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description= SEGM promotes safe, compassionate, ethical and evidence-informed healthcare for children and young adults with gender dysphoria.;
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23 segm held its first official conference in new york which brought together an array of high profile speakers such as mikael landén a psychiatrist and researcher at sweden s karolinska institute and sallie baxendale a professor of clinical neuropsychology at university college london journalists from canadian public radio attended along with then bbc newsnight reporter hannah barnes whose bestselling book time to think chronicled the rise 2024 05 20 the courage to admit you don t know it is especially hard for kids who are making decisions about their identities when those identities are still evolving many construct their lives around this new identity to admit they have changed their minds especially during the excruciatingly self conscious period of adolescence when they are deeply susceptible to peer judgment is that much harder the effects of medical transition 2024 02 05 beleaguered world health organization wades into transgender debate and is met with uproar over plans to develop guidelines on trans healthcare on thursday the society for evidence based gender medicine or segm issued its second letter criticizing the who s effort critiquing the guidelines development process as apparently flawed from the time of its quiet inception two to three years ago segm in its new letter asserted that those original two who guidelines made claims specifically that cross sex 2024 02 01 i spent years investigating the tavistock clinic i have serious concerns about its replacement recently i attended a conference in new york hosted by society for evidence based gender medicine segm a us based non profit where i was asked to give a presentation on lessons from the largest youth gender clinic in the world for that s what gids was the conference was attended by professionals from other youth gender clinics around the western world which like gids have also received a rapid increase in referrals and 2023 11 13 us paediatric leaders back gender affirming approach while also ordering evidence review for two years in a row aap members submitted formal resolutions to the executive board asking that the academy commit to the principles of evidence based medicine by eschewing narrative and other types of non systematic reviews as the basis for its recommendations and either use existing systematic reviews or commission its own a resolution submitted in april with two dozen signatories also asked that an urgent 2023 08 14 medical group backs youth gender treatments but calls for research review in june england s national health service announced that it would restrict the use of puberty blockers to clinical trials because there is not enough evidence to support their safety or clinical effectiveness as a routinely 2023 08 04 sharp increase in incidence of gender dysphoria in children and young people historically the small numbers of children presenting with gender dysphoria were primarily prepubescent males in recent years there has been a sharp increase in referrals of adolescents and particularly adolescent females to gender clinics many do not have a significant history of childhood gender dysphoria and a number suffer from comorbid mental health issues and neurodevelopmental conditions such as autism asd and attention deficit hyperactivity disorder adhd the reasons for these changes are understudied and remain poorly understood childhood onset gender dysphoria has been shown to have a high rate of natural resolution with 61 98 of children reidentifying with their biological sex during puberty the research into the course of gender dysphoria desistance among the cohort presenting with adolescent onset gender dysphoria is still in its infancy due to the novelty of this presentation however recent research from the uk clinic population suggests that 10 12 of youth may be detransitioning within 16 months to 5 years of initiating medical interventions with an additional 20 22 discontinuing treatments for a range of reasons the researchers noted that the detransition rate found in the recently presenting population raises critical questions about the phenomenon of overdiagnosis overtreatment or iatrogenic harm as found in other medical fields u s data suggest that the rate of medical detransition has reached 30 segm on twitter segm in twitter segm segm_ebm __ segm in twitter segm segm_ebm __ segm in twitter segm segm_ebm __ segm in twitter segm segm_ebm __ segm in twitter segm segm_ebm __ segm in twitter segm segm_ebm __ segm in twitter segm segm_ebm __ treatment of gender diverse youth countries across the globe rethink pediatric gender transition historically medical interventions to achieve the appearance of the desired sex were reserved primarily for adults with long histories of dysphoria such interventions were preceded by a prolonged engagement with the patient including thorough psychological assessments while objective population level data of adult gender transitioners show persistent mental health struggles and sharply elevated mortality and morbidity subjective patient reported outcomes suggest low regret rates unfortunately regret studies routinely fail to get in touch with 20 60 of the transitioned patients leaving unanswered questions about the substantial number lost to follow up regret studies also suffer from other significant limitations however there is little reason to doubt that a number of adult transitioners having made an informed decision regarding the balance of benefits harms and uncertainties live rewarding lives however around 2010 s there was a marked change in the approach to the management of gender dysphoria particularly for gender dysphoric youth a number of countries in western europe north america and australia began to promote the gender affirmative model of care for youth under this model of care young people presenting with gender dysphoria or asserting a transgender identity are affirmed in their desire to undergo gender transition and are provided with barrier free hormonal and surgical interventions while mental health professionals are often involved their role is typically limited to preparing the young person for gender transition regardless of any co occurring mental health challenges or whether there was a relatively recent history of transgender identification as such the provision of medical intervention now happens with a much reduced psychological assessment in the last 36 months a growing number of western countries have recognized the significant concerns with the gender affirmative model of care which became visible in part due to the growing voices of detransitioners and regretters coming from the novel population of gender dysphoric youth after completing systematic reviews of evidence which showed that the risk benefit ratio of youth transitions ranges from uncertain to unfavorable these countries have begun to sunset the gender affirmation practice in favor of an approach that favors psychosocial interventions as the first and usually the only line of treatment available to most minors as of the current writing the following countries have made sharp reversals of their previous gender affirmation practices or have signaled an intention to do so in the near future sweden has made the decision to no longer offer gender transition to minors outside of research settings and restricted eligibility to the classic early childhood