The Partial Observer by Dr. William Malone

When Ideology Suppresses Medical Evidence, Patients Pay the Price

Something unusual is happening in medicine. A once-rare diagnosis—gender dysphoria—has become common among American children. An estimated 3 percent of youth now identify as transgender, and another 2 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 healthcare.

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 health authorities in Sweden, Finland, and the UK—as well as recent North American reviews—have concluded that the benefits are uncertain. 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 United States, questioning the evidence can bring reputational risk. Researchers and clinicians who raise concerns are often accused of bias or bigotry.

The pressure on researchers has been intense. The World Professional Association for Transgender Health, 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—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 papers out of fear. One described the experience as “terrifying.”

Such episodes erode trust in the scientific process. 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 material underwent months of review. It cleared every hurdle: conflict-of-interest checks, content review, and accreditation under the rigorous standards of the Accreditation Council for Continuing Medical Education. Then activists discovered it. Online campaigns followed. Almost immediately, the ACCME launched an investigation. The course has been removed.

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. Major CME databases contain dozens of courses promoting “gender-affirming care” but almost none that critically examine the evidence or describe the European shift toward restraint.

This imbalance does not serve patients. 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.

The stakes extend beyond one 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. 

Dr. William Malone is a board-certified endocrinologist and a co-founder of the Society for Evidence-Based Gender Medicine. This piece was originally featured on KevinMD.com.