Kinnon MacKinnon, a Canadian researcher, was only faintly surprised this spring when the website for an upcoming conference did not list his talk alongside the dozens of others. He was slated to discuss one of the most fraught topics in medicine: patients who transition to a different gender but later change their minds, known as detransition.The Pediatric Endocrine Society, which organized the conference, said that his presentation was kept under wraps because of safety concerns; there were protests against gender medicine at the previous year’s gathering. When he gave the talk in a Chicago hotel ballroom, the audience was asked to submit questions anonymously, on notecards. No recording was allowed. The room, though full, was eerily quiet.Dr. MacKinnon, a 39-year-old assistant professor of social work at York University in Toronto, is transgender, and he presented alongside another trans researcher. As he took the microphone, he joked: “They really get the trans people in to talk about the easy topics, eh?”He’s gotten used to trying to defuse tension — at scientific meetings and gender clinics, and in TikTok posts — as detransition, a once-obscure topic, has vaulted into the U.S. presidential campaign and an upcoming Supreme Court case.A small group of detransitioners — mostly young women who underwent medical treatment to live as trans men, but later regretted it — have become the public faces of Republican-led bans on gender medicine for minors. In frequent testimonies in statehouses and appearances in right-wing media, they have described sometimes irreversible procedures they received while adolescents, arguing that they were misled or neglected by their doctors.Activists defending youth gender medicine have argued that such experiences are exceedingly rare, and that patients are much less likely to regret their transitions than to regret common medical procedures, like knee surgeries.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The leader of the long-running study said that the drugs did not improve mental health in children with gender distress and that the finding might be weaponized by opponents of the care.An influential doctor and advocate of adolescent gender treatments said she had not published a long-awaited study of puberty-blocking drugs because of the charged American political environment.The doctor, Johanna Olson-Kennedy, began the study in 2015 as part of a broader, multimillion-dollar federal project on transgender youth. She and colleagues recruited 95 children from across the country and gave them puberty blockers, which stave off the permanent physical changes — like breasts or a deepening voice — that could exacerbate their gender distress, known as dysphoria.The researchers followed the children for two years to see if the treatments improved their mental health. An older Dutch study had found that puberty blockers improved well-being, results that inspired clinics around the world to regularly prescribe the medications as part of what is now called gender-affirming care.But the American trial did not find a similar trend, Dr. Olson-Kennedy said in a wide-ranging interview. Puberty blockers did not lead to mental health improvements, she said, most likely because the children were already doing well when the study began.“They’re in really good shape when they come in, and they’re in really good shape after two years,” said Dr. Olson-Kennedy, who runs the country’s largest youth gender clinic at the Children’s Hospital of Los Angeles.That conclusion seemed to contradict an earlier description of the group, in which Dr. Olson-Kennedy and her colleagues noted that one quarter of the adolescents were depressed or suicidal before treatment.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A survey by the C.D.C. found high rates of sadness, bullying and suicide attempts among transgender and gender-questioning teenagers.About 3.3 percent of high school students identify as transgender and another 2.2 percent are questioning their gender identity, according to the first nationally representative survey on these groups, published by the Centers for Disease Control and Prevention on Tuesday.Transgender and gender-questioning teenagers reported alarmingly higher rates of bullying at school, persistent sadness and suicidal thoughts and behaviors, according to the survey, which was carried out in 2023. About one in four transgender students said they had attempted suicide in the past year, compared with 11 percent of cisgender girls and 5 percent of cisgender boys.“We have 5 percent of young people in the country who, because of the way they identify around their gender, are stigmatized, bullied, made to feel unsafe, feel disconnected at school and consequently have poorer mental health and higher risk for suicide than their cisgender peers,” said Kathleen Ethier, the director of C.D.C.’s adolescent and school health division. “That’s just heartbreaking.”The data come from the agency’s Youth Risk Behavior Surveillance System, a survey of more than 20,000 high school students conducted in public and private schools across the country every two years. The 2023 survey was the first to ask teenagers in all schools whether they identified as transgender.This small group of young people has drawn outsize and often harsh political attention across the country. The survey data were collected during a record year of legislation related to transgender issues. Around two dozen states have passed laws limiting bathroom use, sports participation or access to medical treatments for transgender children under 18.In the C.D.C.’s survey, transgender and gender-questioning students reported feeling worse than even cisgender girls, who have drawn national attention to a crisis in mental health among young people.