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Children and Gender

The medicalization of normal childhood uncertainty.

One of the most significant developments in recent years is the sharp increase in the number of children and adolescents—particularly girls—who identify as transgender or non-binary. Gender care clinics in the United Kingdom, the Netherlands, Sweden, and the U.S. all report a sharp rise in referrals, particularly among those aged 12 to 17.

This has led to a debate over whether normal adolescent uncertainty about identity, body, and sexuality is being medicalized. Puberty blockers—originally used to treat precocious puberty—are being used to delay puberty in gender-dysphoric adolescents. The long-term effects on bone density, fertility, and neurological development have not been fully studied scientifically.

The Cass Review

In 2024, British pediatrician Hilary Cass published her independent investigation into gender care for adolescents in the UK. The report concluded that the scientific basis for puberty blockers in adolescents with gender dysphoria is “surprisingly weak,” and that pressure from activists had distorted the medical and scientific debate. The Tavistock Center, the largest gender clinic for young people in the UK, was closed.

Several European countries—including Sweden, Finland, Denmark, and Norway—have tightened their policies on gender care for minors following their own evaluations. A similar debate is underway in the Netherlands, where the Amsterdam UMC is re-examining its protocol.

Social Contagion

Researchers such as Lisa Littman describe the phenomenon of Rapid Onset Gender Dysphoria: the sudden increase in gender dysphoria among adolescents without early warning signs, often within groups of female friends and following intensive social media use. Her study was initially retracted following activist pressure but later reinstated after peer review. The phenomenon of social influence on gender identification in adolescents has since been confirmed by multiple researchers.

What the international reevaluation reveals

The theme of Children and Gender is not separate from the broader medical reevaluation. The Cass Review (2024) in the United Kingdom led to a de facto halt on puberty blockers within NHS England. SBU and Karolinska in Sweden withdrew their support for medical transition in minors outside of study settings starting in 2022. Finland (COHERE, 2020) and Norway (UKOM, 2023) followed suit. NICE (2020) classified the evidence base for puberty blockers and cross-sex hormones as “very low certainty.”

The Netherlands is lagging behind. The Dutch Protocol—once touted as an international model—is being abandoned elsewhere. The data on which it is based do not come from randomized trials, but from observational studies with cohorts that are not generalizable to the current referral population.

How the discussion is being stifled

When it comes to children and gender, the gender-affirming model is defended through moral pressure and scientific claims that do not hold up to scrutiny. Anyone who refers to the Cass Review or the Scandinavian shift is not met with a rebuttal but labeled as transphobic. The WPATH Files (2024) revealed that even within WPATH, there was uncertainty regarding informed consent for minors.

Parents who come forward with concerns are dismissed as troublemakers. Clinicians who advocate for caution face internal complaints and public campaigns. The result: only one side of the story remains heard.

International Reconsideration

In recent years, various national health authorities have distanced themselves from the gender-affirming model for minors. The common denominator: evidence of lasting benefits is lacking, while the risks are real.

  • Cass Review (2024). Review commissioned by NHS England, conducted by Hilary Cass. Conclusion: the evidence base for puberty blockers and cross-sex hormones in minors is weak. NHS England ceased the routine prescribing of puberty blockers outside of clinical trials.

  • SBU — Sweden (2022). The Swedish Agency for Health Technology Assessment (SBU) and Karolinska University Hospital discontinued the use of puberty blockers and hormones for minors outside of clinical trials. Reason: lack of evidence for effectiveness and safety.

  • NICE — United Kingdom (2020). Two NICE evidence reviews (puberty blockers and cross-sex hormones) classified the evidence base as very low certainty. None of the studies identified met modern methodological standards.

  • COHERE — Finland (2020). The Finnish Council for Choices in Health Care revised its protocol: psychotherapy as first-line treatment, medical transition for minors only in exceptional cases and within a research setting.

  • UKOM — Norway (2023). The Norwegian UKOM classified transgender care for minors as experimental; existing protocols do not meet the requirements for evidence-based care.

  • WPATH Files (2024). Internal discussions among WPATH clinicians acknowledge that informed consent with minors is problematic and that serious side effects (bone density, fertility, cognitive development) are not adequately explained.