In this page we monitor the scientific debate surrounding opposite sex imitation.
Recent, so-called ‘affirmative’ treatment protocols have hinged on The Dutch Protocol
This approach has been endorsed by the ideologically motivated pressure group WPATH.
We are particularly focused on science that concords with our view that opposite sex imitation is an inappropriate treatment for what is clearly a combination of adolescent angst and social indoctrination. We appreciate that this might attract accusations of ‘confirmation bias’; however, there is no logical basis to medicalising a healthy body for ideological reasons. To Our Duty this is the single most important fact at play, and one that has been consistently ignored or overlooked. Such a trite fact should not require a peer-reviewed study to confirm its truth. It is why we call for the medical profession adopt an Objective Model of treatment for young people presenting with transgender ideation.
In short, The Objective Model can be summed up with the inherited wisdom:
- First do no harm.
- If it ain’t broke don’t fix it.
- If there is no evidence it works, then what you are doing is an experiment.
The Society of Evidence-Based Gender Medicine (SEGM) is the key proponent of examining the evidence from a sceptical point of view. However, it is yet to adopt the objective perspective for which we advocate.
The American College of Paediatricians has published a website: Biological Integrity.
When we are able, we shall produce an Accessible Synopsis of an important paper. This is because we know that not all the parents we serve are able to make sense of academic papers.
2024
Lundberg TR, Tryfonos A, Eriksson MJ, Rundqvist H, Rullman E, Holmberg M, Maqdasy S, Linge J, Leinhard OD, Arver S, Andersson DP, Wiik A, & Gustafsson T. Longitudinal changes in regional fat and muscle composition and cardiometabolic biomarkers over 5 years of hormone therapy in transgender individuals. Journal of Internal Medicine (2024) DOI: https://doi.org/10.1111/joim.20039
Dominoni M, Scatigno AL, Pasquali MF, Bergante C, Gariboldi F, Gardella B. Pelvic floor and sexual dysfunctions after genital gender-affirming surgery: a systematic review and meta-analysis. The Journal of Sexual Medicine (2024) DOI: https://doi.org/10.1093/jsxmed/qdae146
Cheung CR, Abbruzzese E, Lockhart E, Maconochie IK, Kingdon CC. Gender medicine and the Cass Review: why medicine and the law make poor bedfellows. DOI: https://doi.org/10.1136/archdischild-2024-327994
Gorin M. What Is the Aim of Pediatric “Gender-Affirming” Care? (2024) DOI: https://doi.org/10.1002/hast.1583
Tabernacki T, Gilbert D, Rhodes S, Scarberry K, Pope R, McNamara M, Gupta S, Banik S, Mishra K. The burden of chronic pain in transgender and gender diverse populations: Evidence from a large US clinical database. (2024). DOI: https://doi.org/10.1002/ejp.4725
Alho J, Gutvilig M, Niemi R. Transmission of Mental Disorders in Adolescent Peer Networks. JAMA Psychiatry. (2024) DOI: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2818735
Twenge JM, Wells BE, Le J. Increases in Self-identifying as Transgender Among US Adults, 2014–2022. Sex Res Soc Policy (2024). DOI: https://doi.org/10.1007/s13178-024-01001-7
