Notable Publications in Gender Medicine, July–August 2025

SEGM Digest, Issue 3 (July–August 2025)
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October 31, 2025

With some delay owing to hosting a major conference, we have now released Issue 3 of the SEGM Digest, our new initiative highlighting recent influential publications in pediatric gender medicine. 

Our Digests help busy professionals stay on top of important publications that relate to youth gender medicine. We have provided short summaries for each paper, followed by longer in-depth reviews. For those who want to fully engage with each paper, we recommend reading the original publication alongside our analysis using the links we have provided. As always, we welcome comments and feedback.

Please feel free to read Issue 1 and Issue 2 if you have not yet already done so.

SEGM Digest: Issue 3

1. “Providers Had no Idea What to do With me”: A Mixed-Methods Analysis of Detransition/Retransition Support, Care, and Information Needs Among Sexual and Gender Minority Individuals. (Rackliff et al., 2025). This latest study on detransition comes from "DARE"—an LGBTQ+ community-led project to research detransitioner experiences and needs. The recruiting strategy aimed to attract not only those who detransitioned due to an identity change, but also those who attributed their detransitions to various external factors, including legislative restrictions. Only 41% of the resulting sample considered themselves as detransitioned, a minority identified as cisgender (19.6%), and many identified with terms such as transgender (43%) or non-binary (33%). Over 40% of the sample reported having "retransitioned"—i.e., resumed transition after temporarily stopping. A key finding of the study is that many participants felt socially isolated during detransition and lacked competent healthcare support; some also felt judged in "affirmative" healthcare settings. The study represents a valuable contribution to the field, but as we elaborate in our review, the sample composition and framing of their discussion introduce interpretive biases that limit the generalizability of some of its conclusions.

 SEGM reviewFull text (external link)

2. Observations of the Effect of Gonadotropin-Releasing Hormone Analog Treatment on Psychosocial Well-Being in Transgender Youth and Their Caregivers: A Pilot Study. (Gohil et al., 2025). This study evaluated the impact of puberty blockade (PB) on the psychosocial well-being of gender-dysphoric (GD) youth, as well as the psychological health of parents/caregivers throughout the youths' treatment. The sample comprised 16 patient-caregiver pairs, with both children/caregiver predominantly female (75%/81%). Treatment was initiated at an average age of 12, with most youths (69%) described as being in later stages of puberty. The researchers found no significant change in the psychological functioning of GD youth (or their parents) after 12 months of PB. The authors propose several possible explanations for their null findings, including initiating the treatment too late in puberty, negative effects of the COVID-19 pandemic on mental health, and an insufficient sample size. They also raise the possibility that decreases in sex-steroid concentrations resulting from PB in later stages of puberty have a negative impact on mental health. The study's results are consistent with several larger studies that did not observe improvements in various measures of mental well-being following the initiation of PB for GD.

 SEGM reviewFull text (external link)

3. GnRH Analogues as a Monotherapy in Transgender and Gender Diverse Adolescents: Clinical Insights From a Single Center Study (Lahaije et al., 2025). A new study from the Dutch Radboud University Medical Centre sex and gender clinic compares short-term effects of puberty blockade (PB) when administered in early puberty (defined by the study as Tanner stage 2–3) and late puberty (Tanner stage 4–5), with a focus on biometrics, biochemistry, and self-reported side effects of PB. The authors analyze retrospective data from 100 youths (67% female) treated with puberty blockers between 2020 and 2023. At baseline, 33% had psychiatric and/or neurodivergent comorbidities, and 36% were overweight or obese. The study reports that side-effects of PBs were common, did not improve over time, and were significantly more prevalent in those starting PB later in puberty (Tanner stage 4–5). The authors suggest that there may be an unfavorable risk-benefit profile of PB for youth in more advanced stages of puberty, particularly for females. The study has several limitations, most notably that by 12 months after initiation of PB, data were available for only about 50% of the patients, and there was a failure to report biometric and most biochemical parameters beyond the baseline measures. If missing data are non-random and due to premature discontinuation of PB as a monotherapy, this may mask an even higher rate of adverse PB effects than reported by the study.

 SEGM reviewFull text (external link)

4. Medical Gender Reassignment in Minors: Why are we Cautious in Finland? (Kaltiala, 2025). In 2020, Finland became the first European country to move its national approach to the treatment of minors with gender dysphoria away from the gender-affirming model to a more cautious approach that prioritizes psychosocial support and psychotherapy as first-line treatment. In a new paper, Kaltiala, head of one of the two child and adolescent psychiatric services in Finland, outlines the recent history of the Finnish approach to minors with GD and describes the current approach. She documents a shift in clinic demographics—especially more adolescent females with complex psychiatric needs—and reports that there is no evidence that medical transition reduces suicide mortality. Finland’s response, she explains, is a cautious pathway centered on psychotherapeutic care and management of comorbidities and stringent eligibility criteria for PB and CSH.

