Notable Publications in Gender Medicine, June 2025

SEGM Digest, Issue 2 (June 2025)
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July 7, 2025

We continue our series in this month’s SEGM Digest, which highlights a shift in the youth gender transition debate, with growing focus on ethical and regulatory concerns. We review key bioethics publications and court rulings likely to shape future regulation which came out in June 2025. Despite increased awareness of poor study design in gender medicine, clinicians continue to publish papers claiming safety and benefits. We begin by examining two new studies—one from four U.S. clinics and one from the Dutch clinic behind the Dutch protocol—finding that their conclusions are not supported by the data. 

SEGM Digest: Issue 2

1. Mental and Emotional Health of Youth After 24 Months of Gender-Affirming Medical Care Initiated With Pubertal Suppression (Olson-Kennedy et al., 2025, pre-print). This long-anticipated paper from the NIH-funded study reports on mental health outcomes in children and adolescents prescribed puberty blockers (PB) for gender dysphoria (GD) at four US pediatric gender clinics. The study found no changes in mental health of youth treated with PB over the 24-month period. After the New York Times revealed the study had been withheld due to unfavorable results, it was published with a reframed conclusion: that the absence of mental health improvement after PB reflects the intervention's success in “prevent[ing] the deterioration of mental health.” Yet this claim remains unsupported, as the study lacked a valid comparison group of untreated youth. This study marks the second failed attempt to replicate the reported success of the Dutch protocol; the first failure was documented in Carmichael et al., 2021 in the UK. Notably, the U.S. pediatric gender clinic where principal investigator Olson-Kennedy worked announced it would close in July 2025.

 SEGM reviewFull text (external link)

2. Sexual Satisfaction and Dysfunction in Transgender Adults Following Puberty Suppression Treatment During Adolescence (van der Meulen et al., 2025). This paper from the Dutch cohort examines the impact of pubertal suppression (PS) on long-term sexual function in youth who continue along the gender-affirming medical pathway. The authors conclude that PS, regardless of its timing, does not impair future sexual function—yet the analysis does not support this conclusion. At an average age of 29, over half of the participants reported at least one sexual dysfunction, and only about half of natal females and 40% of natal males reported satisfaction with their sex lives. The rates of distressing sexual dysfunction appear markedly higher than those in the general population of the Dutch adults in a similar age group. A significant overall dropout rate (70% in the male-to-female participants and 52% overall) raises additional concerns regarding the reliability of the findings. Further, the study is unable to answer the key question whether early (as opposed to late) PS carries additional sexual functioning risks, since there were only five participants who began PS at Tanner stage 2, as recommended by the current "gender-affirmative" treatment protocols.

 SEGM reviewFull text (external link)

3. American Journal of Bioethics, Volume 25, Issue 6 (multiple authors, 2025). A series of 10 papers in the June issue of the American Journal of Bioethics (AJOB) examine the ethics of pediatric medical transition. Nine of ten were responses to the "target" article by Jeffrey Kirby, who argues youth gender transition is justified, albeit with "modifications" such as screening and treatment of mental health problems and full disclosure of harms such as fertility loss. The commentaries in support of Kirby's pro-minor-medicalization stance criticize evidence-based medicine as "laden with normativity" and accuse the critics of youth transitions of "bioessentialism"— defined by the authors as a problematic "belief that there are only two ...sexes." Commentaries critical of Kirby's stance challenge Kirby by highlighting the reliance on cherry-picked, weak studies to erroneously claim benefits of pediatric medical transitions, and by questioning ethical analyses that overemphasize the principle of justice over core bioethics principles of non-maleficence and beneficence. Of note is the response co-authored by Hilary Cass and Camilla Kingdon (who heads up UK's new gender services) addressing the ongoing mischaracterization of the Cass Review.