Cass H. Gender identity services for children and young people: navigating uncertainty through communication, collaboration and care. The British Journal of Psychiatry.(2024) DOI: https://doi.org/10.1192/bjp.2024.162
Clayton A, Amos AJ, Spencer J, Clarke P. Implications of the Cass Review for health policy governing gender medicine for Australian minors. Australasian Psychiatry. 2024. DOI: doi:10.1177/10398562241276335
Özel F, Stratmann M, Papadopoulos FC, Rüegg J, & Bornehag G. Gender-specific play behavior in relation to autistic traits and behavioral difficulties at the age of seven in the SELMA study. PLOS ONE. (2024). DOI: https://doi.org/10.1371/journal.pone.0308605
Clarke P, J Amos A. Gender-affirming care through the lens of abnormal illness behaviour and abnormal treatment behaviour. Australasian Psychiatry. 2024. DOI: doi:10.1177/10398562241276978 Synopsis
Kaltiala R, Helminen M, Holttinen T. Discontinuing hormonal gender reassignment: a nationwide register study. BMC Psychiatry 24(2024). DOI: https://doi.org/10.1186/s12888-024-06005-6
Leonhardt A, Fuchs M, Gander M. et al. Gender dysphoria in adolescence: examining the rapid-onset hypothesis. Gender Dysphoria in Adolescence: The Rapid Onset Hypothesis on the Test Bench (2024). DOI: https://doi.org/10.1007/s40211-024-00500-8
MacKinnon RK, Jeyabalan T, Strang JF, Delgado-Ron JA, Lam JSH, Gould WA, Cooper A, Salway T. Discontinuation of Gender-Affirming Medical Treatments: Prevalence and Associated Features in a Nonprobabilistic Sample of Transgender and Gender-Diverse Adolescents and Young Adults in Canada and the United States. June 2024 DOI: https://doi.org/10.1016/j.jadohealth.2024.05.015
Fine RD, Troncoso SC, & Gelman SA (2024). Transformative tales: The role of story videos on children’s reasoning about transgender identities. British Journal of Developmental Psychology, 00, 1–22. DOI: https://doi.org/10.1111/bjdp.12503
Kronthaler SM, Tissen-Diabaté T, Neymeyer J, Blohmer J, Beier KM, Hatzler L. Prevalence of Sexual Dysfunctions and Healthcare Needs of Transgender and Gender-Diverse People: Results from a Representative Cross-Sectional Survey in Germany The Journal of Sexual Medicine, Volume 21, Issue Supplement_5, June 2024, qdae054.011, DOI: https://doi.org/10.1093/jsxmed/qdae054.011
Tsomokos D. Chronotype and Depression in Adolescence May 2024. DOI: https://doi.org/10.13056/acamh.29556
Bachmann, C J; Golub, Y; Holstiege, J; Hoffmann, F, Gender identity disorders among young people in Germany: prevalence and trends, 2013–2022. An analysis of nationwide routine insurance data Deutscher Ärzteblatt Int 2024; 121: 370-1. DOI: 10.3238/arztebl.m2024.0098
Synopsis
McDeavitt K. Paediatric gender medicine: Longitudinal studies have not consistently shown improvement in depression or suicidality. Acta Paediatr. 2024. DOI: https://doi.org/10.1111/apa.17309
Straub JJ, Paul KK, Bothwell LG, Deshazo SJ, Golovko G, Miller MS, Jehle DV. Risk of Suicide and Self-Harm Following Gender-Affirmation Surgery. Cureus. April 2024. DOI: https://doi.org/10.7759/cureus.57472
Jenkins, P., & Panozzo, D. (2024). “Ethical Care in Secret”: Qualitative Data from an International Survey of Exploratory Therapists Working with Gender-Questioning Clients. Journal of Sex & Marital Therapy, 1–26. DOI: https://doi.org/10.1080/0092623X.2024.2329761
The Cass Review-Final Report, Evidence Base. Independent Systematic Reviews of Existing Evidence.