 SEGM reviewFull text (external link)

5. Cass Informed Psychotherapy for Gender Distressed Youth (Hutchinson, 2025). Many countries are now moving away from the gender-affirming treatment model for gender-distressed youth and instead prioritize supportive interventions without taking an “affirmative” stance of a declared identity. In this paper British clinical psychologist Anna Hutchinson, drawing on the evidence and recommendations in the 2024 Cass Review, outlines the key principles of a respectful, developmentally informed, and holistic psychotherapy model, grounded in standard transdiagnostic (underlying and connecting a group of mental disorders) psychotherapy principles, that can be used with children and adolescents reporting gender distress.

 SEGM reviewFull text (external link)

6. Review of Data, Statistics and Research on Sex and Gender: Report 2: Barriers to Research on Sex and Gender (Sullivan et al., 2025). A two-part U.K. review led by sociology professor Alice Sullivan has identified obstacles to accurate research and data collection on sex and gender. Part 1, released earlier this year, found that sex is being combined with or replaced by gender identity in research data across disciplines, both in research institutions and public bodies. Part 2, reviewed in this issue, focuses on the hostile behaviors that undermine academic research and offers guidance for removing these obstacles and promoting academic freedom.

 SEGM reviewFull text (external link)

7. Sex-Based Violence Against Women and Girls: New Frontiers and Emerging Issues (Alsalem, 2025). Reem Alsalem, the Special Rapporteur on violence against women and girls (including its causes and consequences) delivered a report to the Human Rights Council that highlights the risks associated with pediatric gender medicine and the erasure of sex-specific language, categories, and data. Alsalem writes that allowing children access to such procedures violates their rights to safety, security, and freedom from violence, disregards their human right to the highest attainable standard of health, and runs counter to their best interests.

 SEGM reviewFull text (external link)

1. “Providers Had no Idea What to do With me”: A Mixed-Methods Analysis of Detransition/Retransition Support, Care, and Information Needs Among Sexual and Gender Minority Individuals

  • Rackliff, K., Expósito-Campos, P., Gould, W. A., Kinitz, D. J., Rosen, M., Rudd, S., Lam, J. S. H., Pullen Sansfaçon, A., & MacKinnon, K. R. (2025). “Providers had no idea what to do with me”: A mixed-methods analysis of detransition/retransition support, care, and information needs among sexual and gender minority individuals. International Journal of Transgender Health, 1–18. https://doi.org/10.1080/26895269.2025.2538744.

This study reports the results of a cross-sectional U.S. and Canadian survey that evaluated the care experiences of individuals who underwent an initial gender transition but later detransitioned. "Detransition" was broadly defined as having ever stopped, shifted, paused, or reversed an initial gender transition, or having desired detransition but feeling unable to do so. The "initial gender transition" did not require medical interventions, and could be limited to social or legal transition only. Individuals who "retransitioned" (i.e., resumed gender transition) after a period of detransition were also eligible to participate.

This study is part of the broader DARE (Detransition Analysis, Representation, and Exploration) initiative described as led by LGBTQ+ researchers. The authors claim that the hallmark of the study is its recruitment strategy, which aimed to attract not only individuals who detransitioned due to an internal identity shift, but also those who felt forced to detransition, still identified as transgender, and/or resumed their transitions. The DARE sample was comprised of 957 participants age 16+, at least 75% of whom came from social media recruitment. The sample (as described in this paper and in MacKinnon et al. (2025)) had the following composition:

  • Age: The median age was 24. The single largest group was 18–24 years old (43%), followed by 25–29-year-olds (25%); fewer than 2% were age 50+.
  • Sex: 79% were female.
  • Detransition identification: 41% considered themselves as “detransitioned.” About the same number, 4 in 10 (40%) chose not to describe themselves as “detransitioned.” Approximately 2 in 10 (10-18%) were unsure. About 4 in 10 (42%) said they retransitioned following detransition.
  • Current gender identity: 20% identified as “cisgender”, 43% identified as transgender, and 33% as nonbinary.
  • Sexual orientation: More than half (57%) reported a sexual minority identity. Reported sexual orientations included bisexual (45%), queer (29%), lesbian/homosexual (27%), and gay/homosexual (10%). It is unclear whether participants reported their sexual orientation relative to sex or gender identity.
  • Sexual orientation/identity change: Specific to sexual orientation and gender identities, participants reported an average of 4.2 gender identities/expression labels across their lifespan.

