gender healthcare, minors, children

Summary of Recent World Developments on Gender Affirmation Model for Minors

  1. Leaked internal files from the World Professional Association for Transgender Health (WPATH) which prove that the practice of transgender medicine is neither scientific nor medical. Thousands of doctors worldwide rely on WPATH including our own Ministry of Health Te Whatu Ora – and its pushed by the radical association of NZ doctors called PATHA (Professional Association for Transgender Health Aotearoa). But there’s nothing professional about it.

The leaked internal files provide clear evidence that doctors and therapists are aware that they are offering minors life-changing treatments they cannot fully understand. WPATH members know that puberty blockers, hormones, and surgeries will cause infertility and other complications, including cancer and pelvic floor dysfunction. A growing number of medical and psychiatric professionals say the promotion of pseudoscientific surgical and hormonal experiments is a global medical scandal.

And it’s not only the children that are unaware of the true consequences – mainly because they’re too young and  not mature enough to process it all. The WPATH members admit that parents really don’t understand what’s going on or going to happen either.

Despite these admissions that clients are unable to give “informed consent,” WPATH members repeatedly engaged in victim blaming, asserting that people who regret the irreversible procedures should have known what they signed up for.

WPATH guidelines are the authority here in New Zealand. Guidelines for Gender Affirming Healthcare in Aotearoa New Zealand comes out of a group called PATHA which is the NZ equivalent or affiliate to WPATH. 

And in their Guidelines document they specifically say: 

WPATH is the international body responsible for producing standards of care…  This guideline is not intended to replace the WPATH SOC but to present additional guidance for the provision of gender affirming healthcare in Aotearoa, New Zealand.

And here’s the Ministry of Health website as it stands with an update from January 2024

For referral acceptance to be considered patients need to: meet the eligibility criteria set out in the Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People, published by The World Professional Association for Transgender Health (WPATH) version seven. 

Who is PATHA? It was formed in 2018 and is a group of transactivists – some of whom have found their way into the medical professional setting. A member of the Executive committee is a transgender woman – a NZ activist on the global board of directors for WPATH, and one of the authors of the latest revision of the WPATH Standards of Care.

It is our understanding that they are part of the review of puberty blockers – contracted by Te Whatu Ora!

  1. The NHS England confirmed “Children will no longer be prescribed puberty blockers at gender identity clinics”. The decision comes after an independent review of services for children under 18 and a sharp rise in referrals to the Gender Identity Development Service run by the Tavistock and Portman NHS Foundation Trust. You’ll probably have heard of Tavistock and the debacle happening there.

The NHS cited “a lack of sufficient evidence relating to the safety and clinical effectiveness of [puberty blockers] for children and young people with gender incongruence/dysphoria, including about the benefits, risks and long-term outcomes.” Psychosocial interventions will become the front-line response to gender distress. The government said it welcomed the “landmark decision”, adding it will help ensure care is based on evidence and is the “best interests of the child”.

Puberty blockers were promoted as a safe, no-regrets option merely “pausing” puberty. The marketing of blockers internationally since 2010-15 has been followed by an unprecedented surge in young patients, mostly teenage females, rejecting their birth sex and seeking hormonal interventions and surgery.

  1. At the beginning of this month the Netherlands who pioneered gender-affirming treatment for children, announced, according to a report in the UK Telegraph:

the Dutch government has been told to conduct research into the physical and mental health outcomes of children given puberty blockers, which tends to be the first step on the pathway to changing gender. Cross-sex hormone treatment and surgery often follow. The reason this is such a big deal is that the Netherlands pioneered the use of puberty blockers, using guidelines known as the Dutch Protocol, which has been copied in the UK and around the world since it was first published by a clinic in Amsterdam in 1998. The fact that the Dutch are now having doubts about a practice they effectively exported to the rest of the world has obvious implications

The three stages of the protocol—designed for patients then described as “juvenile transsexuals”—are puberty blockers to stop natural development, cross-sex hormone drugs to masculinize or feminize the body, followed by surgery from age 18.

  1. Sweden, regarded as an exemplar in the field of LGBT rights, started restricting hormone therapy for children in 2022, and now only sanctions it in rare cases.
  2. Norway. According to a February 29 news report in the Norwegian newspaper Verdens Gang (VG), the medical directors of Norway’s four regions have determined that puberty blockers and cross-sex hormones for gender-distressed minors are experimental treatments and should be restricted to clinical trials.
  3. At the end of January, landmark research from Finland which found that suicide risk in a large group of adolescents was predicted by the psychiatric problems that often accompany gender distress, not by the gender distress itself.

