We are an international group of over 100 clinicians and researchers concerned about the lack of quality evidence for the use of hormonal and surgical interventions as first-line treatment for young people with gender dysphoria. We represent expertise from a range of clinical disciplines.
Our objectives include evaluating current interventions for gender dysphoria, providing balanced evidence summaries, promoting the development of effective and supportive psychosocial approaches for the care of young people with gender dysphoria and generating good, answerable questions for research.
Young people with gender dysphoria deserve respect, compassion, and high quality care. Please join us in our mission to promote evidence-based care for children, adolescents, and young adults that prioritizes life (i.e. measures of mortality), quality of life, long-term outcomes, and fully informed consent. SEGM is free from political, ideological, religious, or financial influences.
SEGM is a registered 501(c)(3) nonprofit organization.
Contributions to SEGM are tax-deductible to the extent permitted by law. SEGM’s tax identification number is 84-4520593.
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Frequently Asked Questions
What is SEGM?
SEGM, or the Society for Evidence-based Gender Medicine, is a registered charity in the United States with 501(c)(3) non-profit status. SEGM is an association of professionals united by the mission to improve the quality of research and its applications in the field of gender medicine. Our specific focus is on care received by children, adolescents, and young adults. We have no political or religious affiliations.
What does SEGM do?
Our primary activity is evaluation and dissemination of evidence in the field of gender medicine. Individuals collaborating under the auspices of SEGM have published original research, reviews of evidence, as well as critiques of previously published studies in peer-reviewed journals. In addition, SEGM provides grants to individual researchers and research organizations, and we pay open access fees for publications in scientific peer-reviewed journals to ensure widespread access to quality data and clinical practice guidance.
We also maintain a website with a compendium of literature. It is not an exhaustive list of every study published in the field of gender medicine. Rather, its purpose is to highlight unsettled debates in the field. In our monthly Spotlight, we discuss important developments that inform the ongoing debate regarding the safety and efficacy of interventions for gender dysphoria in young people.
How many members does SEGM have?
SEGM is not a membership organization but, since our inception, SEGM has been contacted by hundreds of clinicians and researchers concerned about the low quality of evidence in the field of gender medicine, and the risk of harm to vulnerable youth. Our aim is to connect professionals who believe that gender medicine should operate according to the same principles of evidence-based decision-making as is required of all other areas of medicine, and to enable them to collaborate more effectively.
What are the credentials of individuals who collaborate with SEGM?
The majority of individuals who collaborate with SEGM are licensed clinicians, in good standing with their respective medical societies, and respected in their communities. Some have direct experience with the practice of gender medicine, having worked in the field for years before becoming concerned over the recent trends. Others are currently working with individuals who desist or detransition. Most, however, are clinicians who provide healthcare to young people more generally, including GPs, internists, family doctors, pediatricians, endocrinologists, psychiatrists, obstetricians and gynecologists, and other physical and mental health professionals. We also collaborate with experts in evidence evaluation and researchers in social sciences, statistics, psychometrics, and related fields. Everyone who collaborates within SEGM shares a commitment to ensuring that gender medicine follows the principles of evidence-based decision-making.
How is SEGM funded?
SEGM has no corporate sponsors and relies on the generosity of individuals wishing to improve the knowledge base and quality of gender medicine for children, adolescents, and young adults. Many professionals volunteer their time, energy, and expertise or deeply discount the services they provide to SEGM.
You can donate to SEGM using a credit card or via a “crowdfunding” account directly on our website. You can also mail us a check, or we can coordinate a bank deposit—just contact us directly and we will provide you with further instructions.
Why is there a “GIDS” graph on the SEGM page and why is it important?
The striking graph on our home page illustrates an unprecedented epidemiological worldwide trend: the sharp rise in the number of adolescents with gender dysphoria, predominantly female teens. Much of the current clinical debate, which centers around the questions of why so many teenagers have begun to experience profound distress with their bodies, and whether hormonal and surgical interventions are the best way to help them, was launched when a prior version of this graph was published in a peer-reviewed journal in 2018.
The data behind the graph came from GIDS, or Gender Identity Development Service. GIDS is also sometimes referred to as "the Tavistock" since it’s operated by the Tavistock and Portman NHS Trust. GIDS is the largest pediatric gender clinic in the world and is part of UK’s publicly funded National Health Service (NHS). The NHS announced that GIDS will be shut down in 2023 due to concerns over the safety of its clinical approach based on the "gender-affirmative" model, as well as general operational failures.
NHS England determined that the first line of treatment for youth gender dysphoria should be psychotherapy. The NHS concluded it's not viable or safe to place the care for gender dysphoric youth in a "gender clinic" led by "gender experts." Going forward, gender-dysphoric youth will be taken care of in standard clinical settings, led by experts in mental health, autism, child and adolescent development, trauma, and other relevant areas of expertise. The NHS decision has put an end to the "gender-clinic" model of care that is built on the foundation of "gender affirmation" endorsed by WPATH, and returned to the previous community standard of care based on a holistic view of identity development in children and adolescents.
How accurate is the information on the SEGM website?