The Rackliff et al. study is the second publication from the DARE project, reporting on the 957 participants' responses to a set of quantitative questions, and a subsample of 563 respondents' answers the the open ended question: "Were there any supports you wish you could have had during your detransition?" The key findings are presented below:

  • Social strain related to detransition: Loneliness, rejection, and isolation from previous "LGBTQ2S+" connections were “notable” among individuals who have experienced detransition. Some also reported losing family support after detransition. Of the 563 participants who answered the qualitative question, nearly 30% reported needs around more community support, and 22% reported more need for interpersonal support (see study Table 4).
  • Lack of technically competent healthcare: More than 4 in 10 participants (43%) reported that providers “never” appeared knowledgeable when discussing detransition (see study Table 3). A lack of medical information (11%), especially regarding protocols for discontinuing hormones, was mentioned as a key gap. There were also unmet needs related to detransition procedures (5.5%) including surgical reconstruction, and a lack of appropriate mental healthcare and support (16%) (see Table 4).
  • Lack of culturally competent healthcare: While some felt comfortable in "gender-affirming" settings, others described negative experiences, such as feeling judged, shamed, and pressured to retransition.
  • Care avoidance behaviors: During detransition, nearly 6 in 10 avoided healthcare providers when they needed care (13% “always” avoided and 45% "sometimes” avoided healthcare providers, see study Table 3).
  • Significance of involuntary detransition: More than 4 in 10 (42%) of DARE participants retransitioned following detransition. The authors report that “many” participants said they would not have detransitioned if affirming support had been present during their initial transition, and predict that the rate of involuntary detransitions will likely increase.

The study’s strengths include recency of sample recruitment, a rigorous strategy used to remove malicious responses, and a large sample size with diverse representation of detransition experiences. Paradoxically, a key limitation of this study arises from it’s effort to capture diverse detransition experiences. By combining two markedly different populations—primary/core detransitioners, whose detransition was motivated by an internal cessation in transgender identity, and individuals whose detransition was driven by external factors—the research might have obscured important distinctions between these groups. As a result, the reported needs and experiences might not accurately reflect either population. 

There are also a number of other limitations:

  • Question framing bias: The qualitative findings, which constitute the bulk of the paper, are based on responses to a negatively framed question: “Were there any supports you wish you could have had during your detransition?” In asking what forms of helpful support were missing, the study potentially failed to capture information about the helpful forms of support that were present, thereby limiting understanding of what type of support should be provided to detransitioners more generally.
  • Vague reporting of results: Key findings are reported with ambiguous descriptors such as “many,” “some,” and “only a few,” making it difficult to assess the magnitude of the effects and introducing considerable uncertainty into the paper’s conclusions. For example, the authors state that “many” say they would not have detransitioned if they had had proper support; at the same time, Table 4 lists the percentage of those who said that their detransition could have been prevented by better access to gender-affirming healthcare, financial, social, or mental health support, as ranging between 4%–9%. The authors do not provide an aggregate percentage of how many endorsed "any" of the above factors, but the statistics that are shared suggest a smaller effect than the adjective "many" implies.
  • One-sided commentary: There are several examples of unbalanced discussion. For example, the authors frame restrictions on pediatric transition as inherently problematic and leading to future forced detransitions, without discussing the alternative possibility that such restrictions may also decrease detransition rates by avoiding premature/misguided early transitions. There is also evidence of selective quoting of the literature, with the authors referencing Gelly et al. (2025) to support the narrative of the “weaponization” of detransition to impose legal restrictions on youth transitions, while failing to reference numerous documented counterexamples of detransitioners publicly advocating for such policy restrictions. 

SEGM comment: This publication represents an important contribution to the study of the complex topic of detransition, adding an explicitly "gender-affirming" dimension to the topic. At the same time, the study has significant limitations arising from potential biases in the sampling strategy and the survey design. Any discussion of detransition findings should be tempered by the reality that the field of detransition research is in its infancy, and—like the phenomenon of transition—detransition is also socially mediated. Societal views of sex and gender identity, and knowledge of the risks, benefits, and uncertainties of transition, are evolving quickly, alongside corresponding shifts in medical, educational, and legal policies. These moving targets introduce substantial complexities that limit interpretation and warrant caution in drawing firm conclusions.

