Alarmed by a lack of research, governments in Europe and conservative-led states in the U.S. are moving to limit gender medical treatments for children.
Last week, the Florida Board of Medicine and the state Board of Osteopathic Medicine approved a ban on puberty blockers, cross-sex hormones, and surgeries to treat gender dysphoria in children.
Dr. Joseph Ladapo, the state's surgeon general commended the decision. "I appreciate the integrity of the Boards for ruling in the best interests of children in Florida despite facing tremendous pressure to permit these unproven and risky treatments," he said.
Other states, like Arkansas, Alabama, and Tennessee are moving in a similar direction.
England's National Health Service (NHS) took an even more aggressive approach in late October, warning that doctors should be mindful that gender dysphoria can be "transient" and severely limiting the use of puberty blockers and cross-sex hormones.
The NHS change follows similar shifts by the governments of Finland and Sweden.
"It's a seismic shift," said Dr. Joseph Burgo, a therapist, and leader with the Gender Exploratory Therapy Association.
Burgo said the NHS guidance cautioning against social transition was especially critical.
"The most important thing they've said is that social transition is not a neutral act. It's an intervention and it has potentially disastrous consequences so it shouldn't be the first-line approach," he said.
The guidance noted "scarce and inconclusive evidence" to inform medical interventions for children in these cases, citing findings by the Cass review, an independent medical investigation commissioned by the NHS in 2020.
The NHS is now moving towards more regional and holistic care for gender dysphoric youth, as it acknowledges a sharp rise in cases from less than 300 ten years ago to more than 5,000 last year alone.
Most are girls who identify as boys.
Experts are noting similar trends in the U.S., with a new study showing 300,000 teenagers that identify as transgender and the number of surgeries spiking close to 400 percent between 2016 and 2019.
Eighteen-year-old Chloe Cole is speaking out against the medicalization of youth. She regrets her surgery.
"I was only 12 years old when I told my parents that I was a boy," she said at a Capitol Hill rally in September. "At 15 I went under the knife for a radical double mastectomy, the kind that breast patients get."
In the US, top medical organizations like the American Academy of Pediatrics, the American Medical Association, and the Children's Hospital Association continue to support what's known as gender-affirming care, which encourages medical treatments.
They even called on Attorney General Merrick Garland in early October to investigate not only bomb threats against pediatric gender care clinics but what they called "an intentional campaign of disinformation" on social media platforms.
These organizations maintain that gender-affirming care is "evidence-based" despite concerns in the U.K., Finland, and Sweden as well as objections raised by professional groups in the US.
The newly formed Society for Evidence-Based Medicine emphasizes "the lack of quality evidence for the use of hormonal and surgical interventions as first-line treatment for young people with gender dysphoria."
Similarly, the Gender Exploratory Therapy Association is calling for therapists to be able to practice meaningful exploration with gender-distressed clients and not serve merely as facilitators for patients seeking hormones and surgery.