In a shocking report for the Free Press, Leor Sapir contextualizes the significance of newly released videos that lay bare the ways in which pediatric medical transition diverges wildly from the ethical principles that guide traditional medicine. The videos—released as part of litigation in Alabama’s Boe v. Marshall—features gender clinicians from the World Professional Association for Transgender Health, and its U.S. affiliate, defending “non-binary” surgical procedures, including what’s known as “gender nullification” procedures, despite a lack of supporting evidence or even a clear clinical indication. “[W]e are doing procedures here where we don’t have outcome data” one doctor said. The major takeaway from Sapir’s expose is that despite ostensible screening guardrails, behind closed doors gender clinicians themselves admit that talk of proper patient assessment and screening by “multidisciplinary teams” is designed to protect physicians from liability, rather than to protect patients from harm. For those seeking to understand how radical this subspeciality of medicine really is, Sapir’s essay is a must read.
In City Journal, I explain how HHS’ recent release of a peer-review supplement to accompany its report on best practices for pediatric gender dysphoria addresses its critics and provides an opportunity to reestablish gender medicine on empirical grounds. Significantly, the report underwent peer review by clinical and medical experts, including experts in evidence-based medicine, who praised the report’s methodology and upheld its finding that there is only “low certainty” evidence for benefits. Despite criticism from organizations like the American Academy of Pediatrics (AAP)—who supports pediatric medical transition—the AAP turned down an opportunity to peer-review the report or to highlight logical or methodological limitations. Unlike the HHS report, the AAP’s position statement on pediatric medical transition is not informed by systematic reviews of evidence. For more reading on the HHS report, see Dr. Kurt Miceli’s piece in RealClearPolitics.
As part of an agreement with the Trump administration to restore federal funding, Northwestern and the Feinberg school of Medicine have agreed not to render medical transition procedures for anyone under 18 and reaffirmed their commitment to upholding Title IX. The administration froze over $700 million in federal funding after launching investigations into allegations that Northwestern allowed antisemitism to flourish on its campus. The agreement is not a formal admission of wrongdoing on Northwestern’s part, although the university agreed to concessions that resolved investigations by the U.S. Departments of Justice, Education, and Health and Human Services. Funding is expected to be restored within 30 days.
Journalist Ben Ryan writes about a new study in the Journal of Pediatrics which concludes that its findings build on the evidence-base in support of the benefits of pediatric medical transition. The study’s main finding was that youth and young adults undergoing hormone treatment for gender dysphoria experienced a “medium-sized effect” improvement in suicidality. While the study does expand on some previous limitations—a larger sample size and longer follow up times to better assess change over time—the study design is not experimental and is fundamentally incapable of isolating the impact of hormones on suicidality scores. As the study's authors themselves concede, patients in the study were also offered medication management and psychotherapy, making it impossible to determine that hormones were responsible for any change in outcomes. Ryan also points out that the positive messaging notwithstanding, nearly 75% of the 432 participants reported no suicidality at the start of treatment, and while nearly one in five experienced some positive change in their score, 5% of youth and young adults also saw worsening suicidality scores.
A Douglas County Court has begun hearing arguments in a challenge to Kansas’ SB63 a law which prohibits dysphoric minors from accessing medical interventions as a treatment for gender dysphoria. The plaintiffs are challenging the law on equal protection grounds and want the Douglas County District Court to issue an injunction halting its enforcement. The Supreme Court’s ruling in Skrmetti, however, is likely to shape the contours of the case after the court determined that Tennessee’s law did not unlawfully discriminate against sex or transgender status but instead “removes one set of diagnoses — gender dysphoria, gender identity disorder, and gender incongruence — from the range of treatable conditions.”
In the Washington Examiner, Colin Wright continues his crusade against activists seeking to subvert our understanding of the sex binary in order to justify their support of the medical transition of gender dysphoric minors. Wright’s piece grapples with a new argument deployed by activists: that while sex is defined by gamete production, “gender” encompasses chromosomes, behavior, expression, height and body size. Wright argues that this concession on sex but quiet attempt to redefine gender is incoherent but strategically useful for activists, allowing them “to appear reasonable on the biology while preserving their justification for medically transitioning minors and adults.”
Two whistleblowers who previously raised the alarm about the failures of England’s Gender Identity Development Service (GIDS), Susan and Marcus Evans, are now raising alarms about the ethics of a UK clinical trial on puberty blockers. Indeed, the two former GIDS employees have written to Health Secretary Wes Streeting, requesting a halt to the clinical trial. Their criticism is three-pronged: GIDS already conducted a puberty blocker study and can follow up with its now adult participants to assess long-term outcomes, the follow up time is too short (two years) to observe the long-term implications of treatment, and minors are arguably fundamentally incapable of consenting to these interventions. “A study cannot claim proper informed consent when participants are fundamentally unable to understand what they are agreeing to, not solely because of their age, but due to their psychological state which prevents them from comprehending what they might be giving up. Any ethics committee approving this research without confronting this paradox has failed in its most fundamental duty” reads the letter to Wes Streeting.
Alberta Premier Danielle Smith has invoked the “notwithstanding clause” of Canada’s Constitution to defend three bills with implications for the trans-identified in healthcare, sports, and education. The bills prohibit medical transition for some dysphoric minors, reserve women’s sports for female athletes, and require parental approval for children under 16 to be addressed by cross-sex pronouns in schools. The controversial provision invoked by Smith allows certain laws to be exempt from legal challenges. Smith cited children’s safety for invoking the clause, adding that “These lawsuits could take years to resolve, including possible appeals to the Supreme Court...These delays are not acceptable to this government when children are in harm’s way.” The Supreme Court is set to hear challenges to the notwithstanding clause next year.
A group of physicians in New Zealand have launched a legal challenge to the nation’s recent prohibition on puberty blockers for the treatment of gender dysphoria. The group in question, the Professional Association for Transgender Health Aotearoa (PATHA), is filing a judicial review where a judge will assess the prohibition on blockers issued by Minister of Health, Hon Simeon Brown. “These regulations are being enacted based on politics, not on clinical evidence,” PATHA president Jennifer Shields said in a press release. Despite Shields’ claim, her statement is verifiably false by the standards of evidence-based medicine, where systematic reviews routinely conclude that the available evidence-base is only of “low certainty.”
Joseph Figliolia
Policy Analyst
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