SEGM reviewFull text (external link)

4. U.S. Supreme Court: U.S. vs Skrmetti (June 2025). In a decision with sweeping implications for pediatric medicine and public policy, the U.S. Supreme Court ruled 6–3 in U.S. v. Skrmetti to uphold Tennessee’s Senate Bill 1, which prohibits gender-transition medical treatments—including puberty blockers, CSH, and surgeries—for minors. Within the framework of evidence-based medicine, a key rationale for the SCOTUS decision was that these interventions, when used for the treatment of gender dysphoria, involve significant medical uncertainties, heightened risks, and unresolved ethical concerns that distinguish them from analogous treatments used for other conditions. The Court noted a lack of reliable evidence supporting claims that these interventions reduce suicide risk, concerns about the lack of permanence of transgender identity in youth, and challenges with informed consent in pediatric populations. It also cited recent international moves to restrict such treatments in minors as further justification for state-level caution. With this ruling, laws passed in more than 20 states imposing age-based restrictions are now likely to take full effect.

 SEGM reviewFull text (external link)

5. Australian Federal Family Court: Re Devin (June 2025). In Australia, if there is disagreement between parents regarding a child commencing puberty blockers, the matter is decided by the Family Court. One such case involving parental disagreement, evaluated by a Family Court judge, resulted in devastating judicial criticism of Australia's leading pediatric gender clinic and its principal clinician Michelle Telfer, who is also the lead author of Australia's affirmative guidelines. After evaluating Telfer's expert witness testimony, Justice Strum issued a scathing opinion, concluding that Telfer gave misleading and unprofessional evidence to the Court, and he criticized the gender clinic for an inappropriate reliance on a child’s self-reported gender identity for only offering medicalization as the treatment approach. Justice Strum concluded that the risks of puberty blockers for the child were unacceptable, and the child was prohibited from being seen at the gender clinic. While the decision applies to a single case, Justice Strum’s full judgement is highly notable as it highlights deficiencies in the clinical practices of one of Australia’s largest publicly funded pediatric gender clinics.

SEGM reviewFull text (external link)

1. Mental and Emotional Health of Youth After 24 Months of Gender-Affirming Medical Care Initiated With Pubertal Suppression

  • Olson-Kennedy, J., Durazo-Arvizu, R., Wang, L., Wong, C. F., Chen, D., Ehrensaft, D., Hidalgo, Marco A., Chan, Y.-M., Garofalo, R., Radix, A. E., & Rosenthal, S. M. (2025). Mental and Emotional Health of Youth after 24 months of Gender-Affirming Medical Care Initiated with Pubertal Suppression. https://doi.org/10.1101/2025.05.14.25327614 [preprint].

As part of the NIH-funded Trans Youth Care US Study, pediatrician Johanna Olson-Kennedy and colleagues report on the mental health outcomes of a cohort of 94 children and adolescents (ages 8–16) who received puberty blockers (PB) for gender dysphoria (GD). The participants were recruited from four US pediatric gender clinics between 2016 and 2019. They completed various mental health rating scales at baseline, and then at six-month intervals up to 24 months.

The study found no significant change in mental health over this period, with the authors reporting that at no point did the mean scores of depression, emotional health, and the parent-rated Child Behavior Checklist (CBCL) constructs reach a clinically concerning range. A substantial minority had moderate to severe depression scores both at baseline (18%) and at the 24-month follow-up (23%).

Despite the lack of improvement, the authors conclude that PB have a positive effect because “it is likely that puberty blockers prevent the deterioration of mental health”.

SEGM analysis: This study has been published as a pre-print and is not yet subject to peer review. However, the version made publicly available suggests serious methodological limitations. It makes misleading conclusions while adding little to our knowledge—we still do not know if PB are likely to improve, worsen, or have no impact on the short-term mental health of young people presenting with gender dysphoria. In addition to the well-described problems with a lack of control groups in much of pediatric gender medicine research, further problems in the study include:

