SEGM and the critical clinicians in gender care

A group of international clinicians and researchers is critical of parts of the international recommendations for gender care for young people. They are not united in a single organization; the best known is the Society for Evidence-Based Gender Medicine (SEGM).

The main article on this subject is Society for Evidence-Based Gender Medicine (SEGM).

Who are these critics?

They are doctors, psychologists and researchers from various countries who believe that treating young people with puberty blockers and hormones is insufficiently supported by evidence. Some of them are affiliated with SEGM, while others publish in their own name.

How they work

The organizations publish commentaries on guidelines, contribute to systematic reviews and incorporate their analyses into government reports such as the Cass Review.

Their place in the debate

The role of these critics is controversial within WPATH; at the same time, their work is increasingly being recognized by national health authorities in the United Kingdom, Sweden and Finland.

SEGM

The best-known organization in this field is the Society for Evidence-Based Gender Medicine (SEGM), founded in 2019. SEGM is registered as a nonprofit organization in the United States and describes its aim as promoting evidence-based principles in gender care for young people. According to its own website, it has worked with hundreds of researchers and clinicians from more than twenty countries. SEGM relies on donations and describes itself as free from political, ideological, religious and financial influence. The criticism is strong. In June 2024, the Southern Poverty Law Center placed SEGM on its list of hate groups. In 2022, researchers from Yale School of Medicine called it an ideological organization with no clear ties to mainstream scientific and professional associations. The Yale report challenging the Cass Review later emerged from the same circle. A description of SEGM's work and the criticism of it can be found at transplek.nl.

Revisions in Finland, Sweden and England

In June 2020, the Finnish Council for Choices in Health Care (COHERE, PALKO in Finnish) issued a recommendation designating psychotherapy as the first-line treatment and ruling out surgery for minors. On February 22, 2022, the Swedish National Board of Health and Welfare concluded that the risks of puberty blockers and hormones for young people under eighteen are currently greater than the possible benefits. Treatment is only possible there in exceptional cases and should preferably take place in a research setting. In England, the Cass Review's final report was published in 2024. The associated reviews by the University of York assessed the guidelines of WPATH and the Endocrine Society as methodologically weak. Only the Finnish and Swedish guidelines were recommended for use.

The WHO's position

The discussion is not limited to national authorities. The World Health Organization is working on a guideline on the health of transgender and gender-diverse people and announced in January 2024 that it would cover adults only. The WHO gave as its reason that the evidence on the long-term outcomes of gender-affirming care for children and adolescents is limited and inconsistent. In June 2024, it added that this referred to publicly available reviews and that it had not itself issued a review or recommendation on minors. See also the Cass Review, systematic reviews on gender care and the criticism of SOC-8.

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