2. Observations of the Effect of Gonadotropin-Releasing Hormone Analog Treatment on Psychosocial Well-Being in Transgender Youth and Their Caregivers: A Pilot Study

  • Gohil, A., Donahue, K., & Eugster, E. A. (2025). Observations of the effect of gonadotropin-releasing hormone analog treatment on psychosocial well-being in transgender youth and their caregivers: a pilot study. Journal of Pediatric Endocrinology and Metabolism, 38(9), 968–972. https://doi.org/10.1515/jpem-2025-0108

This study, from the departments of adolescent medicine and pediatric endocrinology at the Riley Hospital for Children in Indianapolis, examines indices of mental health in GD youth after initiation of PB, following them for 12 months. It also assesses mental health measures of the primary caregivers. Eligible youth had to have reached Tanner stage 2 of puberty, with no prior history of PB use, and no plan to initiate cross-sex hormones (CSH) within 12 months of starting PB. Of the 28 patients initially considered eligible, only 16 remained eligible at the 12-month mark, due to unexpected early progression to CSH or dropout. In the final sample (n=16), the youth and their caregivers were overwhelmingly female (75%) and the mean age to start PB was 12 years.

The young patients and their caregivers completed validated questionnaires from the Patient Reported Outcomes Measurement Information System and the National Institutes of Health Toolbox at baseline, 6 months, and 12 months. Patients completed self-report measures of anger, anxiety, depressive symptoms, psychological stress experiences, and life satisfaction. Caregivers completed proxy-report measures of their child’s anxiety, depressive symptoms, and life satisfaction, as well as self-report measures of their own anxiety, depression, and perceived stress.

In the study abstract, the conclusion states that youth with gender dysphoria "experience more challenges related to psychological well-being compared to the general population" but emphasizes that "psychological well-being remained stable throughout the study." We see several important aspects of the study that are not captured by these conclusions. We discuss them below:

  • Youth's self-reported mental health remained within average range throughout the study. The data indicate that most mean T-scores fell within the average/ ‘normal limits’ range for the general population according to patients’ self-reports.
  • Mental health did not improve. Based on self reports, gender-dysphoric youth began the study with slightly worse functioning on measures of psychological stress and life satisfaction compared to the general population. After 12 months on PB, these measures showed no improvement, and two additional indicators—anger and depression—worsened relative to the general population.
  • Parents rated the youths' mental health worse than the youth themselves. Almost all the parental assessments of children's anxiety, depression, and life satisfaction were considerably worse than the children's self-assessment. The parents in the study themselves had worse anxiety levels than the general population at all time points and higher levels of depression at baseline.
  • High rates of use of psychiatric medications in PB youth. At baseline, 44% of the final participant sample were prescribed psychiatric medications, most commonly SSRIs. This proportion is considerably higher than rates observed in the general population; the CDC reported that in 2019, only 10.9% of 12- to 17-year-olds had taken mental health medications within the previous 12 months.

The study of 16 cases is too small to draw any reliable conclusions and should not be over-interpreted. However, since it's described as a "pilot" study—which suggests that it may give rise to future studies—it's worth noting some key limitations at this stage, so they can be avoided in the future. They include:

  • Significant loss of study participants. Within 12 months, 43% (12/28) no longer met inclusion criteria—6 initiated cross-sex hormones and 5 were lost to follow-up—despite the researchers selecting participants expected to remain on PB without starting CSH. This substantial loss jeopardizes validity, as dropouts and early CSH initiators may differ psychologically from those who completed PB mono-therapy.
  • GD levels were not assessed. Despite the fact that a primary goal of gender-affirming interventions is the amelioration of GD, the study did not attempt to measure GD at any point. Body satisfaction was also not assessed.
  • Psychiatric medication use and psychotherapy represent an uncontrolled confounder. Despite the high rate of psychiatric medication use reported as baseline, the authors provide no data on psychiatric medication use at the 6- or 12-month follow-up assessments. They also omit details regarding psychotherapy use, making psychiatric medication and psychological treatment unmeasured confounders in this study.

SEGM comment: Gohil et al.’s framing of unchanged mental health as “no change,” and their selective citation of studies claiming benefits of PB (e.g., the flawed Kuper et al., 2020; and Tordoff et al., 2022) while omitting systematic reviews finding no credible benefits, mirrors the “spin” seen in other clinic-origin studies struggling to account for null results (e.g., Olson-Kennedy et al., 2025; and Carmichael et al., 2021). At the same time, there appears to be growing acknowledgment that PBs may not be a neutral intervention and that decreases in sex-steroid concentrations resulting from initiation of PB later in puberty may have negative effects. The study adds to the growing body of evidence that PB are not an effective mental health treatment for GD youth.

3. GnRH Analogues as a Monotherapy in Transgender and Gender Diverse Adolescents: Clinical Insights From a Single Center Study

  • Lahaije, F. A. H., van Setten, P. A., Levels, W., Becking-Malpasso, K., & Claahsen-van der Grinten, H. L. (2025). GnRH analogues as a monotherapy in transgender and gender diverse adolescents: Clinical insights from a single center study. Endocrine Connections. https://doi.org/10.1530/EC-25-0292.