  • Sample selection bias. The study subjects had high mental health functioning at baseline —unlike typical gender clinic populations, where over 70% report serious pre-existing mental health issues. According to the study protocol, patients (or parents) with “serious psychiatric symptoms” or who were “visibly distraught” were excluded. Although the study does not provide data on how many of the patients treated at the participating clinics were excluded from the study or why, the protocol criteria and the makeup of the study sample at baseline strongly suggest that the study began with a highly selective, unrepresentative sample.
  • High dropout rate. In addition to starting with a sample biased toward good mental health, it appears that 37% of the participants dropped out by the end of the study period at 24 months. The authors do not report this dropout rate explicitly, but it can be derived by analyzing the text and tables (the number of participants decreased from n=94 at baseline to n=59 at 24 months). High rates of dropout can mask adverse outcomes, introducing another source of bias.
  • Confounding. The study makes no mention of what other interventions—including psychiatric medications or therapy—the study subjects may have received. This is despite the fact that the registered protocol indicates that psychiatric medications use by the study subject was collected. If a substantial number of youths were receiving these co-interventions, it is impossible to determine if high level of functioning at 24 months was due to PB or other interventions.
  • Failure to report on key outcomes. The paper does not report on GD outcomes, despite GD being required for inclusion and listed in the protocol as an evaluation measure. The protocol underwent multiple amendments between 2017 and 2021; the UGDS gender dysphoria scale, originally a key measure, was removed in 2019 without explanation. Other scales listed in the protocol—such as body image, body esteem, and transgender congruence—are also omitted from the final report, with no justification.
  • Unsupported claims about suicidality. Olson-Kennedy et al. claim that while baseline suicidality matched national rates, it was “lower than the national average” after 24 months. However, this claim is unsupported by data analysis. Table 5 shows suicidality was measured only for the prior six months at the 24-month mark, whereas the cited national study (Young et al., 2024) reports lifetime rates. Comparing short-term suicidality to lifetime prevalence is methodologically unsound, as shorter timeframes are expected to yield lower rates. This undermines the paper’s assertion of reduced suicidality.
  • Misrepresentations of prior evidence. In discussing the existing body of literature, Olson-Kennedy et al. selectively cite studies, omit key limitations, and overstate the link between PB and improved mental health. For instance, they claim Costa et al. (2015) found better psychosocial functioning with PB plus therapy compared to those who had psychotherapy alone, yet Costa found no significant difference between groups. They also misrepresent McGregor et al. (2024), stating PB reduced suicidality, when in fact the study found no difference after adjusting for age and sex. Finally, they ignore studies that found no improvement or limited improvement (for a review, see McDeavitt, 2024).

SEGM comment: The authors fail to engage with study results in good faith. The study found no change in mental health after PB, yet Olson-Kennedy et al. claim it shows benefit—arguing PB prevent decline because older youth with gender dysphoria often have poor mental health. While it's true that older adolescents and adults who identify as transgender have high rates of mental health difficulties, drawing strong conclusions of benefits of blocking puberty results from a null result based on speculative comparisons is not justified. Other explanations—such as the selection criteria resulted in a sample that was already high-functioning, and had little room for improvement, or that PB have no positive effect on mental health—are more plausible. This study represents the second unsuccessful attempt to replicate the reported outcomes of the Dutch Protocol; the first failure being Carmichael et al., 2021 in the UK. The significant delay in Olson-Kennedy et al. publishing their findings—reportedly due to unfavorable results, according to the New York Times—closely resembles the pattern observed at the now-closed Tavistock clinic in the UK. The U.S. pediatric gender clinic where principal investigator Olson-Kennedy worked has now also announced its closure, effective July 2025.

2. Van der Meulen et al. (2025) Sexual Satisfaction and Dysfunction in Transgender Adults Following Puberty Suppression Treatment During Adolescence 

  • Meulen, I., Arnoldussen, M., van der Miesen, A., Hannema, S., Steensma, T., Vries, A., & Kreukels, B. (2025). Sexual satisfaction and dysfunction in transgender adults following puberty suppression treatment during adolescence. Journal of Sexual Medicine. https://doi.org/10.1093/jsxmed/qdaf095.

This study assessed long-term sexual satisfaction and dysfunction among 70 individuals who began puberty suppression (PS) at the Amsterdam gender clinic between 1998 and 2011, selected from an original cohort of 145. All participants later initiated cross-sex hormones, and many underwent genital surgery. At an average of 14 years after PS treatment (average age 29), participants completed a questionnaire on sexual experiences.

