Global Perspectives on Youth Gender Distress: SEGM 2025 Conference Report
By: Anne Wæhre, MD, PhD1, Florian Daniel Zepf, MD, FRANZCP2, Martin Feichtinger, MD3, Mikael Scott Bjerkeli4 and Riittakerttu Kaltiala, MD, PhD, BSc5
1Senior Consultant, Head, National Treatment Service for Gender Incongruence Children and Adolescents, Oslo University Hospital Norway, 2Professor/Chair & Clinical Director, Dept. of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany & German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany, 3Child & Adolescent Psychiatrist in private practice, Erfurt, Germany, 4Executive Director, Harry Benjamin Resource Center, Oslo, Norway and 5Professor of Adolescent Psychiatry, Tampere University; Chief Psychiatrist, Department of Adolescent Psychiatry, Tampere University Hospital, Finland
This September 11-14, 2025, the Society for Evidence-Based Gender Medicine (SEGM) hosted a conference in Berlin on the theme of Youth Gender Distress: Evidence, Etiologies, Ethics, and Psychotherapeutic Practice. This conference brought together speakers and attendees from 24 countries, spanning the globe from Norway to Chile to Singapore to South Africa, and was opened by the President of the German Medical Association, Dr. Klaus Reinhardt.
The conference took place at a pivotal moment in the field of pediatric gender medicine, particularly as countries such as Finland, Sweden, and the United Kingdom have conducted systematic reviews of hormonal and surgical interventions for adolescents with gender dysphoria.These reviews found weak evidence for the expected benefits to mental health, functioning and quality of life, along with accumulating evidence of significant risk of harm. As a result, these countries now take a more cautious approach to hormonal and surgical interventions, emphasizing comprehensive assessment and developmentally-informed psychotherapeutic approaches as first-line interventions. In other countries, it is unclear which way clinical practice in this area will evolve.
The conference provided a rare forum for researchers and clinicians to grapple with the unanswered questions that sit at the heart of pediatric gender medicine. We still do not know the natural history of gender dysphoria in youth; nor how to determine which young people may benefit from transition and which may be harmed; nor the long-term outcomes for those who undergo hormonal and surgical interventions; nor whether young people whose self-understandings are still developing can consent to interventions that may profoundly alter their bodies, sexual function, fertility, and life trajectories before they fully grasp the lifelong implications of these interventions.
In his opening remarks, SEGM President Roberto D’Angelo clarified the organization’s mission, stating that “[w]hen it comes to children and young people, our approach is both compassionate and cautious. We take their experiences of gender distress seriously, acknowledging the profound suffering many endure.”
“At the same time, we recognize their developmental stage—their still-evolving capacities for critical thinking, self-reflection, and decision-making in the context of complex social and cultural influences. Our mission is to ensure that the care provided to young people respects their humanity, supports their unique developmental journey, and minimizes the risk of irreversible harm. We reject the false narrative that questioning medical interventions equates to denying identities or causing harm. On the contrary, our commitment to evidence is about safeguarding the health and futures of those who are still growing into themselves.”
On the first day, speakers provided an overview of the evolution of pediatric gender medicine over time, starting with its origins at the VUMC in Amsterdam, the Netherlands, where clinicians—who were concerned that their adult transsexual patients continued to struggle post-transition—hoped that intervening earlier would produce better long-term outcomes. This model, which proceeds from puberty suppression in early adolescence to cross-sex hormones and surgeries, became known as the ‘Dutch protocol’ and was rapidly disseminated around the world on thin evidence of the claimed mental health and quality of life benefits. Speakers then presented systematic reviews of the evidence for social transition, binding and tucking, puberty suppression, the administration of cross-sex hormones, and surgical interventions, as well as presenting new research on detransition and desistance (when young people decide to discontinue or reverse transition) and discussing opportunities for future research. The first day concluded with remarks from Maja Radobuljac, who spoke on behalf of the European Society for Child and Adolescent Psychiatry’s (ESCAP) Policy division, and a panel discussion among senior clinicians who reflected on how the field has changed over time.
On the second day, the focus shifted from the evidence underlying pediatric gender transition to etiologies of gender dysphoria. This included an in-depth exploration of identity development in adolescence, autism spectrum disorders, the role of online communities in shaping youth expectations and intentions for transition, as well as the interplay between gender identity development and sexual development, with a particular focus on young people who may otherwise grow up to be same-sex attracted coming to understand themselves in the framework of a transgender identity instead.
The third day opened with a panel conversation about the ways activist pressure has suppressed scientific inquiry, research, and reporting within this contested field. The day then shifted to ethical considerations in pediatric gender medicine, including a discussion of the role of assessment, adolescent decision-making capacity, a debate over what supporting autonomy of the affected young person means when these people are still in a process of development, and an examination of the ways ethical justifications for the provision of gender-affirming interventions have shifted over time as the absence of evidence of benefit became clear. Dr. Kathleen Stock closed the day with a keynote address on what she termed the “strong informed consent model,” which takes patient values and preferences as paramount and upends the traditional charge of medicine: to do no harm, and to improve the health and wellbeing of patients.
The fourth and final day, focused on psychotherapeutic approaches to youth gender distress. Speakers provided developmentally-informed approaches to helping young people and their families navigate gender issues. The scientific programme concluded with a debate on competing diagnostic frameworks to interpret and approach gender-related distress in childhood and adolescence.
The ethical practice of medicine necessitates open dialogue and constructive disagreement. This area of medicine—which concerns a particularly vulnerable group of young people—has suffered from the lack of such dialogue. In the weeks leading up to the conference, activists in Berlin organized to disrupt the proceedings, vowing to “stress” the conference and singling out speakers for targeted harassment. At the end, the attempt of activists to shut down the conference only underscores the need for forums like the ones the Society for Evidence-Based Gender Medicine provides—spaces where evidence can be scrutinized, diverse perspectives considered, and solutions proposed and pursued.
This article represents the view of its author(s) and does not necessarily represent the view of the IACAPAP's bureau or executive committee.
