The Science Is Clear: Children Shouldn’t Be “Transitioned”

For years, the message to worried parents was simple: The science is settled. Puberty blockers, cross-sex hormones, even removing teenage girls’ healthy breasts—these were called “medically necessary,” or even “lifesaving.” Anyone who questioned this was branded anti-science, or worse.

That message has not held up under scrutiny. Major medical associations themselves are now saying so.

• In January 2026, a New York jury handed down the first malpractice verdict of its kind to a detransitioner. It awarded $2 million in damages to Fox Varian, a young woman who had her healthy breasts removed by doctors at age 16. Jurors concluded her doctors had breached professional medical standards, in part by failing to properly secure her informed consent before the operation.
• The next month, the American Society of Plastic Surgeons put out a statement recommending against “gender-related breast/chest, genital and facial surgery” on minors, stating that such radical and irreversible treatments should not be done until at least age 19.
• The American Medical Association followed within days. It said, “In the absence of clear evidence, surgical interventions in minors should be generally deferred to adulthood.”
• Two months after that, the Pediatric Academic Societies, the country’s most prominent pediatric research conference, held its first-ever panel questioning the practice. The panel featured researchers from Finland, the United Kingdom, and the United States.

The so-called “consensus” that has been foisted on families is crumbling in real time.

None of this happened because the basic facts of biology or gender dysphoria changed. It happened because, one court case, one journal article, and one government review at a time, the real evidence is coming to light. And it does not back up what patients and parents have been told.

The truth is: No child should be “transitioned.” In truth, no child can be “transitioned”; medical science cannot change a girl into a boy. And the science will only continue to prove this true.

Four expert witnesses lay out the science

Four expert witnesses have testified in numerous court cases supported by Alliance Defending Freedom as to what the science actually says regarding gender dysphoria and children.

• Dr. James Cantor is a psychologist with a PhD from McGill University. He spent nearly 15 years on the University of Toronto’s Faculty of Medicine, where he also served as Head of Research for the Sexual Behaviours Clinic at the Centre for Addiction and Mental Health (CAMH). He specializes in research methods and has published widely in peer-reviewed journals on human sexuality.
• Dr. Stephen Levine served for decades as a Clinical Professor of Psychiatry at Case Western Reserve. He founded its Gender Identity Clinic in 1974 and has worked directly with patients with gender dysphoria for over five decades. He was an early member of the World Professional Association for Transgender Health (WPATH) and chaired the committee behind its 5th Standards of Care. He later broke with the organization as it abandoned scientific principles in favor of ideology. Dr. Levine has published widely on gender dysphoria and human sexuality throughout his career.
• Dr. Kristopher Kaliebe is a professor of psychiatry at the University of South Florida. He is board-certified in general, child/adolescent, and forensic psychiatry. He works directly with adolescents and adults with gender dysphoria in university clinics and correctional facilities. He also trains psychiatry residents and fellows and is a Distinguished Fellow of the American Academy of Child and Adolescent Psychiatry.
• Dr. Farr Curlin is a physician-bioethicist and board-certified internist. He is a professor at Duke, where he co-directs its Theology, Medicine, and Culture Initiative. He trained in clinical medical ethics at the University of Chicago. He has spent his career researching and writing on the ethics of medical practice and the doctor-patient relationship.

All four have built their careers, and their credibility, over decades of clinical practice, teaching, and peer-reviewed research. Their testimony, laid out below, tells the real story: what the science says and—just as importantly—what it doesn’t.

The “consensus” was never a consensus

Dr. Cantor reminds us of a basic point, one that’s easy to forget in this debate: Not all evidence is equal. Randomized trials and independent systematic reviews sit at the top of medicine’s evidence hierarchy. Small, uncontrolled studies that just describe what happened to a group of patients, with no comparison group, sit at the bottom, along with self-selected online surveys and clinicians’ opinions about their own patients. Often, the claims of such uncontrolled studies are simply unreliable.

The case for transitioning minors has been built almost entirely on that bottom tier. Much of it comes from clinicians and organizations with a direct financial stake in the answer. The studies most often cited to justify puberty blockers, cross-sex hormones, and surgery for minors were often produced by researchers with conflicts of interest, rather than by outside reviewers with no stake in the outcome. That is exactly the kind of conflict of interest that evidence-based medicine was designed to screen out.

So what happens when truly independent reviewers, people with no financial or professional stake in the outcome, actually take a look at the data?