The authors compared individuals who began PS at earlier puberty stages (Tanner stage 2 or 3) to those who began later (Tanner stage 4 or 5), reporting no differences between the groups. They also compared outcomes to those who transitioned in adulthood without PS, as well as to general population data on sexual function in the Netherlands.

On the basis of these comparisons, and despite the high rates of sexual problems reported in the study, the authors conclude that PS does not negatively impact adult sexual functioning. In a press release titled “Puberty blockers do not cause problems with sexual functioning in transgender adults” they assert that there was “no difference between people who started puberty blockers early or later in puberty,” and that sexual satisfaction in the PS group was comparable to people who had transitioned as adults and the general population.

SEGM analysis: The impact of early puberty suppression on long-term sexual function is one of the most urgent ethical concerns in the debate over pediatric gender transition. A finding that PS has no adverse effect on sexual function would be welcome news to the tens of thousands of families worldwide weighing this intervention. However, this conclusion is undermined by numerous serious methodological limitations in the study, which raise significant doubts about the trustworthiness of the conclusions.

  • Lack of analysis of early PS outcomes (Tanner stage 2): Only 5 participants began PS at Tanner stage 2 (early puberty), making it impossible to analyze their outcomes separately. Instead, their data were merged with those who started PBs at Tanner stage 3 (mid-puberty, n=12). As a result, the study does not provide meaningful insight into sexual outcomes for youth who begin suppression at early puberty—despite puberty blockade at Tanner stage 2 being the standard protocol in current clinical practice, and the question at the center of current debates.
  • Underpowered sample unable to detect differences between early vs late PS: Even after combining participants who began puberty suppression at Tanner stage 2 or 3, the sample size (n=17) is still too small to meaningfully compare rates of sexual dysfunction with those who began at Tanner stage 4 or 5 (n=53), particularly once divided by sex. As a result, the study lacks sufficient statistical power—meaning that even if real differences existed between subgroups, the sample was too small to detect them. Further, the small sample also leads to questionable and counterintuitive results. For example, 58% of natal males who began puberty suppression at later stages (Tanner stage 4 or 5; n=12) reported difficulty achieving orgasm, compared to 0% of those who began at early-to-mid puberty (Tanner stage 2 or 3; n=8). Short of a plausible explanation for such a counterintuitive result, it raises serious concerns about the validity of the question, the representativeness of the sample, and the reliability of the results.
  • Flawed measurement tool weakens conclusions about comparable sexual function: The study relied on a “partly self-created” questionnaire to assess sexual dysfunction, which has major limitations. For example, it asked whether participants had ever experienced sexual problems, without specifying when the issues occurred. Because all participants received cross-sex hormones and many also had genital surgery, it is impossible to know whether any dysfunction was due to puberty blockers, hormones, surgery, or occurred later in life. Additionally, the tool did not include pain—despite it being a common issue in transgender populations and a standard component of sexual dysfunction definitions in comparison studies the authors themselves used (e.g., Kerckhof et al., 2019; van der Meulen et al., 2024).

  • Misleading comparisons to general population data: The study appears to have selectively cited sources to support its claim that high rates of sexual problems in transgender population (including those who underwent PS ) are comparable to the general population. For example, it cites a 42% dysfunction rate in a population survey of young Dutch women under 25 to suggest the PB group’s outcomes aren’t unusual—but that figure reflects any past orgasm difficulty, not distressing dysfunction. A more appropriate measure from the same survey—aligned with the study’s own definition of sexual dysfunction as requiring distress—would have been 9% (de Graaf et al. 2024a, table 4.13.1). Additionally, the cited survey participants were younger (<25 years) than the study's sample, whose average age was 29. Further, survey data from adult Dutch populations from the same agency (Rutgers) are available and point to a markedly different conclusion: that the sexual functioning in the PS sample is much worse than that in the general population. Assuming—as the authors do—that participants reported recent sexual dysfunction, the reported rates of at least one sexual dysfunction in the PS-group (50% of natal males and 58% of natal females) are much higher than reported in the general Dutch population of similar age (7% of males and 17% of females, de Graaf et al., 2024b, Table 8.1.4).