This retrospective cohort study (n=100, 67 females, 33 males) explores the effects of puberty blockers in minors treated at the Radboudumc Expert Center for Sex and Gender in the Netherlands since the clinic's establishment in March 2020. The study includes all participants under 18 who had been prescribed puberty blockers and had at least 6 months of follow-up data. The average age of PB initiation was around 13 years (range: 10–18).

The study compared the biometric, biochemical, and self-reported side effects of puberty blockade in youth whose puberty was blocked in early puberty (defined by the authors as Tanner stages 2-3), to those whose puberty was advanced at the time of PB initiation (Tanner stages 4-5). Biometric assessments included weight, height, blood pressure, BMI, and Tanner stage and were assessed at baseline (T0) and every 3 months thereafter (T1–T4). Biochemical data included hormone levels, renal and liver function, blood cell counts, and indicators of bone health, with blood samples collected at 6 months and annually thereafter. Clinicians also asked about side effects at every visit, which the authors classified as "mild" if they did not pose a burden in daily life, and "severe" if they did. The authors reported the following results:

  • Skewed sex ratio toward females. Two-thirds (67%) of the adolescent were females, and the ratio was most skewed among older adolescents (76%). The authors posit several explanations for the predominance of females; none included the possibility of greater social influence. The authors acknowledge that "a definitive explanation for this phenomenon remains unclear."
  • High rate of psychological comorbidities. Compared to the general population, there was a high rate of psychiatric comorbidity (30% of females, 39% of males), with common neurodivergent conditions such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Use of psychiatric medications was frequent (27% of male adolescents and 13% of female adolescents) as compared to the general Dutch adolescent population (4%).
  • High rate of overweight and obesity. Over one third of all youth were overweight or obese at baseline.
  • High rate of side effects of PB. The most common side effects were flushing, fatigue, localized effects, abdominal effects, and emotional effects. Other side effects included concentration difficulties, hunger, hyperventilation, vertigo, stamina decrease, tantrums, sleeping difficulties, nose bleeds, palpitations, fainting, and pain in joints, scrotum, chest, and inguinal area.
  • More side effects when PB was initiated in advanced stages of puberty. Youth in Tanner stages 4 and 5 reported more frequent effects, including flushing (75%), emotional problems (approximately 43%), and abdominal pain (11%). The authors posit that this may be due to a sudden drop in sex hormone levels, leading to symptoms associated with a hypogonadal state.
  • No reduction in side effects over time and no regression in puberty. Contrary to expectations, there was no significant easing of side effects over time, nor did any signs of pubertal changes that had already occurred before PB initiation regress.

Interpreting these results, however, is severely limited by deficits in data collection and reporting.

  • Unexplained loss of participant's data. The study is a retrospective chart review of 100 youths (67 females, 33 males). However, key biochemical measures are missing for some participants starting at baseline, and by the end of 12 months data are reported for fewer than 50% of the participants. Side-effects are reported for fewer than 50% of the participants at 12 months. Further, despite treatment duration ranging from 6 to 24 months, no data for any parameter are presented beyond 12 months.
  • No key measures reported beyond the baseline. Most of the biochemical measures (presented in two supplementary tables) are reported only at baseline, with no follow-up results. The same is true for biometric measures of height, weight, BMI, and blood pressure in Table 1, which are also only reported at baseline.
  • Limited physical examinations beyond baseline. The authors state that physical examinations were mostly performed only at baseline, aiming “to minimize patient burden, as many find repeated physical examinations distressing.” Following treatment initiation, Tanner stage and physical side effects were self-reported, significantly reducing data reliability.
  • Conflating Tanner stages 2 and 3. While puberty is a continuum, youths in early Tanner stage 2 have much lower levels of sex steroids as compared to youth who are close to completing Tanner stage 3. Given the growing awareness that PB-induced cessation of sex steroids can lead to more physical and psychological side-effects, not separating Tanner stages 2 and 3 in this analysis is a significant limitation.

The authors conclude that patients should be advised of the limited evidence of benefit and a high rate of side effects of PBs when initiated in advanced stages of puberty (Tanner 4–5), and that such treatments should proceed with caution. They advise consideration of alternatives to PBs, such as menstrual suppression in females. They also note that alternatives to PB can have a more favorable profile with respect to fertility preservation.