A drumbeat of independent government reviews reaches the same conclusion

England’s National Health Service asked Dr. Hilary Cass, a senior pediatrician, to lead a full review of its pediatric gender program. In the review’s own words, she was chosen because she had “no prior involvement or fixed views in this area.” Her four-year review was published in 2024, alongside a series of systematic reviews from the University of York. It found there is “not a reliable evidence base upon which to base clinical decisions.” Specifically:

• On puberty blockers: “There were no high-quality studies identified that used an appropriate study design” assessing outcomes in adolescents with gender dysphoria. “No conclusions can be drawn about the effect on gender-related outcomes, psychological and psychosocial health, cognitive development or fertility.” Bone health and height, the review found, “may be compromised.”
• On cross-sex hormones: “No conclusions can be drawn about the effect on gender dysphoria, body satisfaction, psychosocial health, cognitive development, or fertility.” Uncertainty remains, the review found, about “outcomes for height/growth, cardiometabolic and bone health.”
• On surgery: According to Dr. Kaliebe, the York team’s review found almost no evidence on surgical outcomes in adolescents, with data too sparse and methodologically weak to support any conclusion about safety, effectiveness, or regret.
• On the clinical guidelines themselves: The York team reviewed 23 gender-medicine guidelines published worldwide between 1998 and 2022. So many failed to meet basic standards that only two, from Finland and Sweden, could be recommended to physicians.

Dr. Kaliebe traces what happened next. The Cass Review’s findings led to the closure of the NHS’s centralized gender clinic, which had already been rated “inadequate” by England’s Care Quality Commission. Puberty blockers were banned outside clinical trials. And cross-sex hormones, while technically still an available treatment, have not actually been given to any minor since the review’s updated policy took effect. The NHS has confirmed that no minor has been found eligible.

Cass was not an outlier, and she was not the first. Dr. Cantor, Dr. Levine, and Dr. Kaliebe all document this pattern: Nearly every government health authority that has run an independent evidence review, instead of just accepting the word of activist medical organizations, has landed in the same place—and many have moved to restrict or ban the practice outright.

• England’s NHS issued an emergency ban on puberty blockers for minors on May 29, 2024, upheld as lawful by the English High Court a month later. Scotland’s sole gender clinic for minors separately announced it would no longer prescribe puberty blockers or cross-sex hormones to anyone under 18.
• Denmark restricted the use of endocrine intervention in minors in 2023.
• Norway’s Healthcare Investigation Board concluded in 2023 that puberty blockers, cross-sex hormones, and surgeries for minors should be considered “experimental” due to insufficient evidence and recommended restricting them to formal research settings.
• New Zealand banned puberty blockers for gender dysphoria in minors in November 2025, citing similarly poor-quality evidence.

Other countries have not yet gone as far as banning the practice, but their own independent evidence reviews reach the identical conclusion:

• Finland concluded, as early as 2020, that “gender reassignment of minors is an experimental practice.”
• Sweden’s National Board of Health and Welfare found that the risks of puberty blockers and cross-sex hormones are likely to outweigh the purported benefits at the population level.
• McMaster University researchers, publishing updated systematic reviews in 2025, found the evidence on cross-sex hormones predominantly of “very low certainty.”
• The U.S. Department of Health and Human Services, in its own 2025 review of the totality of the evidence, concluded that the risk-benefit profile of medical and surgical interventions for children and adolescents with gender dysphoria “is unfavorable.”

That is the considered judgment of nearly every independent body in the world that has weighed the evidence. Researchers in at least eight countries reached the same answer, using different methods.

When proponents tried to write their own review, it collapsed on inspection

Nothing shows how weak the contrary case is better than the attempt to build one. When Utah passed a moratorium on cross-sex hormone use on minors in 2023, the law required an evidence review to guide the policy. The University of Utah’s Drug Regimen Review Center took on the review. It was released in May 2025, running 1,051 pages. Advocates for medical transition announced it had proven them right.

But an independent review of the review’s methods, published in 2026 by the Society for Evidence-Based Gender Medicine, found otherwise. The review called itself an evidence synthesis, but it never actually performed one, the core task it was supposed to do. It left out the UK’s NICE and University of York reviews entirely. It also failed to prioritize research on detransition, even though state lawmakers had told it to cover that topic. And it failed to disclose something important: four of the six advisors guiding the review had direct ties related to providing “transition” drugs and surgeries to minors.

The process was designed from the start to favor continuing the practice. Even so, it could not do that without leaving out contrary reviews, ignoring what lawmakers required, and hiding the reviewers’ own stake in the outcome. That is the same pattern found in WPATH’s own guidelines.