    The same population survey found that 57% of Dutch men age 25+ were satisfied with their sex lives (de Graaf et al., 2024b, p. 60) compared to just 40% of natal males in van der Meulen’s study. Further, this population survey directly compared sexual problems in transgender vs general populations, finding the former to have far less sexual frequency, more sexual dysfunction, and subjected to more sexual violence (de Graaf et al., 2024b, tables 4.3.1, 4.3.3), as did the population survey cited by the authors (de Graaf et al., 2024a, tables 3.3.1 and 3.3.3)

  • Internal inconsistencies: Although it is unclear why the authors chose to rely on a less applicable survey of Dutch adults <25 to make the claim of comparable sexual function between transgender and general populations, when a more relevant survey of Dutch adults’ sexual functioning issued by the same agency was available, the authors assertions of “comparable” function are contradicted by the very sources they themes cite. For example, in the Discussion section on sexual satisfaction, they claim that satisfaction levels in their PS cohort were “comparable to or slightly higher” than other transgender cohorts that began treatment in adulthood. However, only two sentences later, they cite “systematic reviews” showing that “64%–98%” of transfeminine individuals reported being very satisfied following vaginoplasty. In contrast, their own study found that only 40% of transfeminine participants (all but one of whom had undergone vaginoplasty) reported sexual satisfaction.

    Further, a study by Rosen (2000), cited by the authors themselves, found that in the general population, orgasmic disorder rates are under 10% in males aged 18–59, yet they reported that 35% of young adult natal males who underwent PS had difficulty achieving orgasm. Thus, the authors’ conclusions of similarities in sexual function between PS and all other groups are not supported by the very data they cite.

  • High dropout rate: The study had an overall participation rate of only 48%, with an even lower response rate of just 32% among male-to-female participants. The markedly high dropout rate overall and among the male participants in particular raises concerns about non-responder bias: those who responded may not accurately represent the treated population”
  • Capacity for informed consent: Finally, the study does not address a key ethical issue: the profound difference in capacity for informed consent between an adult and a child as young as nine. The potential for irreversible loss of sexual function underscores the need for extreme caution—particularly given the developmental immaturity of children initiating these interventions. It is likely that a number of participants lacked any pre-PS sexual experiences and have a limited understanding of normal sexual function, questioning the validity of self-reported outcomes.

SEGM comment: The findings of this study are far from reassuring. Participants who underwent puberty suppression (PS) reported high rates of sexual dysfunction compared to the general Dutch adult population—a highly relevant population survey the authors overlooked. Although comparisons across studies with differing methodologies must be interpreted cautiously, these results challenge the authors’ conclusion that PS—regardless of timing—is not associated with future sexual health problems.

Critically, the study’s significant methodological limitations prevent any firm conclusions about whether, or how, the timing of PS influences these outcomes. The disproportionately high dropout rate among male-to-female participants raises further concerns about the outcomes of PS in natal males, and whether this attrition reflects more adverse effects in this subgroup.

Finally, the study fails to address a key ethical issue: the profound difference in capacity for informed consent between an adult and a child as young as nine. The potential for irreversible loss of sexual function underscores the need for extreme caution—particularly given the developmental immaturity of children initiating these interventions.

3. Ethics of Pediatric Medical Transition

A series of papers in the latest issue of the American Journal of Bioethics examines the ethics of pediatric medical transition. The target article is by Jeffrey Kirby:

Kirby undertakes an ethical analysis of pediatric medical transition through four lenses: autonomy, patient welfare, health equity, and justice. He concludes that his "multi-lens ethics analysis" supports transition in transgender and gender-diverse youth, albeit with some modifications, including "formal screening, and treatment as appropriate, for mental health symptomatology/disorders and neurodiversity (that could possibly impair or preclude the informed assent of the youth, or that should be taken into consideration during the formal assessment process)" and full disclosure of the medical burdens of treatment, including infertility.

The Kirby article was accompanied by two editorials. One mounts a defense of the practice of gender transition of minors, co-authored by attorney Craig Konnoth (who published an earlier error-ridden misrepresentation of the Cass Review in NEJM). The other editorial, co-authored by Hilary Cass, outlines the processes and recommendations of the Cass Review, highlighting common mischaracterizations, some of which Kirby repeats in the target article. Notably, the lead author is pediatrician Camilla Kingdon, who leads England's new gender services for children and young people that now operate under a holistic model of care, prioritizing psychological support and following "best practice and evidence". 

