Scott’s presentation came from a batch of nearly 500 videos of conferences held by WPATH that I recently obtained. It’s a motherlode of material on pediatric gender care that the secretive activist medical organization had long fought to keep from the public. The tapes, subpoenaed by the Alabama attorney general in response to a federal lawsuit, covered a pivotal period from 2021 to 2023, when pediatric gender medicine first began to face political backlash. In addition to egregious lapses in judgment on the part of WPATH, the videos are a case study in the excesses of peak woke, neatly preserved, as if in a time capsule. 

During a long winter of dyspepsia, I digested well more than 100 hours of the academic faithful checking their privilege and preaching about “centering lived experience.” And I can now report that there are few subcultures more slavishly faithful to the woke religion than WPATH was during the post-Racial Reckoning micro-era. 

According to sociologist Musa al-Gharbi’s landmark 2024 book, We Have Never Been Woke: The Cultural Contradictions of a New Elite, the term woke, in its original, early-20th-century definition, referred to “an awareness of social injustices and a commitment to rectifying them.” Today, it is typically used pejoratively for anything Left-coded that might “seem ridiculous,” as al-Gharbi observed. And not always unjustly: at its peak, the philosophy amounted to a form of egalitarian signaling by cultural elites that purported to serve the needs of the marginalized — mostly by hewing to politically correct positions on gender, sexuality, race and identity issues — but in fact mostly served their own needs for status and legitimacy. 

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I observed all these tendencies at the WPATH conferences, which were held virtually during Covid times, and then in hotel conference rooms in Montreal and Denver, and featured the titans of transgender medical care. One could only expect such discourse given the cast of characters. There were LGBTQ identities (and allies). There were overly educated cultural elites. There were activists. And there were guilty white people — overwhelmingly and blindingly white people — who sought to compensate for their inadequate melanization through promises to diversify WPATH and promote equity across the land.

These defenders of the marginalized were fluent in the academic-elite lingua franca of critical theory, intersectionality, and social justice, hewing to conformity at the expense of content, common sense, or even their own supposed mission to help gender-distressed children and adolescents. They stayed ahead of what Steven Pinker coined the “euphemism treadmill,” rattling off all the latest identity-politics jargon — deftly observing the imperative to shift from “transgender,” to “gender diverse,” to “gender expansive”; and from “Latino,” to “Latinx,” to “Latine.” They doled out trigger warnings for bread-and-butter medical subjects — to audiences of doctors and psychologists. 

In one session, which concerned the informed-consent model for providing gender surgeries, attendees were instructed to “please feel free to leave or take a break if need be. We want you to prioritize your own well-being above the content that we are sharing here.” 

They succumbed to concept creep, with one presenter defining trauma as “an experience or series of experiences that negatively affect someone’s interactions and experiences of moving through the world” — a definition so diffuse it could apply to anything from the Holocaust to a hangnail. And they undermined their own authority, responsibility, and legitimacy as care providers endowed with doctorates, as they conveyed that their young patients’ narratives were more important than diagnostic and scientific precision and the core principles of medical ethics.

Were there pronoun declarations? But of course. In fact, a WPATH conference is the rare setting where this performance might be useful. However, the vast majority of presenters, sometimes to their own professed chagrin, were not transgender. Most were straight women and gay men; the latter rarely admitted such a jejune and déclassé sexual identity, opting instead for obliquely declaring themselves “a member of the LGBTQ+ community.” 

The presenters didn’t stop with simply professing themselves a they/them. They routinely introduced themselves according to their sexual, racial, and class-based identities, making a point of self-flagellating should their oppression score prove subpar. One typical throat clearing was: “I’m a cisgender white woman who comes from a lot of privilege.” Another team declared: “We are white providers,” who, when caring for patients, took into consideration “the soup we all swim in, which is the dominant white Western ideas of what gender is, can be, should be.” Presenters displayed performative guilt and — with no sense of irony — apologized for their status as central players in a power structure that they were eagerly leveraging to promote the medicalization transgender identity in minors, even as they denounced that system as woefully damaged and damaging. 

Overall, the conference sessions placed a disquieting emphasis on correct-signaling over evidence-based medicine. If the presenters genuinely hoped to win over the public and other medical skeptics and establish gender-transition treatments and surgeries as a settled practice in pediatrics, one might have expected them to observe exacting caution and engage in scientific testing sufficiently rigorous to defend the ethics of providing irreversible, life-changing body alterations to highly distressed and impressionable minors. Alas, no.

