2022 has been nothing short of remarkable for the field of youth gender medicine. Two leading countries in pediatric gender transition, England and Sweden, stopped or announced the intention to stop transitioning youth as routine medical practice. This change in treatment approach came about following each country’s own independent systematic reviews of evidence. These two European countries followed Finland, the first Western country to have conducted a systematic review of the evidence for youth gender transition. The troubling findings of that evidence review, coupled with the Finnish gender clinic’s own experience and finding that the functioning of gender-dysphoric youth treated with hormones does not improve and in fact, often worsens, led Finland to update its guidelines in 2020, sharply curbing provision of such treatment to youth and limiting it to exceptional cases. And just as the year was drawing to a close, on December 30, 2022 a leading Dutch newspaper published the first-ever critical commentary focused on the Dutch youth gender clinic itself, questioning its continued support of radical medical interventions for the rapidly growing numbers of youths seeking gender transition (see the unofficial English translation here). The Dutch originated the practice of gender-transitioning minors, and their research and publications launched this practice worldwide.
The Society for Evidence-Based Gender Medicine (SEGM) has catalyzed positive developments in the field of youth gender medicine worldwide. As the first non-politically and non-religiously-affiliated professional organization of clinicians and researchers fighting to restore the “first do no harm” approach to managing youth with gender dysphoria, we have been calling on the gender medicine establishment to adhere to the fundamental principles of evidence-based medicine. The first, fundamental principle of evidence-based medicine is a requirement to base treatment decisions on “the best available evidence, which ideally will come from systematic summaries of that evidence.” Finland, England, and Sweden have followed this key principle of evidence-based medicine.
Every year, clinicians and researchers contact SEGM with requests to collaborate with us in upcoming research publications or initiatives within their respective professional societies. We accept this responsibility and see our role as supporting all professionals seeking evidence-based medicine to guide practice and policy. In 2023, SEGM will continue to pursue our core mission: to raise the bar on the quality of evidence for the treatment of gender dysphoria. We care about gender-dysphoric youth and believe they deserve high-quality evidence-based care that prioritizes long-term outcomes.
Brief Overview of 2022 International Developments
The growing global interconnectedness ensures that positive changes in treating gender-dysphoric youth in countries known for their progressive and pioneering approaches to gender nonconformity will soon take root in other countries as well. As such, the importance of the dramatic changes in policy and practice in Sweden and England cannot be overstated.
England has been home to the world’s largest pediatric gender clinic—this clinic is now set to close in 2023. NHS England stated that going forward, most English gender-dysphoric youth under age 18 will be treated in regular children’s hospitals by staff who take a whole-person, developmental approach to gender dysphoria, rather than treating it with invasive, risky, and often irreversible “gender-affirming” hormones and surgery. This change came about following UK's systematic reviews of evidence that found that puberty blocking medications do not improve mental health of youth, while the mental health benefits of cross-sex hormones are highly uncertain and come with significant risks.
Sweden, a trailblazer in legal recognition of trans individuals (and the home of the Nobel prize in Medicine) conducted its own systematic review and explicitly stated that the risk-benefit ratio of "gender-affirming" medical interventions in youth is unfavorable: "the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases." Going forward, psychological interventions will be the first line of treatment, while medical “gender transition” should take place exclusively in clinical research settings. Sweden is reducing its number of pediatric gender clinics by half—from 6 to 3.
Other countries, including France, Australia, and New Zealand, have also made changes aimed at safeguarding youth. The National Academy of Medicine in France issued a statement cautioning its medical community about the sharp rise in trans identification in vulnerable youth and prioritizing noninvasive treatment. In Australia and New Zealand, the Royal College of Psychiatrists issued a nuanced statement acknowledging that gender dysphoria in youth arises from many different causes and may be resolved with noninvasive approaches.
In North America, the progress has been less apparent, but it is certainly underway. Florida became the first state to limit the wide-spread use of hormonal and surgical interventions administered to the rapidly growing numbers of gender-dysphoric youth. In early 2022, Florida’s public health authority commissioned an overview of existing English-language systematic reviews of evidence. Following the results of this evidence review, the Florida Boards of Medicine voted to stop gender-transition services to minors outside of research settings in the state.
The American Academy of Pediatrics is also starting to acknowledge the problems. In late 2022, the AAP President stated that only a minority of gender-dysphoric youth should be treated with hormones and surgery. The controversies in “gender-affirmative care” of minors are increasingly platformed by the major U.S. media outlets who, until recently, largely shunned or downplayed any nuanced discussion.
At the same time, the politicization of transgender rights issues also polarized the medical community. Even when gender clinicians recognize the risks of the medical “affirming” interventions, many are “digging in” because they feel that any admission of problems—or even questioning—will be “used” by the critics. When segments of the medical community mix politics with healthcare and suppress known issues and risks in order to score a “win” for their “side,” vulnerable young patients will be harmed. It is in this spirit that we remind our colleagues, friends, supporters, and detractors, that it is our collective responsibility to uphold the solemn oath to “first, do no harm.”
In this same spirit, SEGM emphatically and unequivocally denounces threats of violence against clinicians. This applies to both clinicians delivering “gender-affirming” interventions to youth, as well as those working to curb the provision of these risky and unproven medical interventions.
It’s been a very productive year for SEGM. Our key accomplishments this year include:
- SEGM-affiliated clinicians authored 15 key scientific publications identifying flaws in research describing “gender-affirming” care and its purported benefit—for a total of nearly 60 publications since our inception in 2019
- We funded open access fees to promote dissemination of key publications by SEGM and non-SEGM-affiliated researchers. Collectively, these publications as well the information disseminated on the SEGM website have been accessed more than half a million times in 2022
- We provided detailed feedback to treatment and policy guidelines regarding gender dysphoria treatments in the US and internationally including the US, Canada, Australia, Sweden, Norway, and Iceland
- We continued to serve as the most trusted source of information on international changes in treatment approaches for youth gender dysphoria, providing translations and key summaries
- We became a trusted source for a growing number of mainstream media organizations that now routinely contact SEGM for comment
- We fact-checked key publications, including publications uncritically promoting “affirmation” and problematic government-endorsed documents
- SEGM continued to challenge professional medical societies to take an evidence-based approach to treating gender-dysphoric youth
While 2022 has been very successful, we have even more ambitious plans for 2023. We can’t wait to share the results of our upcoming work! We are deeply grateful for the support we have received from the community. If you’d like to support our work in 2023, please donate using this link (or contact us for alternative donation options). SEGM is a U.S. registered 501(c)(3) nonprofit, and the contributions are tax-deductible as permissible by law.
* This Spotlight has undergone minor edits on Jan 2, 2023 to provide additional clarification and links.