In addition, a series of commentaries respond to Kirby’s article. Several are supportive of continuing gender transitions of minors. They support their positions by:

  • Arguing that concerns with gender transition of minors are problematically rooted in "bioessentialism," which the authors define as a problematic "belief that there are only two … sexes" that are identifiable at birth.
  • Evoking feminist bioethics and stating that evidence-based medicine is "infused with subjective judgments about the right kinds of evidence or the right methods, laden with normativity."
  • Supporting access to hormones for youth in medical settings since restrictions will simply push youth to get hormones illegally (the argument the authors refer to as "DIY justice").
  • Opposing bans on minor transition surgery by asserting that "gender identity of cis persons" is routinely "affirmed" by surgery.

Several commentaries, in addition to the editorial by Kingdon, Stingelin-Giles, and Cass, are critical of Kirby's positions, and identify deficiencies in his arguments for gender transition of minors:

The above commentaries provide key criticisms of Kirby’s analysis, including:

  • Relies on a small number of self-selected studies (i.e., “cherry-picking”) to support Kirby's claims that pediatric medical transition improves mental health outcomes and that harms such as detransition/regret are rare. For example, Kirby cites one study that found less than 1% regret/detransition rate while failing to mention numerous other studies which find much higher rates.
  • Fails to mention the serious methodological weaknesses of the studies which make their findings unreliable (as identified by multiple systematic reviews and papers).
  • Inaccurately makes a strong causal claim (i.e., these “studies have demonstrated that the use of GAC [gender-affirming care] improves the well-being and mental health outcomes of transgender and gender-diverse persons”) despite the authors of the studies themselves acknowledging that the studies report associations, not causation.
  • Erroneously implies that Cass is demanding randomized controlled trials (RCTs) and seems to misunderstand a fundamental issue—that RCTs can be either blind or non-blind.
  • Provides an unbalanced and limited discussion of the bioethical principle of justice, privileging it over other principles such as beneficence/non-maleficence without warrant.

We find the critiques of Kirby’s paper incisive, highlighting the paper's substantial weaknesses. We have identified additional flaws not discussed by any of the commentaries:

  • Kirby inaccurately cites Fleming et al. (2016), to make the claim that only 13.5% of systematic reviews (SRs) are based on RCTs. In fact, all the SRs analyzed by Fleming were based on RCTs.
  • Kirby misrepresents Oyelese’s (2024) thoughtful clinical opinion piece questioning dogmatic reliance on RCTs. Contrary to Kirby’s implication, most critics of the evidence underpinning pediatric medical transition (including Cass) are not merely pointing to the absence of RCTs, but to the absence of quality observational studies (see for example Cheung et al. (2024), Clayton et al. (2025), McDeavitt et al. (2025)). This is in line with Oyelese’s arguments, and he cautions against reliance on poor-quality observational studies: “not all observational studies are good, and it is likely that the proportion of poorly conducted and interpreted observational studies is greater than that of RCTs; thus, observational studies must be scrutinized carefully” (p. 419).

SEGM comment: The debate over the evidence is largely settled, with broad recognition—among good-faith actors on both sides—that the evidence claiming benefits of youth transitions is untrustworthy (or, in evidence-based medicine terms, “very low quality”) and that there are significant possible harms. As a result, the discussion is increasingly shifting to bioethics. It is commendable that American Journal of Bioethics has published diverse viewpoints on pediatric medical transition. We hope more bioethicists will engage in good faith to consider whether, and under what conditions, modern medicine can justify irreversible, function-destroying interventions aimed at affirming identity rather than treating disease—especially when the patients are minors.