SEGM comment: The high rate of side effects of PB in youth in more advanced puberty reported in this paper is a cause for concern. However, it is also concerning that more than 50% of respondents' outcomes are missing by 12 months, and key results are only reported at baseline. If the missing data are due to a significant proportion of the sample discontinuing PB treatment as a monotherapy, this may mask higher levels of treatment-associated problems than those already reported. Currently, the Dutch Health Council is conducting a review of treatment approaches to gender-dysphoric youth at the urging of the Dutch Parliament. The methodological limitations of this paper highlight the need for additional scrutiny of the Dutch protocol and its applications. 

4. Medical Gender Reassignment in Minors: Why are we Cautious in Finland?

In her paper, Riittakerttu Kaltiala, head of Finland’s Child and Adolescent Psychiatric Services, outlines the Finnish approach to gender dysphoria (GD) in minors. Kaltiala provides an overview of the development of youth gender services in Finland, which initially aligned with the gender-affirming approach as set out in international guidelines. 

However, Finnish clinicians quickly identified notable discrepancies between the demographic and clinical characteristics of minors presenting to their gender clinics and those documented in the existing literature. Specifically, they noted a higher number of adolescent female referrals, many of whom lacked a clear history of childhood-onset gender dysphoria and exhibited significant psychiatric comorbidities. Moreover, they found that, for a substantial number of minors, the anticipated benefits of medical gender reassignment (MGR) failed to materialize: hormonal gender reassignment did not resolve the existing psychiatric treatment needs or result in enhanced functional outcomes.

COHERE Finland is responsible for Finnish public health services. In the process of developing guidelines, COHERE commissioned systematic evidence reviews, conducted ethical assessments, and consulted various stakeholders. A 2019 systematic review commissioned by COHERE found that the evidence supporting medical interventions in minors with sex discordant gender experience and related distress was very weak. Kaltiala writes that the evidence base for MGR in minors—both the originally intended target group (as outlined in the Dutch protocol) and newly emerging patient populations—is insufficient, and the intervention should be considered experimental.

Kaltiala details some of the research that she and her colleagues have undertaken and published over the last decade. Importantly, their recent research found that suicide mortality among adolescents with GD, although elevated compared with general population statistics, is rare and is associated with severe psychiatric morbidity rather than GD itself. They also found no evidence that suicide mortality differed between GD patients who underwent MGR and those who did not.

Importantly, Kaltiala highlights that “promoting medical GR by arguing that adolescents with GD face a high suicide risk without treatment—and that GR would alleviate this risk—is ethically problematic. Such messaging may pressure parents into pursuing medical GR prematurely, even if they have concerns about the stability of their child’s gender identity or the safety of medical intervention.”

In Finland, the current clinical approach to minors with GD follows standard child and adolescent psychiatric procedures, with local services conducting a comprehensive assessment. For adolescents, the first-line treatment for GD is exploratory psychotherapeutic intervention within local services, appropriate treatment of any psychiatric comorbidities, and management of child welfare needs. Subsequently, a referral to the centralized gender identity service (GIS) may be made. If strict criteria are met, then medical intervention may be initiated. Kaltiala notes that, since 2021, the number of referrals to GIS has plateaued, but most referrals are still adolescents with severe psychiatric comorbidities and significantly impaired functioning. Thus, the approach to medical gender reassignment during the developmental years has become more cautious.

SEGM comment: In response to Finnish clinicians recognizing deficiencies in the evidence base, changes in demographics, and clinical features of minors referred to the GIS, and their own research demonstrating a lack of benefit from medical transition, Finland became the first European country to move its national treatment model for minors with GD away from the gender-affirming approach as outlined in the Dutch Protocol and WPATH guidelines and toward an evidence-based treatment pathway that prioritized psychosocial support and psychotherapy. For the same reasons, many other countries are now following suit. Thus, this paper provides a helpful guide for other countries’ health services as they grapple with developing new treatment models.

5. Cass Informed Psychotherapy for Gender Distressed Youth

In her paper, British clinical psychologist Anna Hutchinson, drawing on the Cass Review’s recommendations, describes a respectful, developmentally informed, and holistic psychotherapy model, grounded in transdiagnostic psychotherapy principles, that can be used for gender-distressed youth.

Hutchinson emphasizes that children and adolescents presenting with gender distress or with a transgender identification are heterogeneous. However, the gender-distressed child or adolescent does not differ from any other child or adolescent in their broad developmental, emotional, or cognitive capacities, hopes, and needs, and the therapist should approach the child with this in mind.

Hutchinson highlights that social and clinical narratives shape young people’s understanding of their identity, as well as what might best help them. She notes that although we may have inborn predispositions, it is impossible to be born with a complex social identity. Rather, our sense of self—our complex identity—develops over time and is responsive to biological, psychological, and social factors. Importantly, adolescence and childhood are times when identity is uncertain and fluid, and identity exploration is normal. Although some aspects of identity may endure into adulthood, no one (neither child, parent, nor therapist) can predict with certainty which aspects might do so, and all must sit with the uncertainty rather than rush prematurely to claim knowledge of the long-term trajectory. This understanding of identity development is core to all therapeutic approaches when working with children and adolescents.

