David R. Herz
Bet Rimon 179500, Israel
David@transisrael.org
May 25, 2026

Adv. Inbal Chen
Legal Department
Ministry of Health
39 Yirmiyahu St.
Jerusalem 9446724

Re: Response to your letter of 3 May 2026 (Ref: 201069626) regarding medical treatments for gender adaptation – Urgent call for evidence-based policy review

Dear Adv. Chen,

We received your inquiry regarding medical treatments for gender adaptation.

First, we note that in many Western countries — including the United States, Canada, and European Union member states — treatments for gender adaptation are recognized as legitimate medical practice when carried out in accordance with evidence-based professional guidelines, while adhering to the principles of informed consent, the patient’s will, and appropriate medical standards. International medical organizations such as the World Professional Association for Transgender Health (WPATH) and the American Psychiatric Association have published professional guidelines that provide clear standards for diagnosis, hormone therapy, and surgical interventions, according to age, medical condition, and the individual circumstances of each patient.

Israel’s medical policy is based on clinical guidelines of professional associations, and treatment decisions are made on the basis of in-depth multidisciplinary assessment, including psychological and medical accompaniment, with an emphasis on the patient’s well-being and physical and mental health. Furthermore, with regard to minors, gender adaptation procedures are conditional upon the consent of both parents, and genital surgeries are not performed on minors (under the age of 18). Israel’s medical bodies are aware of the evolving professional discourse in the world, of up-to-date reports, and of policy changes in some European countries, and are examining the local guidelines in accordance with the accumulation of scientific evidence.

In Israeli law, the right to autonomy over one’s body is anchored in the recognition of the value and dignity of the human being — values that have been enshrined in Basic Law: Human Dignity and Liberty. From the right to autonomy derives the patient’s right to freedom of decision regarding his or her body, health, and receipt of medical treatment. Thus, the Patient’s Rights Law, 5756-1996, anchors the patient’s right to receive medical treatment out of free choice, after giving informed consent, in which the patient received full information about the nature of the treatment, its purpose, its prospects, and its risks. Therefore, every medical intervention requires a clear framework of transparency, consent, and documentation, and this is also true with regard to treatments for gender adaptation.

Indeed, the process of gender adaptation in Israel is conducted under the supervision of a national professional committee, which examines each application in a professional and thorough manner, while weighing medical, psychological, and social aspects, and ensures that treatment is given only after a defined period of preparation and the giving of full and transparent informed consent. For further information, one may refer to Director-General’s Circular No. 16/2014 on the Ministry of Health website.

Copy:
Dr. Hagar Mizrahi, Head of the Medical Division
Prof. Raz Gross, Chair of the National Committee for Gender Adaptation
Adv. Esti Verhaftig-Bass, Head of Digital and Enforcement Division

With blessings,

Adv. Inbal Chen

David R. Herz
Bet Rimon 179500, Israel
David@transisrael.org

May 25, 2026

Adv. Inbal Chen
Legal Department
Ministry of Health
39 Yirmiyahu St.
Jerusalem 9446724

cc:
Dr. Hagar Mizrahi, Head of the Medical Division
Prof. Raz Gross, Chair of the National Committee for Gender Adaptation
Adv. Esti Verhaftig-Bass, Head of Digital and Enforcement Division

Re:
Response to your letter of 3 May 2026 (Ref: 201069626) regarding medical treatments for gender adaptation – Urgent call for evidence-based policy review

Dear Adv. Chen,

Thank you for your letter of 3 May 2026 and for the reference to the 2014 Director-General’s Circular (No. 16/2014). I appreciate your response. However, I must express deep concern that the 2014 guidance, which remains the foundation of current Israeli policy, rests on remarkably weak evidence.

Major 2024 reports and subsequent analyses have shone a bright light on the scale of the medical disaster that has resulted from this model of care. When the occurrence of a condition or “disease” explodes by hundreds or even thousands of percent in such a short time, it is only responsible to pause, investigate the underlying causes (including social contagion), and refrain from proceeding with what is increasingly recognized as tragically indefensible invasive and irreversible medical intervention.¹

What is the process when it becomes obvious we have done something wrong? How much damage must occur—how many children and young adults must be medicalized, mutilated, and left disfigured—before the Ministry calls for a pause to study the matter? There must be emergency powers available; what exactly must be shown to trigger them? What internal mechanisms exist within the Ministry for updating clinical guidelines when the “chain of trust” in medical care has been broken (as evidenced by systematic reviews and leaks), and how can concerned citizens and experts help activate them? As I suggest below, even if such a mechanism has never been used before, this is precisely the case that demands urgent emergency action to end this damaging line of “therapy.”

