We cannot allow activists masquerading as experts to have the final word any longer. An open letter sent to the Wall Street Journal last month came and went without the public attention it sorely deserved.

Signed by 21 leading experts on paediatric gender medicine from nine countries, they wrote to take issue with the US Endocrine Society’s statement that so-called ‘gender-affirming’ care is best for minors presenting with gender dysphoria.

Gender-affirming care is code for the belief that hormones and surgery is the best and primary treatment for gender dysphoria since it purportedly “reduces the risk of suicide”.

The experts minced no words – the belief is “not supported by evidence”. Rather than cherry-pick studies which fit the narrative, the experts used far deeper meta-studies which found evidence of mental health benefits to be of “low or very low certainty”.

The risks for minors of puberty blockers and surgeries, including permanent sterility, regret, and lifelong dependence on repeat surgeries and medication are very real. Furthermore, the experts wrote that the claim that gender transition reduces suicides is contradicted by every systematic review. Even the Endocrine Society’s review found no reliable evidence that hormonal transition prevents suicide, yet they have no qualms promoting it.

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This is something that every parent across Scotland, deep in their hearts, knew already to be true. That surgery and hormones are unlikely to resolve the underlying mental unwellness that troubles their children.

We live in a world where gender distress has increased in prevalence by several thousand percent in the last two decades – but to question the longevity of these feelings or to describe them in the context of mental health is denounced as transphobic and as provoking suicide. Parents face ultimatums about the suicide of their children despite their being no good reason to believe that puberty blockers will help them.

As Dr Paul McHugh noted all those years ago, “when children who reported transgender feelings were tracked without medical or surgical treatment at Vanderbilt University and London's Portman Clinic, 70%-80% of them spontaneously lost those feelings.”

In the vast majority of cases, the best approach is to love your children and take no medical intervention. Yet, according to The Telegraph, figures show that 98 per cent of children who were given puberty blockers went on to be given cross-sex hormones.

Blockers are dangerous and irreversible in their own right, but they also 'lock-in' children to even more devastating outcomes when they would likely have recovered from the dysphoria without intervention – if only doctors had let them. It is not reality that is causing most of these young people to commit suicide, is it collaborating with a mental disorder with body and mind-altering drugs.

READ MORE: Puberty blockers study found 'majority' of children happier after treatment

Doctors are supposed to advise treatment on the basis of evidence and fully inform their patients. The Tavistock Clinic scandal shows that even the most (formerly) prestigious institutions were letting children down.

In court, the Government’s Gender Identity Service (GIDS) couldn’t even provide data on the outcomes and consequences of puberty blockers on the minors who were given them. Even if the children were old enough to consent, the consent wouldn’t have been informed.

In order to skirt around questions of consent, we are told convenient myths. Puberty blockers are described as a “physically reversible treatment if stopped” by GIDS. This is an improvement, as until 2020 the claim had been that “treatment with GnRH analogues are considered to be fully reversible”, but it is still scandalously misleading to my mind.

The new definition tacitly concedes that the puberty blockers are not and have never been psychologically reversible – they had been promoted as harmless despite little research having gone into finding out whether this was the case. It also allows the words “if stopped” to do an inordinate amount of linguistic legwork.

The fact that the GnRH drugs shut down large parts of the hypothalamus – the hormonal structure of the brain that regulates our perception of the world around us – should have given clinicians pause for thought before allowing them into the developing brains of children. Indeed, these same GnRH analogues are used for chemical castration. But ideology comes first and children come second.

In many cases, the children affected are girls – now around 75% of them – and many also suffer from autism and other issues which are known to affect socialisation. There are strong correlations between such mental disorders and gender dysphoria.

Parents who attempt to remove vulnerable children from suggestive environments, offer a counter-message, or even attempt to make children more comfortable in their natural sex in the meantime are condemned as transphobic. So are those who insist that minors are not capable of consenting to use chemicals which impact their future so profoundly.

In Canada, a father has been jailed for opposing his child’s gender transition. He insisted that his child, who was 13 at the time, was still a ‘she’ – an utterance which is (quite literally) considered criminal violence in Canada.

He refused consent for her to be given puberty blockers. Dragged through the courts, fined thousands, and imprisoned, the father was unable to stop his child being given not just puberty blockers, but cross-sex hormones, causing them to go through puberty with testosterone and changing his child’s life forever.

In Scotland, children as young as nine have been prescribed puberty blockers. Despite activists' best efforts, minors who want surgery and cross-sex hormones in the UK must wait until the frail old age of 17. This is still a child, but it could be so much worse.

The World Professional Association for Transgender Health’s (WPATH) insist that children as young as nine years old can be given cross-sex hormones. Their ‘guidelines’ also permit mastectomies, implants and prosthetic genitals once these children have been on hormones for 12 months, with no mental health assessment.

Tragically, after 12 months, the risk of cancers, infertility and negative psychoactive effects are already high. It is barbaric to do this to children. Doctors who endorse this course of action should not be trusted. In fact, only a third of WPATH’s ethics committee are medical doctors. As with the Endocrine Society, we cannot allow activists masquerading as experts to have the final word any longer. We need our ethics to be based on compassion and understanding rather than politics.

Paul McHugh's seminal 2014 essay should still serve as a critical point of reference on the use of puberty blockers. McHugh, a distinguished former psychiatrist-in-chief at Johns Hopkins Hospital (an institution which was an early pioneer of such surgeries), wrote candidly at a time before the transgender issue became the cultural powder keg it is today.

McHugh identified three subgroups of transgender people who might be given surgery or medication. The first is the opportunist, such as Isla Bryson, who have obvious motives to change sex. The second group are internally and externally suggestible, similarly to anorexia nervosa patients, who are convinced that a physical surgery will fix their psycho-social problems. The third group are often prepubescent children who, in the process of naturally exploring how they fit into the world, begin to imitate behaviours of the opposite sex.

Puberty blockers are obviously not the solution for any of the groups above. It’s too late for the first, inappropriate for the second and unethical and premature for the third. Puberty blockers must be banned.

Dr Azeem Ibrahim OBE is a Director at the New Lines Institute for Strategy and Policy

The Scottish Government say young people are only considered for puberty blockers after psychological and endocrine assessment and that anyone who commences puberty blockers receives regular psychological review, monitoring and support. While the Sandyford Young People’s Gender Identity Service can diagnose gender dysphoria, the clinic does not prescribe puberty hormone inhibitors or blockers but can refer patients to specialist paediatric endocrinology teams for assessment, with such medication only being prescribed if the most appropriate form of treatment. The service has reported referring 90 young people for an appointment with specialist paediatric endocrinology teams over the period 2011 to 2021 inclusive.