In fact, repeated medical studies undercut the narrative that puberty blockers, hormones, and surgeries are the best means of caring for dysphoric children.

The New England Journal of Medicine continues to besmirch its once august reputation by pushing ideology rather than medical science when discussing our nation’s most contentious social issues. This is particularly true about so-called gender-affirming care for minors experiencing gender confusion. Even as repeated medical studies undercut the ideological narrative that puberty blockers, hormones, and even surgeries are the best means of caring for dysphoric children — and as country after country severely restricted those interventions — (with the exception of an unsubstantive criticism of the Cass Review) articles in the NEJM on the question usually pretend that the pushback never happened.

Now, the editors have done it again, publishing an article by Scott Skinner-Thompson, an LGBT activist law professor from the University of Colorado, Boulder, criticizing the Supreme Court for allowing Tennessee to legally prevent such interventions in children. The pretense begins with the headline, “The Faulty Logic behind the Supreme Court’s Failure to Protect Trans Minors.” To the contrary, Tennessee and other jurisdictions that have enacted such laws have done so to protect trans minors from potentially irreversible harm, in the knowledge that most gender dysphoric minors overcome their confusion by the time they reach adulthood.

Then, Skinner-Thompson leans on clearly ideological opinions by medical associations, despite at least one of which (WPATH) having been substantively discredited:

On June 18, 2025, the U.S. Supreme Court upheld Tennessee’s ban on gender-affirming hormonal treatment for transgender minors against an Equal Protection Clause challenge in United States v. Skrmetti. Transgender adolescents who need these medical interventions but live in one of the many states that ban them may need to look elsewhere for care. Nearly every major relevant U.S. health care organization has concluded that the prescription of hormones and puberty blockers for treating gender dysphoria in transgender adolescents is often medically appropriate in that it can improve mental health and well-being, whereas untreated gender dysphoria can lead to depression, anxiety, and suicidality.”

But that is quickly becoming the minority position — or at the very least, certainly does not qualify as a settled issue. For example, much of Western Europe has turned against gender-affirming care, and an increasing number of studies show a lack of evidence for benefit and plenty of proof of potential harm. At most, the questions presented are highly uncertain, as indicated in a recently published study of studies in The Archives of Childhood Diseases:

Results We included 10 studies. Comparative observational studies (n=3), comparing puberty blockers versus no puberty blockers, provided very low certainty of evidence on the outcomes of global function and depression. Before–after studies (n=7) provided very low certainty of evidence addressing gender dysphoria, global function, depression, and bone mineral density.

Conclusions There remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing GD. Methodologically rigorous prospective studies are needed to understand the effects of this intervention.

Typical of the ilk, the new NEJM article also fails to distinguish the use of these substances to treat a physical pathology experienced by a patient — for which blockers may be clearly medically appropriate — and to their use to assuage the subjective psychological feelings of a gender confused child by interfering with normal maturation (a tactic also deployed in dissent by Justice Sotomayer, who is quoted in the article). Skinner-Thompson also fails to mention that blocking normal puberty and administering cross-sex hormones can cause deleterious side effects such as loss of bone density and impaired memory.

Most of the rest of the article expresses Skinner-Thompson’s hope that further constitutional litigation about transgender issues will result in decisions more to his liking. Maybe so, maybe not. But it’s disingenuous not to at least acknowledge the scientific doubts about treating youthful gender dysphoria that not only persist but are growing.

But then, he’s an activist advocating for a cause in which he deeply believes. The editors of the NEJM — which is supposed to be a medical science journal — do not have that excuse. Allowing an author to ignore the strong body of contrary evidence and increasing doubts about these interventions undermines NEJM’s purpose in being, is contrary to the scientific method, and ill serves gender confused children on behalf of whom the editors believe they advocate.