum-nil-nocere' (first, do no harm) principle" and "not to promote experimental and unnecessarily invasive treatments." ESCAP also called for a depolarization of discussions about how to help gender-dysphoric youths.
  • Providing open-access fees for publications. Many debates in the academic arena remain behind a paywall, making crucial information inaccessible to patients, parents, and other stakeholders who need access to accurate information to make informed decisions. In 2024, SEGM continued its longstanding tradition of funding open-access fees for a number of publications that debate the practice of youth gender transition, making them accessible to everyone.
     

In 2024, our efforts were recognized in The New York Times by journalist and columnist Pamela Paul who described SEGM as "one of the most reliable nonpartisan organizations dedicated to the field." Our analysis of the worldwide debate about youth gender medicine has been lauded in prestigious publications, such as The Economist, several British Medical Journal publications, and The Telegraph.
 

Our work has not gone unnoticed by those promoting the highly medicalized gender-affirming approach. Two groups in particular — the so-called “Integrity Project” and the Southern Poverty Law Center — have targeted SEGM with a misinformation campaign. (Both parties are involved in litigation around state restrictions on youth gender transition and apparently feel threatened by the exposure of the field’s shaky evidence base.) We are thankful for the investigative journalists who have scrutinized these attacks and found them baseless.
 

We are also grateful that the clinical community has recognized these actions as misguided attempts to shut down scientific debate, and that SEGM’s mission continues to earn the trust and respect of some of the most notable figures in the field of youth gender medicine and evidence-based medicine worldwide. 

 

What’s next?

The 2024 Cass Review — the most comprehensive evaluation of the practice of youth gender medicine — confirmed the exceptionally weak evidence base underpinning the field of youth gender medicine, and exposed growing problems with on-demand gender transitions not only for adolescents but also for young adults. Following multiple systematic reviews of evidence, and actions by several public health authorities, there is now wide acknowledgment that the practice of youth transition has not demonstrated reliable psychological benefits, and that harms can be significant. However, despite the growing acceptance that providing teens with hormones and surgeries in response to self-declared transgender identity is neither an evidence-based practice nor one that is ethically sound, many unanswered questions remain:
 

  • Why are so many young people experiencing deep distress about their sexed bodies?
  • What are the short- and long-term consequences of puberty blockers, hormones, and surgery on physical health, mental health, brain development and fertility?
  • How many young people’s distress would have abated naturally as they reached maturity?
  • Are there less invasive ways to help young people struggling with gender dysphoria, such as psychotherapy? If so, which models could be most effective, both short- and long-term?
  • What can be done to curb the epidemic of youth gender-related distress, which seems to disproportionately affect girls, persons on the autism spectrum, gay youth, and young people struggling with preexisting mental health problems?
     

These unanswered questions underscore the urgent need for continued support to ensure evidence-based, ethical care that can be made more widely available for these young people. 
 

Looking ahead to 2025

Change is never easy. At the societal level, challenging and rolling back a once-celebrated medical practice is disconcerting; it serves as an uncomfortable reminder that medicine can get things wrong. At the individual level, it takes courage to divest from powerful ideological, professional, and often financial incentives that maintain the status quo. It comes as no surprise that countries with strong centralized public health authorities have been the fastest to course-correct, while countries with distributed healthcare systems vulnerable to financial interests have a more challenging road forward. 
 

At this point, the worldwide shift toward protecting gender-nonconforming and gender-questioning young people from medical harm is undeniable. Gender-dysphoric youth deserve love, respect, and quality healthcare that gives them the best chance at leading healthy and fulfilling lives. We believe that the answer to the current debates is not more vitriol and polarization, but a cooperative commitment to the principles of evidence-based medicine and medical ethics. 
 

We wish everyone a very happy new year and look forward to what we can accomplish together in 2025! 

 

P.S. If you wish to support SEGM's work, you can do so at this link.