Conference attendees were treated, for example, to a short sermon by Florence Ashley (they/them), a Canadian “transfeminine” legal scholar and author of Gender/Fucking: The Pleasures and Politics of Living in a Gendered Body. Ashley, a biological male who claims a loosely designated feminine identity, preached that erecting “gatekeeping” around gender-transition interventions for patients of all ages was “illegitimate by default.” 

There was also a session on experimental medical interventions for patients who identify as nonbinary. Dr. Walter Bouman, a British transgender-care specialist and WPATH leader, acknowledged working in the dark in this particular discipline. “We simply don’t have the evidence,” he admitted. And yet he and other care providers claimed it an imperative to provide mix-and-match sets of sex characteristics based on patients’ demands.

Such blind devotion to patients’ body-modification impulses extended even to minors and their “embodiment goals.” Dr. Johanna Olson-Kennedy, a top pediatric gender doctor practicing in California, confessed at the conference in 2023 that determining whether patients are “really trans” is “actually not the discussion I’m interested in participating in.” Instead, she wanted to talk about “giving the very best possible care to trans young people.” Nowhere in this astonishing confession was there room for determining whether a child’s gender confusion could  prove only temporary— and thus there was no consideration of whether the youth might later regret the medical intervention. 

Instead of caution we got hyperbolic warnings about white supremacy. Presenters such as policy wonk Kellan Baker and ACLU litigator Chase Strangio claimed, with no evidence, that objections to pediatric gender medicine, or to biological males participating in girls and women’s sports, were rooted in racist attitudes. Meanwhile, the conference sessions repeatedly called rueful attention to the fact that, despite everyone’s better efforts at recruitment, the organization’s leadership and its members were overwhelmingly white, as were their pediatric patients, as were youths participating in their studies. 

Such laments were paired with commitments to the equitable provision of medical interventions to nonwhite populations. White presenters ritually groveled over their racial or cispatriarchal supremacy. One, Dr. Carl Streed, a WPATH leader — a white gay man and primary-care physician at Boston Medical Center — heartily agreed to an observation that men of his persuasion controlled trans research and should voluntarily “step down” from leadership positions. 

These scenes highlight the intrinsically unstable nature of the woke belief system, which has always displayed contradiction and paradox. For example: race is a mere arbitrary social construct best dismissed and yet should be a source of monomania given that it is the architecture upon which all of society is built. Or this: given the overwhelmingly white makeup of WPATH and the field’s population of minor patients, perhaps pediatric gender medicine itself is fundamentally white. Where is the respect for marginalized cultures, when one of the chief professed goals is to impose what amounts to a glaringly white undertaking onto black and brown children?

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The only black trans woman I saw in all the WPATH videos I observed was Dr. Elle Lett, an activist-oriented statistician-epidemiologist (and insufferable gadfly on social media). Dr. Lett was still in training at the University of Pennsylvania when she gave a ramblingly woke plenary address to the 2021 conference. “Medicine,” she claimed, was “nested in the system of oppression,” and statistical methods “develop[ed] out of eugenics.” She called on attendees to “reject the notion of sample size and validity” in favor of messier science, provided it gave voice to the voiceless. The most mind-scrambling scenes came from sessions in which presenters preached the imperative to provide gender-transition treatment to Native Americans of all ages. 

I have no doubt that the WPATH conference presenters genuinely approach their medical mission with compassion. They routinely and emphatically expressed concern for their pediatric patient population, with apparent sincerity. But the quasi-religious zealotry I observed provides a weak foundation for a medical movement that seeks to care for a population of psychically unwell teenagers by subjecting them to drastic and permanent physical alterations. And it’s hardly possible to dispassionately weigh the risk versus benefits of these medical interventions when an unfalsifiable mode of new-age spirituality is pressing its finger on the scale. 

But a blindness to one’s own hypocrisy has always been the defining feature of the woke movement. So it’s no surprise that these medical radicals have proved incapable of self-correction, and that external political forces have stepped in to smash the precious temple they’ve built. 

But the consensus was always a mirage — and this week, at least among major US medical groups, it officially vanished.

On Tuesday, the American Society of Plastic Surgeons came out in opposition to providing gender-transition surgeries to minors. The recommendation, the first of its kind from a mainstream medical association, was published in a nine-page policy statement that marks a watershed moment in these debates. It’s part of a broader rethink among many experts, a reminder that science can trump ideology when investigators follow time-tested, evidence-based processes.

