Can you really be transgender at four years old? Matthew Stubbings, and wife Klara Jeynes, both 44, from the English city of Doncaster, believe so. Their “son” Stormy was born as a girl named Emerald. However, from 18 months Emerald identified as a boy like her twin brother Arlo, so they are raising him as a boy.

“His gender identity, what’s in his head, doesn’t match his physical sex,” Stormy’s dad wrote on LinkedIn. “I am so proud that he knows who he is and isn’t constrained by societal norms and prejudices.”

Fortunately for these children and their parents and unfortunately for the experts at gender clinics, the latest news on this front leaves a cloud of doubt hovering over transgender medicine. It is increasingly looking like a kind of 21st century voodoo.  In a series of publications doctors have expressed their dismay at the ready availability of gender transitioning and its rapid spread amongst young people.

At the moment, the accepted wisdom amongst transgender doctors is the so-called Dutch Protocol. This permits puberty blockers at 12 (and even at 8-9, in some cases). Cross-sex hormones (testosterone for girls and estrogen for boys) begin at 16.

However, this week the world-renowned Karolinska Hospital in Sweden put the brakes on — “a watershed moment”, according to the Society for Evidence-Based Gender Medicine. It is the first time that a major hospital has officially deviated from the guidelines issued by the World Professional Association for Transgender Health.

The Karolinska declared in a press release that Swedish government investigations had” showed a lack of evidence for both the long-term consequences of the treatments, and the reasons for the large influx of patients in recent years. These treatments are potentially fraught with extensive and irreversible adverse consequences such as cardiovascular disease, osteoporosis, infertility, increased cancer risk, and thrombosis.

In its understated prose, the press release declares that it is “challenging” for doctors to assess the pros and cons of treatment and “even more challenging” for the patients and their parents to give truly informed consent.

Therefore, the Karolinska will no longer prescribe puberty blockers and cross-sex hormones for minors under age 16. Hormonal treatment for adolescents between 16 and 18 will be allowed, but only as research to be approved by an ethics review board. Basically, the Swedish authorities have decided that conventional gender medication is a potentially dangerous experimental procedure.

Last month, several doctors at the Westmead Children’s Hospital, a large public hospital in Sydney, published a powerful statement of their misgivings about the standard gender dysphoria treatment in the journal Human Systems. It must have taken courage, as the between-the-lines message is that the staff of the hospital’s gender is deeply divided on the issue. In fact, as clinicians, they identify “polarized sociopolitical discourses” as one of the biggest challenges they face.

Here are some of the issues that they raise.

First, that modern medicine still does not understand the phenomenon of gender dysphoria very well. “Despite the existence of guidelines,” they write “the evidence base for all aspects of treatment was and remains sparse.”

But neither the patients nor their families grasped this. “Families tended to medicalize the child’s distress, attributing it solely to gender dysphoria as an isolated phenomenon, with the consequence that the family identified the medical pathway as providing the only potential way forward.”

Second, many of the youths who requested treatment believed that “gender affirmation” means immediate medical intervention – drugs and possibly surgery. The authors tried to get their patients to accept a holistic approach to their dysphoria that took into account their family, psychological and biological issues but their words “fell on deaf ears”.

Why? Partly because the philosophy of “gender affirmation” means unquestioning acceptance of whatever the patient says. But also because of information they had gleaned from friends, the internet, social media, and health care workers.  “Many children did not have the cognitive, psychological, or emotional capacity to understand the decisions they were making.”

Third, their patients often had many other social and psychological problems, or “co-morbidities”, in the medical terminology. They felt bullied by their peers and were in conflict with their parents or carers. Many were autistic, suffered from depression or psychosis or had experienced sexual abuse.

Fourth, there was pressure on doctors to become rubber-stamps for their patients’ self-diagnosis. This was personally distressing and ethically challenging:

From the clinician perspective, we recognized the emergence of this “conveyor belt,” or “tick the box,” mentality—the medical model for treating gender dysphoria stripped bare of holistic (biopsychosocial) care—as being driven by the misguided belief that affirmation of gender dysphoria equates to a medical intervention pathway. Enacted in this way, we felt that this particular sociopolitical discourse put significant pressure on us as clinicians within the Gender Service to abandon ethical, reflective practice in mental health. 

In March the UK National Institute for Health and Care Excellence (NICE) published two systematic evidence reviews of puberty blockers and cross-sex hormones as part of a review of gender dysphoria healthcare. It found that many frequently cited studies are very low quality.

For instance, The Trevor Project, a well-known group which claims to be “the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people under 25”, cites several studies to support its claims gender-affirmative medicine. Nearly all of them were described as deficient by the NICE study. It used damning phrases like: “at high risk of bias”, “poor quality overall”, “No critical outcomes reported”, or “poorly reported”.

There are a many journals and squillions of studies which support medical treatment of teenagers’ gender dysphoria. There is never any lack of highly-paid PhDs with active Twitter accounts to sprinkle the fairy dust of statistical jargon over “evidence”. The question is whether their evidence is robust and trustworthy. From this point of view, the NICE study was devastating.

In December last year a brave young British woman named Keira Bell won her lawsuit against a gender centre which had helped her to “transition” from a male to a female. Within a few years she regretted her decision. In a long and thoughtful judgement, the High Court found that people under 16 could not give informed consent to the life-changing decisions that gender medicine often involves. It also found that the evidence for clinical treatment was thin and unconvincing. It even described it as “experimental treatment”….

The above comes from a May 7 story on