- Taylor J, Hall R, Langton T, et al. Characteristics of children and adolescents referred to specialist gender services: a systematic review. Archives of Disease in Childhood. April 2024. DOI: https://doi.org/10.1136/archdischild-2023-326681
- Hall R, Taylor J, Hewitt CE, et al. Impact of social transition in relation to gender for children and adolescents: a systematic Archives of Disease in Childhood. April 2024. DOI: https://doi.org/10.1136/archdischild-2023-326112
- Heathcote C, Taylor J, Hall R, et al. Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review. Archives of Disease in Childhood. April 2024. DOI: https://doi.org/10.1136/archdischild-2023-326347
- Taylor J, Mitchell A, Hall R. Interventions to suppress puberty in adolescents experiencing gender dysphoria or incongruence: a systematic review. Archives of Disease in Childhood. April 2024. DOI: https://doi.org/10.1136/archdischild-2023-326669
- Taylor J, Mitchell A, Hall R, et al. Masculinising and feminising hormone interventions for adolescents experiencing gender dysphoria or incongruence: a systematic review. Archives of Disease in Childhood. April 2024. DOI: https://doi.org/10.1136/archdischild-2023-326670
- Taylor J, Hall R, Langton T, et al. Care pathways of children and adolescents referred to specialist gender services: a systematic review. Archives of Disease in Childhood. April 2024. DOI: https://doi.org/10.1136/archdischild-2023-326760
da Silva LMB, Freire SND, Moretti E. Pelvic Floor Dysfunction in Transgender Men on Gender-affirming Hormone Therapy: A Descriptive Cross-sectional Study. Int Urogynecol J 35, 1077–1084 (2024). DOI: https://doi.org/10.1007/s00192-024-05779-3
Pando Christine, Gerlach Leah R, Challa Sai Alekha, Pan Amy Y, Francis Jessica (2024) Operative Complications, Vaginal Bleeding, and Practice Considerations for Patients on Testosterone Undergoing Gender-Affirming Hysterectomy
JMIG DOI: https://doi.org/10.1016/j.jmig.2024.05.026
Ruuska SM, Tuisku K, Holttinen T, Kaltiala R. All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996-2019: a register study. BMJ Mental Health. DOI: 10.1136/bmjment-2023-300940.
2023
Christina Tan, Lauren Kim Sing, Ron Danziger, Alex Aw, Chae Kim, Stephen Avila, Vilakshan Alambyan, Angud Mehdi, Michael Gezalian, Maranatha Ayodele, and Shahed Toossi. Testosterone Therapy in a Transgender Male Patient as a cause of Acute Ischemic Stroke. (2023) DOI: https://doi.org/10.1212/WNL.0000000000202704
Susan McPherson & David E. P. Freedman (2023) Psychological Outcomes of 12–15-Year-Olds with Gender Dysphoria Receiving Pubertal Suppression in the UK: Assessing Reliable and Clinically Significant Change, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2023.2281986
Halasz G, Amos A. Gender dysphoria: Reconsidering ethical and iatrogenic factors in clinical practice. Australasian Psychiatry. 2023;0(0). doi:10.1177/10398562231211130
Heino E, Ellonen N, Kaltiala R. Transgender Identity Is Associated With Bullying Involvement Among Finnish Adolescents. Front Psychol. 2021 Jan 8;11:612424. doi: 10.3389/fpsyg.2020.612424. PMID: 33488479; PMCID: PMC7820417.