WPATH: an authority built on ideology, not evidence

The World Professional Association for Transgender Health (WPATH) is the organization whose “Standards of Care Version 8” (“SOC8”) enthusiastically recommends both sex-impairing hormonal interventions and irreversible surgeries on minors. Many have trusted and cited the recommendations of WPATH’s SOC8 in the mistaken belief that it was created through a neutral scientific process. It was not.

The problems start with methodology. The Cass Review scored gender-medicine guidelines using AGREE II, the standard tool for appraising clinical guidelines, across six domains, including “rigour of development.” WPATH’s 2022 Standards of Care, known as SOC-8, rated just 35 out of 100 on that measure, below Finland’s 2020 guideline (51) and Sweden’s 2022 guideline (71)—the only two the review recommended for practice. Part of the reason, the review found, is circularity: WPATH helped shape the Endocrine Society’s guidelines, then cited those same guidelines as independent support for its own recommendations. In the Cass review’s own words, “the circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.”

The problems extend to who wrote it. SOC-8 required committee members to be WPATH members “in good standing,” meaning the guideline-writing team came only from an advocacy group’s own dues-paying members. That guaranteed exactly what conflict-of-interest rules exist to prevent. WPATH told the public its process screened out such conflicts; it didn’t. Dr. Kaliebe documents how Eli Coleman, chair of the SOC-8 committee, admitted under oath that his own research was substantially funded by the Tawani foundation—the same foundation that was also the main financial backer of the WPATH SOC8 development process. In other words, the person deciding what the guidelines should say and the funder paying to produce them had a direct financial relationship with each other. And the Tawani Foundation itself is far from neutral: It is, in fact, a funding vehicle for Jennifer Natalya Pritzker, born James Nicholas Pritzker, who has been called the world’s “first transgender billionaire.” HHS’s 2025 review found “serious questions regarding the accuracy” of WPATH’s claim that no conflicts were “significant or consequential.” Coleman himself admitted under oath that conflict-of-interest screening for committee members didn’t begin until roughly six months after those members had already been chosen.

This isn’t new for WPATH. Dr. Levine chaired WPATH’s own standards committee in the 1990s and resigned in 2002, concluding the organization had become “dominated by politics and ideology, rather than by scientific process.” What followed only got worse: the 2012 guidelines (SOC-7) called puberty blockers “fully reversible,” without evidence, and SOC-8 added a chapter approving surgical castration for men who “identify” as eunuchs while quietly dropping minimum-age limits for blockers, hormones, and surgery entirely.

Dr. Kaliebe traces the pattern back further still. In 2018, WPATH commissioned systematic reviews from Johns Hopkins University’s Evidence-Based Practice Center. When some findings raised concerns among WPATH leadership that they might “negatively affect the provision of transgender health care,” WPATH asserted final say over publication. Of the six systematic reviews that the Johns Hopkins team conducted, only two were published. The Economist covered the episode under the headline “Marking their own homework.”

The field’s own members agree: More than 2,000 people, many of them clinicians, have signed the “Beyond WPATH” declaration stating that WPATH discredited itself with SOC-8.

WPATH’s own recent legal filings make the point more plainly than any outside critic could. In June 2026, the FTC, joined by Alaska, Iowa, Nebraska, and Texas, sued WPATH, alleging SOC-8 amounts to deceptive trade practices. Rather than argue SOC-8 reflects settled science, WPATH’s motion to dismiss says, “The statements in SOC-8 are opinions about what conclusions existing scientific research supports,” not verifiable fact. An organization that tells the public its guidelines reflect medical consensus, while it tells a federal court they are merely opinion, has conceded exactly what critics have been saying for years.

Dr. Kaliebe’s own conclusion is blunt. WPATH, he writes, “has mismanaged conflicts of interest, committed research malfeasance, systematically misrepresents evidence to make recommendations based on low-quality supporting evidence, and has redefined medical necessity to include experimental procedures with life-altering consequences.” An organization that fits that description is not offering a scientific consensus. It is offering the judgment of a guild defending its own practice.

Today’s patients don’t match yesterday’s research

Even if WPATH’s guidelines were trustworthy, they would still be answering questions about the wrong patients. The population showing up in gender clinics has changed radically in recent years.

Historically, childhood gender dysphoria was extremely rare and mostly affected prepubertal boys. Without social or medical transition, the child’s discomfort with his sex usually vanished by adulthood. What clinics are now seeing, Dr. Cantor explains, is something new: a surge of adolescent-onset gender dysphoria. It mostly affects teenage girls with no childhood history of cross-sex behavior, and the numbers affected are many times higher than historical rates of dysphoria. This surge began showing up in Western referral data at scale only after roughly 2012. That timing tracks almost exactly with the rise of smartphones and social media among teenagers.