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A national survey found promising signs that key mental health measures for teens, especially girls, have improved since the depths of the pandemic.In 2021, a survey by the Centers for Disease Control and Prevention on teen mental health focused on a stark crisis: Nearly three in five teenage girls reported feeling persistent sadness, the highest rate in a decade.But the newest iteration of the survey, distributed in 2023 to more than 20,000 high school students across the country, suggests that some of the despair seen at the height of the pandemic may be lessening.Fifty-three percent of girls reported extreme depressive symptoms in 2023, down from 57 percent in 2021. For comparison, just 28 percent of teenage boys felt persistent sadness, about the same as in 2021.Suicide risk among girls stayed roughly the same as the last survey. But Black students, who reported troubling increases in suicide attempts in 2021, reported significantly fewer attempts in 2023.Still, the number of teens reporting persistent sadness in 2023 remained higher than at any point in the last decade aside from 2021. And around 65 percent of lesbian, gay, bisexual and transgender high school students reported persistent hopelessness, compared with 31 percent of their cisgender or heterosexual peers. One in five L.G.B.T.Q. students reported attempting suicide in the past year.“For young people, there is still a crisis in mental health,” said Kathleen Ethier, head of the C.D.C.’s adolescent and school health program. “But we’re also seeing some really important glimmers of hope.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Newly released emails from an influential group issuing transgender medical guidelines indicate that U.S. health officials lobbied to remove age minimums for surgery in minors because of concerns over political fallout.Health officials in the Biden administration pressed an international group of medical experts to remove age limits for adolescent surgeries from guidelines for care of transgender minors, according to newly unsealed court documents.Age minimums, officials feared, could fuel growing political opposition to such treatments.Email excerpts from members of the World Professional Association for Transgender Health recount how staff for Adm. Rachel Levine, assistant secretary for health at the Department of Health and Human Services and herself a transgender woman, urged them to drop the proposed limits from the group’s guidelines and apparently succeeded.If and when teenagers should be allowed to undergo transgender treatments and surgeries has become a raging debate within the political world. Opponents say teenagers are too young to make such decisions, but supporters including an array of medical experts posit that young people with gender dysphoria face depression and worsening distress if their issues go unaddressed.In the United States, setting age limits was controversial from the start.The draft guidelines, released in late 2021, recommended lowering the age minimums to 14 for hormonal treatments, 15 for mastectomies, 16 for breast augmentation or facial surgeries, and 17 for genital surgeries or hysterectomies.The proposed age limits were eliminated in the final guidelines outlining standards of care, spurring concerns within the international group and with outside experts as to why the age proposals had vanished.The email excerpts released this week shed light on possible reasons for those guideline changes, and highlight Admiral Levine’s role as a top point person on transgender issues in the Biden administration. The excerpts are legal filings in a federal lawsuit challenging Alabama’s ban on gender-affirming care.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Dr. Hilary Cass published a landmark report that led to restrictions on youth gender care in Britain. U.S. health groups said it did not change their support of the care.After 30 years as one of England’s top pediatricians, Dr. Hilary Cass was hoping to begin her retirement by learning to play the saxophone.Instead, she took on a project that would throw her into an international fire: reviewing England’s treatment guidelines for the rapidly rising number of children with gender distress, known as dysphoria.At the time, in 2020, England’s sole youth gender clinic was in disarray. The waiting list had swelled, leaving many young patients waiting years for an appointment. Staff members who said they felt pressure to approve children for puberty-blocking drugs had filed whistle-blower complaints that had spilled into public view. And a former patient had sued the clinic, claiming that she had transitioned as a teenager “after a series of superficial conversations with social workers.”The National Health Service asked Dr. Cass, who had never treated children with gender dysphoria but had served as the president of the Royal College of Pediatrics and Child Health, to independently evaluate how the agency should proceed.Over the next four years, Dr. Cass commissioned systematic reviews of scientific studies on youth gender treatments and international guidelines of care. She also met with young patients and their families, transgender adults, people who had detransitioned, advocacy groups and clinicians.Her final report, published last month, concluded that the evidence supporting the use of puberty-blocking drugs and other hormonal medications in adolescents was “remarkably weak.” On her recommendation, the N.H.S. will no longer prescribe puberty blockers outside of clinical trials. Dr. Cass also recommended that testosterone and estrogen, which allow young people to develop the physical characteristics of the opposite sex, be prescribed with “extreme caution.