4. United States v. Skrmetti

On June 18, 2025, the Supreme Court upheld Tennessee’s Senate Bill 1 (SB1), prohibiting medical treatments such as PB, cross-sex hormones, and surgeries aimed at facilitating gender transitions in minors. SB1 allowed these treatments for other medical conditions, like hormonal disorders, precocious puberty, or intersex traits. Three minors, represented by the ACLU, challenged the law, arguing it violated the Equal Protection Clause of the Fourteenth Amendment by unlawfully discriminating against transgender minors; they asserted that these treatments were medically identical regardless of the condition treated.

The Court rejected this claim, concluding that treatments for gender dysphoria involve distinct medical uncertainties, risks, and ethical considerations. It ruled that Tennessee’s law focused on the patient's age and specific clinical diagnosis rather than sex or transgender status, making it permissible under the "rational basis" standard. Additionally, the justices expressed concern about ideological bias and methodological flaws in current medical guidelines, highlighting recent international caution regarding pediatric gender-transition treatments. They also acknowledged uncertainty about the permanence of transgender identity in minors, challenges involving informed consent, and insufficient evidence supporting claims that these interventions significantly reduce suicide risk.

SEGM comment: The Skrmetti decision affirms states’ authority to regulate pediatric gender medicine. It underscored the urgent need for an unbiased reassessment of existing medical guidelines. Without a rigorous, evidence-based guideline development process, there is a significant risk of increasing regulatory fragmentation and intensifying political polarization—with “red states” banning the practice and leaving youth in advanced stages of transition in limbo, while “blue states” become “sanctuaries” offering on-demand services to any minor who requests them. The way out of this polarization is to treat pediatric gender transition as a medical intervention, not a civil rights issue—and to prioritize evidence-based practices to protect patient safety and promote long-term health outcomes for vulnerable youth. 

5. Australian Federal Family Court re Devin Judgement

In the case of re Devin, the mother, who had been taking Devin (now age 12) to Melbourne’s Royal Children’s Hospital Gender Clinic (RCHGC) since the age of 6, wanted him to be assessed by a pediatrician to allow for potential treatment with puberty blockers (PB). The father objected, which landed the case in Family Court. After reviewing expert witness statements, Justice Strum concluded that the risks of PB were unacceptable and found for the father. He issued an injunction against the child returning to the RCHGC unless both parents agreed.

Although the case only concerned one child, the judgement was scathing of the RCHGC and two of its clinicians who gave evidence in the case. One of these was Associate Professor Michelle Telfer, one of Australia’s leading pediatric gender clinicians and lead author of the affirmative Australian Standards. Strum found Telfer gave misleading evidence to the Court that was “contrary to the obligations as an expert witness.” Strum criticized the RCHGC’s practice on multiple grounds including that there was an inadequate assessment/diagnostic process, failure to evaluate co-morbid conditions such as neurodevelopmental disorders, an inappropriate reliance on a child’s self-reported gender identity, and a single treatment approach on offer. He noted that RCHGC’s senior clinical psychologist was unable to “identify a single case of a child who had been referred by her, or one of her colleagues, to a pediatrician at the [RCHGC] who had not been prescribed puberty blockers” (paragraph 128).

The judgement also rejected the notion presented by the gender clinicians that gender identity is innate and immutable, recording that neither of the RCH experts:

“were able to point to any empirical or substantive basis for their opinion but, rather, only to anecdotal reports from transgender adults about their experience of their gender identity. Further, neither expert was able to point to any other aspects of human identity that are similarly said to be immutable. … The proposition is also difficult to reconcile with the necessarily conceded incidence of detransitioning (albeit that the frequency thereof is disputed), as well as the evidence of some children’s gender incongruence/dysphoria resolving upon going through puberty” (paragraph 88).

SEGM comment: Typically, the identity of the specific gender clinic and the views of the clinicians involved is withheld from the public due to confidentiality. In this case, Justice Strum lifted that suppression order citing public interest reasons. Strum’s detailed 58,000-word judgement makes for sobering reading. Due to clinical confidentiality, it is ordinarily challenging to discern the extent to which clinicians are wedded to a particular agenda. However, in this trial, notes disclosed under subpoena provide a troubling insight into significant failures at one of Australia’s most prominent pediatric gender clinics. Strum’s summary highlights substantial shortcomings in clinical practice, raising broader questions about transparency and accountability in gender medicine for minors.