Dr. Cantor traces the same pattern through Finland’s own clinic data. Researchers there observed that the surge in adolescent referrals arrived “simultaneously with the emergence of the widely recognized crisis in mental health among adolescents and young adults … largely associated with the increasing use of social media.” Dr. Cantor cites Lisa Littman’s peer-reviewed survey of detransitioners. It found that 60 percent belonged to a friendship group in which one or more members became transgender-identified around the same time. More than a third said a majority of their friends did. That pattern, Dr. Cantor argues, is hard to square with the claim that transgender identity is an innate, fixed trait.

The mental health conditions clinics overlook

If the population has changed, so has its clinical complexity. Here, too, clinical practice has not kept pace.

The fact is that the young people showing up at gender clinics today—and being guided towards irreversible hormonal interventions—are deeply troubled quite apart from distress about their sex, and in need of thoughtful mental health care. In one sample of six-to-eleven-year-olds referred to gender clinics in Toronto and Utrecht for gender identity concerns, roughly 62 percent met the criteria for a mental health condition other than gender dysphoria. A study in Finland, where centralized national medical records enable a thoroughness and precision not possible within the United States’ decentralized system, found that 75% of young people referred to a gender clinic had severe mental health problems that predated their experience of gender dysphoria, including depression, anxiety, suicidality, self-harm, eating disorders, and autistic-spectrum disorder.

To take just one of these so-called “comorbidities,” at the U.K.’s leading gender clinic, almost 35% of patients presented with moderate-to-severe autistic traits (as compared to less than 2% in the general population). This matters because autism on its own can produce symptoms that look like gender dysphoria: trouble with social belonging, black-and-white thinking about one’s body and what it means to be a “boy” or “girl.” Prior trauma—and in particular sexual abuse—can likewise produce symptoms too easily misdiagnosed as gender dysphoria, including social isolation and severe discomfort with one’s own body.

Dr. Kaliebe and the Cass Review both note that clinicians and parents have seen cases where a young person’s distress traces back to undiagnosed autism, an eating disorder or body-image issues, or abuse or trauma. When these conditions are treated on their own terms, the gender dysphoria sometimes resolves as a side effect, without ever touching a hormone or a scalpel. Clinical guidance that pushes toward medical transition, without first diagnosing, treating, and resolving these pre-existing conditions, risks treating the symptom and inflicting further harm while leaving the real cause unaddressed.

So-called “transition” does not prevent suicide

No single argument has shut down debate more effectively than the claim that “transition” prevents suicide. Examined directly, that claim collapses.

Dr. Levine insists on a distinction the public debate keeps erasing. Suicidal thoughts are common among gender-dysphoric teens, as they are among many struggling adolescents. But completed suicide, thankfully, is rare. An analysis of eleven years of data from London’s Tavistock clinic, the largest pediatric gender service in the world, found only four completed suicides. That is across an estimated 30,000 patient-years, including patients who had not yet begun any medical transition while on the waiting list. England’s own National Suicide Prevention Strategy lead, Professor Louis Appleby, reviewed the same data independently. He concluded flatly that claims that subjecting minors to puberty blockers, cross-sex hormones, or surgery reduces suicide “do not meet basic standards for statistical evidence.”

In fact, activist and ACLU lawyer Chase Strangio gave away the game when pressed in oral argument before the U.S. Supreme Court, admitting in response to a question from Justice Alito that “there is no evidence in … the studies that this treatment reduces completed suicide.” That’s the science.

Dr. Kaliebe cites a separate study that found the opposite of what transition activists repeatedly claim: The share of patients needing psychiatric care actually rose after receiving hormones, surgery, or both, from 9.8 percent to 60.7 percent among males and from 21.6 percent to 54.5 percent among females, with more recent patients faring worse than earlier ones.

Gender-dysphoric teenagers are in real distress, and that distress deserves to be taken seriously. But the specific claim that medical transition is the only thing standing between these kids and suicide is a fabrication absolutely unsupported by the data.

What detransitioners are actually reporting

Understanding why some children end up on this path starts earlier than the clinic. Proponents often present social transition—letting a young child live as the opposite sex without drugs or surgery—as a safe, reversible middle ground. It’s framed as a way to support a child without the risks of puberty blockers or hormones. On the contrary, the evidence shows that even standing alone, social transition is a decisive psychotherapeutic intervention that changes outcomes, putting children on what Dr. Levine calls a “conveyor belt” towards puberty blockers, sterilizing cross-sex hormones, and a lifetime as a patient.