To wit, the ASPS examined the thorny cross-section of scientific research and medical ethics that inform the question of whether to provide gender-transition interventions for minors. After considering the weakness of the relevant scientific evidence and the balance of risks versus benefits, the organization urged its 11,000 members to delay gender-transition surgeries — including breast removal and augmentation, penis inversions, and facial-feminization surgery — until patients reach age 19. 

The document — which, while addressed to plastic surgeons, is not a clinical-practice guideline — also cautions that the prospect of treating gender distress in minors with blockers and hormones raises serious ethical concerns due to the shaky state of the supporting science, the challenges of procuring  minors’ informed consent, and the irreversibility of hormones in particular.

While supporters of gender-transition surgeries often falsely characterize them as rare, approximately 1,000 minors received such interventions annually in recent years — overwhelmingly mastectomies for girls who identify as male or nonbinary.

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The ASPS’s position is grounded in systematic literature reviews — the gold standard of scientific evidence — and pays deference to Britain’s  mammoth Cass Review of the field. Accordingly, the document validates the evidence-based-medicine approach to this discipline advocated by the quietly influential — and much-maligned by transgender activists — Society for Evidence-Based Medicine. 

The policy document points to widely debated and criticized research that has suggested that, absent a gender transition, most youths with gender dysphoria will grow out of it. It goes on to point out that even highly experienced clinicians are unable to reliably predict which adolescent patients will persist in their gender-related distress. It then tips its hat to the massive report on pediatric gender medicine commissioned by the US Department of Health and Human Services, which was published in its final form in November and has been roundly dismissed as politically tainted, biased and therefore irrelevant by transgender advocates.

The ASPS continues: “The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and nonmaleficence (i.e., promoting health and well-being while avoiding harm) requires a precautionary approach.”

Those bold assertions are all but guaranteed to enrage and demoralize transgender activists, especially given that this policy statement arrives amid attacks on pediatric gender medicine by the Trump administration as well as a larger fracturing of the global elite consensus about pediatric gender medicine. The cracks have fast expanded after multiple systematic literature reviews found that the evidence backing the benefits of giving gender-transition interventions to minors is weak and uncertain. 

Health authorities in a swath of European nations and the ruling Labour party in Britain sharply restricted minors’ access to gender-transition interventions. In the United States, just more than half of states, all of them red, have banned these practices. And on Friday, a jury in Westchester County awarded $2 million in damages to a detransitioner after her attorney convinced a jury that her psychologist and plastic surgeon had deviated from best practices and harmed her by removing her breasts when she was 16 years old. It was a landmark case — the first decision of its kind — and is expected to serve as a catalyst for others.

The ASPS’s position statement calls into question the logic pushed by many transgender activists that patient autonomy should be paramount  — even absolute — among minors seeking these interventions. The document states that “patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk-benefit profile.” 

Wading into the policy debate, the ASPS asserted that it opposed the criminalization of gender-transition interventions for young people and other “punitive legislative approaches.” A few states — Idaho, Oklahoma and Florida among them — impose such harsh criminal penalties. And yet, the ASPS stopped short of explicitly opposing bans that impose only civil consequences, which comprise the vast majority of state bans on pediatric gender medicine.  

The ASPS policy document’s age cut-off of 19 for surgeries puts the ASPS in line with policies of the Trump administration as it has engaged in a whole-of-government assault on what remains of the pediatric gender medicine field. 

Yet leaders at the ASPS saw the new recommendations as necessary. Dr. Scot Glasberg is a plastic surgeon in private practice in New York and a past ASPS president. He was not directly involved with the new policy statement but said he was intimately familiar with its development. He said the organization selected age 19 as a cutoff because by that point young people are safely out of puberty. 

“This entire statement revolves around a vulnerable population,” Glasberg told UnHerd. “The ages of development are key.” And given the weakness of the evidence base, he continued, “we felt it would be best to recommend to wait until the age of 19” to allow young people time to mature. 

Facing what is sure to be considerable backlash from liberal groups and transgender advocates, Glasberg asserted that the ASPS’s work on this document was fully independent of the Trump administration. “We have the beauty as an organization to be out of the line of politics,” Glasberg said. “We deal with science and evidence and data, and that’s why we made the decision we did.”

The ASPS had telegraphed its discomfort with gender-transition interventions for minors during the Biden administration. In August 2024, the organization made clear that it did not endorse such practices. The organization’s president at the time, California plastic surgeon Dr. Steven Williams, said in an Instagram live interview the following month that he wouldn’t commit to the ASPS coming out in opposition to those bans.