Dramatic claims of the risk of attempted suicide among trans-identifying youth are typically based on low-quality anonymous online self-report surveys with no follow-up checks, potential exaggeration driven by a constant “transition or suicide” narrative, and “convenience samples” unlikely to be representative.

The new Finnish study vindicates that country’s 2020 adoption of a more cautious treatment policy which first targets psychiatric, social and educational problems among gender-distressed youth before any assumption of a stable trans identity justifying “experimental” affirmation with hormones or surgery.

“It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide; in addition, health policies need to ensure that accurate information is provided to professionals along these lines,” the researchers say in their BMJ Mental Health paper.

The research team includes the psychiatrist Riittakerttu Kaltiala, from Tampere University Faculty of Medicine, who helped pioneer paediatric gender medicine in Finland, but became concerned when she and her colleagues did not see the good outcomes promised by the internationally imitated “Dutch protocol” of puberty blockers followed by cross-sex hormones and surgery.

Parents hesitant about these poorly evidenced medical interventions have reportedly been asked by clinicians, “Do you want a live son or a dead daughter?”

The suicide narrative also figures in the practice of schools keeping a child’s social transition secret from parents, in the shutting down of debate about the efficacy and safety of hormonal and surgical interventions, and in the promotion of ill-defined bans on “conversion therapy” and “hate speech.”

“Although the rate of suicide [in the Finnish study] is just over four times higher among trans young people than their peers, this is explained by their more serious psychiatric problems. When these psychiatric problems are taken into account, there is no evidence that transgender people have a higher rate of suicide.”

  1. France French senators have published a report that expresses alarm at the excesses of child gender transition and have proposed a bill to put an end to it.
  2. Denmark In a marked shift in the country’s approach to caring for youth with gender dysphoria, most youth who are referred to the centralised gender clinic now receive therapeutic counselling and support, rather than a prescription for puberty blockers. (2023)
  3. Finland 2020 revised its treatment guidelines, prioritising psychological interventions and support over medical interventions.
  4. USA 2023-24: A total of 22 states have so far passed laws protecting children from routine medicalisation of gender distress. The laws vary in what they proscribe and in the penalties imposed and some of them are subject to ongoing legal challenges. This interactive map provides state by state details.
  5. A landmark study from the Netherlands published April 2024 (and conveniently ignored by the media) has found that the majority of gender-confused children grow out of that feeling by the time they are fully grown adults. Coincidentally, the finding was made by a team of researchers in the Netherlands, home of the so-called Dutch protocol, which since gave rise to the infamous treatment known as “gender-affirming care”.

Published in the peer-reviewed scientific journal Archives of Sexual Behaviour, the study tracked 2,700 participants who were followed up every three years from age 11 to 26. Results showed at the start of the research, around one-in-10 children (11 percent) expressed ‘gender non-contentedness’ to varying degrees. But by age 25, just one-in-25 (4 percent) said they ‘often’ or ‘sometimes’ were discontent with their gender.

The researchers from the University of Groningen concluded: ‘The results of the current study might help adolescents to realize that it is normal to have some doubts about one’s identity and one’s gender identity during this age period and that this is also relatively common.

  1. JUST RELEASED – England’s National Health Service commissioned this independent review, by pediatrician Hilary Cass, of the nation’s just-closed pediatric gender care clinic and the research backing pediatric gender-transition treatment. [see below] 

Summary of The Dr. Cass Review


Led by Dr Hilary Cass, a Paediatrician and former president of the Royal College of Paediatrics and Child Health. The Cass Review aims to ensure that children and young people who are questioning their gender identity or experiencing gender dysphoria and who need support from the NHS receive a high standard of care that meets their needs and is safe, holistic and effective.

The review’s scope was wide-ranging and included looking at different aspects of gender identity services, from primary care to specialist gender services in the NHS. This included looking at key elements of the chain of care given to a young person when they are referred to specialist services, the clinical decisions around how doctors and healthcare professionals support and care for patients with gender dysphoria and examining the rise in the number of children seeking treatment.

The review examined published evidence (national and international) and qualitative and quantitative research and had professional input from clinicians, professional bodies, and frontline staff. Focus groups with young people and young adults, support and advocacy groups, and interviews with service users and their families were also conducted. In addition, roundtable discussions, along with consensus-building discussions, were facilitated to make recommendations on services and treatments for children and young people and families facing gender identity distress.