Wright JD, Chen L, Suzuki Y, Matsuo K, Hershman DL. National Estimates of Gender-Affirming Surgery in the US. JAMA Netw Open. 2023;6(8):e2330348. doi:10.1001/jamanetworkopen.2023.30348
Erlangsen A, Jacobsen AL, Ranning A, Delamare AL, Nordentoft M, Frisch M. Transgender Identity and Suicide Attempts and Mortality in Denmark. JAMA. 2023;329(24):2145–2153. doi:10.1001/jama.2023.8627
Sarah C. J. Jorgensen (2023) Iatrogenic Harm in Gender Medicine, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2023.2224320
Cohn, J. The Detransition Rate Is Unknown. Arch Sex Behav (2023). https://doi.org/10.1007/s10508-023-02623-5
Jorgensen, S.C.J. Transition Regret and Detransition: Meanings and Uncertainties. Arch Sex Behav (2023). https://doi.org/10.1007/s10508-023-02626-2
Ludvigsson, J.F., Adolfsson, J., Höistad, M., Rydelius, P.-A., Kriström, B. and Landén, M. (2023), A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. Acta Paediatr. Accepted Author Manuscript. https://doi.org/10.1111/apa.16791
Diaz, S., Bailey, J.M. Rapid Onset Gender Dysphoria: Parent Reports on 1655 Possible Cases. Arch Sex Behav (2023). https://doi.org/10.1007/s10508-023-02576-9
Maria A T C van der Loos, MD, Daniel T Klink, MD, PhD, Sabine E Hannema, MD, PhD, Sjoerdje Bruinsma, MSc, Thomas D Steensma, PhD, Baudewijntje P C Kreukels, PhD, Peggy T Cohen-Kettenis, PhD, Annelou L C de Vries, MD, PhD, Martin den Heijer, MD, PhD, Chantal M Wiepjes, MD, PhD, Children and adolescents in the Amsterdam Cohort of Gender Dysphoria: trends in diagnostic- and treatment trajectories during the first 20 years of the Dutch Protocol, The Journal of Sexual Medicine, 2023; DOI: https://doi.org/10.1093/jsxmed/qdac029
E. Abbruzzese, Stephen B. Levine & Julia W. Mason (2023) The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2022.2150346
John D. Haltigan, Tamara M. Pringsheim, Gayathiri Rajkumar, (2023) Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion?, Comprehensive Psychiatry, Volume 121,
https://doi.org/10.1016/j.comppsych.2022.152362.
2022
Levine SB, Abbruzzese E, & Mason JW. What Are We Doing to These Children? Response to Drescher, Clayton, and Balon Commentaries on Levine et al. Journal of Sex & Marital Therapy, 49(1), 115–125. (2022). DOI: https://doi.org/10.1080/0092623X.2022.2136117
Boyd I, Hackett T, Bewley S. Care of Transgender Patients: A General Practice Quality Improvement Approach. Healthcare. (2022)DOI: https://doi.org/10.3390/healthcare10010121
Clayton, A. Gender-Affirming Treatment of Gender Dysphoria in Youth: A Perfect Storm Environment for the Placebo Effect—The Implications for Research and Clinical Practice. Arch Sex Behav 52, 483–494 (2023). https://doi.org/10.1007/s10508-022-02472-8
Jorgensen, S.C.J., Hunter, P.K., Regenstreif, L., Sinai, J. and Malone, W.J. (2022), Puberty blockers for gender dysphoric youth: A lack of sound science. J Am Coll Clin Pharm, 5: 1005-1007. https://doi.org/10.1002/jac5.1691
J. Cohn (2022) Some Limitations of “Challenges in the Care of Transgender and Gender-Diverse Youth: An Endocrinologist’s View”, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2022.2160396
Stephen B. Levine, E. Abbruzzese & Julia W. Mason (2022) What Are We Doing to These Children? Response to Drescher, Clayton, and Balon Commentaries on Levine et al., 2022, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2022.2136117
Levine, S. B., Abbruzzese, E., & Mason, J. M. (2022). Reconsidering informed consent for trans-identified children, adolescents, and young adults. Journal of Sex & Marital Therapy, 48(7), 706–727. doi:10.1080/0092623X.2022.2046221 [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
Bradley, S. J. (2022). Understanding vulnerability in girls and young women with high-functioning autism spectrum disorder. Women, 2(1), 64–67. doi:10.3390/women2010007 [Crossref], [Google Scholar]
