Mastectomy for Minors: SEGM Challenges WPATH's Position of "Proven" Safety, Efficacy, and Medical Necessity

SEGM files an Amicus Brief with the US 9th Circuit Court of Appeals

The Society for Evidence-Based Gender Medicine (SEGM) has filed an Amicus Brief with the 9th Circuit Court of Appeals, challenging the position held by WPATH and set forth in WPATH’s and the Pediatric Endocrine Society’s Amicus Brief that mastectomies for gender-dysphoric adolescents are evidence-based. 

SEGM recognizes the right of mature adults to undergo "gender-affirming" interventions despite the low quality of evidence (i.e., small study samples, weak study designs, very limited long term follow-up, etc.) on which these interventions are based. However, we are very concerned about applying what are experimental procedures to vulnerable youth, whose gender identity is still developing and whose ability to meaningfully consent to interventions with unknown long-term outcomes is highly uncertain. SEGM formed this conclusion after thorough evaluation of the evidence, further informed by direct experience working with this population.

The attached Amicus Brief highlights the evidence that supports our position, including:

  • the rapid rise in numbers of gender dysphoric adolescent females with co-occurring mental health problems
  • the brief history of pediatric medical transition, its questionable outcomes, and its lack of applicability to the currently presenting cases
  • the low quality evidence underpinning the practice of providing mastectomies to gender-dysphoric minors
  • the lack of an established standard of care, the poor quality of WPATH "Standards of Care," and growing dissent from WPATH's recommendations by leading gender clinics worldwide
  • the emerging direction coming from pioneers in medical transition of minors that psychotherapy, rather than hormones and surgery, must be the first-line treatment for all gender-dysphoric youth.

The current state of scientific knowledge does not support the assertion that "gender-affirming" surgical interventions for minors are safe, effective, and medically necessary. SEGM’s concern is reinforced by a recent surge of minors with post-pubertal emergence of transgender identity, complicated by multiple mental health issues. This further amplifies the risks of applying irreversible interventions not based on quality, reliable scientific evidence.