Yet major LGBTQ and liberal nonprofits, including GLAAD, the Human Rights Campaign, and the ACLU, have continued to routinely make the false claim that all major medical organizations endorse what they call gender-affirming care for minors. 

As recently as December, the ACLU made this claim in a statement about its efforts to combat the Trump administration’s threats to strip Medicaid funding from hospitals that provide gender-transition interventions to patients under age 19. The ACLU release stated: “The administration’s proposal seeks to block the provision of evidence-based, medically necessary care for transgender people under 18 — care that is supported by every major medical association in the United States, including the American Medical Association and the American Academy of Pediatrics.”

After UnHerd challenged the ACLU over the veracity of its statement, a representative replied: “The ASPS opposes bans on gender-affirming medical care, like those the ACLU has challenged in court, so your claim is misleading at best.” Contacted for further comment after the ASPS released its new policy statement, the ACLU didn’t reply. GLAAD and HRC also didn’t reply to a request for comment.

The ASPS’s policy statement is already providing ample fodder for the legal profession.

Alabama Attorney General Steve Marshall, who has tangled with the ACLU in court, was eager to provide a comment. “For years, legal advocacy groups like the ACLU have worked hand-in-hand with medical interest groups,” he said, “to manufacture a narrative for use in court that providing sex-change procedures to children is medically necessary and recommended by every major medical organization,” he told UnHerd. “The claim has always been false, and I am glad that responsible medical organizations are finally beginning to put patient safety and evidence-based review ahead of ideology.”

 Legal experts said the ASPS appeared eager to ward off attempts by litigators to leverage its new policy document in detransitioner lawsuits against plastic surgeons. More than two dozen suits have been filed by such plaintiffs so far, including some that, like the case that won the judgment in Westchester on Friday, include a plastic-surgeon defendant. 

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 A critical statement in the ASPS document reads: “This position statement is not a retroactive judgment, but a forward-looking response to evolving evidence.”

 Yet Charles LiMandri — a partner at the California law firm LiMandri and Johnna, which is behind two of the most famous detransitioner lawsuits — still sees an opening. “What the opposition has always said,” LiMandri told UnHerd, is that pediatric gender medicine “is evidence-based medicine, and that the science was settled and supportive. Those were lies.” He continued: “The fact that people are coming out now and saying there never was good science to support this proves those were lies. So in one sense they could say, ‘Well, the new ASPS standards can’t be applied retroactively.’ But on the other hand, they can’t deny the fact that if there’s no evidence for it now, there never was. And they said there was.” 

 Adam Deutsch, a personal-injury attorney in White Plains who represented the plaintiff in the detransitioner lawsuit, referenced the difference, dissected during the three-week trial, between the 16-year-old girl’s desire for surgery and the responsibility of the care providers to determine whether it was in a minor’s best interest. He said that the ASPS position statement validated his successful effort to point the finger at the defendants.

 Deutsch noted another element of the policy document that dovetailed with his client’s lawsuit: what he interpreted as the ASPS asserting that plastic surgeons needed to conduct their own due diligence when screening patients and not merely rely on the independent word of a referring mental-health professional. 

The attorney suggested that the ASPS might be putting more doctors on notice than just those who care for minors. He said he thought such a position by the ASPS would place greater pressure on surgeons when considering performing gender-transition surgeries on adults, as well. 

The once-impenetrable edifice of gender activism is beginning to crumble.

Then, on Monday, Aaron Sibarium of the Free Beacon reported that the FBI is investigating a series of social-media posts published in advance of Kirk’s assassination that “appeared to indicate foreknowledge” of the shooting. Several of those accounts appear to be run by transgender individuals, and at least one of them apparently followed Robinson’s trans roommate on TikTok, Sibarium reported.

Among the most hyperbolic polemics on the Right about this quickly shifting story are those from Daily Wire pundit Matt Walsh, who took to X over the weekend to declare: “Transgenderism is a death cult.” He added that “trans militants” are “inherently violent” and insisted that the “threat they pose is very serious.” Then there was Donald Trump Jr., who before the shooter was identified, said in an interview with Fox News, “I can’t frankly name a mass shooting in the last year or two in America that wasn’t committed by a transgender lunatic that’s been pumped up on probably hormones since they were 3-year-olds.” (Donald Jr.’s grasp of the age a minor might start hormone therapy, even at the outer limits, is wildly inaccurate.)

