A year ago, the Finnish Health Authority (PALKO/COHERE) deviated from WPATH's "Standards of Care 7," by issuing new guidelines that state that psychotherapy, rather than puberty blockers and cross-sex hormones, should be the first-line treatment for gender-dysphoric youth. This change occurred following a systematic evidence review, which found the body of evidence for pediatric transition inconclusive. 

In December of 2020, the Endocrine Society, in partnership with the Pediatric Endocrine Society, released a Position Statement regarding transgender health. That position statement asserts that there is a biological underpinning to transgender identification and that hormonal and surgical interventions for those suffering from gender dysphoria are safe and effective. The statement additionally claims that such interventions are "standard of care." A recently published peer-reviewed letter to the editor of the Journal of Clinical Endocrinology and Metabolism (JCEM), an official journal of the Endocrine Society, argues that these positions are unsupported by current medical evidence.

Over the last few years, a growing community of detransitioners has formed online. Despite the visibility recently given to the topic in mainstream media, including a recent 60 Minutes episode featuring detransitioners and their stories, detransition is still a poorly understood phenomenon. A recent exploratory cross-sectional study aims to serve as a springboard for further academic research on the subject. It focuses particularly on uncovering the specific needs that detransitioners experience and the support - or lack thereof - that they receive. The study also provides information about the average age of transition, detransition, and the duration of transition among study participants.

Following the 60 Minutes episode earlier this week, which highlighted the controversies surrounding medical interventions for gender dysphoric youth, SEGM has been receiving an increasing number of inquiries about the state of gender care for youth in the United States. One question in particular has been asked most frequently: how difficult or easy is it to obtain hormones and surgeries in the US? There are over 60 pediatric “gender clinics” in the US, according to the Human Rights Commission’s interactive map. However, the total number of clinics and medical offices that provide hormonal interventions to minors is likely much higher, and is currently estimated at over 300. We cannot speak for all the clinics and their practices. However, we can provide some general observations and insights about the state of pediatric gender care in the US.

Update May 08, 2021. The Karolinska Hospital in Sweden recently issued a new policy statement regarding treatment of gender-dysphoric minors. This policy, affecting Karolinska's pediatric gender services at Astrid Lindgren Children's Hospital (ALB), has ended the practice of prescribing puberty blockers and cross-sex hormones to gender-dysphoric patients under the age of 18.

Suppressing puberty in children suffering from gender dysphoria — by administering Gonadotropin-Releasing Hormone agonist (GnRHa) — entails several known risks. One is that patients could “end with a decreased bone density, which is associated with a high risk of osteoporosis” (Delemarre-van de Waal & Cohen-Kettenis 2006). Bone density was one of the outcomes tracked by the English experiment with GnRHa on children between the ages of 12 and 15, launched by the Tavistock clinic in 2011. As the endocrinologists Dr William J. Malone (an adviser to SEGM) and Dr Michael Laidlaw have pointed out, the published results (Joseph, Ting, & Butler 2019) showed that children experienced a significant decline in bone density relative to the norm for their sex and age—as measured by Z-scores. The study tabulated only the mean and the standard deviation of the Z-scores, and so the proportion of children with Z-scores in the abnormal range was unknown.

In 2020, the UK National Institute for Health and Care Excellence (NICE) undertook two systematic evidence reviews of the use of GnRH agonists (also known as "puberty blockers") and cross-sex hormones as treatments for gender dysphoric patients <18 years old. These reviews were commissioned by NHS England, as part of a review of gender dysphoria healthcare led by Dr Hilary Cass OBE. These reviews, which were published earlier this week, make for sober reading. The reviews' major finding is that GnRH agonists lead to little or no change in gender dysphoria, mental health, body image and psychosocial functioning. All the studies evaluated had results of “very low” certainty, and were subject to bias and confounding.

It is a well-established observation that individuals suffering from gender dysphoria (GD) demonstrate an increased prevalence of mental health issues when compared to the general population. One theory that explains the link between GD and mental illness is the minority stress model. Gender-non-conforming and GD youth experience elevated rates of victimization, discrimination, and prejudice. According to the minority stress theory, these adverse experiences are the primary cause of the poorer mental health status of GD individuals. There are two issues which contradict the minority stress theory. First, evidence shows that mental health issues often precede the onset of gender identity concerns. Second, long-term studies have not been able to demonstrate lasting mental health benefits of “gender-affirmative” (hormonal and surgical) interventions. These findings do not support the argument that minority stress is the primary reason for the high co-occurrence of GD and other psychiatric disorders. An alternative explanatory model for the co-occurrence of GD and other forms of distress and mental illness is that both arise as a result of a complex interplay of biological, relational, and cultural factors.

Gender detransition, broadly defined as the interruption or reversal of a gender transition process, has acquired noticeable visibility in recent years. Those who detransition, commonly referred to as "detransitioners," have started to share their experiences on social media and other online platforms, raising substantial questions for clinicians working in the field of gender dysphoria.

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.

In 2018 Andrea Davidson’s 12-year-old daughter, Meghan, announced she was “definitely a boy”. Ms Davidson says her child was never a tomboy but the family doctor congratulated her and asked what pronouns she had chosen, before writing a referral to the British Columbia Children’s Hospital (BCCH). “We thought we were going to see a psychologist, but it was a nurse and a social worker,” says Ms Davidson (both her and her daughter’s names have been changed).

The Society for Evidence-Based Gender Medicine (SEGM) maintains that treatments for gender-dysphoric people should be supported by high quality evidence. We commend the thorough process undertaken by the UK High Court to assess the ability of young people to consent to treatment that has serious side effects and lacks adequate supporting evidence.

In September 2019, JAMA Psychiatry published an article, Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. The article concluded that therapies that did not "affirm" an individual's transgender identity (which the article refers to as "gender-identity conversion efforts / "GICE") lead to severe distress and even suicide attempts. These findings have been used to promote legislative bans on non-affirmative therapies worldwide.

In October 2019, the American Journal of Psychiatry (AJP) published a study from the Karolinska Institute in Sweden, and the Yale School of Public Health which reported that “gender-affirming" surgeries for gender dysphoric patients are associated with improved mental health outcomes (1). Looking at mental health utilization in the year 2015, a retrospective analysis showed that the more time passed since surgery, the fewer mental services were utilized by patients, with an average 8% reduction in mental health ut