All information shared on the SEGM site undergoes a painstaking, rigorous peer-review process. SEGM was the first English-language website to translate and disseminate the Finnish, Swedish, and French position statements and treatment guideline updates regarding pediatric gender medicine. The authenticity of these documents can be easily verified. SEGM also reprints, with permission, relevant articles from authoritative publications such as The Economist and The Times. As a research-focused organization, SEGM is committed to transparency and debate. If there are any errors in the information we share on our website, contact us directly and we will correct the record.
Does SEGM support legislative efforts to regulate gender medicine?
SEGM opposes the politicization of transgender care. At the same time, SEGM recognizes that medicine has the potential to both help and harm and that regulation of medicine is a core and necessary function in order to safeguard patients from undue harm. Each country has a unique medical system, varying mechanisms for financing healthcare, and different approaches to regulating healthcare. It is up to these entities to work within their legal frameworks to balance the vital importance of protecting the patient-physician relationship with the mandate to safeguard youth from harm.
What is the role of debate in gender medicine?
In medicine, as in all of science, debate is an essential mechanism that allows the field to self-correct and progress. The now debunked but once widespread practice of lobotomy was widely endorsed by mainstream medical communities, and the pioneer of the practice received the Nobel Prize in Medicine. A more recent example is the prescription of opioids for chronic pain, which was also endorsed by medical societies, and opposition to this practice was labeled “opiophobic.”
The history of medicine is rife with triumphant feats and tragic failures. Unfortunately, it sometimes takes years or decades to differentiate between the two. Debate shortens this journey.
Does SEGM support LGBTQ people?
SEGM believes that LGBTQ people should be treated with dignity and afforded the same human rights and protections as all other individuals. Many of the professionals collaborating within SEGM are lesbian and gay, and a number have loved ones who identify as transgender.
The field of pediatric gender medicine is currently engulfed in an intense international scientific debate. Although most are debating in good faith, some have met SEGM’s position of concern over the unknown risk/benefit profile of youth gender transitions with accusations of “transphobia.” If such a standard is to be applied, then entire countries that have expressed the same concern as SEGM, including the UK, Norway, Finland, Denmark, and Sweden—the first country to recognize transgender people’s legal status—would be similarly labeled “transphobic.” Resorting to ad hominem attacks is often a reflection of weakness in one’s own argument, and we believe such tactics detract from the quality of scientific debate.
In recent months, we have seen a shift toward more civil debates, and we have been grateful to see our position of concern fairly represented by the New York Times, The Economist, The Associated Press, Newsweek, Wall Street Journal, Medscape, NPR, Kaiser Health News, the BMJ, and a growing number of other news sources.
What is the standard of care in pediatric gender medicine?
There is much confusion about the “standard of care” in gender medicine. Standard of care is a medicolegal concept essential for determining whether clinicians are negligent and liable for their actions in the context of malpractice lawsuits. For example, if a certain treatment harmed the patient, but the doctor only did what any other competent and skilled doctor would do in a similar situation, the doctor’s attorney will assert that they practiced according to a standard of care and should not be liable, even if the patient was demonstrably harmed.
What is contributing to the confusion is that an organization that promotes the practice of "gender-affirmation" of youth with hormones and surgeries, The World Professional Association for Transgender Health (WPATH), named their treatment guidelines "Standards of Care" also known as "SOC." In a recent court case, WPATH clarified that despite the misleading name, their practice guidelines are indeed treatment recommendations and not a "standard of care."
Ultimately only the courts can determine whether clinicians who provide “gender-affirming” interventions can successfully invoke the standard of care argument when sued by a patient alleging harm. Those who will argue for it will point out that currently a number of medical organizations have embraced the practice of “gender affirmation” following WPATH's treatment recommendations. However, such an argument may not withstand scrutiny due to two key facts: the evidence base for "gender-affirming" interventions, as well as the WPATH guidelines themselves are recognized to be of very low quality; and a growing number of healthcare systems in the Western world recently diverged from WPATH recommendations, sharply limiting pediatric gender transitions to a few exceptional cases.
Are “gender-affirming” surgeries performed on children?
The answer to this question depends on the country. In the United States, transgender surgeries on children are not uncommon. For example, this NIH-funded research describes mastectomies in children as young as 13. Other published research suggests that even 12 year olds get mastectomies. Because there is no U.S. national registry or reporting mechanism for these surgeries, it is not known how frequently they occur. However, recent data published in JAMA Pediatrics suggests that around 500 mastectomies were performed on minors in 2019 in the U.S. in hospital-owned surgical centers. This is likely a significant undercount since many plastic surgeons who specialize in these procedures own their own surgery centers and the mastectomies they performed would be excluded from the counts in JAMA Pediatrics.
In other countries, such as Sweden and the UK, where healthcare is publicly funded, such surgeries for youth <18 are typically not performed. For example, in the UK, the National Health Service will fund mastectomies for 17-year-olds in Scotland, but not in other regions. In Finland, transgender surgeries are never performed on gender dysphoric minors.
The draft 2022 WPATH guidelines lowered the age of mastectomy to 15 and orchiectomy (removal of testicles) and a number of other genital surgeries to 17. However, the final guidelines removed all lower age limits. It is not clear if other countries’ public health systems will follow these WPATH recommendations or if they will default to their own guidelines.