It’s obviously tempting for some on the Right to claim Kirk’s murder as a general indictment of trans people — and equally, for their opponents on the Left, to fervently deny any connection between violence and trans identities. A better society, however, would tread carefully. Science on trans issues has indeed been politicised, not least by trans activists, but this is no reason to give up on it. Everyone is left poorer by each side’s rigidity and refusal to examine the facts.

Let’s start with the claim that transgender people are more likely to be mass shooters. Such figures are difficult to assess, since comparisons depend on a morass of diffuse and distortable data, including the definition of mass shooting and the size of the trans population. In fact, Kirk’s last words — “Including gang violence?” — addressed the issue of how difficult it is to define these matters, in response to a question from a student at Utah Valley University.

Assessing the per capita mass-shooting rate for trans people is also challenging, given the increasingly broad definition of what it means to be transgender and the inability for authorities to determine each shooter’s gender identity; such uncertainty leaves the door open for both sides of this issue to juice the numbers in favour of their preferred conclusion. Also, the population of trans youth has been growing faster than data analysts can necessarily keep up.

Caveats aside, the day before Kirk’s assassination, PolitiFact, a nonpartisan fact-checking organisation, published an examination of the claim that trans people are disproportionately represented in the mass-shooter population and found no evidence to support it. PolitiFact examined Gun Violence Archive data and determined that seven out of 4,147, or 0.17%, of mass shootings since 2018 were committed by people with a trans or nonbinary identity.

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PolitiFact calculated the mass shootings tally fairly broadly, which means it both included gang-violence incidents as well as the shooting at the Annunciation Catholic School in Minneapolis in August, which resulted in two deaths not including the perpetrator. According to the Williams Institute at the University of California, Los Angeles, considered the most reliable source of such data, about 1% of the overall US population identifies as trans or nonbinary; and among adolescents and young adults, the figure is just above 3%. So simply comparing those admittedly very rough figures, the claim that there is a disproportionate mass-murder trend among trans people is not supported by the evidence.

Importantly, there have been no academic studies that have analysed the available data to produce an estimate of the per-capita rates of mass shootings among trans people versus other demographics.

As for what the psychological research shows about whether trans people are more prone to violence, there’s a similar dearth of information. Researchers such as Amy Tishelman, a psychology professor at Boston College and one of the leading experts in the care of young people with gender dysphoria, suggest the reverse is largely true. “Youth who identify as transgender are actually more likely to experience internalising symptoms — anxiety, depression — than externalising symptoms, including aggression and violence,” she told me.

A Finnish study published in 2021 did find that transgender youth were more likely to be both victims and perpetrators of bullying. But overwhelmingly, the available scholarship has established that this population is disproportionately victimised, subjected to physical violence, bullying, dating violence, and forced sex.

What is abundantly clear is that the quickly ballooning population of youths with gender dysphoria also typically suffer from a host of other major psychiatric conditions. A 2021 paper found that, compared with their siblings, trans youth receiving care from military services from 2010 to 2018 were five times as likely to have a mental-health diagnosis. A 2018 paper found 30% to 50% of trans and gender-questioning youth reported a recent suicide attempt, compared with 18% of girls and 10% of boys. And a 2015 study of a Boston community health center found that, compared with matched controls of youth who were not trans, trans youth were three to four times more likely to have been diagnosed with depression and anxiety, to have experienced suicidal ideation, and to have engaged in self-harm.

Irrespective of their gender identities, this is a remarkably troubled population of young people. And it is substantial. According to Leor Sapir, a senior fellow at the conservative Manhattan Institute, between 2017 and 2023, some 320,000 to 400,000 minors received a gender-dysphoria-related diagnosis.

Interpreting these research findings to address the question of any greater potential for violence moves into the realm of speculation. Tishelman raised the question of whether there is a certain stratum of people who are indeed prone to violence and who profess to be transgender but who are not in fact genuinely trans. The Minneapolis shooter, after all, confessed in a diary entry shortly before the incident to regretting transitioning. 

This line of thinking rests in part on the fact that the profile of youth with gender-related distress has undergone a sea change. A generation ago, cross-sex identification among minors was very rare, and the youth who presented to mental-health professionals with what was then known as gender-identity disorder had lower rates of other psychiatric diagnoses than what is seen today, according to research by Canadian psychologist Ken Zucker and his colleagues.