The Cass Review emphasized that psychotherapists need to approach gender-distressed children and adolescents in the same way as they would any other distressed minor—the gender-distressed child/adolescent should not be exceptionalized. Hutchinson reminds therapists that they already have the general training and expertise to guide their clinical practice. However, knowledge specific to gender related distress is also required—the therapist needs to understand the debates in this field, how the NHS came to routinely provide medical transition to children and adolescents in the past, and why the Cass Review could not recommend its continuation. 

As per standard practice therapists should undertake a comprehensive biopsychosocial assessment. Hutchinson highlights that the Cass Review recommends both diagnosis and individualized formulation when working with gender-distressed children and adolescents. However, a diagnosis alone of gender incongruence or gender dysphoria is of limited clinical utility because it has no explanatory power or predictive validity. 

Thus, the individualized clinical formulation is of paramount importance; it synthesizes all available information, including the diagnosis and the hypotheses about the reasons for the person’s reported distress. Ideally, it is developed by the clinician in concert with the child and parent and it guides the individualized clinical approach. Hutchinson writes that psychotherapists need to respect individual identities, but also acknowledge the inherent uncertainty of identity development. Thus, it is important that they create an environment that sits with this uncertainty and allows for a diverse range of outcomes. It is also critical that psychotherapists be honest and engage openly with children and adolescents, and their parents, about the knowledge gaps and differing perspectives on gender distress and the optimal management approach. 

SEGM comment: Due to the lack of evidence of benefits and increasing evidence of harms, many international jurisdictions now recommend psychotherapy and other psychosocial supports as first-line (or the only) interventions for young people. However, more information is required about these approaches. Anna Hutchinson is a therapist with extensive experience working with gender-distressed children and adolescents and previously worked for many years at England’s GIDS. Her paper outlines a thoughtful and respectful psychotherapeutic approach grounded in the basic principles of psychotherapy that can be applied transdiagnostically. Hutchinson helpfully highlights the vital role of clinical formulation. She also explains that ethical psychotherapy is not conversion therapy: it does not aim to change a person’s identity and, at all times, respects the developmental process and the uncertainty inherent in identity during childhood and adolescence. 

As Cass has noted, there is a lack of evidence for psychotherapy as a treatment modality for gender-distressed children and adolescents, but there is strong evidence supporting psychotherapy as a treatment for various mental health conditions that frequently co-occur with gender-related distress. Cass has called for more research into psychosocial approaches for children and adolescents with gender distress.

Hutchinson’s paper is timely in the U.K., where services are transitioning away from specialized services that offered gender-affirmative treatment toward models that prioritize psychosocial interventions delivered by local services. It should also be useful for other jurisdictions that are replacing models that prioritized pediatric medical transition with those that focus on psychosocial interventions. 

6. Review of Data, Statistics and Research on Sex and Gender: Report 2: Barriers to Research on Sex and Gender

  • Sullivan, A., et al. (2025). Review of data, statistics and research on sex and gender: Report 2: Barriers to research on sex and gender. UK Government Department for Science, Innovation, and Technology.https://sullivanreview.uk/barriers.pdf.

The Sullivan Review was commissioned by the U.K. Government (via the Department for Science, Innovation and Technology) in October 2023. The Review was led by Professor Alice Sullivan, a sociologist at University College London. Part 1 of the Review (published in March 2025) explored the quality and nature of the data being collected for official U.K. datasets over time, finding that sex-based data is increasingly being erased or made unreliable by being combined or replaced with gender identity data. It highlighted serious implications for U.K. society and governance. Part 2 of the Review was published in July 2025. It explores the challenges faced by those researching sex and gender within U.K. institutions, which affect our ability to collect data and improve understanding within the field. 

To meet its aims, Part 2 of the Review examines a range of existing public evidence such as governmental legislation and institutional policies, and conducted a public call for evidence from members of the academic community. For this evidence, it welcomed submissions from students, academics, and other staff, representing a range of experiences and views. It also included in-depth case studies of recent high-profile cases, such as Kathleen Stock.

A wide range of barriers was found to be impeding rigorous scholarship within the field. Although the report found the environment to be unpleasant for many researchers across the ideological spectrum, it identified an imbalance in the level and nature of barriers faced by researchers based on their personal beliefs. It found that gender-critical researchers faced barriers that were significantly higher in frequency and seriousness than other individuals.

