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Publication bias and scientific controversies in the gender field

The field of gender medicine has seen several controversies: unpublished data, a retracted publication, disagreement over the reliability of systematic reviews and attacks on researchers. Each case has to be judged on its own; this article sets out a number of them, with sources.

Unpublished data — Olson-Kennedy

Johanna Olson-Kennedy (Children's Hospital Los Angeles) led an NIH-funded study of puberty blockers and hormones in young people. She told The New York Times (October 2024) that the puberty blocker study had not shown an improvement in mental health and that she was delaying publication because the results could be used politically against this care (source). A researcher working with public money ought to publish results, including disappointing ones. See also the evidence-based objection.

A publication dispute — WPATH/Johns Hopkins

According to The BMJ (31 October 2024), Johns Hopkins University researchers who carried out systematic reviews for WPATH wrote that the commissioning body tried to restrict their ability to publish; WPATH denied having banned publication (source). Eli Coleman, lead author of SOC8, stated that WPATH had disputed the timing of publication but had not withheld any publication (source). The Cass Review also concluded that WPATH 8 presents the strength of the evidence as stronger than it is (source). See the WPATH Files and the SOC versions.

Controversies around publications and researchers

• Lisa Littman (2018) — parent survey published in PLOS ONE; in 2019 the journal published a correction stating that it is a hypothesis-generating study of parents' observations and that "rapid-onset gender dysphoria" is not a formal diagnosis (source). See ROGD.
• J. Michael Bailey and Suzanna Diaz (2023) — their study of 1,655 possible cases of ROGD (parent reports) was published in Archives of Sexual Behavior and retracted by the journal the same year; according to the retraction notice, participants had not given written consent to take part in research and to the publication of their answers, which the authors dispute (source).
• Kenneth Zucker, who led CAMH's gender identity clinic, was dismissed in December 2015 after an external review of the clinic; in 2018 CAMH apologised to him and paid him 586,000 dollars, acknowledging errors in the report. His desistance research is still cited.
• J. Michael Bailey's book (2003), which draws on autogynephilia and the Blanchard typology, became the target of a campaign against its author, documented by Alice Dreger (2008) (source).

Attacks on researchers

Bailey's book The Man Who Would Be Queen (2003) led to a campaign against its author, documented by Alice Dreger (2008) (source). In the foreword to her final report (2024), Hilary Cass writes that the toxicity of the debate is exceptional and that there are few other areas of healthcare where professionals are so afraid to openly discuss their views (source).

The methodological debate

The study by Tordoff et al. (2022), an observational study of 104 young people followed for one year, associated puberty blockers and hormones with lower odds of depression and suicidality; at the end of the study 35 young people had received neither (source). The systematic reviews of the Cass Review, SBU and NICE have also been criticised: Noone et al. (2025) concluded that the reviews for the Cass Review carry a high risk of bias, while Cheung et al. (2025) wrote that the Cass Review received broad clinical support (source, source). See also the regret study.

An apparent consensus?

The idea of a "scientific consensus" on gender-affirming care deserves nuance. The Cass Review (paras 9.20–9.22) writes that the early versions of the Endocrine Society guideline (2009) and WPATH 7 influenced almost all other guidelines, and that this circularity may explain the apparent consensus (source). Outside the US several countries have tightened their approach: the Cass Review (2024) judged only the Finnish (2020) and Swedish (2022) guidelines to be recommendable for practice, and the Swedish guideline reserves medical treatment for research protocols or exceptional cases (source). See also the Cass Review, SBU, COHERE and the Tavistock closure.