Since then, profound cultural shifts have taken place in swift succession. In 2007, Boston Children’s Hospital became the first American clinic to offer puberty blockers and cross-sex hormones to treat paediatric gender dysphoria. The Occupy Wall Street movement, in 2011, heralded the dawning of the social-justice-warrior era, which saw dramatically overhauled mores about sex and gender among progressives in particular. And during the early 2010s, children first became exposed to smartphone-based social media, opening them to a new realm of online identity exploration and expression as well as myriad unprecedented hazards.

As psychologist Erica Anderson, who specialises in caring for youth with gender dysphoria, told me, “It changed from kids that I saw as likely persistently trans, and who didn’t have flagrant coexisting psychiatric problems, to a heterogeneity of cases and kids who clearly had psychiatric issues that needed, in my opinion, to be treated before we could sort out the gender issues.” She continued: “The appropriation of the word trans has come to include people who would not have been characterised as trans 10 years ago and would not have been encouraged to medicalise.” 

Almost all of the trans shooters included in the PolitiFact tally were under 30 and thus part of the surge in trans identification among youths that began in the early 2010s. 

All this is to say that while we obviously have a mass-shooter problem, there is no clear scientific basis to argue that it is a trans mass-shooter problem. There are too many other complicating factors at play.

Leading researchers have been eager to sweepingly blame the poor mental health of gender-dysphoric people on what’s known as minority stress, or the suffering spawned by stigma and mistreatment regarding an individual’s trans identity. This theory is similar to many others that color the progressive approach to societal problems: that external, or so-called structural, factors are overwhelmingly, or exclusively, to blame for disparate negative outcomes among disadvantaged populations. 

When applied to people with gender dysphoria, minority-stress theory is predicated on the notion that a trans identity is a fixed facet of the inner self and that hostility directed at that identity unidirectionally causes internal suffering. Leaders of the paediatric gender care field have fervently denied that trans identities are ever a product of social influence. 

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It may, however, be time to distinguish between the subgroups under the trans umbrella, and to acknowledge, as many detransitioners have attested, that factors outside of brain wiring could possibly lead some people to identify as transgender. Have some youth adopted a trans identity as part of a deeper psychopathology that is itself tied to violence? Is this identity misdirection being fuelled by an internet culture that foments violence and also intersects with spaces where young people cultivate their gender identities? Enterprising — and brave — researchers might consider addressing these admittedly hazardous questions.  

To do so could lend credence to a theory that is anathema in paediatric gender medicine: that for some, asserting a trans identity may be a maladaptive coping mechanism and a distraction from a deeper wellspring of psychological distress. If this is true, then at least in some cases, gender-transition treatment and surgeries might only exacerbate the individual’s struggles with mental health. 

“What’s totally unhelpful and unproductive, not to say petty and just false, is to say that anybody who identifies as trans is inherently a threat, and should be regarded as such,” Sapir told me. The question, he noted, is how to grapple with any possible connection between violence and a portion of the trans population without resorting to trans hatred. “To focus only on the people who actually pull the trigger, and not on all the systemic causes that enable and encourage that type of behaviour seems to be totally unhelpful,” Sapir said. 

Sapir faulted many trans activists for being what he called “agents of pessimism.” These activists, he said, tell their followers, “‘Your life sucks, the world hates you.’” Even amid aggressive pushback by the Trump administration against the goals of transgender activism, Sapir insisted such messaging is hyperbolic and that it could be radicalising.

Psychologist Erica Anderson added that when it comes to transgender issues, “too much of the chatter online is polemical, over-generalises, and demonises ‘the other side.’” She expressed concern that “someone who is seeing themselves as a victim and feels that they have an identified enemy may be more likely to lash out.”

Trans activists would no doubt characterise such a view as blaming the victim. However, the one thing science — and the epidemic of mass shootings of all types tell us — is that we have a generation of youth, trans and otherwise, in desperate need of better care. We should not be afraid to ask questions and answer them diligently with science in service of protecting both their well-being and society at large. 

Yet in response to ferocious pressure from trans activists, Guyatt disavowed his research team’s besieged funder; explicitly denounced the use of his work to justify bans of these controversial interventions; and contradicted his own findings about the evidence base. Given Guyatt’s academic prowess, his recent about-face has stunned critics of pediatric gender medicine. (Guyatt declined my requests for comment.)

Guyatt’s capitulation follows a concerted campaign by transgender activists to smear the trio of systematic reviews that his team recently published, suggesting Left-wing cancel culture still poses a threat to academic freedom and free inquiry where pediatric gender medicine is concerned. 