Earlier research on non-transitioned children found that most (in some cases nearly 90 percent) ceased to experience gender dysphoria by the time they reached young adulthood. But in a sharp contrast, the first study of prepubescent children who were socially transitioned found that just 7.3 percent regained comfort with their sex. Dr. Levine points to a similar finding: Fewer than 20 percent of boys who socially transitioned before puberty had outgrown their dysphoria when surveyed at age 15 or older. Social transition is not a courtesy or a neutral accommodation. Treating a young child as the opposite sex appears to confirm rather than relieve the child’s discomfort with his or her sex and body, and to reinforce the child’s scientifically impossible desire to be the opposite sex.

It is impossible, and young people are being gravely misinformed—even lied to—about the reality, risks, and consequences. When detransitioners were asked directly about the consent process they went through, the numbers are stark. Dr. Cantor and Dr. Levine both cite this same data: Two-thirds said they’d been poorly informed about the risks of the procedures. Three-quarters said they were not adequately informed about alternatives. Fewer than one in ten had been told that their specific situation was essentially unstudied. These are first-person accounts from people who went through exactly the process that WPATH recommends.

Transitioning children is unethical

All of this raises a more basic question underneath the others. Even setting the scientific uncertainty aside, can a minor give valid informed consent to any of this? And if the benefits are unproven, is subjecting children to potentially sterilizing drugs or irreversible surgeries ethical at all, or is it unethical human experimentation?

Medical ethics already has settled answers for situations like this one. Informed consent, as a general matter, requires three things: adequate information, genuine comprehension, and voluntariness. Medicine’s oldest ethical commitment, enshrined in the Hippocratic Oath since the fourth century B.C. and rephrased in the modern Declaration of Geneva, is: “First, do no harm.”

Dr. Curlin argues that pediatric gender medicine fails this standard. Doctors cannot give minors and parents enough information for informed decision-making when the safety and effectiveness data doesn’t exist. Simply proceeding anyway, and letting families discover the risks on their own, is not informed consent. Understanding a lifelong, irreversible tradeoff, like permanent sterilization or permanent loss of sexual response, is not something the law credits minors with in almost any other context. And voluntariness is further undermined by WPATH’s own admission: A large share of adolescents seeking transition also have mental health conditions that can independently impair decision-making.

The harms Curlin describes are not merely hypothetical. Dr. Kaliebe catalogs documented outcomes of these interventions, including increased risk of cardiovascular disease, pelvic floor dysfunction, hair loss, and loss of sexual response. He also cites a 2024 review finding that puberty blockers carry a “possible detrimental impact on IQ,” a concern serious enough that the Endocrine Society’s own 2017 guidelines warn that the effects on brain development are simply “unknown.”

When the evidence for benefit is this uncertain and the potential for harm this serious, the default that timeless principles of medical ethics prescribe is caution, not intervention.

The “consensus” was never real

The pattern is not subtle. Country after country that has taken an honest look at the evidence—Britain, Sweden, Finland, Denmark, Norway, New Zealand—has moved to restrict or ban pediatric medical transition. Medical associations that spent years insisting the science was closed are, one by one, quietly admitting that it isn’t. And WPATH, the organization that built its authority on claiming to engage in evidence-based research, has been shown, in its own internal records and recent admissions, to be exactly the kind of interested party evidence-based medicine is designed to guard against.

Young people are confused and hurting, and they deserve compassion and care based on science and a respect for biological reality. What the evidence requires is honesty. The claim that “the science is settled” was never true. It was a fabrication from the start. Families deserve to know that before another irreversible decision is made in a doctor’s office.

No child should be “transitioned,” and the science is only making that clearer.

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Expert Declarations

Dr. James Cantor

• Expert Report: Boe v. Marshall (May 19, 2023)
• Supplemental Report: Boe v. Marshall (February 02, 2024)
• Expert Report: Roe v. Critchfield (July 21, 2025)

Dr. Farr Curlin

• Supplemental Expert Report: Boe v. Marshall (February 2, 2024)

Dr. Steven Levine

• Expert Report: McCord v. South Madison School Corporation (August 14, 2024)
• Expert Report: Wyatt Bury v. City of Kansas City, Missouri (April 14, 2025)
• Expert Declaration: Osborn v. Houston Independent School District (July 8, 2025)
• Expert Rebuttal Declaration: Female Athletes United v. Ellison (August 13, 2025)

Dr. Kristopher Kaliebe

• Expert Report: DeGross v. Senn (March 20, 2026)
• Expert Declaration: Tingley v. Brown (June 23, 2026)
• Expert Rebuttal Report: K.M.K. v. Washington Interscholastic Activities Association (August 7, 2026)