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9. The adoption of safe policy following evidence reviews


Internationally there is now a move to revise gender policy to better align with the principle of ‘do no harm’. When the evidence used in support of paediatric medical transition is reviewed, it is found to be weak, inconclusive, or misleading.


We ask APS to examine:


  • The 2021 NICE evidence review (UK National Institute for Health and Care Excellence) found that studies evaluating the use of puberty blockers for adolescents were of very low quality. They found similar flaws with the evidence for cross-sex hormones. The Society for Evidence Based Gender Medicine summarized this NICE review with: “The irreversible nature of the effects of cross-sex hormones, and the potential for puberty blockers to alter the natural course of identity formation should give pause to all ethical clinicians

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


  • In Sweden, a new cautious stance on paediatric gender transitions adopted by the Karolinska and other hospitals


  • In Finland, a policy change to prioritize psychotherapy over hormones, following a review that found inconclusive evidence for paediatric transition.


  • In Australia and New Zealand, the new RANZCP position statement acknowledges a paucity of evidence and that “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”. The RANZCP shift from ‘affirmation only’ to holistic care is summarised here.


  • The attached review of AusPATH guidelines by the Society for Evidence Based Gender Medicine.


  • Prominent WPATH and USPATH members call for caution

    • In this Washington Post article psychologists Dr Laura Edwards-Leeper (WPATH) and Erica Anderson (USPATH) blow the whistle on rubber-stamp ‘affirmation’ and call for exploratory therapy for children and teens presenting with gender dysphoria.

    • Trans doctors blow the whistle on ‘sloppy’ care - Dr Marci Bowers has conducted thousands of vaginoplasty surgeries and warns that children on puberty blockers may experience lifelong sexual dysfunction. “If you've never had an orgasm pre-surgery and your puberty’s blocked, it’s very difficult to achieve an orgasm. I consider that a big problem...”

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