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The change followed a sweeping review by England’s National Health Service that found “remarkably weak” evidence for youth gender treatments.Scotland’s National Health Service has stopped all new prescriptions of puberty-blocking drugs and other hormone treatments for minors, citing a sweeping review of youth gender services released in England last week. It is the sixth country in Europe to limit such treatments, and its changes are among the most restrictive.The review, commissioned by N.H.S. England and carried out by Dr. Hilary Cass, an independent pediatrician, over the course of four years, concluded that the evidence for benefits of youth gender treatments was “remarkably weak” and that pressing questions remained about potential long-term risks.This month, following recommendations by Dr. Cass, N.H.S. England halted puberty blockers for children outside of clinical trials. Hormone therapies, including estrogen and testosterone, are still available to teenagers in England aged 16 and up.Scotland’s new changes go further, pausing prescriptions of puberty blockers while also restricting hormone therapies until teenagers turn 18. The changes will not affect patients already getting these medications from the country’s Young People Gender Service.“We will continue to give anyone who is referred into the Young People Gender Service the psychological support that they require while we review the pathways in line with the findings,” said Dr. Emilia Crighton, director of public health for N.H.S. Greater Glasgow and Clyde, which houses Scotland’s sole youth gender clinic, Sandyford Sexual Health Services.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Five European countries have recently restricted hormone treatments for adolescents with gender distress. They have not banned the care, unlike many U.S. states.The National Health Service in England started restricting gender treatments for children this month, making it the fifth European country to limit the medications because of a lack of evidence of their benefits and concern about long-term harms.England’s change resulted from a four-year review released Tuesday evening by Dr. Hilary Cass, an independent pediatrician. “For most young people, a medical pathway will not be the best way to manage their gender-related distress,” the report concluded. In a related editorial published in a medical journal, Dr. Cass said the evidence that youth gender treatments were beneficial was “built on shaky foundations.”The N.H.S. will no longer offer drugs that block puberty, except for patients enrolled in clinical research. And the report recommended that hormones like testosterone and estrogen, which spur permanent physical changes, be prescribed to minors with “extreme caution.” (The guidelines do not apply to doctors in private practice, who serve a small fraction of the population.)England’s move is part of a broader shift in northern Europe, where health officials have been concerned by soaring demand for adolescent gender treatments in recent years. Many patients also have mental health conditions that make it difficult to pinpoint the root cause of their distress, known as dysphoria.In 2020, Finland’s health agency restricted the care by recommending psychotherapy as the primary treatment for adolescents with gender dysphoria. Two years later, Sweden restricted hormone treatments to “exceptional cases.”In December, regional health authorities in Norway designated youth gender medicine as a “treatment under trial,” meaning hormones will be prescribed only to adolescents in clinical trials. And in Denmark, new guidelines being finalized this year will limit hormone treatments to transgender adolescents who have experienced dysphoria since early childhood.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The survey reflects the life experiences of more than 92,000 transgender and nonbinary Americans.Transgender and nonbinary Americans experience stark rates of unemployment and harassment, according to the largest survey of their life experiences to date. The data reflect a longstanding pattern of discrimination at a time when states across the country have passed laws restricting their health care, bathroom access and participation in sports.The findings come from the U.S. Transgender Survey, which many researchers and policymakers have relied on since a version of it debuted in 2011. The National Center for Transgender Equality, an advocacy group, carried out the latest iteration of the survey in late 2022, garnering responses from more than 92,000 transgender and nonbinary Americans, age 16 and up, from every state in the country.The group released a preliminary analysis of responses to the survey’s 600 questions on Wednesday, with the full report expected later this year.The survey was not given to a random sample of transgender people, so it cannot be interpreted as representative of the transgender population as a whole. It also skewed young, with 43 percent of respondents ages 18 to 24.Still, there were more than three times as many respondents as there were in 2015, the last time the survey was conducted, when 28,000 people participated.