Important to note:  In 2022, the Review published an interim report, which provided some initial advice. It set out the importance of evidence-based service development. It highlighted major gaps and weaknesses in the research base underpinning the clinical management of children and young people with gender incongruence and gender dysphoria, including the appropriate approaches to assessment and treatment. Critically, the interim report highlighted that little is known about the medium- and longer-term outcomes for children and young people

Key points
  • The review was commissioned to make recommendations on models of care, appropriate treatment approaches, audit, long-term follow-up and research, and workforce requirements. It was also asked to explore the reasons for the increase in referrals for gender identity services and the change in the demographics of the referred population. Additionally, the review set out to examine the use and impact of puberty blockers and gender-affirming hormones.
  • Dr Cass makes it clear in the report that the surrounding noise and increasingly toxic, ideological, and polarised public debate made the work significantly harder, adding no value to discussions and doing nothing to serve the children and young people at the heart of the work.
  • The report highlighted that clinical practice (in gender identity development services) was disconnected from the clinical evidence base and ignored warning signs of a struggling service delivery model. The use of puberty blockers as routine practice in the treatment of children dealing with gender identity distress or gender incongruence was found to be without clear evidence of being beneficial for a young person. The use and prescription of puberty blockers had moved from being a research-only protocol to being made widely available for not only routine clinical practice but also for patients who did not meet the inclusion criteria for use.
  • There are conflicting views about the clinical approach, some of which are far from usual clinical practice for children and young people. Some thought the clinical approach should follow a social justice model (which sounds like NZ) rather than an evidence-based model.
 Overview of findings
  • The review conducted a survey on international guidelines for the care and treatment of children and young people dealing with gender identity distress or gender incongruence and found no single guideline that could be applied in its entirety to the NHS England context.
  • The evidence base of the care and treatment of children and young people by gender-identity services was often misrepresented and overstated in public discourse/social debate and scientific publications.
  • The use of gender-affirming hormones in individuals under 18 presented more unknowns than clear benefits. The lack of long-term follow-up data, esp. for children who got these treatments at an earlier age, meant there is inadequate information about the range of outcomes for this group.
  • The rationale for the use of puberty blockers is still unclear. There is weak/poor evidence of its impact on gender dysphoria and mental or psychosocial health. The effect on cognitive and psychosexual development also remains unknown.
  • For most young people, a medical pathway, i.e. a medical transition, will not be the best way to manage their gender-related distress. Even for young people where a medical pathway is clinically suggested, it isn’t enough and does not negate the need to address wider mental health and psychosocial challenges.
  • Young people facing gender-related distress had no significantly different levels of suicide risk to other young people with similar levels of complex presentations.
  • No evidence that gender-affirming treatment reduces suicide risk.
  • Going forward, gender-care medicine needs to have a proportionate level of monitoring, oversight and regulation that allows for progress while preventing the creep of unproven approaches into clinical practice. Service-delivery models for this kind of healthcare need to be evidence-based.
Overview of Recommendations
  • Recommendations took a holistic approach to the healthcare provided for children and young people in gender-related distress.
    • Children referred to gender services must be treated holistically, i.e. a holistic assessment of their needs and individualised care plan that would factor in screening for neurodevelopmental conditions, spectrum disorders and mental health conditions.
    • Services (gender identity development-related) must operate similarly to other services for children and young people with complex presentations and risk factors
    • There needs to be provision for people considering detransition, recognising that they may not wish to re-engage with the services whose care they were previously under.
    • The current gender healthcare model (for children and young people) must expand its capacity to include paediatric services with strengthened links between secondary and specialist services.
    • The use of gender-affirming hormones from age 16 needs extreme caution. There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18. Every case considered for medical treatment should be discussed at a national Multi- Disciplinary Team (MDT).
    • There should be a separate pathway for pre-pubertal children and their families. Ensuring they are prioritised for early discussion about how parents can best support their child in a balanced and non-judgemental way. When families/carers are making decisions about the social transition of pre-pubertal children, services should ensure they can be seen by a clinical professional with relevant experience as early as possible.
    • There needs to be a follow-through service for 17-25 years to ensure continuity of care and support at a potentially vulnerable stage in their journey.
    • Standard evidence-based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress from gender incongruence and concurrent conditions, including support for parents/carers and siblings as appropriate.
    • A full research programme should be established to examine the characteristics, interventions, and outcomes of every young person presenting to the NHS gender services.
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