Ayad, S., D’Angelo, R., Kenney, D., Levine, S.B., Marchiano, L., & O’Malley, S. (2022). A Clinical Guide for Therapists Working with Gender-Questioning Youth Version 1. Gender Exploratory Therapy Association. Retrieved December 2, 2022 from https://genderexploratory.com/wp-content/uploads/2022/12/GETA_ClinicalGuide_2022.pdf [Google Scholar]
Biggs M. Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom Arch Sex Behav 51, 685–690 (2022). DOI: https://doi.org/10.1007/s10508-022-02287-7
2021
Hall R, Mitchell L, Sachdeva J. Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review. BJPsych Open. (2021) DOI: doi:10.1192/bjo.2021.1022
Dallas K, Kuhlman P, Eilber K, Scott V, Anger J, Reyblat P. Rates of Psychiatric Emergencies Before and After Gender Affirming Surgery. Journal of Urology. (2021) DOI: https://doi.org/10.1097/JU.0000000000001971.20
Evans S, & Evans M. (2021). Gender Dysphoria: A Therapeutic Model for Working with Children, Adolescents and Young Adults. Oxfordshire: Phoenix Publishing House. [Google Scholar]
Singh D, Bradley SJ, & Zucker KJ. (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Frontiers in Psychiatry, 12, 287. doi:10.3389/fpsyt.2021.632784 [Crossref], [Web of Science ®], [Google Scholar]
Griffin, L., Clyde, K., Byng, R., & Bewley, S. (2021). Sex, gender and gender identity: A re-evaluation of the evidence. BJPsych Bulletin, 45(5), 291-299. doi:10.1192/bjb.2020.73
Paz-Otero M, Becerra-Fernández A, Pérez-López G, et al. (2021) A 2020 Review of Mental Health Comorbidity in Gender Dysphoric and Gender Non-Conforming People. J Psychiatry Treat Res 3(1):44-55. DOI: 10.36959/784/425
2020
Warrier, V., Greenberg, D.M., Weir, E. et al. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nat Commun 11, 3959 (2020). https://doi.org/10.1038/s41467-020-17794-1
2019
Churcher Clarke, A., & Spiliadis, A. (2019). ‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties. ClinicalChild Psychology and Psychiatry, 24(2), 338–352. doi:10.1177/1359104518825288 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
2018
Kenneth J. Zucker (2018) The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018), International Journal of Transgenderism, 19:2, 231-245, DOI: 10.1080/15532739.2018.1468293
Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolesc Health Med Ther. 2018 Mar 2;9:31-41. doi: 10.2147/AHMT.S135432
2017
DeLay, D., Lynn Martin, C., Cook, R.E. et al. The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity?. J Youth Adolescence 47, 636–649 (2018). https://doi.org/10.1007/s10964-017-0749-6
Balvin, Nikola; Banati, Prerna (2017). The Adolescent Brain: A second window of opportunity – A compendium, Miscellanea, UNICEF Office of Research – Innocenti, Florence
https://www.unicef-irc.org/article/1750-the-adolescent-brain-a-second-window-of-opportunity.html
2016
Ristori, J., & Steensma, T. D. (2016). Gender dysphoria in childhood. International Review of Psychiatry, 28(1), 13–20. doi:10.3109/09540261.2015.1115754 [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
2014
Drescher, J. and Pula, J. (2014). Ethical Issues Raised by the Treatment of Gender-Variant Prepubescent Children. Hastings Center Report, 44: S17-S22. DOI: https://doi.org/10.1002/hast.365
2011
Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT. Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology and Psychiatry. 2011;16(4):499-516. doi:10.1177/1359104510378303
Dhejne C, Lichtenstein P, Boman M, Johansson ALV, Långström N, Landén M (2011) Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE 6(2): e16885. https://doi.org/10.1371/journal.pone.0016885
2008
Wallien MS, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry. 2008 Dec;47(12):1413-23. doi: 10.1097/CHI.0b013e31818956b9. PMID: 18981931.
Korte A, Lehmkuhl U, Goecker D, Beier KM, Krude H, Grüters-Kieslich A. Gender identity disorders in childhood and adolescence: currently debated concepts and treatment strategies. Dtsch Arztebl Int. 2008 Nov;105(48):834-41. doi: 10.3238/arztebl.2008.0834.