Overall, the barriers explored within the report were categorized as:

  • Self-censorship
  • Bullying, harassment, and ostracism
  • Barriers to publication
  • Barriers to data collection
  • Barriers to holding events
  • Institutional policies and training
  • Complaints, including coordinated complaints
  • Management behavior
  • Barriers to career progression
  • Research ethics processes
  • Compelled speech
  • No-platforming and discrimination against speakers
  • Student experiences
  • Barriers to research funding
  • Discrimination by administration or services
  • Disinvitations from projects or collaborations

Sullivan emphasized that the core problem is not disagreement itself but hostile behavior that undermines the norms of scholarly exchange. While often carried out by a vocal minority, the impacts are far-reaching, silencing inquiry and narrowing the scope of permissible debate. It also highlighted the role that institutional policies and processes can play in perpetuating harassment and discrimination.

Ironically, the Review itself also faced attacks, with a section of the report detailing coordinated efforts to undermine the project.

The report provided 20 recommendations for future directions to improve academic freedom protections, highlighting the role of individuals, institutions, and national legislation. The recommendations focus on the government and universities, but the authors clarify that they are “also relevant for organizations outside higher education that are involved in research, in particular the NHS.”

One of the examples presented in the review is a “call to action” directed at the Royal College of Psychiatrists. The activists identified speakers that, among other things, had collaborated with SEGM or participated in our conferences. They also urged Hilary Cass and other keynote speakers “to consider whether they wish to be associated with the dangerous ideologies and practices of groups such as SEGM and CAN-SG.”

SEGM comment: Part 2 of the Sullivan Review shines a light on dynamics many clinicians and researchers in the field of sex and gender medicine will recognize. The chilling effect described here mirrors the challenges faced by many when conducting and publishing evidence-based work, particularly for those who are perceived to hold or express gender-critical views. It also highlights the concerning and inappropriate power that activism currently wields within many academic and publishing institutions, affecting their policies and papers and thereby influencing the scope and availability of much needed research. Sullivan’s report underscores a crucial truth: rigorous science depends on open debate and the freedom to pursue questions wherever the evidence leads. Policymakers, funders, and academic institutions should take note—removing barriers to research is an academic and public health necessity.

7. Sex-Based Violence Against Women and Girls: New Frontiers and Emerging Issues

Last May, the United Nations published the report “A/HRC/59/47: Sex-based violence against women and girls: new frontiers and emerging issues”, authored by Reem Alsalem, Special Rapporteur on violence against women and girls, to be delivered at the 59th session of the Human Rights Council.

The report analyzes new and evolving forms of violence against women and girls and proposes recommendations to address them. Like Sullivan and her team, Alsalem warns that some countries and institutions have replaced or conflated “sex” with “gender identity”, and highlights that collecting accurate sex-based data is “essential to evidence-based policymaking across sectors, from healthcare to criminal justice.” Moreover, the Special Rapporteur notes the emerging tension between the obligation of States to foster equality and the evolving concept of gender identity. According to the report, sexist stereotypes are directly related to different forms of violence against women and girls. These stereotypes, however, are sometimes framed as "true manifestations of gender identity."

Notably, the report expresses concerns about gender dysphoria and medical transition for minors, stating that emerging evidence of long-term harms “has rightly led several countries, such as Brazil, the Kingdom of the Netherlands and the United Kingdom to change course and restrict children’s access to puberty blockers, cross-sex hormones and surgery on sexual and reproductive organs.” The author also argues that children are “not able to provide informed consent for such procedures.”

Alsalem makes the following recommendations regarding medical transition for minors:

  • Prohibition of social, legal, and medical transition in minors
  • Creation of laws and policy that provide remedy, accountability and support for those affected, including detransitioners.
  • Funding of special support services for vulnerable girls to address “heightened risk of bodily dysphoria and bodily dissociation.”

SEGM comment: Alsalem links medical transition for minors to violence by arguing that these procedures violate children's rights to "safety, security and freedom from violence," as well as their right to the highest attainable standard of health. This framing positions medical transition of minors as a human rights issue related to protecting children from harm, which explains its inclusion in a report specifically focused on violence against women and girls.

We welcome the interest of a Special Rapporteur of the United Nations in the field of pediatric gender medicine. Alsalem echoes the concerns expressed by many clinicians and researchers about the long-term effects of medical transition, the prevalence of mental health comorbidities and the challenges of obtaining informed consent from minors. The report further highlights the substitution of “sex” with “gender identity” as an obstacle for the collection of accurate research data, an issue also recognized in the Sullivan Review. This report illustrates the broad implications of pediatric gender medicine and the importance of reliable evidence for medical policy.