I assume it is our shared goal to ensure that Israeli policymakers and the public have access to the best available evidence so that we do not inadvertently cause harm to our children and young adults. I also have a very personal stake in this. I want to stop the damage being done to my son, his girlfriend, a friend’s daughter, and so many others who I don’t know. I want to end the family trauma this causes. I want to see our children grow up healthy in the bodies G-d meant for them.

But mostly, I’d like to believe that our law and policy makers actually care at some level. It is easier for me to understand the hate unleashed on October 7 than it is to understand the seeming indifference of those who actually have it in their power to end this travesty of care.

The current Israeli framework treats puberty blockers, cross-sex hormones, and related interventions for gender dysphoria as standard care despite remarkably weak evidence of long-term benefit and well-documented risks of harm. These treatments must be removed entirely from the national health basket and reclassified as experimental. They should be available only as part of appropriately structured clinical research protocols that meet full ethical, safety, and long-term outcome-tracking standards. Medicalization of gender dysphoria before completion of brain development—which current science indicates continues well into the mid-20s (and in some respects into the early 30s), with cross-sex hormones and puberty blockers interfering with normal neurological and pubertal processes—warrants particular caution.²

The 2014 Circular is Outdated, Structurally Problematic, and Insufficient for Experimental Treatments

The 2014 circular seems to represent an attempt to regulate adult surgeries and establish multidisciplinary oversight. However, it does not justify itself, and there is an increasing awareness that the state of the researach was such that it never could have. This was laid bare in the Cass Review (2024), the WPATH Files (2024), and the major European systematic evidence reviews that have shown the landscape for what it truly is since then.³

The structural design of the Circular—particularly the composition and approval process of the national multidisciplinary committee—almost certainly places activists rather than disinterested surgeons and practitioners in key decision-making roles.

Moreover, the informed-consent form attached to the Circular is inadequate for experimental interventions. It lacks mandatory independent ethics review (IRB/Helsinki principles), long-term outcome tracking, and other safeguards required under the Israeli Patient Rights Law 1996 and the Ministry’s own research protocols for human subjects, especially youth.

Given the documented dramatic rise in incidence—thousands of percent in short timeframes at Israeli clinics⁴—I respectfully ask: what specific mechanisms does the Ministry use to monitor and address potential social contagion, including the role of social media and peer influence?

Critiques of WPATH, the Affirmative Model, and the Claim of International Consensus

Your letter treats WPATH as an authoritative source. Unfortunately, WPATH’s Standards of Care Version 8 (SOC8) rely on what has been described as a “circular web of authority” or “citation cartel.” WPATH guidelines are cited by other organizations (e.g., the Endocrine Society), which are then cited back by WPATH, creating an illusion of consensus despite remarkably weak underlying evidence. This exact concern was highlighted in the Cass Review and the accompanying systematic reviews:

“The circularity of this approach may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.”⁵

Taylor et al. (2024), in their systematic review of guideline quality published in Archives of Disease in Childhood, and the independent AGREE II appraisal of SOC8 by Zhang et al. (2026) in Archives of Sexual Behavior, both scored WPATH’s guidelines poorly on rigor of development, editorial independence, and applicability.⁶ Court documents and analyses by the Society for Evidence-Based Gender Medicine (SEGM) further document WPATH’s interference in independent systematic reviews.

The Cass Review and the European systematic reviews (UK, Sweden, Finland, and Norway) are clear: puberty blockers show no reliable long-term mental-health benefit, lead to near 100% progression of patients to cross-sex hormones, and carry significant risks including infertility, sexual dysfunction, bone-density loss, and cardiovascular issues.⁷ We are also seeing a rapid adolescent-onset surge (especially among natal females), with over-representation of autism, ADHD, and same-sex attraction—many of whom would likely resolve naturally without medicalization.

While your letter notes that many Western countries and states continue to support these treatments, history demonstrates that majority medical consensus has been wrong before—sometimes with tragic consequences. Widely endorsed practices later abandoned due to evidence of harm include: prefrontal lobotomies for psychiatric disorders (tens of thousands performed, Nobel Prize awarded in 1949); thalidomide for morning sickness (over 10,000 children born with severe birth defects in the 1950s–60s); diethylstilbestrol (DES) for miscarriage prevention (cancer in offspring); insulin coma therapy for schizophrenia; overly aggressive radical Halsted mastectomies for breast cancer; routine episiotomies; and early hormone-replacement-therapy regimens later overturned by rigorous trials.