“You don’t see data sets like this,” Sandy James, an attorney and the lead researcher of the new survey, said in a press briefing. “Tens of thousands of trans people knew that it was imperative that they make their voices heard.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The discovery could lead to better treatments for severe nausea and vomiting during pregnancy.The nausea and vomiting that often define the first trimester of pregnancy are primarily caused by a single hormone, according to a study published on Wednesday in the journal Nature. Researchers said that the discovery could lead to better treatments for morning sickness, including rare, life-threatening cases of it.The study confirms prior research that had pointed to the hormone, called GDF15. The researchers found that the amount of hormone circulating in a woman’s blood during pregnancy — as well as her exposure to it before pregnancy — drives the severity of her symptoms.More than two-thirds of pregnant women experience nausea and vomiting during the first trimester. And roughly 2 percent of women are hospitalized for a condition called hyperemesis gravidarum, which causes relentless vomiting and nausea throughout the entire pregnancy. The condition can lead to malnutrition, weight loss and dehydration. It also increases the risk of preterm birth, pre-eclampsia and blood clots, threatening the life of the mother and the fetus.Perhaps because nausea and vomiting are so common in pregnancy, doctors often overlook hyperemesis, dismissing its severe symptoms as psychological, even though it is the leading cause of hospitalization during early pregnancy, experts said. Although celebrities like Kate Middleton and Amy Schumer have raised the condition’s profile in recent years by sharing their experiences, it remains understudied.“I’ve been working on this for 20 years and yet there are still reports of women dying from this and women being mistreated,” said Dr. Marlena Fejzo, a geneticist at the University of Southern California Keck School of Medicine and a co-author of the new study.She knows the pain of the condition firsthand. During her second pregnancy, in 1999, Dr. Fejzo was unable to eat or drink without vomiting. She rapidly lost weight, becoming too weak to stand or walk. Her doctor was dismissive, suggesting she was exaggerating her symptoms to get attention. She was eventually hospitalized, and miscarried at 15 weeks.Dr. Fejzo said she asked the National Institutes of Health to fund a genetic study of hyperemesis, but was rejected. Undeterred, she convinced 23andMe, a popular genetic testing company, to include questions about hyperemesis in surveys of tens of thousands of customers. In 2018, she published a paper showing that customers with hyperemesis tended to carry a variant in a gene for GDF15.Hormones are chemicals that send messages across the body. GDF15 is released by many tissues in response to stress, such as an infection. And its signal is highly specific: Receptors for the hormone are clustered in a part of the brain responsible for feeling sick and vomiting.In the new study, Dr. Fejzo and collaborators at the University of Cambridge in England measured the hormone in pregnant women’s blood and analyzed the genetic risk factors for hyperemesis.The researchers found that women experiencing hyperemesis had significantly higher GDF15 levels during pregnancy than did those who had no symptoms.But the hormone’s effect seems to depend on the woman’s sensitivity and exposure to the hormone before pregnancy. The researchers found, for example, that women in Sri Lanka with a rare blood disorder causing chronically high levels of GDF15 rarely experienced nausea or vomiting in pregnancy.“It completely obliterated all the nausea. They pretty much have next to zero symptoms in their pregnancies,” said Dr. Stephen O’Rahilly, an endocrinologist at Cambridge who led the research.Dr. O’Rahilly hypothesized that prolonged exposure to GDF15 before pregnancy could have a protective effect, making women less sensitive to the sharp surge in the hormone caused by the developing fetus.In lab experiments, the scientists exposed some mice to a small amount of the hormone. When given a much larger dose three days later, the mice did not lose their appetites as much as did animals that were not given the earlier dose — showing a robust effect of desensitization.The findings offer hope for better treatments for hyperemesis, experts said. Patients with hyperemesis could one day take medications to block the hormone’s effects in the brain, if clinical trials were to find the drugs safe in pregnancy. Such medications are being tested in trials of cancer patients with a loss of appetite and vomiting also caused by GDF15.It may even be possible to prevent the condition. Women who are at risk, such as those who experienced severe nausea and vomiting during a previous pregnancy, could be exposed to low doses of the hormone before becoming pregnant. (One diabetes drug, metformin, increases levels of GDF15 and is already prescribed to aid fertility in some patients.)The new study is powerful because it offers genetic proof of a causal relationship between GDF15 and the disease, said Dr. Rachel Freathy, who is a geneticist at the University of Exeter and was not involved in the study. That will help the condition gain greater recognition, she said.“There is kind of an assumption made by many people that women should just be able to cope with this,” Dr. Freathy said. With this biological explanation, she said, “there will be more belief that this is a real thing rather than something in somebody’s head.”