Therapy First and Genspect clash over the approach to gender care

At the beginning of October 2026, around four hundred therapists, psychologists and clinicians gathered in New York for the annual conference of Therapy First — the professional organization that has advocated since 2021 for “psychotherapy before any medical treatment” for young people with gender dysphoria. Among the speakers were Erica Anderson, herself a trans woman and clinical psychologist; Laura Edwards-Leeper, the founding psychologist of the first American gender clinic for children; and Anna Hutchinson, the whistleblower from the now-closed Tavistock clinic in London. At first glance, it was a united group of cautious professionals. But anyone listening closely could hear a division just as sharp as that between supporters and opponents of medical transition itself.

Two varieties of caution

Therapy First, chaired by Paul Garcia-Ryan, formulates its position cautiously: medical interventions for young people “should be approached with due restraint” given the limited evidence and the developmental stage they are in. Therapy remains the first step, but later medical treatment is not ruled out in principle. Genspect, the organization founded by psychotherapist Stella O’Malley, goes a step further: medical transition should never take place for minors, and gender dysphoria is interpreted more as a form of “extreme overvalued belief” than as a condition requiring hormonal or surgical treatment. Two organizations that are both critical of the affirmative model, but on entirely different grounds — a nuance that often disappears from public debate beneath the simple binary of supporter or opponent.

A departure that reveals something

Just how real that tension is became clear when clinical social worker Pamela Garfield-Jaeger left and publicly distanced herself from Therapy First. According to reporting by Gender Clinic News (Bernard Lane, September 28, 2026), critics are particularly concerned about how much room an “exploratory” approach actually leaves for young people who, after careful guidance, still choose medical steps. This is where Therapy First encounters a problem inherent to every middle position: anyone who refuses to say a firm “never” or a firm “always” is criticized by both sides — by affirmative clinicians who already see caution as obstruction, and by Genspect supporters who regard any opening to medical treatment as one compromise too many.

What the figures do and do not say

As so often, part of the dispute revolves around figures. At the conference, reference was made to the review by Ristori and Steensma (2016), which, based on ten prospective follow-up studies, showed that gender dysphoria naturally subsides around puberty in a substantial proportion of children — with figures varying widely between the individual studies. Affirmative clinicians often downplay such findings, while strict critics sometimes present them too categorically. The actual methodological criticism — concerning who is counted as “lost to follow-up” and how early social transition affects the outcome — is more nuanced than either camp lets on in public debate. Genderinfo.nl presents these desistance figures and the criticism of them separately.

Why an internal brawl matters

It is tempting to dismiss this as a quarrel between allies that carries little weight outside their own bubble. But the episode highlights something with broader relevance: when clinicians within their own profession raise critical questions about a dominant treatment model, social or professional pressure to remain silent often follows — something that also happened earlier this year to an American ACOG section chair after criticism of WPATH guidelines. Whether that pressure comes from supporters of affirmative care or, as in Garfield-Jaeger’s case, from within the cautious camp itself, the pattern is the same: differing clinical judgments are punished rather than substantively discussed. Anyone who wants to learn more about the central figures in this broader debate — from Erica Anderson to the developers of the Dutch Protocol — can find an extensive overview of key figures on Dutch Protocol, the networking site that maps the Dutch treatment model and its international critics.

For parents and clinicians looking for a path between two extremes, this offers little reassurance: even organizations that agree on the need for caution cannot find common ground on what that caution should mean in concrete terms in the consulting room. It shows that “restraint” is not a fixed protocol, but a constantly negotiated position — with every clinician who ventures into it becoming a new target.

Sources

• Gender Clinic News, Bernard Lane, “Let’s talk”, September 28, 2026. genderclinicnews.com
• Therapy First, “About us”, accessed October 2026. therapyfirst.org