Several leading European nations have already moved away from the affirmative model: the UK (Cass Review → indefinite ban on routine puberty blockers for minors), Sweden, Finland, and Norway have sharply restricted these interventions for youth, prioritizing psychotherapy and limiting medicalization to exceptional cases or research settings. The Netherlands—birthplace of the original Dutch Protocol—has also initiated a parliamentary-mandated independent review of puberty blockers and is facing growing professional calls to revise its guidelines.⁸ Major reversals have also occurred in the United States, where more than 25 states have enacted laws or regulations restricting or banning puberty blockers, cross-sex hormones, and surgeries for minors. Even the American Society of Plastic Surgeons (ASPS) has recommended that gender-related surgeries for minors be delayed until at least age 19 due to insufficient evidence, and the American Medical Association (AMA) has similarly agreed that surgical interventions in minors should generally be deferred until adulthood.⁹ Growing numbers of professional organizations and even LGB groups are publicly questioning rapid medicalization. Regardless, it is responsibility of the Ministry to follow the best available evidence, not shifting majorities.

The Situation in Israel – A Documented Growth Industry, Costs, Transparency, and Ethical Failures

I welcome the confirmation that no genital surgeries are performed on minors under 18. However, puberty blockers and cross-sex hormones already constitute medicalization with lifelong irreversible consequences.

Of great concern is how these treatments entered routine public funding in the first place. While gender-reassignment surgeries were explicitly added to the Health Basket in 1986 (and updated in the 2014 circular), hormone therapy and puberty blockers appear to have been integrated through off-label use of drugs already listed in the basket for other indications (e.g., precocious puberty). There is no public record of the annual Health Basket Committee ever conducting a formal evidence review, safety analysis, or cost-effectiveness determination specifically for the indication of gender dysphoria. This stands in stark contrast to the rigorous process required for virtually every other medication or technology added to the basket. The only recent gender-specific addition was voice therapy in 2022. In short, these interventions appear to have bypassed the standard evidentiary gatekeeping that protects the integrity of the national health basket.¹⁰

Israel has seen an 11-fold increase in pediatric gender-dysphoria referrals since 2013.¹¹ Organizations such as Maavarim (maavarim.org/community-activities) have grown into major funded NGOs supporting thousands of cases annually, while the publicly shared directory of “trans-friendly” professionals demonstrates expanding clinical infrastructure across the country. These trends, combined with widespread social-media access, underscore the urgent need for vigilant monitoring of social contagion.

Health funds do not publish comprehensive public data on numbers, ages, comorbidities, desistance/detransition rates, or total system costs. Lifetime per-patient costs (based on available data) represent a significant and growing public burden.

Growing Professional and LGB Community Opposition Worldwide

While some international bodies continue to reference the affirmative model, a rapidly growing number of medical professionals, researchers, and organizations—including prominent voices from within the lesbian, gay, and bisexual (LGB) community—are publicly opposing the rapid medicalization of gender-dysphoric youth.

Leading professional groups include the Society for Evidence-Based Gender Medicine (SEGM),¹² an international network of clinicians and researchers dedicated to evidence-based care; Genspect,¹³ an alliance of professionals, parents, and detransitioners advocating for high-quality, non-medicalized approaches; and Therapy First, which prioritizes exploratory psychotherapy over hormonal or surgical interventions.

This broadening dissent demonstrates that the affirmative model is facing increasing scrutiny from within the very communities once assumed to be its strongest allies, reinforcing the urgent need for an independent Israeli evidence review.

Specific Requests for Explanation and Action

Given the evidence and concerns set forth above, please explain why the Ministry is not currently pursuing the following (or provide the current status and timeline if any steps are already underway):

1. Immediate moratorium on puberty blockers and cross-sex hormones pending independent review.
2. Commission of an independent, non-WPATH-influenced systematic evidence review (modeled on Cass) by Israeli experts in psychiatry, endocrinology, pediatrics, and medical ethics.
3. Mandatory collection of data and public annual reporting by all health funds and clinics on referrals, treatments, off-label drug use in this area, comorbidities, desistance/detransition, and long-term outcomes.
4. Shift to an exploratory, therapy-first, non-medicalized approach with rigorous differential diagnosis for comorbidities and social influences.
5. Urgent update or replacement of the 2014 circular with evidence-based safeguards.
6. Classification of these interventions as experimental, with full research protocols (IRB approval, long-term tracking, etc.).
7. Public statement acknowledging the international evidence shift and committing to child/youth protection.
8. A formal review of how puberty blockers and cross-sex hormones for gender dysphoria were incorporated into the Health Basket without the standard evidence-based process applied to other treatments, and confirmation that they will be removed from routine basket funding and made available only through properly structured experimental protocols.

Though I am not currently in Israel, I remain available to meet (virtually or in person upon my return). I continue to keep abreast of developments and regularly update transisrael.org to reflect the latest information and data. For further discussion of these issues, please visit transisrael.org. Protecting our children and youth from low-evidence, experimental interventions is a fundamental public-health and human-rights responsibility. I hope the Ministry will choose evidence-based caution and leadership rather than continue with an outdated framework. I would be pleased to provide a full dossier of references, studies, and Israeli data compiled on transisrael.org.

