A group of 21 doctors from countries around the world wrote publicly on Thursday that the ongoing push to provide young children with transgender “transition” procedures is unsupported by current evidence and that medical officials should shift their approaches to managing youth gender dysphoria. 

The open letter, published in the Wall Street Journal on July 13, responded to a June letter in the Journal by Endocrine Society President Stephen Hammes.

In that letter, Hammes claimed that transgender medical treatment “improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.” Hammes referred to “lifesaving gender-affirming care,” which often involves the use of synthetic hormones and irreversible surgeries on reproductive organs, sometimes for children younger than the age of 18. 

In their response this week, the group of clinicians and researchers — from countries including Finland, France, South Africa, and the United States — argued that the risks of cross-sex hormone usage for youths “are significant and include sterility, lifelong dependence on medication, and the anguish of regret.”

A number of European authorities and international medical groups “now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth,” the doctors wrote. 

The writers urged medical societies in the U.S. to “align their recommendations with the best available evidence” rather than “exaggerating the benefits and minimizing the risks.”

Among the signatories to the letter include Anne Wæhre, a senior consultant at Norway’s Oslo University Hospital. Norway is among the European countries that have recently pulled back on offering extreme transgender treatment to youth, with the country’s Healthcare Investigation Board earlier this year demanding that Norway revise its guidelines for surgeries and hormone treatment for transgender-identifying children. 

Several French doctors also signed the letter, including Picardy Jules Verne University professor Celine Masson. France’s National Academy of Medicine said in a statement last year that “a great medical caution must be taken in children and adolescents” who claim to identify as the opposite sex. 

The “greatest reserve” is required for the usage of hormones in young children, the academy said, pointing to side effects “such as impact on growth, bone fragility, risk of sterility, emotional and intellectual consequences and, for girls, symptoms reminiscent of menopause.”

In the U.S., some researchers have attempted to explain the explosion in transgender-identifying youths around the country and the world. In 2018, Lisa Littman, then an adjunct professor at Icahn School of Medicine at Mount Sinai, authored a controversial report on the phenomenon of what she deemed “rapid onset of gender dysphoria.” 

Littman in the report characterized the condition as an “onset of gender dysphoria” that “seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same time frame.”

Major U.S. authorities, on the other hand, have publicly supported extreme youth transgender treatments, including the federal government. The U.S. Department of Health and Human Services’ Office for Civil Rights, for instance, claimed in a press release last year that “gender-affirming care for minors” can “improv[e] their physical and mental health.”