Something unusual is happening in medicine. A once-rare diagnosis (gender dysphoria) has become common among American children and adolescents. An estimated three percent of youth now identify as transgender, and another two percent are questioning their gender identity. That surge should have prompted urgent, transparent scientific inquiry. Instead, the field of pediatric gender medicine has become one of the most ideologically-charged, and least open to critical debate, areas in modern health care.
In nearly every branch of medicine, new interventions undergo rigorous testing and transparent review before being widely administered to patients or incorporated into clinical practice guidelines. When evidence is limited, we acknowledge uncertainty and proceed cautiously. Yet gender medicine has taken a different path. Puberty blockers, cross-sex hormones, and, in some cases, surgeries are being offered to minors despite a striking lack of evidence on long-term safety or efficacy.
Systematic reviews commissioned by European health authorities in Sweden, Finland, and the U.K., as well as recent North American reviews, have all concluded that the benefits are uncertain at best. This prompted a growing number of European health authorities to state that psychological support and psychotherapy, rather than hormones and surgeries, should be the first-line approach. But in the U.S., questioning the evidence can bring reputational or professional risk. Researchers and clinicians who raise concerns are often accused of bias or bigotry. This atmosphere of intimidation discourages the kind of open inquiry on which medicine depends.
The pressure on researchers has been intense. The World Professional Association for Transgender Health (WPATH), which promotes gender transition of minors, commissioned the Johns Hopkins University Evidence-Based Practice Center to review the literature on pediatric gender medicine. When the findings reportedly failed to support WPATH’s assumptions that hormones and surgery are beneficial, the organization pressured Johns Hopkins not to publish the results.
A similar story unfolded when the Society for Evidence-Based Gender Medicine (SEGM) (a group I created alongside professionals united by the mission to improve the quality of research and its applications in the field of gender medicine) engaged McMaster University to conduct independent systematic reviews. Activists harassed the researchers, leading several to withdraw their names from their own papers out of fear. One described the experience as “terrifying” and “traumatizing.”
Such episodes don’t just affect academics; they erode trust in the scientific process itself. When data can be suppressed because the results are politically inconvenient, doctors and patients suffer.
This same pattern has now spread to continuing medical education (the mechanism by which practicing physicians stay informed). Earlier this year, SEGM, with Washington State University as the accredited provider, offered a CME series on evolving European approaches to treating pediatric gender dysphoria. The course brought together leading clinicians and researchers to discuss the evidence and how it should inform patient care. The material underwent months of review by WSU’s CME office. It cleared every hurdle: conflict-of-interest checks, content review, and accreditation under the rigorous standards of the Accreditation Council for Continuing Medical Education. The course went live without incident and remained available for months.
Then activists discovered it. Online campaigns followed. Almost immediately, the ACCME, the agency that certifies much of the U.S. continuing medical education content, launched an investigation. In a departure from normal procedure, the course has been removed under pressure in the meantime.
To those of us who teach or practice evidence-based medicine, this is alarming. A course that met every standard of scientific vetting was effectively canceled preemptively because it presented data that diverged from an activist political narrative.
Physician education isn’t a political exercise; it’s how clinicians keep up with emerging science. Suppressing accredited education narrows physicians’ access to balanced information and, ultimately, harms patients.
At present, major CME databases contain dozens of courses promoting “gender-affirming care” but almost none that critically examine the evidence base or describe the European shift toward restraint. Many contain demonstrably false claims that are no longer allowed in Europe. It is increasingly likely that American physicians only get to hear one side of the conversation, even as our international counterparts revise protocols to emphasize caution, mental-health assessment, and individualized care.
This imbalance does not serve patients. It risks reducing complex clinical questions to moral tests of allegiance, elevating politics over science.
Medicine’s strength lies in its self-correcting nature: Hypotheses are tested, challenged, and refined. When ideological conformity replaces that process, the result is stagnation, and potential harm.
Institutions must resist pressure to censor research that unsettles prevailing views. Young people struggling with gender dysphoria deserve care grounded in empathy and scientific integrity, not in activism or fear.
The stakes extend beyond this one field. If professional intimidation succeeds here, it will set a precedent for silencing debate in any field. The erosion of open scientific discourse harms everyone, regardless of viewpoint. We must reclaim the freedom to ask hard questions, analyze data critically, and teach the next generation to do the same. Evidence, not ideology, must guide care. Patients, families, and physicians all deserve nothing less.
William Malone is an endocrinologist.