Thank you for your attention to this critical matter. I look forward to your substantive reply.

Yours sincerely,

David R. Herz

הסרת השדיים הבריאים של בתי

אני נמצאת בקבוצת תמיכה להורים של אנשים שטוענים שהם טרנס. לשניים מהמשתתפים שלנו יש בנות נחושות מאוד להסיר את השדיים שלהן.

הן מכירות את הסיפורים על המספר ההולך וגדל של בנות ונשים שעברו כריתת שדיים כפולה אלקטיבית בשם המעבר המגדרי, רק כדי להבין את טעותן זמן מה מאוחר יותר. יש את הכאב של שד עם רקמת שד שיורית שמתנפחת בחלב כדי להאכיל תינוק חדש, אבל אין פטמה תפקודית שדרכה החלב יכול לצאת. יש את הכאב של אי-יכולת לטפל בילד כפי שהטבע התכוון, כי הן נסחפו ברעיון שהתעודד על ידי אנשים בחלוקי מעבדה. הן יודעות על הפטמה שאינה עוד אזור ארוגני, שאינה יכולה להגיב למגע של בעל או בן זוג לחיים. הן יודעות על הקול שהעמיק ואינו יכול לדבר במלוא עוצמתו כי מיתרי הקול גדלו יותר מדי עבור הגרון הנשי. (ואלה הן המקרים המאושרים: יש כאלה שחסימת גיל ההתבגרות שלהן גרמה לכך שלעולם לא ידעו אורגזמה; יש כאלה שעברו כריתת רחם וכריתת שחלות והן עוברות גיל המעבר או סובלות מאוסטאופורוזיס בשנות העשרים שלהן).

הן מכירות את הסיפורים האלה שתמיד כוללים סדרה של „ספקי טיפול” שמעודדים במקום להזהיר ילדים, שלקחו את אי-הנוחות והבלבול של הילדים ומכרו להם טיול קסום שיפתור את כל, או לפחות רוב, הבעיות שלהן.

האמהות האלה יודעות שילדיהן אינם מסוגלים לקבל החלטות קיצוניות כאלה המשנות חיים באופן רדיקלי, אבל הם חוקית בגיל מתאים. האמהות (והאבות) האלה הרוסות.

הן יודעות שזה לא נכון. אלפי רופאים יודעים שזה לא נכון. ארגונים רפואיים מרכזיים יודעים שזה לא נכון. מדינות רבות סוגרות את ה„טיפול” הזה, או לפחות מכירות בכך שהוא ניסיוני, לכל היותר.

הן זועקות שהקיסר עירום.

הן זקוקות לכם להיות המבוגרים בחדר, לומר בפשטות: „אנחנו לא כל כך בטוחים לגבי זה. אולי הגיע הזמן לקחת הפסקה בזמן שאנחנו בודקים.”

בבקשה, בבקשה, הכירו את מה שקורה כאן ועשו את הצעדים הראשונים.
משפחות נהרסות בגלל זה בכל יום. אתם יכולים לעזור לעצור את זה.

Removing My Daughter’s Healthy Breasts

I am in a Support Group for parents of people who claim to be trans. Two of our participants have daughters hell-bent on having their breasts off.

They know the stories of the growing number of girls and women who have had elective double-mastectomies in the name of gender-transition, only to realize their mistakes some time later. There is the pain of a breast with residualy mammary tissue engorging with milk to feed a newborn that has no functional nipple through which to exit. There is the pain of not being able to tend to a child as nature intended because they were swept up by an idea encouraged by people in lab coats. They know about the nipple that is no longer an errogenous zone, that can not respond to the touch of a husband or life partner. They know of the deepened voice that can not speak at full volume because the vocal chords have grown too big for the female larynx. (And these are the lucky ones: there are those whose puberty was blocked who will never know an orgasm; there are those who had hysterectomies and oopherectomies who are going through menopause or suffering osteoporosis in their twenties).

They know these stories always include a series of “care providers” who encouraged rather than cautioned children, who took children’s discomfort and confusion, and sold them a magic trip that would solve all, or at least most, of their problems.

These mothers know their children are not capable of making these radically life-altering decisions, but they are legally old enough. These mothers (and fathers) are devastated.

They know this is wrong. Thousands of doctors know this is wrong. Major medical organizations know this is wrong. Multiple countries are shutting this “treatment” down, or at least acknowledging it is experimental, at best.

They are crying out that the emporer has no clothes.

They need you to be the adults in the room, to say simply: “We’re not so sure about this. Maybe it is time to take a pause while we look.”

Please, please, acquaint yourself with what is going on here and take the first steps.
Families are being wrecked by this every day. You can help stop this.