Evidence-based medicine is a revolutionary meta-scientific discipline that has sought to synthesize the analysis of research findings. The goal is to determine the quality of evidence about any particular medical practice, support more precise and transparent treatment guidelines, and ultimately improve clinical decision-making. The legitimacy of the field depends, at least in part, on academics’ independence and detachment from the political fray.

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This year, the McMaster team published the first three of five systematic reviews on gender-transition interventions for youths: on puberty blockers, cross-sex hormones, and gender-transition mastectomies. While the mastectomy review was the first of its kind, the others were but the latest in a solemn parade of such reviews by researchers across the Western world. McMaster concluded that the evidence in all three treatment areas was weak and uncertain. Similar findings from researchers across the Atlantic have prompted health authorities in a swath of European nations to sharply restrict minors’ access to gender-transition treatments. 

Guyatt’s research was funded by the US-based Society of Evidence-Based Gender Medicine, a group founded in 2019 with a mission to scrutinize the scientific evidence backing gender-transition interventions for youths. As determined by academics in a 2024 systematic review commissioned to support the Cass Review of pediatric gender medicine in Britain, this field is sorely lacking for guidelines that pass evidence-based muster. SEGM sought to help fill that void. In 2021, it commissioned the systematic reviews from Guyatt’s team at McMaster; the project was headed by Dr. Romina Brignardello-Peterson, an associate professor of health-research methods. 

In North America, SEGM has prompted skepticism about the safety, efficacy, and ethics of these interventions. Recognizing the nonprofit’s mounting influence, trans activists have campaigned to poison its reputation. In December 2023, the Southern Poverty Law Center released a report about a supposed “pseudoscientific” network of anti-LGBTQ groups, including SEGM, that sought to harm trans youth. The report sought to tie SEGM to funding streams that also back conservative anti-LGBT organizations. But the allegations were misleading, given that these were generic donor advisory funds that, as it happens, also channel millions of dollars in donations to SPLC itself; the SPLC officially designated SEGM a hate group in June 2024, which catalyzed the activist uprising against Guyatt’s team.

Guyatt caved. On Aug. 14, he and four of his colleagues published a statement on McMaster’s website in which they disavowed SEGM. “When the agreement started in 2021, the organization appeared,” they tersely wrote, “to be legitimately evidence-based.” They offered no evidence to back this cryptic take-down. The McMaster team also lamented how its own work was being “misused to harm trans youth,” calling it “unconscionable to forbid clinicians” to provide such interventions.

Dr. Steven Montante, a plastic surgeon in Richmond, Va., was among the four review-paper coauthors who didn’t sign the statement. “I don’t necessarily agree that he has the authority to dictate” how his work is used, he said of Guyatt. “To be so prescriptive waters down the notion of why we do these systematic reviews, and the notion of evidence-based medicine. There should be some level of detachment.”

“Why didn’t the institution defend the science?” said Dr. Paul Garner, an emeritus professor of evidence synthesis in global health at Liverpool School of Tropical Medicine. “I see this is an institutional failure.” He added: “This is obviously a toxic ideological area.” 

Montante and other sources with knowledge of Guyatt’s team told me that the statement was a direct response to activist pressure. The activist campaign was driven in part by an incendiary, anonymous Instagram account that targeted the researchers and their ties to SEGM and demanded retractions of the review papers. The social-media posts featured videos of activists confronting Guyatt and Brignardello-Peterson and, in a dubious reference to the SPLC report, claiming that SEGM “shares funding streams with US white-nationalist organizations and lobbies for discrimination against, and ultimately extermination of, trans people.” Eventually, the researchers came under mounting internal pressure, as well, from trans advocates at McMaster and university administrators, Montante and other sources told me. 

The pressure campaign spilled into broader view on July 12, when a group of physicians and academics, including one from McMaster, published an editorial in the university’s local paper denouncing the Guyatt team’s work as “pseudoscience,” absent any direct evidence. The editorial relied on the same brand of guilt-by-association that SPLC levied against SEGM’s supposed ties to anti-LGBTQ conservative groups. 

Speaking anonymously for fear of reputational harm, a number of evidence-based-medicine experts told me that by crumbling in the face of activist pressure, Guyatt in particular called into question his capacity to provide dispassionate analyses about any scientific subject. Critics also expressed astonishment that Guyatt’s team announced it had made a donation to Egale Canada, which calls itself “Canada’s leading organization for 2SLGBTQI people and issues” and calls gender-transition treatment “life-saving.” This is not an evidence-based claim, and some experts told me such tithing represents a brazen conflict of interest. Also egregious, experts told me, was the McMaster statement’s use of activist rhetoric. This includes characterizing gender-transition treatment as “medically necessary,” despite the team’s own conclusions that the efficacy of these treatments remains essentially unknown. 