onset of gender dysphoria all others are to be treated with psychosocial support and psychotherapy with a focus on accepting and thriving in natal puberty finland has sharply restricted eligibility for gender transition to minors with a classic early childhood onset of gender dysphoria and no mental health comorbidities and stated that psychotherapy should be the first line of treatment england banned the use of puberty blockers for gender dysphoria outside of research trials nhs england s interim clinical policy states that the primary intervention for children and young people who are assessed as suitable for the service is psychosocial including and psychological support and intervention the psychoeducation main objective is to alleviate distress associated with gender incongruence and promote the individual s global functioning and wellbeing on march 21 2024 the nhs also updated its policy on cross sex hormones for youth removing the requirement of puberty blockers as a prerequisite step for cross sex hormone treatment presumably to make two policies better aligned since puberty blockers will no longer be available the final cass report was published in april 2024 segm s analysis concluded that the report signaled the end of the era of gender affirmative gender clinic led model of care in england with significant worldwide implications no new prescriptions of cross sex hormones for minors have been issued since the publication of the final cass report and the use of puberty blockers are only be allowed as part of the pathways clinical trial which is set to start recruitment during 2026 following the cass report wales and scotland joined england in stopping new prescriptions of puberty blockers as a treatment for gender dysphoria in youth 18 scotland s policy goes even further than england s while in england cross sex hormones can still be prescribed around the patient s 16th birthday they cannot cannot be accessed in scotland until a patient is 18 denmark has restricted eligibility for puberty blockers and cross sex hormones currently transitioning only 6 of youth referrals whose gender dysphoria is most consistent with the classic dutch presentation early childhood onset that intensified in adolescence but otherwise uncomplicated by mental illness this change in practice predated a change to treatment guidelines which will be updated later this year norway s healthcare investigation board nhib ukom has deemed puberty blockers cross sex hormones surgery for children young people experimental determining that the current gender affirmative guidelines are not evidence based and must be revised norway s public health authority has signaled an intention to respond to ukom s concerns with an adjustment to the current treatment guidelines other countries are seeing growing debate in australia the health minister mark butler announced a national review of care and treatment guidelines for children and young people who identify as transgender this announcement followed the decision by queensland s health minister to initiate an independent review of prescribing puberty blockers and cross sex hormones to gender dysphoric youth citing regulatory tightening in finland norway denmark sweden and the uk the queensland review was published in december 2025 the same day the government of queensland announced a pause in prescriptions of puberty blockers and cross sex hormones for minors pending the publication of the results from the uk s pathways study shortly after the government of the norther territory announced restrictions for the prescription of puberty blockers the royal australian and new zealand college of psychiatrists ranzcp acknowledged that evidence and professional opinion is divided as to whether an affirmative approach should be taken in relation to treatment of transgender children or whether other approaches are more appropriate new zealand delayed its release of evidence review and recommendations for the use of puberty blockers citing in part the cass report and the need to consider its findings and recommendations on november 2025 the health ministry announced new regulation halting prescriptions of puberty blockers italy s national bioethics committee cnb just updated its stance on puberty blockers pb for gender dysphoria the november 2024 guidance states that pbs should only be provided after mental health internvetions failed and only in the context of proper research trials the official journal of the german medical association published an article on the controversies in youth gender transition stating that the scientific evidence that these therapies are more beneficial than harmful is not as robust as has long been proclaimed the article discussed the deficiencies in the evidence noted that countries that were among the first to implement the practice of youth gender transition are rowing back and raised questions about implications for germany s policy a key german language systematic review with an english translated appendix updated the nice systematic reviews and concurred with the findings concerning very low certainty of evidence at the same time the association of the scientific medical societies in germany completed a consensus guideline that ignores the systematic reviews of evidence and promotes youth transitions following public criticism of the methodology including by 15 prominent german chairs of child adolescent psychiatry the german guidelines were revised with considerably more cautious rec france s national academy of medicine has signaled that work is underway to address the emerging issues with medial gender affirmation in minors belgium s director of cochrane belgium has expressed public concerns that puberty blockers are experimental and that the treatment guidelines promulgated by wpath are not evidence based however it is not clear whether the belgium health authority plans to act on these concerns in the netherlands amsterdam umc the clinic that pioneered the dutch protocol has responded to the cass report the response indicated that the dutch 2018 treatment guidelines are currently undergoing revision according to the dutch health council the minister for medical care has asked the health council among other things to map out what is scientifically known about the long term consequences of puberty blockers and gender affirming hormone treatments for physical and mental health the minister also asks to compare the dutch approach with the approach in other countries and with care standards and applicable laws and regulations it is apparent that the international debate about youth transitions has reached the netherlands in the meantime in north america at the federal level following the biden administration s assertions that gender affirming care is safe and effective the trump administration issued an executive order eo instructing federal agencies to stop the support for the hormonal and surgical gender transitions for minors and to rescind their reliance on wpath the eo ordered the hhs to independently evaluate the evidence and approaches to youth gender dysphoria treatments within 90 days this executive order will have significant implications for the practice of youth gender medicine in the united states florida was the first state to have its public health authority disallow medical transitions for youth under 18 while grandfathering existing cases at least 24 and as many as 26 states passed laws to ban gender reassignment of minors which have proven contentious one of the state lawsuits u s v skrmetti is ...
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