New Systematic Reviews of Puberty Blockers and Cross-Sex Hormones Published by NICE

Weighing potential benefits against profound long-term uncertainties

In 2020, the UK National Institute for Health and Care Excellence (NICE) undertook two systematic evidence reviews of the use of GnRH agonists (also known as "puberty blockers") and cross-sex hormones as treatments for gender dysphoric patients <18 years old. These reviews were commissioned by NHS England, as part of a review of gender dysphoria healthcare led by Dr Hilary Cass OBE. These reviews, which were published earlier this week, make for sober reading. The reviews' major finding is that GnRH agonists lead to little or no change in gender dysphoria, mental health, body image and psychosocial functioning. All the studies evaluated had results of “very low” certainty, and were subject to bias and confounding.

New Study Raises Questions About the Gender Minority Stress Model

Gender dysphoria emerges in youth who have problematic developmental histories

It is a well-established observation that individuals suffering from gender dysphoria (GD) demonstrate an increased prevalence of mental health issues when compared to the general population. One theory that explains the link between GD and mental illness is the minority stress model. Gender-non-conforming and GD youth experience elevated rates of victimization, discrimination, and prejudice. According to the minority stress theory, these adverse experiences are the primary cause of the poorer mental health status of GD individuals. There are two issues which contradict the minority stress theory. First, evidence shows that mental health issues often precede the onset of gender identity concerns. Second, long-term studies have not been able to demonstrate lasting mental health benefits of “gender-affirmative” (hormonal and surgical) interventions. These findings do not support the argument that minority stress is the primary reason for the high co-occurrence of GD and other psychiatric disorders. An alternative explanatory model for the co-occurrence of GD and other forms of distress and mental illness is that both arise as a result of a complex interplay of biological, relational, and cultural factors.

A Typology of Gender Detransition and Its Implications for Healthcare Providers

Gender detransition, broadly defined as the interruption or reversal of a gender transition process, has acquired noticeable visibility in recent years. Those who detransition, commonly referred to as "detransitioners," have started to share their experiences on social media and other online platforms, raising substantial questions for clinicians working in the field of gender dysphoria.

2020 Gender Medicine Highlights

SEGM end-of-year review

The year 2020 has been pivotal in the field of gender medicine. Earlier this month, in a landmark decision, the UK High Court ruled that children under 16 are unlikely to be able to consent to the use of puberty blockers, which the Court deemed to be an experimental treatment. Rather than a “pause button,” the court recognized puberty blockers as the first step in a largely irreversible pathway of medical transition.

An English Ruling on Transgender Teens Could Have Global Repercussions

The following Economist article has been reproduced fully, with permission.

In 2018 Andrea Davidson’s 12-year-old daughter, Meghan, announced she was “definitely a boy”. Ms Davidson says her child was never a tomboy but the family doctor congratulated her and asked what pronouns she had chosen, before writing a referral to the British Columbia Children’s Hospital (BCCH). “We thought we were going to see a psychologist, but it was a nurse and a social worker,” says Ms Davidson (both her and her daughter’s names have been changed).

UK High Court Ruling on the Use of Puberty Blockers in Gender Dysphoric Minors (Bell v. Tavistock)

SEGM position statement

The Society for Evidence-Based Gender Medicine (SEGM) maintains that treatments for gender-dysphoric people should be supported by high quality evidence. We commend the thorough process undertaken by the UK High Court to assess the ability of young people to consent to treatment that has serious side effects and lacks adequate supporting evidence.

The Danger of Conflating Ethical Psychotherapy with Conversion Therapy

SEGM clinicians examine a study purporting harms of psychotherapy

In September 2019, JAMA Psychiatry published an article, Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. The article concluded that therapies that did not "affirm" an individual's transgender identity (which the article refers to as "gender-identity conversion efforts / "GICE") lead to severe distress and even suicide attempts. These findings have been used to promote legislative bans on non-affirmative therapies worldwide.

Correction of a Key Study: No Evidence of “Gender-Affirming” Surgeries Improving Mental Health

Allowing scientific debate in transgender medicine improves evidence basis

In October 2019, the American Journal of Psychiatry (AJP) published a study from the Karolinska Institute in Sweden, and the Yale School of Public Health which reported that “gender-affirming" surgeries for gender dysphoric patients are associated with improved mental health outcomes (1). Looking at mental health utilization in the year 2015, a retrospective analysis showed that the more time passed since surgery, the fewer mental services were utilized by patients, with an average 8% reduction in mental health utilization for each year following surgery. From this, the study concluded that surgery has a beneficial effect on mental health, and that benefits continue to accrue over time. However, following a reanalysis of the data, this conclusion has now been officially corrected to indicate that there is “no advantage of surgery.”