In 2023, when Guyatt sat on a panel at SEGM’s conference in New York, he sounded a different note. Asked whether it was acceptable to call pediatric gender medicine “life-saving” and “medically necessary” when it’s backed only by low-quality evidence, he said: “Of course not.” The rational approach, he said, would be “not to say it’s medically necessary, it’s to say we are putting an extremely high value on autonomy.” Indeed, the recent statement from Guyatt’s team asserted that when a treatment is backed by low or very low certainty evidence then the “high respect for autonomy becomes particularly important.”

Conservative US policymakers have argued that if doctors fail to self-police and protect children from themselves, the state is justified in stepping in. On a July 30 call, according to Montante, Guyatt expressed his unhappiness that his team’s papers had been cited in a US Department of Health and Human Services report on pediatric gender medicine. Published in May, the report concluded that the known and potential harms of these medical interventions were so concerning that providing them was unethical. 

Another inside source said that administrators told Guyatt’s team that if they didn’t distance themselves from SEGM, they’d risk being branded unfriendly to LGBTQ interests and thus might lose funding opportunities from the Canadian Institutes of Health Research. 

Montante provided me with emails that Brignardello-Peterson, the leader of the SEGM-commissioned reviews, sent in February on her and Guyatt’s behalf to the review authors. Expressing unhappiness that “our work is being misused and may be causing harm,” the pair proposed adding a paragraph to all the reviews’ conclusions emphasizing the importance of patient autonomy and denouncing policies restricting medical interventions. When Montante’s objected that such a post-hoc edit “may undermine the research,” they scrapped that idea. Instead, they proposed sending a letter to the editor to the journals that had published their reviews, which Montante and three others declined to sign and that was similar to the statement ultimately published in August. 

More recently, Brignardello-Peterson and Guyatt have sought to divorce themselves from two reviews nearing publication. This includes a paper on social transitions (changing names, pronouns, style of dress), and another on binding breasts and “tucking” the penis and scrotum. Montante, who is a co-author of the latter pending paper, said the McMaster team wants a wholesale abandonment of authorship, leaving only him and one other co-author, an independent researcher. Such a sweeping disavowal of prominent, nearly published scholarship is extremely unusual in academia.

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According to sources close to the matter, McMaster also sought to cancel various independent commissions that individual university researchers received from SEGM. This has jettisoned, for example, years of work on an evaluation of the influential trans-care guidelines for adolescents published in 2022 by the World Professional Association for Transgender Health. The outstanding systematic reviews, Montante insisted, should be published. “Let the work stand for itself,” he said. Of his many dealings with SEGM, he said: “I’ve never gotten any kind of vibe or any kind of perception that this was some kind of anti-trans group.”

In a recent interview, Guyatt said he had evidence that SEGM at least effectively supported bans of pediatric gender medicine. But he failed to produce any such evidence. Otherwise, Guyatt made clear that he’d prioritized protecting his reputation in the eyes of one faction of the gender-medicine war rather than adhering to the principles of academic freedom. Regardless of the truth, he said, he had to cut ties with SEGM because associating with a group with such a toxic reputation meant getting “tarred and feathered.”

In a statement, SEGM co-founder Zhenya Abbruzzese said, “SEGM and Dr. Guyatt have had a longstanding but collegial debate about the role of child autonomy in gender medicine.” Nevertheless, the nonprofit’s collaboration with his team, she said, had been “grounded in mutual respect.” Expressing disappointment that the academics had yielded to activist pressure, Abbruzzese added: “Young people experiencing gender dysphoria deserve evidence-based care.”

Bringing Guyatt to heel is but the latest chapter in a history of campaigns to attack the reputations of academics who threaten trans activists’ ambitions where children are concerned. In one notable pile-on, Michael Bailey, a pioneering psychology professor at Northwestern University, saw his 2023 paper on “rapid-onset gender dysphoria” subjected to an avalanche of scorn from trans activists and activist-academics. They ultimately succeeded in getting the paper retracted due to what Bailey insisted was unwarranted censorship based on a mere pretext. 

“I have some regrets in life, but my unwillingness to buckle under ideological pressure like Dr. Guyatt did isn’t one of them,” said Bailey, who republished his paper elsewhere. “Indeed, it’s one of the things I’m proudest of.” Such bravery remains rare, and is invaluable to defend academic freedom in a field in desperate need of better research.